Skip to main content Accessibility help
×
Home

Nose Picking and Nasal Carriage of Staphylococcus aureus

  • Heiman F. L. Wertheim (a1), Menno van Kleef (a1), Margreet C. Vos (a1), Alewijn Ott (a1), Henri A. Verbrugh (a1) and Wytske Fokkens (a2) (a3)...

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.

Copyright

Corresponding author

Department of Medical Microbiology and Infectious Diseases, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, The Netherlands, (h.wertheim@erasmusmc.nl)

References

Hide All
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.
2. Lowy, F. Staphylococcus aureus infections. N Engl J Med 1998; 339:520532.
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.
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.
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.
6. Perl, TM, Cullen, JJ, Wenzel, RP, et al. Intranasal mupirocin to prevent postoperative Staphylococcus aureus infections. N Engl J Med 2002; 346:18711877.
7. Doebbeling, BN. Nasal and hand carriage of Staphylococcus aureus in healthcare workers. J Chemother 1994;6(Suppl 2):1117.
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.
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.
10. Jefferson, JW, Thompson, TD. Rhinotillexomania: psychiatric disorder or habit? J Clin Psychiatry 1995; 56:5659.
11. Patti, JM, Allen, BL, McGavin, MJ, Hook, M. MSCRAMM-mediated adherence of microorganisms to host tissues. Annu Rev Microbiol 1994; 48:585617.
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.
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.
14. Weidenmaier, C, Kokai-Kun, JF, Peschel, A. Reply to “Nasal colonization by Staphylococcus aureus” . Nat Med 2004; 10:447.
15. Foster, TJ. Nasal colonization by Staphylococcus aureus . Nat Med 2004; 10:447.
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.
17. Cole, AM, Tahk, S, Oren, A, et al. Determinants of Staphylococcus aureus nasal carriage. Clin Diagn Lab Immunol 2001; 8:10641069.
18. Solberg, CO. A study of carriers of Staphylococcus aureus with special regard to quantitative bacterial estimations. Acta Med Scand Suppl 1965; 436:196.
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.
20. Hare, R, Thomas, CG. The transmission of Staphylococcus aureus . Br Med J 1956; 12:840844.

Metrics

Altmetric attention score

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed