Evaluation of swabbing methods for estimating the prevalence of bacterial carriage in the upper respiratory tract: a cross sectional study

Objectives Bacterial carriage in the upper respiratory tract is usually asymptomatic but can lead to respiratory tract infection (RTI), meningitis and septicaemia. We aimed to provide a baseline measure of Streptococcus pneumoniae, Moraxella catarrhalis, Pseudomonas aeruginosa, Staphylococcus aureus...

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Published in:	BMJ open 2014-10, Vol.4 (10), p.e005341-e005341
Main Authors:	Coughtrie, A L, Whittaker, R N, Begum, N, Anderson, R, Tuck, A, Faust, S N, Jefferies, J M, Yuen, H M, Roderick, P J, Mullee, M A, Moore, M V, Clarke, S C
Format:	Article
Language:	eng
Subjects:	Adolescent Adult Age groups Aged Aged, 80 and over Antibiotics Bacterial Infections - diagnosis Bacterial Infections - epidemiology Carrier State - diagnosis Carrier State - epidemiology Child Child, Preschool Cross-Sectional Studies Epidemiology Female Haemophilus influenzae - isolation & purification Humans Infant Infant, Newborn Male Microorganisms Middle Aged Moraxella catarrhalis - isolation & purification Mouth - microbiology Nasal Cavity - microbiology Nasopharynx - microbiology Neisseria meningitidis - isolation & purification Pathogens Pilot Projects Pseudomonas aeruginosa - isolation & purification Questionnaires Response rates Sample size Self Care Specimen Handling - methods Staphylococcus aureus - isolation & purification Streptococcus infections Streptococcus pneumoniae - isolation & purification United Kingdom Young Adult
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Summary:	Objectives Bacterial carriage in the upper respiratory tract is usually asymptomatic but can lead to respiratory tract infection (RTI), meningitis and septicaemia. We aimed to provide a baseline measure of Streptococcus pneumoniae, Moraxella catarrhalis, Pseudomonas aeruginosa, Staphylococcus aureus, Haemophilus influenzae and Neisseria meningitidis carriage within the community. Self-swabbing and healthcare professional (HCP) swabbing were compared. Design Cross-sectional study. Setting Individuals registered at 20 general practitioner practices within the Wessex Primary Care Research Network South West, UK. Participants 10 448 individuals were invited to participate; 5394 within a self-swabbing group and 5054 within a HCP swabbing group. Self-swabbing invitees included 2405 individuals aged 0–4 years and 3349 individuals aged ≥5 years. HCP swabbing invitees included 1908 individuals aged 0–4 years and 3146 individuals aged ≥5 years. Results 1574 (15.1%) individuals participated, 1260 (23.4%, 95% CI 22.3% to 24.5%) undertaking self-swabbing and 314 (6.2%, 95% CI 5.5% to 6.9%) undertaking HCP-led swabbing. Participation was lower in young children and more deprived practice locations. Swab positivity rates were 34.8% (95% CI 32.2% to 37.4%) for self-taken nose swabs (NS), 19% (95% CI 16.8% to 21.2%) for self-taken whole mouth swabs (WMS), 25.2% (95% CI 20.4% to 30%) for nasopharyngeal swabs (NPS) and 33.4% (95% CI 28.2% to 38.6%) for HCP-taken WMS. Carriage rates of S. aureus were highest in NS (21.3%). S. pneumoniae carriage was highest in NS (11%) and NPS (7.4%). M. catarrhalis carriage was highest in HCP-taken WMS (28.8%). H. influenzae and P. aeruginosa carriage were similar between swab types. N. meningitidis was not detected in any swab. Age and recent RTI affected carriage of S. pneumoniae and H. influenzae. Participant costs were lower for self-swabbing (£41.21) versus HCP swabbing (£69.66). Conclusions Higher participation and lower costs of self-swabbing as well as sensitivity of self-swabbing favour this method for use in large population-based respiratory carriage studies.
ISSN:	2044-6055 2044-6055