title: Validation of self-administered nasal swabs and postage for the isolation of Staphylococcus aureus.
abstract: Staphylococcus aureus carriers are at higher risk of S. aureus infection and are a reservoir for transmission to others. Detection of nasal S. aureus carriage is important for both targeted decolonization and epidemiological studies. Self-administered nasal swabbing has been reported previously, but the effects of posting swabs prior to culture on S. aureus yield have not been investigated. A longitudinal cohort study was performed in which healthy volunteers were recruited, trained in the swabbing procedure and asked to take weekly nasal swabs for 6 weeks (median: 3 weeks, range 1-6 weeks). Two swabs were taken at each sampling episode and randomly assigned for immediate processing on arrival to the laboratory (Swab A) or second class postage prior to processing (Swab B). S. aureus was isolated using standard methods. A total of 95 participants were recruited, who took 944 swabs (472 pairs) over a median of 5 weeks. Of these, 459 swabs were positive for S. aureus. We found no significant difference (P=0.25) between 472 pairs of nasal self-swabs processed immediately or following standard postage from 95 study participants (51.4 % vs. 48.6 %, respectively). We also provide further evidence that persistent carriers can be detected by two weekly swabs with high degrees of sensitivity [92.3 % (95 % CI 74.8-98.8 %)] and specificity [95.6 % (95 % CI 84.8-99.3 %)] compared with a gold standard of five weekly swabs. Self-swabbing and postage of nasal swabs prior to processing has no effect on yield of S. aureus, and could facilitate large community-based carriage studies.
authors.affiliation: Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Ewan M
authors.initials: EM
authors.lastname: Harrison
authors.affiliation: Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Nicholas S
authors.initials: NS
authors.lastname: Gleadall
authors.affiliation: Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Xiaoliang
authors.initials: X
authors.lastname: Ba
authors.affiliation: Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: John
authors.initials: J
authors.lastname: Danesh
authors.affiliation: Wellcome Trust Sanger Institute, Hinxton, UK.|Department of Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Peacock
authors.affiliation: Department of Veterinary Medicine, University of Cambridge, Cambridge, UK.
authors.forename: Mark
authors.initials: M
authors.lastname: Holmes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002353:Carrier State / Q000382:microbiology*; D015331:Cohort Studies; D005260:Female; D064368:Healthy Volunteers; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009666:Nose / Q000382:microbiology*; D011177:Postal Service; D012646:Self Administration; D012680:Sensitivity and Specificity; D013048:Specimen Handling / Q000379:methods*; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology; D013211:Staphylococcus aureus / Q000254:growth & development / Q000302:isolation & purification*; D055815:Young Adult