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Nose Picking and Nasal Carriage of Staphylococcus aureus

Published online by Cambridge University Press:  21 June 2016

Heiman F. L. Wertheim*
Affiliation:
Departments of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
Menno van Kleef
Affiliation:
Departments of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
Margreet C. Vos
Affiliation:
Departments of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
Alewijn Ott
Affiliation:
Departments of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
Henri A. Verbrugh
Affiliation:
Departments of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands
Wytske Fokkens
Affiliation:
Ear, Nose, and Throat Diseases, Erasmus University Medical Center, Rotterdam, The Netherlands Department of Ear, Nose, and Throat Diseases, Academic Medical Center, Amsterdam, The Netherlands
*
Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands, (h.wertheim@erasmusmc.nl)

Abstract

Objective.

Nasal carriage of Staphylococcus aureus is an important risk factor for S. aureus infection and a reservoir for methicillin-resistant S. aureus. We investigated whether nose picking was among the determinants of S. aureus nasal carriage.

Setting and Participants.

The study cohort comprised 238 patients who visited the ear, nose, and throat (ENT) disease outpatient clinic of a tertiary care hospital and did not have a nose-specific complaint (defined as ENT patients) and 86 healthy hospital employees (including medical students and laboratory personnel).

Measurements.

All participants completed a questionnaire on behavior regarding the nose and were screened for S. aureus nasal carriage; only ENT patients underwent nasal examination by an ear, nose, and throat physician for clinical signs of nose picking.

Results.

Among ENT patients, nose pickers were significantly more likely than non–nose pickers to carry S. aureus (37 [53.6%] of 69 vs 60 [35.5%] of 169 patients; relative risk, 1.51 [95% confidence interval, 1.03-2.19]). Among healthy volunteers, there was a statistically significant positive correlation between the self-perceived frequency of nose picking and both the frequency of positive culture results (R = 0.31; P = .004) and the load of S. aureus present in the nose (R = 0.32; P = .003).

Conclusion.

Nose picking is associated with S. aureus nasal carriage. The role of nose picking in nasal carriage may well be causal in certain cases. Overcoming the habit of nose picking may aid S. aureus decolonization strategies.

Type
Original Articles
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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References

1. Richards, MJ, Edwards, JR, Culver, DH, Gaynes, RP. Nosocomial infections in combined medical-surgical intensive care units in the United States. Infect Control Hosp Epidemiol 2000; 21:510515.CrossRefGoogle ScholarPubMed
2. Lowy, F. Staphylococcus aureus infections. N Engl J Med 1998; 339:520532.CrossRefGoogle ScholarPubMed
3. Kluytmans, J, van Belkum, A, Verbrugh, H. Nasal carriage of Staphylococcus aureus: epidemiology, underlying mechanisms, and associated risks. Clin Microbiol Rev 1997; 10:505520.CrossRefGoogle ScholarPubMed
4. Wertheim, HF, Vos, MC, Ott, A, et al. Risk and outcome of nosocomial Staphylococcus aureus bacteremia in nasal carriers versus non-carriers. Lancet 2004; 364:703705.CrossRefGoogle ScholarPubMed
5. Wertheim, HF, Vos, MC, Ott, A, et al. Mupirocin prophylaxis against nosocomial Staphylococcus aureus infections in nonsurgical patients: a randomized study. Ann Intern Med 2004; 140:419425.CrossRefGoogle ScholarPubMed
6. Perl, TM, Cullen, JJ, Wenzel, RP, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002; 346:18711877.CrossRefGoogle ScholarPubMed
7. Doebbeling, BN. Nasal and hand carriage of Staphylococcus aureus in healthcare workers. J Chemother 1994;6(Suppl 2):1117.CrossRefGoogle ScholarPubMed
8. Wertheim, HFL, Boelens, HAM, Nouwen, JL, Ott, A, Vos, MC, Verbrugh, HA. Nose picking and nasal carriage of Staphylococcus aureus. Paper presented at: 9th International Symposium on Staphylococci; 2000; Kolding, Denmark.Google Scholar
9. VandenBergh, MF, Yzerman, EP, van Belkum, A, Boelens, HA, Sijmons, M, Verbrugh, HA. Follow-up of Staphylococcus aureus nasal carriage after 8 years: redefining the persistent carrier state. J Clin Microbiol 1999; 37:31333140.CrossRefGoogle ScholarPubMed
10. Jefferson, JW, Thompson, TD. Rhinotillexomania: psychiatric disorder or habit? J Clin Psychiatry 1995; 56:5659.Google ScholarPubMed
11. Patti, JM, Allen, BL, McGavin, MJ, Hook, M. MSCRAMM-mediated adherence of microorganisms to host tissues. Annu Rev Microbiol 1994; 48:585617.CrossRefGoogle ScholarPubMed
12. Cho, SH, Strickland, I, Boguniewicz, M, Leung, DY. Fibronectin and fibrinogen contribute to the enhanced binding of Staphylococcus aureus to atopic skin. J Allergy Clin Immunol 2001; 108:269274.CrossRefGoogle Scholar
13. Weidenmaier, C, Kokai-Kun, JF, Kristian, SA, et al. Role of teichoic acids in Staphylococcus aureus nasal colonization, a major risk factor in nosocomial infections. Nat Med 2004; 10:243245.CrossRefGoogle Scholar
14. Weidenmaier, C, Kokai-Kun, JF, Peschel, A. Reply to “Nasal colonization by Staphylococcus aureus” . Nat Med 2004; 10:447.CrossRefGoogle Scholar
15. Foster, TJ. Nasal colonization by Staphylococcus aureus . Nat Med 2004; 10:447.CrossRefGoogle ScholarPubMed
16. O'Brien, LM, Walsh, EJ, Massey, RC, Peacock, SJ, Foster, TJ. Staphylococcus aureus clumping factor B (ClfB) promotes adherence to human type I cytokeratin 10: implications for nasal colonization. Cell Microbiol 2002; 4:759770.CrossRefGoogle ScholarPubMed
17. Cole, AM, Tahk, S, Oren, A, et al. Determinants of Staphylococcus aureus nasal carriage. Clin Diagn Lab Immunol 2001; 8:10641069.CrossRefGoogle ScholarPubMed
18. Solberg, CO. A study of carriers of Staphylococcus aureus with special regard to quantitative bacterial estimations. Acta Med Scand Suppl 1965; 436:196.Google ScholarPubMed
19. Reagan, DR, Doebbeling, BN, Pfaller, MA, et al. Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. Ann Intern Med 1991; 114:101106.CrossRefGoogle ScholarPubMed
20. Hare, R, Thomas, CG. The transmission of Staphylococcus aureus . Br Med J 1956; 12:840844.CrossRefGoogle Scholar