title: Higher prevalence of coagulase-negative staphylococci carriage among reclaimed water spray irrigators.
abstract: Coagulase negative staphylococci (CoNS) are leading causes of nosocomial infections and community-acquired methicillin-resistant CoNS (MRCoNS) infections are increasing. CoNS have been previously detected in reclaimed water. To date, no studies have evaluated the prevalence of CoNS carriage among humans exposed to reclaimed water in the U.S. We examined the prevalence and odds of CoNS and antibiotic-resistant CoNS carriage in spray irrigators exposed to reclaimed water compared to controls. We collected nasal and dermal swab samples from 19 reclaimed water spray irrigation workers (n=96 total samples) and 24 controls (n=92 total samples). Samples were analyzed for CoNS using culture-based assays. Isolates were confirmed using biochemical tests and PCR. Antimicrobial susceptibility testing was performed using disk diffusion. Data were analyzed by two-sample proportion tests, logistic regression, and generalized linear mixed effects models. The prevalence of CoNS, antibiotic-resistant CoNS, and MRCoNS carriage among spray irrigation workers was 79% (15/19), 32% (6/19), and 16% (3/19), compared to 13% (3/24), 4% (1/24), and 0% (0/24) of controls. Spray irrigators were more likely to be carriers of CoNS (p<0.01), antibiotic-resistant CoNS (p<0.01), and MRCoNS (p=0.02) compared to controls. The odds of CoNS carriage significantly increased with exposure to reclaimed water (p=0.04) even accounting for changes over time (p=0.05). Our data highlight the need to further examine the potential dissemination of CoNS and antibiotic-resistant CoNS from reclaimed water into the environment and human communities and related public health implications.
authors.affiliation: Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA. Electronic address: rerosenb@umd.edu.
authors.forename: Rachel Rosenberg
authors.initials: RR
authors.lastname: Goldstein
authors.affiliation: Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA; Department of Microbiology & Immunology, Albert Einstein College of Medicine, Bronx, NY, USA. Electronic address: lara.kleinfelter@phd.einstein.yu.edu.
authors.forename: Lara
authors.initials: L
authors.lastname: Kleinfelter
authors.affiliation: Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA. Electronic address: xinhe@umd.edu.
authors.forename: Xin
authors.initials: X
authors.lastname: He
authors.affiliation: Department of Plant Science and Landscape Architecture, University of Maryland, College Park, MD 20742, USA; Center for Food Safety and Security Systems University of Maryland, College Park, Maryland, USA. Electronic address: smicall@umd.edu.
authors.forename: Shirley A
authors.initials: SA
authors.lastname: Micallef
authors.affiliation: Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA. Electronic address: ars@umd.edu.
authors.forename: Ashish
authors.initials: A
authors.lastname: George
authors.affiliation: Department of Environmental Health, Indiana University School of Public Health, Bloomington, Indiana, USA,. Electronic address: gibbss@indiana.edu.
authors.forename: Shawn G
authors.initials: SG
authors.lastname: Gibbs
authors.affiliation: Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Sapkota
mesh_terms: D057914:Agricultural Irrigation; D002353:Carrier State / Q000453:epidemiology*; D003030:Coagulase; D024881:Drug Resistance, Bacterial; D006801:Humans; D008826:Microbial Sensitivity Tests; D009666:Nose / Q000382:microbiology; D016273:Occupational Exposure; D015995:Prevalence; D012867:Skin / Q000382:microbiology; D013210:Staphylococcus / Q000201:enzymology / Q000302:isolation & purification*; D014867:Water; D018508:Water Purification
chemical_list: D003030:Coagulase; D014867:Water
keywords: Alternative water sources; Antibiotic-resistant bacteria; CoNS; Occupational exposure; Spray irrigation