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