Hostname: page-component-745bb68f8f-lrblm Total loading time: 0 Render date: 2025-01-22T10:47:06.896Z Has data issue: false hasContentIssue false
  • English
  • Français

Airborne Dispersal as a Novel Transmission Route of Coagulase-Negatwe Staphylococci Interaction Between Coagulase-Negative Staphylococci and Rhinovirus Infection

Published online by Cambridge University Press:  02 January 2015

Werner E. Bischoff ,
Stefano Bassetti ,
Barbara A. Bassetti-Wyss ,
Michelle L. Wallis ,
Brian K. Tucker ,
Beth A. Reboussin ,
Ralph B. D'Agostino Jr. ,
Michael A. Pfaller ,
Jack M. Gwaltney Jr.  and
Robert J. Sherertz
Werner E. Bischoff*
Affiliation:
Section on Infectious Diseases, Winston-Salem, North Carolina
Stefano Bassetti
Affiliation:
Section on Infectious Diseases, Winston-Salem, North Carolina
Barbara A. Bassetti-Wyss
Affiliation:
Section on Infectious Diseases, Winston-Salem, North Carolina
Michelle L. Wallis
Affiliation:
Section on Infectious Diseases, Winston-Salem, North Carolina
Brian K. Tucker
Affiliation:
Section on Infectious Diseases, Winston-Salem, North Carolina
Beth A. Reboussin
Affiliation:
Section on Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Ralph B. D'Agostino Jr.
Affiliation:
Section on Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Michael A. Pfaller
Affiliation:
Medical Microbiology Division, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
Jack M. Gwaltney Jr.
Affiliation:
Division of Epidemiology and Virology, University of Virginia Health Sciences Center, Charlottesville, Virginia
Robert J. Sherertz
Affiliation:
Section on Infectious Diseases, Winston-Salem, North Carolina
*
Wake Forest University School of Medicine, Department of Internal Medicine, Section on Infectious Diseases, Medical Center Boulevard, Winston-Salem, NC 27157-1042
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective:

To investigate whether rhinovirus infection leads to increased airborne dispersal of coagulase-negative staphylococci (CoNS).

Design:

Prospective nonrandomized intervention trial.

Setting:

Wake Forest University School of Medicine, Winston-Salem, North Carolina.

Participants:

Twelve nasal Staphylococcus aureus-CoNS carriers among 685 students screened for S. aureus nasal carriage.

Interventions:

Participants were studied for airborne dispersal of CoNS in a chamber under three conditions (street clothes, sterile gown with a mask, and sterile gown without a mask). After 2 days of pre-exposure measurements, volunteers were inoculated with a rhinovirus and observed for 14 days. Daily quantitative nasal and skin cultures for CoNS and nasal cultures for rhinovirus were performed. In addition, assessment of cold symptoms was performed daily, mucous samples were collected, and serum titers before and after rhinovirus inoculation were obtained. Sneezing, coughing, and talking events were recorded during chamber sessions.

Results:

All participants had at least one nasal wash positive for rhinovirus and 10 developed a symptomatic cold. Postexposure, there was a twofold increase in airborne CoNS (P = .0004), peaking at day 12. CoNS dispersal was reduced by wearing a gown (57% reduction, P < .0001), but not a mask (P = .7). Nasal and skin CoNS colonization increased after rhinovirus infection (P<.05).

Conclusions:

We believe this is the first demonstration that a viral pathogen in the upper airways can increase airborne dispersal of CoNS in nasal S. aureus carriers. Gowns, gloves, and caps had a protective effect, whereas wearing a mask did not further reduce airborne spread.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 25 , Issue 6 , June 2004 , pp. 504 - 511
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2004

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.Noble, WC, Pitcher, DG. Microbial ecology of the human skin. Advances in Microbial Ecology 1978;2:245–253.Google Scholar
2.Kloos, WE. Taxonomy and systematics of staphylococci indigenous to humans. In: Crossly, KB, Archer, GL, eds. The Staphylococci in Human Disease. New York: Churchill Livingstone; 1997:113–137.Google Scholar
3.Jarlov, JO, Hojberg, T, Busch-Sorensen, C, et al.Coagulase-negative staphylococci in Danish blood cultures: species distribution and antibiotic susceptibility. J Hosp Infect 1996;32:217–227.CrossRefGoogle ScholarPubMed
4.Goldmann, DA, Leclair, J, Macone, A. Bacterial colonization of neonates admitted to an intensive care environment. J Pediatr 1978;93:288–293.Google Scholar
5.National Nosocomial Infections Surveillance (NNIS) System. National Nosocomial Infections Surveillance (NNIS) System report: data summary from October 1986-April 1997, issued May 1997. Am J Infect Control 1997;25:477–487.Google Scholar
6.Thylefors, JD, Habarth, S, Pittet, D. Increasing bacteremia due to coagulase-negative staphylococci: fiction or reality? Infect Control Hosp Epidemiol 1998;19:581–589.Google Scholar
7.Banerjee, SN, Emori, TG, Cilver, DH, et al.Secular trends in nosocomial primary bloodstream infections in the United States, 1980-1989. Am J Med 1991;91(suppl 3B):86S–89S.Google Scholar
8.Abbott, N, Walrath, JM, Scanlon-Trump, E. Infection related to physiologic monitoring: venous and arterial catheters. Heart Lung 1983;12:28–34.Google Scholar
9.Maki, DG, Ringer, M, Alvarado, CJ. Prospective randomised trial of povidone-iodine, alcohol, and chlorhexidine for prevention of infection associated with central venous and arterial catheters. Lancet 1991;338:339–343.Google Scholar
10.Karchmer, AW. Infections of prosthetic heart valves. In: Waldvogel, FA, Bisno, AL, eds. Infections Associated With Indwelling Medical Devices, ed. 3. Washington, DC: American Society of Microbiology Press; 2000:145–172.Google Scholar
11.Roos, KL, Scheld, WM. Central nervous system infections. In: Crossley, KB, Archer, GL, eds. The Staphylococci in Human Disease. New York: Churchill Livingstone; 1997:413–439.Google Scholar
12.National Nosocomial Infections Surveillance (NNIS) System. National Nosocomial Infections Surveillance (NNIS) System report data summary from January 1992-June 2001, issued August 2001. Am J Infect Control 2001;29:404–421.Google Scholar
13.Oppenheim, BA, Hartley, JW, Lee, W, Burnie, JP. Outbreak of coagulase-negative staphylococcus highly resistant to ciprofloxacin in a leukaemia unit. BMJ 1989;299:294–297.Google Scholar
14.Schwalbe, RS, Stapelton, JT, Gilligan, PH. Emergence of vancomycin resistance in coagulase-negative staphylococci. N Engl J Med 1987;316:927–931.Google Scholar
15.Martin, MA, Pfaller, MA, Wenzel, RP. Coagulase negative staphylococcal bacteremia: mortality and hospital stay. Ann Intern Med 1989;110:9–16.Google Scholar
16.White, A. Relation between quantitative nasal cultures and dissemination of staphylococci. J Lab Clin Med 1961;58:273–277.Google Scholar
17.Sherertz, RJ, Reagan, DR, Hampton, KD, et al.A cloud adult: the Staphylococcus aureus-virus interaction revisited. Ann Intern Med 1996;124:539–547.Google Scholar
18.Andersen, AA. New sampler for the collection, sizing, and enumeration of viable airborne particles. J Bacterial 1958;76:471–484.Google Scholar
19.Hatch, TF. Respiratory dust retention and elimination. In: The Proceedings of the Pneumoconiosis Conference, Johannesburg. London: J & A Churchill; 1959:113–132.Google Scholar
20.Jensen, PA, Todd, WF, Davis, GN, et al.Evaluation of eight bioaerosol samplers challenged with aerosols of free bacteria. American Industrial Hygiene Association Journal 1992;53:660–667.Google Scholar
21.White, A, Hemmerly, T, Martin, MP, et al.Studies on the origin of drug-resistant staphylococci in a mental hospital. Am J Med 1959;27:26–39.Google Scholar
22.Stone, AA, Bovbjerg, DH, Neale, JM, et al.Development of common cold symptoms following experimental rhinovirus infection is related to prior stressful life events. Behav Med 1992;18:115–120.Google Scholar
23.Belani, A, Sherertz, RJ, Sullivan, ML, Russell, BA, Reumen, PD. Outbreak of staphylococcal infection in two nurseries traced to a single nasal carrier. Infect Control 1986;7:487–490.Google Scholar
24.Harris, JM II, Gwaltney, JM Jr. Incubation periods of experimental rhinovirus infection and illness. Clin Infect Dis 1996;23:1287–1290.Google Scholar
25.Hollis, RJ, Bruce, JL, Fritschel, SJ, et al.Comparative evaluation of an automated ribotyping instrument versus pulsed-field gel electrophoresis for epidemiological investigation of clinical isolates of bacteria. Diagn Microbiol Infect Dis 1999;34:263–268.Google Scholar
26.De Buyser, ML, Morvan, A, Aubert, S, Dilasser, F, el Solh, N. Evaluation of ribosomal RNA gene probe for the identification of species and subspecies within the genus Staphylococcus. J Gen Microbiol 1992;138:889–899.CrossRefGoogle ScholarPubMed
27.Eichenwald, H, Kotsevalov, O, Fasso, LA. The ‘cloud baby’: an example of bacterial-viral interaction. Am J Dis Child 1960;100:161–173.Google Scholar
28.Bassetti, S, Bischoff, WE, Walter, M, et al.Airborne dispersal of Staphylococcus aureus associated with a rhinovirus infection. Infect Control Hosp Epidemiol. Submitted.Google Scholar
29.Gwaltney, JM. Rhinovirus. In: Mandell, GL, Bennett, JE, Dolin, R, eds. Principles and Practice of Infectious Diseases. Philadelphia: Churchill Livingstone; 2000:1940–1948.Google Scholar
30.Davies, RR, Noble, WC. Dispersal of bacteria on desquamated skin. Lancet 1962;22:1295–1297.Google Scholar
31.Cole, AM, Dewan, P, Ganz, T. Innate antimicrobial activity of nasal secretions. Infect Immun 1999;67:3267–3275.Google Scholar
32.Shiomori, T, Yoshida, S, Miyamoto, H, Makishima, K. Relationship of nasal carriage of Staphylococcus aureus to pathogenesis of perennial allergic rhinitis. J Allergy Clin Immunol 2000;105:449–454.Google Scholar
33.Nouwen, J, Van Belkum, A, Verbrugh, HA. Determinants of Staphylococcus aureus nasal carriage. NethJ Med 2001;59:126–133.Google Scholar
34.Cole, AM, Tahk, S, Oren, A, et al.Determinants of Staphylococcus aureus nasal carriage. Clin Diagn Lab Immunol 2001;8:1064–1069.CrossRefGoogle ScholarPubMed
35.Noble, WC, Lidwell, OM, Kingston, D. The size distribution of airborne particles carrying micro-organisms. Journal of Hygiene (Cambridge) 1963;61:385–391.Google ScholarPubMed
36.Duguid, JP. The size and duration of air-carriage of respiratory droplets and droplet-nuclei. Journal of Hygiene (Cambridge) 1946;44:471–479.Google Scholar
37.Hamre, D, Connelly, AP Jr, Procknow, JJ. Virologic studies of acute respiratory disease in young adults. Am J Epidemiol 1966;83:238–249.Google Scholar
38.Boyce, JM, Potter-Bynoe, G, Opal, SM, Dziobek, L, Medeiros, AA. A common source outbreak of Staphylococcus epidermidis infections among patients undergoing cardiac surgery. J Infect Dis 1990;161:493–499.Google Scholar
39.Vermont, CL, Hartwig, NG, Fleer, A, et al.Persistence of clones of coagulase-negative staphylococci among premature neonates in neonatal intensive care units: two-center study of bacterial genotyping and patient risk factors. J Clin Microbiol 1998;36:2485–2490.CrossRefGoogle ScholarPubMed
40.Krediet, TG, Jones, ME, Janssen, K, Gerards, LJ, Fleer, A. Prevalence of molecular types and mecA gene carriage of coagulase-negative staphylococci in a neonatal intensive care unit: relation to nosocomial septicemia. J Clin Microbiol 2001;39:3376–3378.Google Scholar
41.Villari, P, Sarnataro, C, Iacuzio, L. Molecular epidemiology of Staphylococcus epidermidis in a neonatal intensive care unit over a three-year period. J Clin Microbiol 2000;38:1740–1746.Google Scholar
42.Kluytmans, J, Berg, H, Steegh, P, et al.Outbreak of Staphylococcus schleiferi wound infections: strain characterization by random amplified polymorphic DNA analysis, PCR ribotyping, conventional ribotyping, and pulsed-field gel electrophoresis. J Clin Microbiol 1998;36:2214–2219.CrossRefGoogle ScholarPubMed
43.Nouwen, JL, van Belkum, A, de Marie, S, et al.Clonal expansion of Staphylococcus epidermidis strains causing Hickman catheter-related infections in a hemato-oncologic department. J Clin Microbiol 1998;36:2696–2702.Google Scholar
44.Monsen, T, Olofsson, C, Roennmark, M, Wistroem, J. Clonal spread of staphylococci among patients with peritonitis associated with continuous ambulatory peritoneal dialysis. Kidney Int 2000;57:613–618.Google Scholar
45.Dharan, S, Pittet, D. Environmental controls in operating theatres. J Hosp Infect 2002;51:79–84.Google Scholar
46.Frebourg, NB, Cauliez, B, Lemeland, JF. Evidence for nasal carriage of methicillin-resistant staphylococci colonizing intravascular devices. J Clin Microbiol 1999;37:1182–1185.CrossRefGoogle ScholarPubMed
47.Garner, JS, Hospital Infection Control Practices Advisory Committee. Guideline for isolation precautions in hospitals. Infect Control Hosp Epidemiol 1996;17:53–80.Google Scholar
48.John, JF Jr, Barg, NL. Staphylococcus aureus. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore: Williams & Wilkins; 1996:271–290.Google Scholar
49.Hartstein, AI, Mulligan, ME. Methicillin-resistant Staphylococcus aureus. In: Mayhall, CG, ed. Hospital Epidemiology and Infection Control. Baltimore: Williams & Wilkins; 1996:290–306.Google Scholar
50.Williams, R, Blowers, R, Garrod, L, et al.Staphylococcal infections: introduction. In: Williams, REO, ed. Hospital Infection: Causes and Prevention, ed. 2. London: Lloyd-Luke; 1966:22–41.Google Scholar
51.Nichol, KP, Cherry, JD. Bacterial-viral interrelations in respiratory infections of children. N Engl J Med 1967;277:667–672.Google Scholar
52.Gwaltney, JM, Sande, MA, Austrian, R, Hendley, JO. Spread of Streptococcus pneumoniae in families: relation of transfer of S. pneumoniae to incidence of colds and serum antibody. J Infect Dis 1975;132:62–68.Google Scholar
53.Harrison, LH, Armstrong, CW, Jenkins, SR, et al.A cluster of meningococcal disease on a school bus following epidemic influenza. Arch Intern Med 1991;151:1005–1009.Google Scholar
54.Gwaltney, JM, Hayden, FG. The nose and infection. In: Proctor, DF, Andersen, I, eds. The Nose: Upper Airway Physiology and the Atmospheric Environment. Amsterdam: Elsevier Biomedical Press; 1982:399–422.Google Scholar