title: Livestock-Associated, Antibiotic-Resistant Staphylococcus aureus Nasal Carriage and Recent Skin and Soft Tissue Infection among Industrial Hog Operation Workers.
abstract: Swine production work is a risk factor for nasal carriage of livestock-associated (LA-) Staphylococcus aureus and also for skin and soft tissue infection (SSTI). However, whether LA-S. aureus nasal carriage is associated with increased risk of SSTI remains unclear. We aimed to examine S. aureus nasal carriage and recent (≤3 months prior to enrollment) SSTI symptoms among industrial hog operation (IHO) workers and their household contacts. IHO workers and their household contacts provided a nasal swab and responded to a questionnaire assessing self-reported personal and occupational exposures and recent SSTI symptoms. Nasal swabs were analyzed for S. aureus, including methicillin-resistant S. aureus (MRSA), multidrug-resistant-S. aureus (MDRSA), absence of scn (livestock association), and spa type. S. aureus with at least one indicator of LA was observed among 19% of 103 IHO workers and 6% of 80 household members. Prevalence of recent SSTI was 6% among IHO workers and 11% among 54 minor household members (0/26 adult household members reported SSTI). Among IHO workers, nasal carriers of MDRSA and scn-negative S. aureus were 8.8 (95% CI: 1.8, 43.9) and 5.1 (95% CI: 1.2, 22.2) times as likely to report recent SSTI as non-carriers, respectively. In one household, both an IHO worker and child reported recent SSTI and carried the same S. aureus spa type (t4976) intranasally. Prevalence of scn-negative S. aureus (PR: 5.0, 95% CI: 1.2, 21.4) was elevated among IHO workers who reported never versus always wearing a face mask at work. Although few SSTI were reported, this study of IHO workers and their household contacts is the first to characterize a relation between nasal carriage of antibiotic-resistant LA-S. aureus and SSTI. The direction and temporality of this relation and IHO workers' use of face masks to prevent nasal carriage of these bacteria warrant further investigation.
authors.affiliation: Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America.
authors.forename: Maya
authors.initials: M
authors.lastname: Nadimpalli
authors.affiliation: Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America.
authors.forename: Jill R
authors.initials: JR
authors.lastname: Stewart
authors.affiliation: Department of Environmental Sciences & Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, North Carolina, United States of America.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Pierce
authors.affiliation: Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Nora
authors.initials: N
authors.lastname: Pisanic
authors.affiliation: Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.|Johns Hopkins Center for a Livable Future, Johns Hopkins University, Baltimore, Maryland, United States of America.
authors.forename: David C
authors.initials: DC
authors.lastname: Love
authors.affiliation: Rural Empowerment Association for Community Help, Warsaw, North Carolina, United States of America.
authors.forename: Devon
authors.initials: D
authors.lastname: Hall
authors.affiliation: Microbiology and Infection Control, Statens Serum Institut, Copenhagen, Denmark.
authors.forename: Jesper
authors.initials: J
authors.lastname: Larsen
authors.affiliation: Division of Medical Microbiology, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.|Microbiology Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, United States of America.
authors.forename: Karen C
authors.initials: KC
authors.lastname: Carroll
authors.affiliation: Microbiology Laboratory, Johns Hopkins Hospital, Baltimore, Maryland, United States of America.
authors.forename: Tsigereda
authors.initials: T
authors.lastname: Tekle
authors.affiliation: Division of Infectious Diseases, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.|Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Trish M
authors.initials: TM
authors.lastname: Perl
authors.affiliation: Department of Environmental Health & Engineering, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.|Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Christopher D
authors.identifier: http://orcid.org/0000-0003-3211-8495
authors.initials: CD
authors.lastname: Heaney
mesh_terms: D000328:Adult; D000818:Animals; D005191:Family Characteristics; D005260:Female; D006801:Humans; D007221:Industry; D058751:Livestock / Q000382:microbiology*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000502:physiology*; D009666:Nose / Q000382:microbiology*; D016273:Occupational Exposure / Q000706:statistics & numerical data*; D015995:Prevalence; D012307:Risk Factors; D012867:Skin / Q000382:microbiology*; D018461:Soft Tissue Infections / Q000453:epidemiology / Q000382:microbiology; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013552:Swine; D013752:Tetracycline / Q000494:pharmacology
chemical_list: D013752:Tetracycline