Anterior nares colonization with Methicillin-resistant Staphylococcus aureus (MRSA) among chiropractic students: An observational cohort study and epidemiologic survey protocol

Chiropractic students are in frequent skin-on-skin or fomite contact as they train academically. It is likely that chiropractic students become MRSA-colonized at a much higher rate than the US population as a whole, and may therefore be a potential source of MRSA colonization in the community after graduation as they enter chiropractic practice.

The purpose of this observational cohort study and epidemiologic survey is to determine the rate of anterior nares MRSA colonization in chiropractic students, and to compare those rates to cohorts of medical and physical therapy students, as well as to general graduate students. These rates will be compared to published data of anterior nares MRSA colonization rates in the civilian, noninstitutionalized US population. Risk factors for MRSA colonization will be assessed through an epidemiologic survey administered to each swabbed and cultured participant. Multiple regression analysis with stepwise selection will be utilized to determine which risk factors best explain or predict the detected colonization rates among cohorts and overall, and to determine if educational setting is predictive of MRSA colonization. A sufficient number of participants will be sampled and cultured to allow the detection of an increase from the civilian, noninstitutionalized US population background rate of 1.5% to a 4.5% anterior nares colonization rate in each cohort with 80% power on a one-tailed test (with alpha ≤.05). Through this study, the possible contribution of chiropractic education as an predictor of MRSA colonization will be explored. This presentation will review the proposed protocol and background for this study.