Year 2026,
Volume: 18 Issue: 1, 62 - 67, 24.03.2026
Şeyma Taştemur
,
Tuba Doğan Karataş
,
Özlem Aldemir
,
Murtaza Öz
References
-
1. Gnanamani A, Hariharan P, Paul-Satyaseela M. Staphylococcus aureus: overview of bacteriology, clinical diseases, epidemiology, antibiotic resistance and therapeutic approach [Internet]. In: Enany S, Crotty Alexander LE, editors. Frontiers in Staphylococcus aureus. London: IntechOpen; 2017. doi:10.5772/67338.
-
2. Al-Mebairik NF, El-Kersh TA, Al-Sheikh YA, Marie MAM. A review of virulence factors, pathogenesis, and antibiotic resistance in Staphylococcus aureus. Reviews in Medical Microbiology. 2016;27(2):50–6. doi:10.1097/MRM.0000000000000067.
-
3. Cheung GYC, Bae JS, Otto M. Pathogenicity and virulence of Staphylococcus aureus. Virulence. 2021;12(1):547–69. doi:10.1080/21505594.2021.1878688.
-
4. Taylor TA, Tobin EH, Unakal CG. Staphylococcus aureus infection [Internet]. StatPearls Treasure Island (FL): StatPearls Publishing; 2025. [cited 2025 Dec 14] Available from: https://www.ncbi.nlm.nih.gov/books/NBK441868
-
5. Tobin EH, Jogu P, Koirala J. Methicillin-resistant Staphylococcus aureus [Internet]. StatPearls Treasure Island (FL): StatPearls Publishing; 2025. [cited 2025 Dec 20] Available from: https://www.ncbi.nlm.nih.gov/books/NBK482221
-
6. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing. CLSI supplement M100. 35th ed. USA: CLSI; 2025.
-
7. Bhoi P, Otta S, Swain B, Kar BR. Prevalence of nasal carriage of MRSA in diabetic patients attending the outpatient department. Int J Res Med Sci. 2020;8(4):1336–9. doi:10.18203/2320-6012.ijrms20201320.
-
8. Alvarez S, Coffey R, Mathias PM, Algotar AM. Prediabetes [Internet]. StatPearls Treasure Island (FL): StatPearls Publishing; 2025. [cited 2025 Dec 14]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459332
-
9. Akbari M, Hassan-Zadeh V. IL-6 signalling pathways and the development of type 2 diabetes. Inflammopharmacology. 2018;26(3):685–98. doi:10.1007/s10787-018-0458-0.
-
10. Dulkadiroğlu E, Özden H, Demirci H. The evaluation of intracellular energy metabolism in prediabetic patients and patients newly diagnosed with type 2 diabetes mellitus. Turk J Med Sci. 2021;51(1):238–45. doi:10.3906/sag-1912-60.
-
11. American Diabetes Association Professional Practice Committee. 2. Diagnosis and classification of diabetes: standards of care in diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S20-42. doi:10.2337/dc24-S002.
-
12. Akbari M, Hassan-Zadeh V. Hyperglycemia affects the expression of inflammatory genes in peripheral blood mononuclear cells of patients with type 2 diabetes. Immunol Investig. 2018;47(7):654–65. doi:10.1080/08820139.2018.1480031.
-
13. Tsalamandris S, Antonopoulos AS, Oikonomou E, Papamikroulis GA, Vogiatzi G, Papaioannou S, et al. The role of inflammation in diabetes: current concepts and future perspectives. Eur Cardiol. 2019;14(1):50-9. doi:10.15420/ecr.2018.33.1.
-
14. Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: a review of pathogenesis. Indian J Endocrinol Metab. 2012;16(Suppl 1):S27–36. doi:10.4103/2230-8210.94253.
-
15. Wang Q, Nurxat N, Zhang L, Liu Y, Wang Y, Zhang L, et al. Diabetes mellitus promotes the nasal colonization of high virulent Staphylococcus aureus through the regulation of SaeRS two-component system. Emerg Microbes Infect. 2023;12(2):2276335. doi:10.1080/22221751.2023.2276335.
-
16. Tsao S, Hsu C, Yin M. Meticillin-resistant Staphylococcus aureus infection in diabetic mice enhanced inflammation and coagulation. J Med Microbiol. 2006;55(Pt 4):379–85. doi:10.1099/jmm.0.46054-0.
-
17. Cheong HS, Chang Y, Kim Y, Joo EJ, Kwon MJ, Wild SH, et al. Glycaemic status, insulin resistance, and risk of infection-related mortality: a cohort study. Eur J Endocrinol. 2023;188(2):197–205. doi:10.1093/ejendo/lvad011.
-
18. Stacey HJ, Clements CS, Welburn SC, Jones JD. The prevalence of methicillin-resistant Staphylococcus aureus among diabetic patients: a meta-analysis. Acta Diabetol. 2019;56:907–21. doi:10.1007/s00592-019-01301-0.
-
19. Wang SH, Sun ZL, Guo YJ, Yang BQ, Yuan Y, Wei Q, et al. Meticillin-resistant Staphylococcus aureus isolated from foot ulcers in diabetic patients in a Chinese care hospital: risk factors for infection and prevalence. J Med Microbiol. 2010;59(10):1219–24. doi:10.1099/jmm.0.020537-0.
-
20. Abbas MM, Almasri M, Abu-Zant A, Sharef S, Mahajne S, Kananbi K. Prevalence of anterior nares colonization of Palestinian diabetic patients with Staphylococcus aureus or methicillin-resistant Staphylococcus aureus. Qual Assur Saf Crops Foods. 2023;15(4):32-41. doi:10.15586/qas.v15i4.1380.
-
21. World Health Organization (WHO). World report on social determinants of health equity [Internet]. Geneva: World Health Organization; 2025. [cited 2025 Dec 20] Available from: https://www.who.int/publications/i/item/9789240107588
-
22. Elgart JF, Torrieri R, Ré M, Salazar M, Espeche W, Angelini JM, et al. Prediabetes is more than a pre-disease: additional evidences supporting the importance of its early diagnosis and appropriate treatment. Endocrine. 2023;79(1):80-5. doi:10.1007/s12020-022-03249-8.
-
23. Olsen K, Danielsen K, Wilsgaard T, Sangvik M, Sollid JU, Thune I, et al. Obesity and Staphylococcus aureus nasal colonization among women and men in a general population. PLoS One. 2013;8(5):e63716. doi:10.1371/journal.pone.0063716.
-
24. Stanaway S, Johnson D, Moulik P, Gill G. Methicillin-resistant Staphylococcus aureus (MRSA) isolation from diabetic foot ulcers correlates with nasal MRSA carriage. Diabetes Res Clin Pract. 2007;75(1):47–50. doi:10.1016/j.diabres.2006.05.021.
-
25. Campbell MP, Mott MD, Owen JR, Reznicek JE, Beck CA, Muthukrishnan G, et al. Low albumin level is more strongly associated with adverse outcomes and Staphylococcus aureus infection than hemoglobin A1C or smoking tobacco. J Orthop Res. 2022;40(11):2670–7. doi:10.1002/jor.25282.
-
26. Karanika S, Zervou FN, Zacharioudakis IM, Paudel S, Mylonakis E. Risk factors for meticillin-resistant Staphylococcus aureus colonization in dialysis patients: a meta-analysis. J Hosp Infect. 2015;91(3):257–63. doi:10.1016/j.jhin.2015.07.014.
-
27. Tamer A, Karabay O, Ekerbicer H. Staphylococcus aureus nasal carriage and associated factors in type 2 diabetic patients. Jpn J Infect Dis. 2006;59(1):10-4.
-
28. Shih HI, Chang CM, Shen FC, Lee YJ, Wu CH, Hsu HC, et al. High prevalence nasal carriage of methicillin-resistant Staphylococcus aureus among long term care facility healthcare workers in relation to patient contact. Infect Prev Pract. 2021;3(1):100117. doi:10.1016/j.infpip.2021.100117.
-
29. Westgeest AC, Hanssen JLJ, de Boer MGJ, Schippers EF, Lambregts MMC. Eradication of community-onset methicillin-resistant Staphylococcus aureus carriage: a narrative review. Clin Microbiol Infect. 2025;31(2):173–81. doi:10.1016/j.cmi.2024.01.003.
Nasal Carriage of Methicillin-Resistant Staphylococcus aureus in Prediabetes and Type 2 Diabetes Mellitus
Year 2026,
Volume: 18 Issue: 1, 62 - 67, 24.03.2026
Şeyma Taştemur
,
Tuba Doğan Karataş
,
Özlem Aldemir
,
Murtaza Öz
Abstract
Aim: Staphylococcus aureus (S. aureus) nasal colonization, especially with methicillin-resistant S. aureus (MRSA), is a significant risk factor for infection and transmission. While diabetes mellitus (DM) is a recognized risk factor, its association with prediabetes (preDM) is less apparent. This study investigated MRSA nasal carriage in DM and preDM and its relation to metabolic and anthropometric parameters.
Material and Methods: This cross-sectional study included 300 participants: 100 with type 2 DM, 100 with preDM and 100 non-diabetic controls attending General Internal Medicine clinics (May–August 2025). PreDM and DM were defined by American Diabetes Association (ADA) criteria and individuals with recent antibiotic use, acute infection, immunosuppression, dialysis or malignancy were excluded. Nasal swabs were cultured on blood agar, identified by MALDI-TOF and tested for methicillin resistance using oxacillin MIC per Clinical and Laboratory Standards Institute (CLSI M100 35th ed., 2025) standards. Clinical and laboratory parameters were assessed using nonparametric statistical tests, with significance set at p < 0.05.
Results: MRSA nasal carriage was higher in DM patients than controls (8% vs 1%, p=0.035). DM was associated with greater waist circumference and poorer glycemic profiles. MRSA carriage showed weak positive correlations with body weight, fasting glucose, HbA1c and triglycerides, and a weak negative correlation with albumin. Prediabetes showed a nonsignificant increase compared with controls.
Conclusion: Type 2 DM was associated with increased MRSA nasal carriage, whereas prediabetes was not; intermediate rates in prediabetes do not support routine MRSA screening in this group. These findings support a selective, risk-based approach rather than routine MRSA screening in prediabetic populations.
Ethical Statement
This study was approved by the Sivas Cumhuriyet University Health Sciences Research Ethics Committee (Date: 04 April 2025, number: 2025-04/105).
Supporting Institution
The authors received no financial support for this article.
Thanks
We would like to thank health technician Ayşe Gül ALTUN for her technical support in this study.
References
-
1. Gnanamani A, Hariharan P, Paul-Satyaseela M. Staphylococcus aureus: overview of bacteriology, clinical diseases, epidemiology, antibiotic resistance and therapeutic approach [Internet]. In: Enany S, Crotty Alexander LE, editors. Frontiers in Staphylococcus aureus. London: IntechOpen; 2017. doi:10.5772/67338.
-
2. Al-Mebairik NF, El-Kersh TA, Al-Sheikh YA, Marie MAM. A review of virulence factors, pathogenesis, and antibiotic resistance in Staphylococcus aureus. Reviews in Medical Microbiology. 2016;27(2):50–6. doi:10.1097/MRM.0000000000000067.
-
3. Cheung GYC, Bae JS, Otto M. Pathogenicity and virulence of Staphylococcus aureus. Virulence. 2021;12(1):547–69. doi:10.1080/21505594.2021.1878688.
-
4. Taylor TA, Tobin EH, Unakal CG. Staphylococcus aureus infection [Internet]. StatPearls Treasure Island (FL): StatPearls Publishing; 2025. [cited 2025 Dec 14] Available from: https://www.ncbi.nlm.nih.gov/books/NBK441868
-
5. Tobin EH, Jogu P, Koirala J. Methicillin-resistant Staphylococcus aureus [Internet]. StatPearls Treasure Island (FL): StatPearls Publishing; 2025. [cited 2025 Dec 20] Available from: https://www.ncbi.nlm.nih.gov/books/NBK482221
-
6. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing. CLSI supplement M100. 35th ed. USA: CLSI; 2025.
-
7. Bhoi P, Otta S, Swain B, Kar BR. Prevalence of nasal carriage of MRSA in diabetic patients attending the outpatient department. Int J Res Med Sci. 2020;8(4):1336–9. doi:10.18203/2320-6012.ijrms20201320.
-
8. Alvarez S, Coffey R, Mathias PM, Algotar AM. Prediabetes [Internet]. StatPearls Treasure Island (FL): StatPearls Publishing; 2025. [cited 2025 Dec 14]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK459332
-
9. Akbari M, Hassan-Zadeh V. IL-6 signalling pathways and the development of type 2 diabetes. Inflammopharmacology. 2018;26(3):685–98. doi:10.1007/s10787-018-0458-0.
-
10. Dulkadiroğlu E, Özden H, Demirci H. The evaluation of intracellular energy metabolism in prediabetic patients and patients newly diagnosed with type 2 diabetes mellitus. Turk J Med Sci. 2021;51(1):238–45. doi:10.3906/sag-1912-60.
-
11. American Diabetes Association Professional Practice Committee. 2. Diagnosis and classification of diabetes: standards of care in diabetes-2024. Diabetes Care. 2024;47(Suppl 1):S20-42. doi:10.2337/dc24-S002.
-
12. Akbari M, Hassan-Zadeh V. Hyperglycemia affects the expression of inflammatory genes in peripheral blood mononuclear cells of patients with type 2 diabetes. Immunol Investig. 2018;47(7):654–65. doi:10.1080/08820139.2018.1480031.
-
13. Tsalamandris S, Antonopoulos AS, Oikonomou E, Papamikroulis GA, Vogiatzi G, Papaioannou S, et al. The role of inflammation in diabetes: current concepts and future perspectives. Eur Cardiol. 2019;14(1):50-9. doi:10.15420/ecr.2018.33.1.
-
14. Casqueiro J, Casqueiro J, Alves C. Infections in patients with diabetes mellitus: a review of pathogenesis. Indian J Endocrinol Metab. 2012;16(Suppl 1):S27–36. doi:10.4103/2230-8210.94253.
-
15. Wang Q, Nurxat N, Zhang L, Liu Y, Wang Y, Zhang L, et al. Diabetes mellitus promotes the nasal colonization of high virulent Staphylococcus aureus through the regulation of SaeRS two-component system. Emerg Microbes Infect. 2023;12(2):2276335. doi:10.1080/22221751.2023.2276335.
-
16. Tsao S, Hsu C, Yin M. Meticillin-resistant Staphylococcus aureus infection in diabetic mice enhanced inflammation and coagulation. J Med Microbiol. 2006;55(Pt 4):379–85. doi:10.1099/jmm.0.46054-0.
-
17. Cheong HS, Chang Y, Kim Y, Joo EJ, Kwon MJ, Wild SH, et al. Glycaemic status, insulin resistance, and risk of infection-related mortality: a cohort study. Eur J Endocrinol. 2023;188(2):197–205. doi:10.1093/ejendo/lvad011.
-
18. Stacey HJ, Clements CS, Welburn SC, Jones JD. The prevalence of methicillin-resistant Staphylococcus aureus among diabetic patients: a meta-analysis. Acta Diabetol. 2019;56:907–21. doi:10.1007/s00592-019-01301-0.
-
19. Wang SH, Sun ZL, Guo YJ, Yang BQ, Yuan Y, Wei Q, et al. Meticillin-resistant Staphylococcus aureus isolated from foot ulcers in diabetic patients in a Chinese care hospital: risk factors for infection and prevalence. J Med Microbiol. 2010;59(10):1219–24. doi:10.1099/jmm.0.020537-0.
-
20. Abbas MM, Almasri M, Abu-Zant A, Sharef S, Mahajne S, Kananbi K. Prevalence of anterior nares colonization of Palestinian diabetic patients with Staphylococcus aureus or methicillin-resistant Staphylococcus aureus. Qual Assur Saf Crops Foods. 2023;15(4):32-41. doi:10.15586/qas.v15i4.1380.
-
21. World Health Organization (WHO). World report on social determinants of health equity [Internet]. Geneva: World Health Organization; 2025. [cited 2025 Dec 20] Available from: https://www.who.int/publications/i/item/9789240107588
-
22. Elgart JF, Torrieri R, Ré M, Salazar M, Espeche W, Angelini JM, et al. Prediabetes is more than a pre-disease: additional evidences supporting the importance of its early diagnosis and appropriate treatment. Endocrine. 2023;79(1):80-5. doi:10.1007/s12020-022-03249-8.
-
23. Olsen K, Danielsen K, Wilsgaard T, Sangvik M, Sollid JU, Thune I, et al. Obesity and Staphylococcus aureus nasal colonization among women and men in a general population. PLoS One. 2013;8(5):e63716. doi:10.1371/journal.pone.0063716.
-
24. Stanaway S, Johnson D, Moulik P, Gill G. Methicillin-resistant Staphylococcus aureus (MRSA) isolation from diabetic foot ulcers correlates with nasal MRSA carriage. Diabetes Res Clin Pract. 2007;75(1):47–50. doi:10.1016/j.diabres.2006.05.021.
-
25. Campbell MP, Mott MD, Owen JR, Reznicek JE, Beck CA, Muthukrishnan G, et al. Low albumin level is more strongly associated with adverse outcomes and Staphylococcus aureus infection than hemoglobin A1C or smoking tobacco. J Orthop Res. 2022;40(11):2670–7. doi:10.1002/jor.25282.
-
26. Karanika S, Zervou FN, Zacharioudakis IM, Paudel S, Mylonakis E. Risk factors for meticillin-resistant Staphylococcus aureus colonization in dialysis patients: a meta-analysis. J Hosp Infect. 2015;91(3):257–63. doi:10.1016/j.jhin.2015.07.014.
-
27. Tamer A, Karabay O, Ekerbicer H. Staphylococcus aureus nasal carriage and associated factors in type 2 diabetic patients. Jpn J Infect Dis. 2006;59(1):10-4.
-
28. Shih HI, Chang CM, Shen FC, Lee YJ, Wu CH, Hsu HC, et al. High prevalence nasal carriage of methicillin-resistant Staphylococcus aureus among long term care facility healthcare workers in relation to patient contact. Infect Prev Pract. 2021;3(1):100117. doi:10.1016/j.infpip.2021.100117.
-
29. Westgeest AC, Hanssen JLJ, de Boer MGJ, Schippers EF, Lambregts MMC. Eradication of community-onset methicillin-resistant Staphylococcus aureus carriage: a narrative review. Clin Microbiol Infect. 2025;31(2):173–81. doi:10.1016/j.cmi.2024.01.003.