title: Association between Staphylococcus aureus nasal carriage and disease phenotype in patients affected by systemic lupus erythematosus.
abstract: Staphylococcus aureus (SA) is a commensal bacterium representing one of the most important components of the skin microbiome, mostly isolated in the anterior nares. A higher rate of SA nasal colonization in patients affected by Wegener's granulomatosis and rheumatoid arthritis compared with healthy subjects (HS) has been described. No studies focusing on systemic lupus erythematosus (SLE) are available. We aimed at analyzing the prevalence of SA nasal carriers in an SLE cohort and evaluating correlation between nasal colonization and clinical, laboratory and therapeutic features.
  
  
  
  We enrolled 84 patients with SLE (number of male/female patients 6/78; mean age 41.3 ± 12.2 years, mean disease duration 142.1 ± 103.8 months) and 154 HS blood donors. Patients with SLE underwent a physical examination and the clinical/laboratory data were collected. All the patients with SLE and the HS received a nasal swab for SA isolation and identification.
  
  
  
  SA nasal colonization prevalence was 21.4 % in patients with SLE and 28.6 % in HS (P not significant). We analyzed patients with SLE according to the presence (n = 18, SA-positive SLE) or the absence (n = 66, SA-negative SLE) of nasal colonization. Renal involvement was significantly more frequent in SA-positive SLE (11.6 % vs 3.0 %; P = 0.0009). Moreover, the presence of anti-dsDNA, anti-Sm, anti-SSA, anti-SSB, anti-RNP antibodies was significantly higher in SA-positive SLE (P < 0.0001, P = 0.01, P = 0.008, P = 0.03, P = 0.03, respectively).
  
  
  
  SA colonization is a relatively frequent condition in patients with SLE, with a frequency similar to HS. The presence of SA seems associated with a peculiar SLE phenotype characterized by renal manifestations and autoantibody positivity, confirming the role of the microbiome in disease phenotype.
authors.affiliation: Lupus Clinic, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Fabrizio
authors.initials: F
authors.lastname: Conti
authors.affiliation: Lupus Clinic, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Fulvia
authors.initials: F
authors.lastname: Ceccarelli
authors.affiliation: DAI Malattie Infettive e Tropicali, Azienda Policlinico Umberto I, Rome, Italy.
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Iaiani
authors.affiliation: Lupus Clinic, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Perricone
authors.affiliation: Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Rome, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Giordano
authors.affiliation: Sanità Pubblica e Malattie Infettive, Sapienza Università di Roma, Rome, Italy.
authors.forename: Luigino
authors.initials: L
authors.lastname: Amori
authors.affiliation: Lupus Clinic, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Francesca
authors.initials: F
authors.lastname: Miranda
authors.affiliation: Lupus Clinic, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Massaro
authors.affiliation: Lupus Clinic, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Viviana Antonella
authors.initials: VA
authors.lastname: Pacucci
authors.affiliation: Lupus Clinic, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Truglia
authors.affiliation: UOC Immunoematologia e Medicina Trasfusionale, Azienda Policlinico Umberto I, Rome, Italy.
authors.forename: Gabriella
authors.initials: G
authors.lastname: Girelli
authors.affiliation: UOC Immunoematologia e Medicina Trasfusionale, Azienda Policlinico Umberto I, Rome, Italy.
authors.forename: Azis
authors.initials: A
authors.lastname: Fakeri
authors.affiliation: Dipartimento Medicina Clinica, Sapienza Università di Roma, Rome, Italy.
authors.forename: Gloria
authors.initials: G
authors.lastname: Taliani
authors.affiliation: Dipartimento Medicina Clinica, Sapienza Università di Roma, Rome, Italy.
authors.forename: Chiara
authors.initials: C
authors.lastname: Temperoni
authors.affiliation: Lupus Clinic, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Francesca Romana
authors.initials: FR
authors.lastname: Spinelli
authors.affiliation: Lupus Clinic, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Viale del Policlinico 155, 00161, Rome, Italy. cristiano.alessandri@uniroma1.it.
authors.forename: Cristiano
authors.initials: C
authors.lastname: Alessandri
authors.affiliation: Lupus Clinic, Dipartimento di Medicina Interna e Specialità Medica, Sapienza Università di Roma, Viale del Policlinico 155, 00161, Rome, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Valesini
mesh_terms: D000328:Adult; D001323:Autoantibodies / Q000097:blood / Q000276:immunology; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000276:immunology* / Q000382:microbiology* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009297:Nasal Mucosa / Q000382:microbiology*; D010641:Phenotype; D013211:Staphylococcus aureus
chemical_list: D001323:Autoantibodies
keywords: Microbiome; Staphylococcus aureus; Systemic lupus erythematosus