Sains Malaysiana 49(3)(2020): 583-591

http://dx.doi.org/10.17576/jsm-2020-4903-13

The Prevalence of Staphylococcus aureus in the Oral Cavity of Healthy Adults in Malaysia

(Kelaziman Staphylococcus aureus pada Kaviti Oral Dewasa Sihat di Malaysia)

AMIR HARRIZ AZMI¹, SITI NOOR ADNALIZAWATI ADNAN² & NORMALIZA AB MALIK¹*

¹Department of Conservative Dentistry and Prosthodontics, Faculty of Dentistry, Universiti Sains Islam Malaysia, 55100 Kuala Lumpur, Federal Territory, Malaysia

²Department of Basic Sciences and Oral Biology, Faculty of Dentistry, Universiti Sains Islam Malaysia, 55100 Kuala Lumpur, Federal Territory, Malaysia

Diserahkan: 17 Februari 2019/Diterima: 6 Disember 2019

ABSTRACT

The aim of this study was to determine the prevalence of Staphylococcus aureus in the oral cavity of healthy adults and the factors that may influence the presence of the bacteria. A cross-sectional study was conducted on a number of selected healthy adults in a district in Malaysia, during which, information about their socio-demographic background and oral hygiene practices was obtained. Oral rinse samples of the respondents were also collected using phosphate buffered saline and the data obtained was subsequently analyzed using SPSS.  A total of 140 oral rinse samples were collected and the results of the analysis conducted showed a prevalence of approximately 40% of the Staphylococcus aureus in the oral cavity of the participants. There was no significant association observed between both the socio-demographic factor and oral hygiene practices with the presence of Staphylococcus aureus.  The use of prostheses was found to be a significant factor for a higher prevalence of Staphylococcus aureus in the oral cavity (OR 5.13; P<0.05, 95%CI 1.410 - 18.76). The prevalence of Staphylococcus aureus in the oral cavity of healthy adults was high and the use of prostheses was a factor associated with the presence of the bacteria. This accentuates the importance of a good oral hygiene, as oral cavity can be the primary route for Staphylococcus aureus to cause potential systemic infections. 

Keywords: Adults; infection; oral cavity; oral health; Staphylococcus aureus

ABSTRAK

Tujuan kajian ini adalah untuk mengenal pasti prevalen bakteria Staphylococcus aureus di dalam rongga mulut orang dewasa yang sihat dan faktor yang mungkin mempengaruhi kewujudan bakteria tersebut. Suatu kajian keratan lintang telah dijalankan ke atas sejumlah orang dewasa yang sihat di satu daerah di Malaysia dan semasa kajian tersebut, maklumat mengenai latar belakang sosio-demografi dan amalan-amalan penjagaan kebersihan mulut peserta telah diperoleh. Larutan bergaram tertimbal fosfat iaitu sampel air kumuran daripada peserta dikumpulkan dan data yang diperoleh seterusnya dianalisis menggunakan perisian SPSS.  Sebanyak 140 sampel dikumpul dan hasil kajian menunjukkan peratusan prevalen Staphylococcus aureus di dalam rongga mulut peserta setinggi 40%. Selain itu, didapati bahawa tidak wujud perkaitan signifikan antara kedua-dua faktor sosio-demografi dan amalan kebersihan mulut dengan kehadiran Staphylococcus aureus. Sementara itu, kajian juga menunjukkan bahawa protesis gigi ialah faktor penyumbang utama kepada peratusan tinggi prevalen Staphylococcus aureus di dalam rongga mulut (OR 5.13; P < 0.05, 95% CI 1.410 – 18.76). Prevalen Staphylococcus aureus di dalam rongga mulut orang dewasa yang sihat adalah tinggi dan prostesis gigi ialah faktor yang dikaitkan dengan kewujudan bakteria tersebut di dalam rongga mulut. Ini menegaskan lagi betapa pentingnya kebersihan mulut yang baik, kerana rongga mulut boleh menjadi laluan utama bagi Staphylococcus aureus yang akan menyebabkan kemungkinan berlakunya jangkitan sistemik.

Kata kunci: Dewasa; jangkitan; kesihatan mulut; rongga mulut; Staphylococcus aureus

RUJUKAN

Ab Malik, N., Abdul Razak, F., Mohamad Yatim, S.A., Lam, O.L.T., Jin, L., Li, L.S.W. & Mcgrath, C. 2018. Oral health interventions using chlorhexidine-effects on the prevalence of oral opportunistic pathogens in stroke survivors: A randomized clinical trial. Journal of Evidence Based Dental Practice 18(2): 99-109.

Abe, S., Ishihara, K. & Okuda, K. 2001. Prevalence of potential respiratory pathogens in the mouths of elderly patients and effects of professional oral care. Archives of Gerontology and Geriatrics 32: 45-55.

Albrich, W.C. & Harbarth, S. 2008. Health-care workers: Source, vector, or victim of MRSA? The Lancet Infectious Diseases 8: 289-301.

American Public Health Association. 1993. Standard Methods for The Examination of Dairy Products. 16th edition. Apha, Washington, D.C.

Bahl, R., Sandhu, S., Singh, K., Sahai, N. & Gupta, M. 2014. Odontogenic infections: Microbiology and management. Contemporary Clinical Dentistry 5(3): 307-311.

Chapman, G.H. 1945. The significance of sodium chloride in studies of staphylococci. Journal of Bacteriology 50(2): 201-203.

Choi, C.S., Yin, C.S., Bakar, A.A., Sakewi, Z., Naing, N.N., Jamal, F. & Othman, N. 2006. Nasal carriage of Staphylococcus aureus among healthy adults. Journal of Microbiology, Immunology and Infection 39: 458-464.

Costelloe, C., Metcalfe, C., Lovering, A., Mant, D. & Hay, A.D. 2010. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: Systematic review and meta-analysis. British Medical Journal 340: C2096.

Davis, S., Perri, M., Donabedian, S., Manierski, C., Singh, A., Vager, D., Haque, N., Speirs, K., Muder, R. & Robinson-Dunn, B. 2007. Epidemiology and outcomes of community-associated methicillin-resistant Staphylococcus aureus infection. Journal of Clinical Microbiology 45: 1705-1711.

Fridkin, S.K., Hageman, J.C., Morrison, M., Sanza, L.T., Como-Sabetti, K., Jernigan, J.A., Harriman, K., Harrison, L.H., Lynfield, R. & Farley, M.M. 2005. Methicillin-resistant Staphylococcus aureus disease in three communities. New England Journal of Medicine 352: 1436-1444.

Friedlander, A.H. 2010. Oral cavity staphylococci are a potential source of prosthetic joint infection. Clinical Infectious Diseases 50: 1682-1683.

Harbarth, S., Fankhauser, C., Schrenzel, J., Christenson, J., Gervaz, P., Bandiera-Clerc, C., Renzi, G., Vernaz, N., Sax, H. & Pittet, D. 2008. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. Journal of the American Medical Association 299: 1149-1157.

Hetem, D.J., De Ruiter, S.C., Buiting, A.G., Kluytmans, J.A., Thijsen, S.F., Vlaminckx, B.J., Wintermans, R.G., Bonten, M.J. & Ekkelenkamp, M.B. 2011. Preventing Staphylococcus aureus bacteremia and sepsis in patients with Staphylococcus aureus colonization of intravascular catheters: A retrospective multicenter study and meta-analysis. Medicine 90: 284-288.

Irani, S. 2017. Orofacial bacterial infectious diseases: An update. Journal of International Society of Preventive & Community Dentistry 7: S61-S67.

Irek, E.O., Amupitan, A.A., Obadare, T.O. & Aboderin, A.O. 2018. A systematic review of healthcare-associated infections in Africa: An antimicrobial resistance perspective. African Journal of Laboratory Medicine 7: 796-796.

Jackson, M., Bagg, J., Gupta, M. & Sturrock, R. 1999. Oral carriage of staphylococci in patients with rheumatoid arthritis. Rheumatology (Oxford, England) 38: 572-575.

Jackson, M.S. 2000. Staphylococci in the oral flora of healthy children and those receiving treatment for malignant disease. Microbial Ecology in Health and Disease 12: 60-64.

Khan, H.A., Baig, F.K. & Mehboob, R. 2017. Nosocomial infections: Epidemiology, prevention, control and surveillance. Asian Pacific Journal of Tropical Biomedicine 7: 478-482.

Kim, D.H., Spencer, M., Davidson, S.M., Li, L., Shaw, J.D., Gulczynski, D., Hunter, D.J., Martha, J.F., Miley, G.B. & Parazin, S.J. 2010. Institutional prescreening for detection and eradication of methicillin-resistant Staphylococcus aureus in patients undergoing elective orthopaedic surgery. The Journal of Bone & Joint Surgery 92: 1820-1826.

Klevens, R.M., Edwards, J.R., Tenover, F.C., Mcdonald, L.C., Horan, T., Gaynes, R. & System, N.N.I.S. 2006. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. Clinical Infectious Diseases 42: 389-391.

Koukos, G., Sakellari, D., Arsenakis, M., Tsalikis, L., Slini, T. & Konstantinidis, A. 2015. Prevalence of Staphylococcus aureus and methicillin resistant Staphylococcus aureus (MRSA) in the oral cavity. Arch. Oral. Biol. 60(9): 1410-1415.

Lewis, A., Wallace, J., Deutsch, A. & King, P. 2015a. Improving the oral health of frail and functionally dependent elderly. Aust. Dent. J. 60(1): 95-105.

Lewis, N., Parmar, N., Hussain, Z., Baker, G., Green, I., Howlett, J., Kearns, A., Cookson, B., Mcdonald, A., Wilson, M. & Ready, D. 2015b. Colonisation of dentures by Staphylococcus aureus and MRSA in out-patient and in-patient populations. European Journal of Clinical Microbiology & Infectious Diseases: Official Publication of the European Society of Clinical Microbiology 34: 1823-1826.

Loberto, J.C.S., Martins, C.A., Santos, S.S., Cortelli, J.R. & Jorge, A.O.C. 2004. Staphylococcus spp. in the oral cavity and periodontal pockets of chronic periodontitis patients. Brazilian Journal of Microbiology 35: 64-68.

Lockhart, P.B., Brennan, M.T., Thornhill, M., Michalowicz, B.S., Noll, J., Bahrani-Mougeot, F.K. & Sasser, H.C. 2009. Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia. The Journal of the American Dental Association 140: 1238-1244.

Mantey, I., Hill, R., Foster, A., Wilson, S., Wade, J. & Edmonds, M. 2000. Infection of foot ulcers with Staphylococcus aureus associated with increased mortality in diabetic patients. Communicable Disease and Public Health 3: 288-290.

Marsh, P.D. 2000. Role of the oral microflora in health. Microbial Ecology in Health and Disease 12: 130-137.

Mccormack, M., Smith, A., Akram, A., Jackson, M., Robertson, D. & Edwards, G. 2015. Staphylococcus aureus and the oral cavity: An overlooked source of carriage and infection? American Journal of Infection Control 43: 35-37.

Mertz, D., Frei, R., Periat, N., Zimmerli, M., Battegay, M., Flückiger, U. & Widmer, A.F. 2009. Exclusive Staphylococcus aureus throat carriage: At-risk populations. Archives of Internal Medicine 169: 172-178.

Miyake, Y., Iwai, T., Sugai, M., Miura, K., Suginaka, H. & Nagasaka, N. 1991. Incidence and characterization of Staphylococcus aureus from the tongues of children. Journal of Dental Research 70: 1045-1047.

Murakami, M., Nishi, Y., Seto, K., Kamashita, Y. & Nagaoka, E. 2015. Dry mouth and denture plaque microflora in complete denture and palatal obturator prosthesis wearers. Gerodontology 32: 188-194.

Nair, V.V., Karibasappa, G., Dodamani, A. & Prashanth, V. 2016. Microbial contamination of removable dental prosthesis at different interval of usage: An in vitro study. The Journal of the Indian Prosthodontic Society 16(4): 346-351.

Nilsson, P. & Ripa, T. 2006. Staphylococcus aureus throat colonization is more frequent than colonization in the anterior nares. Journal of Clinical Microbiology 44: 3334-3339.

Norazah, A., Lim, V., Munirah, S. & Kamel, A. 2003. Staphylococcus aureus carriage in selected communities and their antibiotic susceptibility patterns. Medical Journal of Malaysia 58: 255-261.

O'donnell, L.E., Smith, K., Williams, C., Nile, C.J., Lappin, D.F., Bradshaw, D., Lambert, M., Robertson, D.P., Bagg, J. & Hannah, V. 2016a. Dentures are a reservoir for respiratory pathogens. Journal of Prosthodontics 25: 99-104.

O'donnell, L.E., Smith, K., Williams, C., Nile, C.J., Lappin, D.F., Bradshaw, D., Lambert, M., Robertson, D.P., Bagg, J., Hannah, V. & Ramage, G. 2016b. Dentures are a reservoir for respiratory pathogens. Journal of Prosthodontics 25: 99-104.

Ohara-Nemoto, Y., Haraga, H., Kimura, S. & Nemoto, T. 2008. Occurrence of staphylococci in the oral cavities of healthy adults and nasal-oral trafficking of the bacteria. Journal of Medical Microbiology 57: 95-99.

Oza, N. & Doshi, J.J. 2017. Angular cheilitis: A clinical and microbial study. Indian Journal of Dental Research 28: 661-665.

Paju, S. & Scannapieco, F. 2007. Oral biofilms, periodontitis, and pulmonary infections. Oral Disease 13(6): 508-512.

Russell, S.L., Boylan, R.J., Kaslick, R.S., Scannapieco, F.A. & Katz, R.V. 1999. Respiratory pathogen colonization of the dental plaque of institutionalized elders. Special Care in Dentistry 19: 128-134.

Sakr, A., Brégeon, F., Mège, J.L., Rolain, J.M. & Blin, O. 2018. Staphylococcus aureus nasal colonization: An update on mechanisms, epidemiology, risk factors, and subsequent infections. Frontiers in Microbiology 9: 2419.

Samaranayake, L.P., Macfarlane, T.W., Lamey, P.J. & Ferguson, M.M. 1986. A comparison of oral rinse and imprint sampling techniques for the detection of yeast, coliform and Staphylococcus aureus carriage in the oral cavity. Journal of Oral Pathology 15: 386-388.

Scannapieco, F.A. & Cantos, A. 2016. Oral inflammation and infection, and chronic medical diseases: Implications for the elderly. Periodontology 2000 72: 153-175.

Smith, A., Robertson, D., Tang, M., Jackson, M., Mackenzie, D. & Bagg, J. 2003. Staphylococcus aureus in the oral cavity: A three-year retrospective analysis of clinical laboratory data. British Dental Journal 195: 701-703.

Smith, A., Jackson, M. & Bagg, J. 2001. The ecology of staphylococcus species in the oral cavity. Journal of Medical Microbiology 50: 940-946.

Suzuki, J., Komatsuzawa, H., Sugai, M., Suzuki, T., Kozai, K., Miyake, Y., Suginaka, H. & Nagasaka, N. 1997. A long-term survey of methicillin-resistant Staphylococcus aureus in the oral cavity of children. Microbiology and Immunology 41(9): 681-686.

Terpenning, M.S., Taylor, G.W., Lopatin, D.E., Kerr, C.K., Dominguez, B.L. & Loesche, W.J. 2001. Aspiration pneumonia: Dental and oral risk factors in an older veteran population. Journal of The American Geriatrics Society 49: 557-563.

Tortora, G.J., Funke, B.R. & Case, C.L. 2016. Microbiology: An Introduction. 12th edition. Harlow: Pearson.

Ullman, A., Long, D. & Lewis, P. 2011. The oral health of critically Ill children: An observational cohort study. Journal of Clinical Nursing 20: 3070-3080.

Von Eiff, C., Becker, K., Machka, K., Stammer, H. & Peters, G. 2001. Nasal carriage as a source of Staphylococcus aureus bacteremia. New England Journal of Medicine 344: 11-16.

Wertheim, H.F., Melles, D.C., Vos, M.C., Van Leeuwen, W., Van Belkum, A., Verbrugh, H.A. & Nouwen, J.L. 2005. The role of nasal carriage in Staphylococcus aureus infections. The Lancet Infectious Diseases 5: 751-762.

*Pengarang untuk surat-menyurat; email: liza_amalik@usim.edu.my