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Background   Staphylococcus aureus  is one of the most isolated pathogens from the airways of cystic fibrosis (CF) patients. There is a lack of information about the clonal nature of  S. aureus  cultured from CF patients and their impact on disease. We hypothesized that patients would differ in their clinical status depending on  S. aureus  clonal carriage profiles during persistence.    Methods  During a 21-months prospective observational multicenter study ( Junge et al., 2016 ), 3893  S. aureus  isolates (nose, oropharynx, and sputa) were cultured from 183 CF patients (16 German centers, 1 Austrian center) and subjected to  spa -sequence typing to assess clonality. Data were associated to lung function, age, gender, and antibiotic treatment by multivariate regression analysis.    Results  Two hundred and sixty-five different  spa -types were determined with eight prevalent  spa -types (isolated from more than 10 patients): t084, t091, t008, t015, t002 t012, t364, and t056. We observed different carriage profiles of  spa -types during the study period: patients being positive with a prevalent  spa -type, only one, a dominant or related  spa -type/s. Patients with more antibiotic cycles were more likely to be positive for only one  spa -type ( p  = 0.005), while older patients were more likely to have related ( p  = 0.006), or dominant  spa -types ( p  = 0.026). Two percent of isolates were identified as methicillin-resistant  S. aureus  (MRSA) and evidence of transmission of clones within centers was low.    Conclusion  There was a significant association of antibiotic therapy and age on  S. aureus  carriage profiles in CF patients indicating that antibiotic therapy prevents acquisition of new clones, while during aging of patients with persisting  S. aureus , dominant clones were selected and mutations in the  spa- repeat region accumulated.

Antibiotic Treatment and Age Are Associated With Staphylococcus aureus Carriage Profiles During Persistence in the Airways of Cystic Fibrosis Patients