[SOLVED] Staphylococcus aureus Nasal Carriage Rate Study
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This document is a collection of research papers and studies on the nasal carriage rate of Staphylococcus aureus. It includes various articles from 2010 to 2015 that explore the prevalence, population structure, and molecular characteristics of methicillin-resistant S. aureus clones. The studies cover different populations, including university students in Thailand, healthcare workers in Norway, and preclinical medical students in China. The research aims to understand the epidemiology, pathophysiology, clinical manifestations, and management of Staphylococcus aureus infections.
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Running head: S.AUREUS NASAL CARRIAGE 1
NASAL CARRIAGE OF STAPHYLOCOCCUS AUREUS ON MICROBIOLOGY STUDENTS
Student’s Name
University Affiliation
Course
Date
NASAL CARRIAGE OF STAPHYLOCOCCUS AUREUS ON MICROBIOLOGY STUDENTS
Student’s Name
University Affiliation
Course
Date
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S.AUREUS NASAL CARRIAGE 2
ABSTRACT
The emergence of infections associated with MRSA among microbiology students
became very common leading to increased need for research. Infections due to MRSA are now
categorized as both Community- Associated MRSA (CA-MSRA) and Health Care -associated
MRSA (HA-MRSA). Colonization of S.aureus is a very critical risk factor for persistent
infections associated with MRSA. The purpose of this survey was to screen healthy
microbiology students for S.aureus nasal carriage, identify the rates of carriage, virulence
markers of nasal S.aureus, its subtypes and isolates on mecA gene detection gathered from the
healthy microbiology students. This survey investigates the prevalence of nasal carriage of
S.aureus and its variation over several years of research. S.aureus is among the primary agents of
both health care and the communities with associated infections. A total of 662 subjects were
assessed for nasal carriage following verbal consent. The subjects comprised of both health care
workers and students. Specimens were collected from the anterior nares of the students using
pre-moistened sterile swabs which were then inoculated into mannitol salt and blood agar at a
temperature of 37centigarde for 24-48 hours. The S.aureus was confirmed using disk diffusion.
Semi-structured questionnaires were used to collect data. Based on the findings, 184 participants
out of 662 were positive for nasal carriage of S.aureus. This number was equivalent to 27.79%
prevalence of S.aureus nasal carriage among microbiology students.
INTRODUCTION
The S.aureus species of bacteria together with the Methicillin Resistant Variant (MRSA)
have a foundational niche of ecology in the nasal cavity of humans. However, it can invade the
intestines and the perennial parts of the human body. S.aureus is among the major factors
ABSTRACT
The emergence of infections associated with MRSA among microbiology students
became very common leading to increased need for research. Infections due to MRSA are now
categorized as both Community- Associated MRSA (CA-MSRA) and Health Care -associated
MRSA (HA-MRSA). Colonization of S.aureus is a very critical risk factor for persistent
infections associated with MRSA. The purpose of this survey was to screen healthy
microbiology students for S.aureus nasal carriage, identify the rates of carriage, virulence
markers of nasal S.aureus, its subtypes and isolates on mecA gene detection gathered from the
healthy microbiology students. This survey investigates the prevalence of nasal carriage of
S.aureus and its variation over several years of research. S.aureus is among the primary agents of
both health care and the communities with associated infections. A total of 662 subjects were
assessed for nasal carriage following verbal consent. The subjects comprised of both health care
workers and students. Specimens were collected from the anterior nares of the students using
pre-moistened sterile swabs which were then inoculated into mannitol salt and blood agar at a
temperature of 37centigarde for 24-48 hours. The S.aureus was confirmed using disk diffusion.
Semi-structured questionnaires were used to collect data. Based on the findings, 184 participants
out of 662 were positive for nasal carriage of S.aureus. This number was equivalent to 27.79%
prevalence of S.aureus nasal carriage among microbiology students.
INTRODUCTION
The S.aureus species of bacteria together with the Methicillin Resistant Variant (MRSA)
have a foundational niche of ecology in the nasal cavity of humans. However, it can invade the
intestines and the perennial parts of the human body. S.aureus is among the major factors
S.AUREUS NASAL CARRIAGE 3
associated with health care and community –acquired infections. Commonly, S.aureus colonizes
body sites such as device sites and open wounds, that is, the nose and the exposed skin areas.
Some of the commonest infections associated with S.aureus include pneumonia, food poisoning,
skin infections, Toxic Shock Syndrome (Otto, 2014) and blood poisoning which is also known as
bacteremia (Tong, Davis, Eichenberger, Holland & Fowler, 2015).
The clinical significance of S.aureus is that its infections are dependent on the virulence
of a particular bacteria strain, host immunity and size of the inoculum. Its infections are
suppurative leading to abscesses containing damaged leukocytes and pus that are surrounded by
necrotic tissue. Skin infections are the most prevalent of all the infections associated with
S.aureus bacteria. These infections may be in form of pimples or boils. Sometimes, the infections
are characterized by some pus or form of drainage which can be swollen, painful or reddish in
color (Frank, Feazel, Bessesen, Price, Janoff & Pace, 2010). These may sometimes shift to
impetigo which is capable of changing into a skin crust. The skin infections due to S.aureus
bacteria can attack anyone irrespective of factors such as age or location (Chen, Xie, Ni, Dai, Lu,
Wu, & Huang, 2017).
The most significant and effective way of preventing infection due to staphs is keeping
hands and wounds clean always. In most cases, the staphs are managed through infection
drainage and use of antibiotics. There are some individuals who are at a higher risk of having the
infections than others. Some of those at a higher risk include those with weak immunity, severe
or chronic underlying illnesses such as diabetes, prolonged and recurrent exposure to antibiotics
and invasive procedure such as catheterization and open wounds (DeLeo, Otto, Kreiswirth &
Chambers, 2010).
associated with health care and community –acquired infections. Commonly, S.aureus colonizes
body sites such as device sites and open wounds, that is, the nose and the exposed skin areas.
Some of the commonest infections associated with S.aureus include pneumonia, food poisoning,
skin infections, Toxic Shock Syndrome (Otto, 2014) and blood poisoning which is also known as
bacteremia (Tong, Davis, Eichenberger, Holland & Fowler, 2015).
The clinical significance of S.aureus is that its infections are dependent on the virulence
of a particular bacteria strain, host immunity and size of the inoculum. Its infections are
suppurative leading to abscesses containing damaged leukocytes and pus that are surrounded by
necrotic tissue. Skin infections are the most prevalent of all the infections associated with
S.aureus bacteria. These infections may be in form of pimples or boils. Sometimes, the infections
are characterized by some pus or form of drainage which can be swollen, painful or reddish in
color (Frank, Feazel, Bessesen, Price, Janoff & Pace, 2010). These may sometimes shift to
impetigo which is capable of changing into a skin crust. The skin infections due to S.aureus
bacteria can attack anyone irrespective of factors such as age or location (Chen, Xie, Ni, Dai, Lu,
Wu, & Huang, 2017).
The most significant and effective way of preventing infection due to staphs is keeping
hands and wounds clean always. In most cases, the staphs are managed through infection
drainage and use of antibiotics. There are some individuals who are at a higher risk of having the
infections than others. Some of those at a higher risk include those with weak immunity, severe
or chronic underlying illnesses such as diabetes, prolonged and recurrent exposure to antibiotics
and invasive procedure such as catheterization and open wounds (DeLeo, Otto, Kreiswirth &
Chambers, 2010).
S.AUREUS NASAL CARRIAGE 4
Virulence factors of S.aureus play a crucial role in its pathogenicity. Enzymes like
kinase, hemolysin, leucocidin and leukotoxins are key facilitators of the spread of the bacteria
species in various body tissues and organs (Argudín, Tenhagen, Fetsch, Sachsenröder,
Käsbohrer, Schroeter & Mendoza, 2011). Surface proteins such as capsule inhibit the phagocytic
mechanism of the bacteria. Additionally, the biochemical proteins such as carotenoids and
catalase promote the survival of the species in the phagocytes. Health Care -Associated MRSA
differ from Community –Associated MRSA based on microbiology, epidemiology and clinical
manifestations. CA-MRSA strains are regarded to be more susceptible to antibiotics since they
contain csssete of chromosome type IV which produce a virulence factor called panton-Valentine
leucocidin which causes soft tissue and skin infections to those who get invaded by MRSA
(Argudín, Tenhagen, Fetsch, Sachsenröder, Käsbohrer, Schroeter & Mendoza, 2011).
Active surveillance for the students colonized with Methicillin Resistant Staphylococcus
Aureus (MRSA) is the key recommendation in prevention of all infections associated with
MSRA. Several research studies so far have reported on how prevalent MRSA nasal carriage is
in health care settings (Halablab, Hijazi, Fawzi & Araj, 2010). Infection control multidisciplinary
team in a local hospital in Delhi expressed much concern on the rising number of patients
admitted to the hospital with MRSA colonization. Based on the high rate of admissions, it was
suggested that the local community in Delhi might be having a high prevalence of MRSA
(DeLeo, Otto, Kreiswirth & Chambers, 2010).
An MRSA survey was then undertaken aimed at screening health care workers and
patients for MRSA nasal carriage, identifying risk factors of colonization of MRSA and
determining their pattern of resistance. From this survey, it was concluded that Community
Associated MRSA contributes to approximately 30% of infections associated with S.aureus in
Virulence factors of S.aureus play a crucial role in its pathogenicity. Enzymes like
kinase, hemolysin, leucocidin and leukotoxins are key facilitators of the spread of the bacteria
species in various body tissues and organs (Argudín, Tenhagen, Fetsch, Sachsenröder,
Käsbohrer, Schroeter & Mendoza, 2011). Surface proteins such as capsule inhibit the phagocytic
mechanism of the bacteria. Additionally, the biochemical proteins such as carotenoids and
catalase promote the survival of the species in the phagocytes. Health Care -Associated MRSA
differ from Community –Associated MRSA based on microbiology, epidemiology and clinical
manifestations. CA-MRSA strains are regarded to be more susceptible to antibiotics since they
contain csssete of chromosome type IV which produce a virulence factor called panton-Valentine
leucocidin which causes soft tissue and skin infections to those who get invaded by MRSA
(Argudín, Tenhagen, Fetsch, Sachsenröder, Käsbohrer, Schroeter & Mendoza, 2011).
Active surveillance for the students colonized with Methicillin Resistant Staphylococcus
Aureus (MRSA) is the key recommendation in prevention of all infections associated with
MSRA. Several research studies so far have reported on how prevalent MRSA nasal carriage is
in health care settings (Halablab, Hijazi, Fawzi & Araj, 2010). Infection control multidisciplinary
team in a local hospital in Delhi expressed much concern on the rising number of patients
admitted to the hospital with MRSA colonization. Based on the high rate of admissions, it was
suggested that the local community in Delhi might be having a high prevalence of MRSA
(DeLeo, Otto, Kreiswirth & Chambers, 2010).
An MRSA survey was then undertaken aimed at screening health care workers and
patients for MRSA nasal carriage, identifying risk factors of colonization of MRSA and
determining their pattern of resistance. From this survey, it was concluded that Community
Associated MRSA contributes to approximately 30% of infections associated with S.aureus in
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S.AUREUS NASAL CARRIAGE 5
hospitals in Delhi. There is an urgency to study and research about S.aureus which is rapidly
growing in communities and health centers (Tong, Davis, Eichenberger, Holland & Fowler,
2015).
MATERIALS AND METHODS
The survey was conducted for more than 11 months between 2013 and 2017. The
experiments which were performed involved nasal swabs from Microbiology Students at RMIT
University who were considered to be generally healthy. The study included the students who
voluntarily decided to participate in the survey and a one-time sampling of the participants was
employed. The sample of microbiology students who participated in the study were all screened
for Nasal Carriage of S.aureus after verbal consent had been obtained from them.
Specimens were collected using pre-moistened sterile cotton swabs from the anterior
nares of the healthy students. Specimen inoculation was carried out with the aim of introducing a
vaccine or an antigen to their bodies to produce a strong immunity for bacterial infections. The
incubation of the inoculation was carried out in ambient air for a duration of 24-48 hours using
sheep blood agar and mannitol salt (Lozano, Gómez-Sanz, Benito, Aspiroz, Zarazaga, M., &
Torres, 2011).
Colonies which suggested S.aureus were white/ cream non-hemolytic or hemolytic
yellow on Oxacillin Blood Agar and Mannitol Salt Agar. Catalase, gram stain, slide and tube
coagulase tests were applied in identification of the S.aureus colonies. Confirmation of S.aureus
isolates was done using disk confusion in accordance with the Clinical Laboratory Standards.
Colonies of isolated presumptive of S.aureus were also confirmed after the discussion together
hospitals in Delhi. There is an urgency to study and research about S.aureus which is rapidly
growing in communities and health centers (Tong, Davis, Eichenberger, Holland & Fowler,
2015).
MATERIALS AND METHODS
The survey was conducted for more than 11 months between 2013 and 2017. The
experiments which were performed involved nasal swabs from Microbiology Students at RMIT
University who were considered to be generally healthy. The study included the students who
voluntarily decided to participate in the survey and a one-time sampling of the participants was
employed. The sample of microbiology students who participated in the study were all screened
for Nasal Carriage of S.aureus after verbal consent had been obtained from them.
Specimens were collected using pre-moistened sterile cotton swabs from the anterior
nares of the healthy students. Specimen inoculation was carried out with the aim of introducing a
vaccine or an antigen to their bodies to produce a strong immunity for bacterial infections. The
incubation of the inoculation was carried out in ambient air for a duration of 24-48 hours using
sheep blood agar and mannitol salt (Lozano, Gómez-Sanz, Benito, Aspiroz, Zarazaga, M., &
Torres, 2011).
Colonies which suggested S.aureus were white/ cream non-hemolytic or hemolytic
yellow on Oxacillin Blood Agar and Mannitol Salt Agar. Catalase, gram stain, slide and tube
coagulase tests were applied in identification of the S.aureus colonies. Confirmation of S.aureus
isolates was done using disk confusion in accordance with the Clinical Laboratory Standards.
Colonies of isolated presumptive of S.aureus were also confirmed after the discussion together
S.AUREUS NASAL CARRIAGE 6
with my survey demonstrator (Lozano, Gómez-Sanz, Benito, Aspiroz, Zarazaga, M., & Torres,
2011).
RESULTS
From the 662 microbiology students who were screened during the survey, 184 of the
participants turned positive for S.aureus nasal carriage. The colonies that suggested S.aureus had
a typical morphology on Mannitol Salt Agar, were Mannitol Positive, Catalase Positive and
Gram-positive cocci with a typical morphology on microscopy. The ultimate confirmation of the
survey findings was the tests on coagulase tests.
The table below show the coagulation tests results in percentage for the respective years when
the screening was carried out:
Table 1.0
Year of screening Coagulation tests results in
percentage (%)
2013 35.45
2014 19.26 and 29.20
2016 34.81 and 23.08
with my survey demonstrator (Lozano, Gómez-Sanz, Benito, Aspiroz, Zarazaga, M., & Torres,
2011).
RESULTS
From the 662 microbiology students who were screened during the survey, 184 of the
participants turned positive for S.aureus nasal carriage. The colonies that suggested S.aureus had
a typical morphology on Mannitol Salt Agar, were Mannitol Positive, Catalase Positive and
Gram-positive cocci with a typical morphology on microscopy. The ultimate confirmation of the
survey findings was the tests on coagulase tests.
The table below show the coagulation tests results in percentage for the respective years when
the screening was carried out:
Table 1.0
Year of screening Coagulation tests results in
percentage (%)
2013 35.45
2014 19.26 and 29.20
2016 34.81 and 23.08
S.AUREUS NASAL CARRIAGE 7
S. aureus nasal carriage rates of RMIT Students from 2013 to 2018
The findings for collective data were as tabulated below:
Table 2.0
Year No. of S.aureus
Carriers
Total number of
students screened
2013 39 110
2014 26 135
2015 33 113
2016 47 135
2017 39 169
DISCUSSION
Methicillin –resistant Staphylococcus Aureus (MRSA) has become the leading
contributing factor of soft-tissues and skin disorders. Recent studies reports that infections
associated with MRSA among the healthy individuals in community settings don’t have prior
history of S.aureus bacteria (Rackham, Ray, Franks, Bielak & Pinn, 2010). This survey
discovered that 184 out of 662 microbiology students had nasal carriage of S.aureus. This
number of participants was equivalent to 27.79 percent of the total number of the participants.
The quoted conventionally values of nasal carriage for S.aureus ranged from 20 percent to 40
percent (Kitti, Boonyonying & Sitthisak, 2011).
Papers regarding outpatient interaction from the Cosmopolitan population at Dehli
showed a colonization rate of 5.3 percent, Japan had a rate of 32.4% while USA reported a
S. aureus nasal carriage rates of RMIT Students from 2013 to 2018
The findings for collective data were as tabulated below:
Table 2.0
Year No. of S.aureus
Carriers
Total number of
students screened
2013 39 110
2014 26 135
2015 33 113
2016 47 135
2017 39 169
DISCUSSION
Methicillin –resistant Staphylococcus Aureus (MRSA) has become the leading
contributing factor of soft-tissues and skin disorders. Recent studies reports that infections
associated with MRSA among the healthy individuals in community settings don’t have prior
history of S.aureus bacteria (Rackham, Ray, Franks, Bielak & Pinn, 2010). This survey
discovered that 184 out of 662 microbiology students had nasal carriage of S.aureus. This
number of participants was equivalent to 27.79 percent of the total number of the participants.
The quoted conventionally values of nasal carriage for S.aureus ranged from 20 percent to 40
percent (Kitti, Boonyonying & Sitthisak, 2011).
Papers regarding outpatient interaction from the Cosmopolitan population at Dehli
showed a colonization rate of 5.3 percent, Japan had a rate of 32.4% while USA reported a
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S.AUREUS NASAL CARRIAGE 8
percentage of 32.4 among the adults with S.aureus. This was higher than the results of this
survey. The survey found that S.aureus prevalence in healthy students was 27.79 percent which
is lower than the findings of Delhi which had a percentage of 37.3. Other surveys among workers
in health care centers especially the ones in burns and Intensive Care Units have a conclusion
that the rate of carrier of S.aureus is ranges from 6-50 percent. The spread of the bacterial is
associated with the hands of health care workers (Halablab, Hijazi, Fawzi & Araj, 2010).
The bacteria species has a significant transmission medium through hand carriers which
act as the reservoirs (Shibabaw, Abebe & Mihret, 2013). Prolonged use of antibiotics and
hospitalizations contribute to the increased conveyance rate and transmission of S.aureus. The
survey was limited since conducting surveys with specimens from the hind nares for screening
detects only 75 percent of the bacteria. The prevalence of S.aureus colonization could have been
underestimated by the nasal cultures since the bacteria can invade other parts of the body such as
axilla and pharynx (Rackham, Ray, Franks, Bielak & Pinn, 2010).
CONCLUSION
The survey indicates that S.aureus nasal carriage is rated at 27.79 percent which
corresponds to 184 out of 662 participants. The survey also singles out that incoming facilities
pose an independent risk for S.aureus colonies. The findings of this survey are significant in
control and prevention of the rapid spread of the MRSA among microbiology students which can
extend to the community at large. It is recommendable to encourage hand washing among health
care workers and enlighten the community about the bacteria to prevent it from spreading and
minimize infections.
percentage of 32.4 among the adults with S.aureus. This was higher than the results of this
survey. The survey found that S.aureus prevalence in healthy students was 27.79 percent which
is lower than the findings of Delhi which had a percentage of 37.3. Other surveys among workers
in health care centers especially the ones in burns and Intensive Care Units have a conclusion
that the rate of carrier of S.aureus is ranges from 6-50 percent. The spread of the bacterial is
associated with the hands of health care workers (Halablab, Hijazi, Fawzi & Araj, 2010).
The bacteria species has a significant transmission medium through hand carriers which
act as the reservoirs (Shibabaw, Abebe & Mihret, 2013). Prolonged use of antibiotics and
hospitalizations contribute to the increased conveyance rate and transmission of S.aureus. The
survey was limited since conducting surveys with specimens from the hind nares for screening
detects only 75 percent of the bacteria. The prevalence of S.aureus colonization could have been
underestimated by the nasal cultures since the bacteria can invade other parts of the body such as
axilla and pharynx (Rackham, Ray, Franks, Bielak & Pinn, 2010).
CONCLUSION
The survey indicates that S.aureus nasal carriage is rated at 27.79 percent which
corresponds to 184 out of 662 participants. The survey also singles out that incoming facilities
pose an independent risk for S.aureus colonies. The findings of this survey are significant in
control and prevention of the rapid spread of the MRSA among microbiology students which can
extend to the community at large. It is recommendable to encourage hand washing among health
care workers and enlighten the community about the bacteria to prevent it from spreading and
minimize infections.
S.AUREUS NASAL CARRIAGE 9
References
Argudín, M. A., Tenhagen, B. A., Fetsch, A., Sachsenröder, J., Käsbohrer, A., Schroeter, A., ...
& Mendoza, M. C. (2011). Virulence and resistance determinants in German
Staphylococcus aureus ST398 isolates from non-human origin. Applied and
environmental microbiology.
Chen, B. J., Xie, X. Y., Ni, L. J., Dai, X. L., Lu, Y., Wu, X. Q., ... & Huang, S. Y. (2017).
Factors associated with Staphylococcus aureus nasal carriage and molecular
characteristics among the general population at a Medical College Campus in
Guangzhou, South China. Annals of clinical microbiology and antimicrobials, 16(1), 28.
DeLeo, F. R., Otto, M., Kreiswirth, B. N., & Chambers, H. F. (2010). Community-associated
meticillin-resistant Staphylococcus aureus. The Lancet, 375(9725), 1557-1568.
Frank, D. N., Feazel, L. M., Bessesen, M. T., Price, C. S., Janoff, E. N., & Pace, N. R. (2010).
The human nasal microbiota and Staphylococcus aureus carriage. PloS one, 5(5), e10598.
Halablab, M. A., Hijazi, S. M., Fawzi, M. A., & Araj, G. F. (2010). Staphylococcus aureus nasal
carriage rate and associated risk factors in individuals in the community. Epidemiology &
Infection, 138(5), 702-706.
Kitti, T., Boonyonying, K., & Sitthisak, S. (2011). Prevalence of methicillin-resistant
Staphylococcus aureus among university students in Thailand. Southeast Asian Journal
of Tropical Medicine and Public Health, 42(6), 1498.
References
Argudín, M. A., Tenhagen, B. A., Fetsch, A., Sachsenröder, J., Käsbohrer, A., Schroeter, A., ...
& Mendoza, M. C. (2011). Virulence and resistance determinants in German
Staphylococcus aureus ST398 isolates from non-human origin. Applied and
environmental microbiology.
Chen, B. J., Xie, X. Y., Ni, L. J., Dai, X. L., Lu, Y., Wu, X. Q., ... & Huang, S. Y. (2017).
Factors associated with Staphylococcus aureus nasal carriage and molecular
characteristics among the general population at a Medical College Campus in
Guangzhou, South China. Annals of clinical microbiology and antimicrobials, 16(1), 28.
DeLeo, F. R., Otto, M., Kreiswirth, B. N., & Chambers, H. F. (2010). Community-associated
meticillin-resistant Staphylococcus aureus. The Lancet, 375(9725), 1557-1568.
Frank, D. N., Feazel, L. M., Bessesen, M. T., Price, C. S., Janoff, E. N., & Pace, N. R. (2010).
The human nasal microbiota and Staphylococcus aureus carriage. PloS one, 5(5), e10598.
Halablab, M. A., Hijazi, S. M., Fawzi, M. A., & Araj, G. F. (2010). Staphylococcus aureus nasal
carriage rate and associated risk factors in individuals in the community. Epidemiology &
Infection, 138(5), 702-706.
Kitti, T., Boonyonying, K., & Sitthisak, S. (2011). Prevalence of methicillin-resistant
Staphylococcus aureus among university students in Thailand. Southeast Asian Journal
of Tropical Medicine and Public Health, 42(6), 1498.
S.AUREUS NASAL CARRIAGE
10
Lozano, C., Gómez-Sanz, E., Benito, D., Aspiroz, C., Zarazaga, M., & Torres, C. (2011).
Staphylococcus aureus nasal carriage, virulence traits, antibiotic resistance mechanisms,
and genetic lineages in healthy humans in Spain, with detection of CC398 and CC97
strains. International Journal of Medical Microbiology, 301(6), 500-505.
Ma, X. X., Sun, D. D., Wang, S., Wang, M. L., Li, M., Shang, H., ... & Luo, E. J. (2011). Nasal
carriage of methicillin-resistant Staphylococcus aureus among preclinical medical
students: epidemiologic and molecular characteristics of methicillin-resistant S. aureus
clones. Diagnostic microbiology and infectious disease, 70(1), 22-30.
Olsen, K., Sangvik, M., Simonsen, G. S., Sollid, J. U. E., Sundsfjord, A., Thune, I., & Furberg,
A. S. (2013). Prevalence and population structure of Staphylococcus aureus nasal
carriage in healthcare workers in a general population. The Tromsø Staph and Skin
Study. Epidemiology & Infection, 141(1), 143-152.
Otto, M. (2014). Staphylococcus aureus toxins. Current opinion in microbiology, 17, 32-37.
Rackham, D. M., Ray, S. M., Franks, A. S., Bielak, K. M., & Pinn, T. M. (2010). Community-
associated methicillin-resistant Staphylococcus aureus nasal carriage in a college student
athlete population. Clinical Journal of Sport Medicine, 20(3), 185-188.
Shibabaw, A., Abebe, T., & Mihret, A. (2013). Nasal carriage rate of methicillin resistant
Staphylococcus aureus among Dessie Referral Hospital health care workers; Dessie,
Northeast Ethiopia. Antimicrobial resistance and infection control, 2(1), 25.
10
Lozano, C., Gómez-Sanz, E., Benito, D., Aspiroz, C., Zarazaga, M., & Torres, C. (2011).
Staphylococcus aureus nasal carriage, virulence traits, antibiotic resistance mechanisms,
and genetic lineages in healthy humans in Spain, with detection of CC398 and CC97
strains. International Journal of Medical Microbiology, 301(6), 500-505.
Ma, X. X., Sun, D. D., Wang, S., Wang, M. L., Li, M., Shang, H., ... & Luo, E. J. (2011). Nasal
carriage of methicillin-resistant Staphylococcus aureus among preclinical medical
students: epidemiologic and molecular characteristics of methicillin-resistant S. aureus
clones. Diagnostic microbiology and infectious disease, 70(1), 22-30.
Olsen, K., Sangvik, M., Simonsen, G. S., Sollid, J. U. E., Sundsfjord, A., Thune, I., & Furberg,
A. S. (2013). Prevalence and population structure of Staphylococcus aureus nasal
carriage in healthcare workers in a general population. The Tromsø Staph and Skin
Study. Epidemiology & Infection, 141(1), 143-152.
Otto, M. (2014). Staphylococcus aureus toxins. Current opinion in microbiology, 17, 32-37.
Rackham, D. M., Ray, S. M., Franks, A. S., Bielak, K. M., & Pinn, T. M. (2010). Community-
associated methicillin-resistant Staphylococcus aureus nasal carriage in a college student
athlete population. Clinical Journal of Sport Medicine, 20(3), 185-188.
Shibabaw, A., Abebe, T., & Mihret, A. (2013). Nasal carriage rate of methicillin resistant
Staphylococcus aureus among Dessie Referral Hospital health care workers; Dessie,
Northeast Ethiopia. Antimicrobial resistance and infection control, 2(1), 25.
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