Patterns, Associated Factors, and Anatomical Concordance of Nasal and Throat Staphylococcus aureus Carriage Among Community-Dwelling Adults in Germany

Despite its clinical importance, Staphylococcus aureus colonization in community populations remains insufficiently understood. This study aimed to determine the prevalence, anatomical distribution (nasal versus throat), and antimicrobial resistance patterns of Staphylococcus aureus colonization in healthy community-dwelling adults and to identify demographic and clinical factors associated with carriage. A cross-sectional study was conducted among 100 community-dwelling adults in Germany, yielding 200 nasal/throat samples. Staphylococcal isolates were identified using MALDI-TOF MS, and antimicrobial susceptibility was determined according to EUCAST guidelines. MRSA and PVL genes were assessed using molecular assays, and genetic relatedness was evaluated by rep-PCR. Associations with demographic and clinical variables were analyzed using multivariable logistic regression in R. Staphylococcus aureus carriage prevalence was 39%, higher in the nose (33%) than the throat (19%), with rare MRSA (3%) and no PVL detection. Significant nasal–throat discordance was observed (p < 0.01), with a fair agreement between sites (κ = 0.34). Resistance patterns among Staphylococcus aureus isolates were dominated by penicillin G resistance (47%), while 35% remained fully susceptible, and multidrug resistance was rare (6%). Multivariable analyses indicated no strong associations between overall, nasal, or throat carriage and age, sex, recent antibiotic use, or other clinical exposures (p > 0.05), with wide confidence intervals, potentially reflecting limited statistical power and only modest model discrimination (AUC 0.65–0.68). These findings indicate that community Staphylococcus aureus colonization is potentially marked by modest prevalence, substantial anatomical discordance, and a low-risk resistance profile, while common demographic and clinical factors contributed little to explaining carriage patterns.