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Airborne Dispersal as a Novel Transmission Route of Coagulase-Negatwe Staphylococci Interaction Between Coagulase-Negative Staphylococci and Rhinovirus Infection

Published online by Cambridge University Press:  02 January 2015

Werner E. Bischoff*
Section on Infectious Diseases, Winston-Salem, North Carolina
Stefano Bassetti
Section on Infectious Diseases, Winston-Salem, North Carolina
Barbara A. Bassetti-Wyss
Section on Infectious Diseases, Winston-Salem, North Carolina
Michelle L. Wallis
Section on Infectious Diseases, Winston-Salem, North Carolina
Brian K. Tucker
Section on Infectious Diseases, Winston-Salem, North Carolina
Beth A. Reboussin
Section on Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Ralph B. D'Agostino Jr.
Section on Biostatistics, Wake Forest University School of Medicine, Winston-Salem, North Carolina
Michael A. Pfaller
Medical Microbiology Division, The University of Iowa Hospitals and Clinics, Iowa City, Iowa
Jack M. Gwaltney Jr.
Division of Epidemiology and Virology, University of Virginia Health Sciences Center, Charlottesville, Virginia
Robert J. Sherertz
Section on Infectious Diseases, Winston-Salem, North Carolina
Wake Forest University School of Medicine, Department of Internal Medicine, Section on Infectious Diseases, Medical Center Boulevard, Winston-Salem, NC 27157-1042



To investigate whether rhinovirus infection leads to increased airborne dispersal of coagulase-negative staphylococci (CoNS).


Prospective nonrandomized intervention trial.


Wake Forest University School of Medicine, Winston-Salem, North Carolina.


Twelve nasal Staphylococcus aureus-CoNS carriers among 685 students screened for S. aureus nasal carriage.


Participants were studied for airborne dispersal of CoNS in a chamber under three conditions (street clothes, sterile gown with a mask, and sterile gown without a mask). After 2 days of pre-exposure measurements, volunteers were inoculated with a rhinovirus and observed for 14 days. Daily quantitative nasal and skin cultures for CoNS and nasal cultures for rhinovirus were performed. In addition, assessment of cold symptoms was performed daily, mucous samples were collected, and serum titers before and after rhinovirus inoculation were obtained. Sneezing, coughing, and talking events were recorded during chamber sessions.


All participants had at least one nasal wash positive for rhinovirus and 10 developed a symptomatic cold. Postexposure, there was a twofold increase in airborne CoNS (P = .0004), peaking at day 12. CoNS dispersal was reduced by wearing a gown (57% reduction, P < .0001), but not a mask (P = .7). Nasal and skin CoNS colonization increased after rhinovirus infection (P<.05).


We believe this is the first demonstration that a viral pathogen in the upper airways can increase airborne dispersal of CoNS in nasal S. aureus carriers. Gowns, gloves, and caps had a protective effect, whereas wearing a mask did not further reduce airborne spread.

Original Articles
Copyright © The Society for Healthcare Epidemiology of America 2004

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