Drivers of pig trucks constitute a potential route of human transmission of livestock-associated methicillin-resistant
Staphylococcus aureus
(LA-MRSA) CC398. In this study we determined MRSA prevalence in pig truck drivers (n=47) and monitored the nasal microbiota of nine drivers three times daily throughout one workweek (n=113 samples) and compared it to their spouses (n=25 samples from six spouses) and 89 non-exposed subjects.
S. aureus
isolates (n=232) derived from a subset of nasal and truck samples were whole-genome sequenced.
Nasal alpha diversity of drivers in the beginning of the workday was lower compared to non-exposed subjects. During the workday, it increased significantly. Similarly, the drivers’ nasal composition shifted during the workday, becoming increasingly different from spouses and non-exposed individuals. Clustering into community state types (CSTs) revealed frequent switches from either
S. aureus
- or
Corynebacterium
-dominated CSTs in the mornings to a
Psychrobacter-
dominated CST during the workday.
Six intermittent MRSA carriers were mostly MRSA-negative in the mornings and their nasal microbiota resembled that of non-exposed subjects. When acquiring MRSA during the workday, they switched to the
Psychrobacter-
dominated CST. In contrast, the nasal microbiota of two persistent MRSA carriers was dominated by staphylococci.
In conclusion, we show that the nasal microbiota of pig truck drivers is very dynamic, undergoes drastic changes during workdays, and differs from non-exposed subjects even before pig-contact.
MRSA-carrying drivers may eventually introduce MRSA into the community and health care facilities. Carriage dynamics, however, showed that for most drivers CC398 MRSA is rapidly lost and only rarely causes transmission to spouses.
Importance
In Denmark, the number of human MRSA cases has increased dramatically since the early 2000s, starting from imported cases and spread in the community. However, today approximately one third of all new cases are attributed to livestock-associated MRSA (LA-MRSA) CC398. This mirrors the increase in pig farms of which 95% are now positive for LA-MRSA, mainly caused by three dominant lineages enriched for a number of key antimicrobial resistance genes. Whereas most human LA-MRSA CC398 infections in Denmark are linked to livestock contact, still up to one third is not. Pig truck drivers constitute a hitherto understudied occupation group which may transmit LA-MRSA CC398 to household members, the community, and hospitals. In this study, we demonstrate dramatic work-related changes in the nasal microbiota of pig truck drivers, as well as in their carriage of LA-MRSA CC398. However, they likely do not constitute an important reservoir for LA-MRSA CC398 dissemination.