Staphylococcus aureus colonization and acquisition of skin and soft tissue infection among Royal Marines recruits: a prospective cohort study

E. Jauneikaite, T. Ferguson, M. Mosavie, J. L. Fallowfield, T. Davey, N. Thorpe, A. Allsopp, A. M. Shaw, D. Fudge, M. K. O'Shea, D. Wilson, M. Morgan, Bruno Pichon, Angela Kearns, S. Sriskandan, L. E. Lamb*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

9 Citations (Scopus)

Abstract

Objectives: Skin and soft tissue infections (SSTIs) are a serious health issue for military personnel. Of particular importance are those caused by methicillin-resistant Staphylococcus aureus and Panton–Valentine leucocidin (PVL)-positive S. aureus (PVL-SA), as they have been associated with outbreaks of SSTIs. A prospective observational study was conducted in Royal Marine (RM) recruits to investigate the prevalence of PVL-SA carriage and any association with SSTIs. 

Methods: A total of 1012 RM recruits were followed through a 32-week training programme, with nose and throat swabs obtained at weeks 1, 6, 15 and 32. S. aureus isolates were characterized by antibiotic susceptibility testing, spa typing, presence of mecA/C and PVL genes. Retrospective review of the clinical notes for SSTI acquisition was conducted. 

Results: S. aureus colonization decreased from Week 1 to Week 32 (41% to 26%, p < 0.0001). Of 1168 S. aureus isolates, three out of 1168 (0.3%) were MRSA and ten out of 1168 (0.9%) PVL-positive (all MSSA) and 169 out of 1168 (14.5%) were resistant to clindamycin. Isolates showed genetic diversity with 238 different spa types associated with 25 multi-locus sequence type (MLST) clonal complexes. SSTIs were seen in 35% (351/989) of recruits with 3 training days lost per recruit. SSTI acquisition rate was reduced amongst persistent carriers (p < 0.0283). 

Conclusions: Nose and throat carriage of MRSA and PVL-SA was low among recruits, despite a high incidence of SSTIs being reported, particularly cellulitis. Carriage strains were predominantly MSSA with a marked diversity of genotypes. Persistent nose and/or throat carriage was not associated with SSTI acquisition. Putative person-to-person transmission within troops was identified based on spa typing requiring further research to confirm and explore potential transmission routes.

Original languageEnglish
Pages (from-to)381.e1-381.e6
JournalClinical Microbiology and Infection
Volume26
Issue number3
Early online date26 Jul 2019
DOIs
Publication statusPublished - Mar 2020

Bibliographical note

Funding Information: All authors of this manuscript confirm no conflicts of interest. This study was funded by the Surgeon General's Research Strategy Group , Ministry of Defence and the work in the paper was supported by the National Institute for Health Research Health Protection Research Unit (NIHR HPRU) , Imperial College London, in partnership with Public Health England (PHE). EJ is currently a Rosetrees/Stoneygate 2017 Imperial College Research Fellow, funded by Rosetrees Trust and the Stoneygate Trust .

Open Access: No Open Access licence.

Publisher Copyright: © 2019 Published by Elsevier Ltd on behalf of European Society of Clinical Microbiology and Infectious Diseases.

Citation: E. Jauneikaite, T. Ferguson, M. Mosavie, J.L. Fallowfield, T. Davey, N. Thorpe, A. Allsopp, A.M. Shaw, D. Fudge, M.K. O'Shea, D. Wilson, M. Morgan, B. Pichon, A.M. Kearns, S. Sriskandan, L.E. Lamb, Staphylococcus aureus colonization and acquisition of skin and soft tissue infection among Royal Marines recruits: a prospective cohort study, Clinical Microbiology and Infection, Volume 26, Issue 3, 2020, Pages 381.e1-381.e6, ISSN 1198-743X.

DOI: https://doi.org/10.1016/j.cmi.2019.07.014.

Keywords

  • Methicillin-resistant S. aureus
  • Panton–Valentine leucocidin
  • Royal Marines
  • Skin and soft tissue infections
  • Staphylococcus aureus

Fingerprint

Dive into the research topics of 'Staphylococcus aureus colonization and acquisition of skin and soft tissue infection among Royal Marines recruits: a prospective cohort study'. Together they form a unique fingerprint.

Cite this