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Public and Environmental Health Microbiology

Vaginal Tampon Colonization by Staphylococcus aureus in Healthy Women

Myriam Chiaruzzi, Alexia Barbry, Anaëlle Muggeo, Anne Tristan, Isaline Jacquemond, Cedric Badiou, Laurence Cluzeau, Sabine Bourdeau, Thibaut Durand, Astrid Engelmann, Dorian Bosquet, Michèle Bes, Claire Prigent-Combaret, Jean Thioulouse, Daniel Muller, Gérard Lina
Donald W. Schaffner, Editor
Myriam Chiaruzzi
aCIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
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Alexia Barbry
aCIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
bCentre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
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Anaëlle Muggeo
bCentre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
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Anne Tristan
aCIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
bCentre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
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Isaline Jacquemond
aCIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
cUniversité de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, Villeurbanne, France
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Cedric Badiou
aCIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
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Laurence Cluzeau
aCIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
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Sabine Bourdeau
aCIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
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Thibaut Durand
bCentre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
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Astrid Engelmann
bCentre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
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Dorian Bosquet
bCentre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
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Michèle Bes
aCIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
bCentre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
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Claire Prigent-Combaret
cUniversité de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, Villeurbanne, France
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Jean Thioulouse
dUniversité de Lyon, Université Lyon 1, CNRS, Laboratoire de Biométrie et Biologie Evolutive UMR 5558, Villeurbanne, France
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Daniel Muller
cUniversité de Lyon, Université Claude Bernard Lyon 1, CNRS, INRA, VetAgro Sup, UMR Ecologie Microbienne, Villeurbanne, France
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Gérard Lina
aCIRI, Centre International de Recherche en Infectiologie, Inserm U1111, Université Lyon 1, Ecole Normale Supérieure de Lyon, CNRS UMR 5308, Lyon, France
bCentre National de Référence des Staphylocoques, Institut des Agent infectieux, Hôpital de la Croix Rousse, Hospices Civils de Lyon, Lyon, France
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Donald W. Schaffner
Rutgers, The State University of New Jersey
Roles: Editor
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DOI: 10.1128/AEM.01249-20
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ABSTRACT

Tampons recovered from a cohort of 737 healthy women (median age, 32 years) were analyzed for the presence of Staphylococcus aureus. A total of 198 tampons (27%) were colonized by S. aureus, 28 (4%) by a strain producing toxic shock syndrome toxin 1 (TSST-1). S. aureus was detected more frequently in tampons that did not require an applicator for their insertion (74/233 [32%] versus 90/381 [24%]; odds ratio [OR] = 1.51 [95% confidence interval, 1.04 to 2.17]) and in women who used an intrauterine device for contraception (53/155 [34%] versus 145/572 [27%]; OR = 1.53 [95% confidence interval, 1.05 to 2.24]). The S. aureus strains isolated from tampons belonged to 22 different clonal complexes (CCs). The most prevalent CC was CC398 agr1 (n = 57 [27%]), a clone that does not produce superantigenic toxins, followed by CC30 agr3 (n = 27, 13%), producing TSST-1 (24/27 [89%]), the principal clone of S. aureus involved in menstrual toxic shock syndrome (MTSS).

IMPORTANCE Menstrual toxic shock syndrome (MTSS) is an uncommon severe acute disease that occurs in healthy menstruating women colonized by TSST-1-producing S. aureus who use intravaginal protection, such as tampons and menstrual cups. The catamenial product collected by the protection serves as a growth medium for S. aureus and allows TSST-1 production. Previous studies evaluated the prevalence of genital colonization by S. aureus by vaginal swabbing, but they did not examine tampon colonization. This study demonstrated a high prevalence of tampon colonization by S. aureus and the presence of the CC30 TSST-1 S. aureus clone responsible for MTSS in tampons from healthy women. The results support the vaginal carriage of this lineage in healthy women. In addition, the higher prevalence of S. aureus within tampons that do not require an applicator indicates a crucial role for handwashing before tampon handling to decrease the risk of tampon contamination.

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Vaginal Tampon Colonization by Staphylococcus aureus in Healthy Women
Myriam Chiaruzzi, Alexia Barbry, Anaëlle Muggeo, Anne Tristan, Isaline Jacquemond, Cedric Badiou, Laurence Cluzeau, Sabine Bourdeau, Thibaut Durand, Astrid Engelmann, Dorian Bosquet, Michèle Bes, Claire Prigent-Combaret, Jean Thioulouse, Daniel Muller, Gérard Lina
Applied and Environmental Microbiology Sep 2020, 86 (18) e01249-20; DOI: 10.1128/AEM.01249-20

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Vaginal Tampon Colonization by Staphylococcus aureus in Healthy Women
Myriam Chiaruzzi, Alexia Barbry, Anaëlle Muggeo, Anne Tristan, Isaline Jacquemond, Cedric Badiou, Laurence Cluzeau, Sabine Bourdeau, Thibaut Durand, Astrid Engelmann, Dorian Bosquet, Michèle Bes, Claire Prigent-Combaret, Jean Thioulouse, Daniel Muller, Gérard Lina
Applied and Environmental Microbiology Sep 2020, 86 (18) e01249-20; DOI: 10.1128/AEM.01249-20
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KEYWORDS

Staphylococcus aureus
colonization
healthy women
menstruation
Vagina

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