Article

Hormonal Contraceptive Use and Persistent Staphylococcus aureus Nasal Carriage

Institut für Tropenmedizin, Eberhard Karls Universität, Tübingen.
Clinical Infectious Diseases (Impact Factor: 9.42). 09/2012; 55(12). DOI: 10.1093/cid/cis778
Source: PubMed

ABSTRACT Background. Human nares colonized with Staphylococcus aureus are the most important reservoir for this pathogen. We studied the influence of sex and hormonal contraceptive use on persistent S. aureus nasal carriage.Methods. We conducted a cohort study in healthy volunteers and determined carriage status at baseline and again at follow-up by using the results of 2 swab samples at each time point. We applied logistic regression to analyze associations of interest.Results. At baseline, 266 of 1180 volunteers (22.5%) were classified as persistent nasal carriers. Compared with women not using hormonal contraceptives, women taking reproductive hormones (odds ratio [OR]. 1.88; 95% confidence interval [CI], 1.29-2.75; P = .001) and men (OR., 1.57; 95% CI, 1.08-2.28; P = .02) were more likely to be persistent carriers. These associations remained stable after adjusting for known risk factors of nasal carriage. Women taking hormonal contraceptives and being persistent carriers at baseline were more likely to remain carriers after a median follow-up time of 70 days than women not using such medication (OR, 3.25; 95% CI, 1.44-7.34; P = .005). No patterns of association could be observed between persistent carriage among women and type of progestin or dose of estrogen used. Assuming causality and using estimates from multivariable logistic regression, we approximated that 20% (95% CI, 2.4%-34.9%) of persistent nasal carriage among women represented by our sample is attributable to hormonal contraception (population-attributable fraction).Conclusions. The widespread use of hormonal contraception may substantially increase the human S. aureus reservoir with potential impact on S. aureus infection and transmission.

0 Followers
 · 
99 Views
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background. Genetically determined variation in the expression of innate defense molecules may explain differences in the propensity to be colonized with Staphylococcus aureus.Methods. We determined S. aureus nasal carriage in 603 volunteers, analyzed polymorphisms in the DEFB1 promoter at the positions-52 G>A (rs1799946), -44 C>G (rs1800972), -20 G>A (rs11362), and measured the content of human β-defensin (hBD) -1 and -3 mRNA in 192 samples of healthy and experimentally wounded human skin.Results. Compared to GGG at the positions -52/-44/-20, the ACG haplotype was more common among persistent S. aureus nasal carriers (OR 1.93, 95% confidence interval 1.2-3.1, P=0.006) and at the same time associated with reduced expression of hBD-1 (GGG>ACG>GCA, P<0.001) and hBD-3 (GGG>GCA>ACG, P=0.04) in skin when measured 72 hours after wounding. Furthermore, a 50% lowering of hBD-1 and -3 mRNA expression in wounded skin increased the odds of persistent carriage by 1.45 (0.93-2.26, P=0.1) and 1.48 (1.01-2.17, P=0.04), respectively. Adjusting for known risk factors of persistent S. aureus carriage did not substantially change the associations of both, DEFB1 haplotypes and β-defensin expression with S. aureus colonization.Conclusion. DEFB1 polymorphisms may promote persistent S. aureus colonization by altering β-defensin expression in keratinocytes of human skin.
    The Journal of Infectious Diseases 11/2012; 207(4). DOI:10.1093/infdis/jis735 · 5.78 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Staphylococcus aureus is a common human commensal but carriage varies between e.g. geographic location, age, gender, ethnicity and body niche. The nares, throat and perineum are the most prevalent sites for carriage in the general adult population. Other sites of the skin and the intestine are also frequently colonised. Thus, a successful establishment is dependent on multiple factors. This review describes results from observational studies of S. aureus carriage and the influence bacterial, host and environmental/modifiable factors might have on the relationship.
    Infection, genetics and evolution: journal of molecular epidemiology and evolutionary genetics in infectious diseases 04/2013; 21. DOI:10.1016/j.meegid.2013.03.020 · 3.26 Impact Factor
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Obesity and diabetes mellitus (DM) have been linked to increased risk of infections, and Staphylococcus aureus nasal colonization is a major risk factor for developing infections with the microbe. We therefore sought to find whether body mass index (BMI) and waist circumference (WC) could be associated with S. aureus colonization independent of DM. S. aureus colonization was assessed by nasal swab cultures among 2,169 women and 1,709 men, aged 30-87 years, in the population-based Tromsø Staph and Skin Study in 2007-08. Height (cm), weight (kg), WC (cm), and glycated haemoglobin (HbA1c,%) were measured. Multivariable logistic regression analyses including information on DM, HbA1c, hormonal contraceptive use and other potential confounders were used. In the female population, each 2.5 kg/m(2) increase in BMI was associated with a 7% higher odds of S. aureus nasal colonization (P = 0.01). When comparing obese and lean women aged 30-43 years, we observed that BMI ≥32.5 versus <22.5 kg/m(2) and WC ≥101 versus <80 cm was associated with a 2.60 and 2.12 times higher odds of S. aureus colonization, respectively (95% confidence intervals 1.35-4.98 and 1.17-3.85). Among men, high WC was also associated with S. aureus nasal colonization. The associations did not change significantly when the analysis was restricted to participants without signs of pre-diabetes (HbA1c <6.0%) among women and men, and to non-users of hormonal contraceptives among women. Our results support that obesity is a possible determinant for S. aureus nasal colonization independent of DM, in particular for premenopausal women. The role of obesity at different ages and by sex should be addressed in future prospective studies of S. aureus colonization.
    PLoS ONE 05/2013; 8(5):e63716. DOI:10.1371/journal.pone.0063716 · 3.53 Impact Factor
Show more