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. 2025 May 30:16:1585718.
doi: 10.3389/fimmu.2025.1585718. eCollection 2025.

Associations between total protein, globulin, and nasal Methicillin-Resistant Staphylococcus aureus (MRSA) colonization in US adults: results from the national health and nutrition examination survey 2001-2004

Kanchao Chen #  1   2 , Xiaomeng Feng #  1   2 , Futong Liu #  3 , Yuping Fan  1   2 , Tingting Zhang  1   2 , Hui Wang  4 , Sizhou Feng  1   2
Affiliations

Associations between total protein, globulin, and nasal Methicillin-Resistant Staphylococcus aureus (MRSA) colonization in US adults: results from the national health and nutrition examination survey 2001-2004

Kanchao Chen et al. Front Immunol. .

Abstract

Objective: There is limited evidence on the association between total serum protein (TP), serum globulin (GLB), and Methicillin-Resistant Staphylococcus aureus (MRSA) nasal colonization. The purpose of this study was to investigate the association between TP, GLB, and MRSA nasal colonization in US adults with data derived from the National Health and Nutrition Examination Survey (NHANES).

Methods: Using NHANES 2001-2004 data, we employed propensity score matching (PSM) to control confounders, weighted logistic regression to evaluate associations of TP and GLB with MRSA colonization, restricted cubic splines (RCS) for non-linear analysis, and subgroup and sensitivity analyses for validation.

Results: Among 7,585 adults, 1.31% (n = 99) had MRSA nasal colonization. Adjusted multivariable regression identified TP and GLB as independent protective factors (TP: OR=0.92, 95%CI 0.88-0.96; GLB: OR=0.91, 95%CI 0.86-0.97; p< 0.05 for all). Categorizing TP and GLB into quartiles (Q4 vs. Q1) reinforced this association (TP: OR=0.21, 95%CI 0.07-0.59; GLB: OR=0.28, 95%CI 0.12-0.67; p< 0.05 for all) with consistent results post-PSM. Restricted cubic splines confirmed dose-dependent negative correlations. Subgroup analyses and sensitivity analyses supported the robustness of these findings.

Conclusion: There was a negative correlation between TP, GLB, and MRSA nasal colonization in participants aged 18 years or older. Our data support the protective role of TP and GLB in MRSA colonization, and the specific mechanisms of these biomarkers in MRSA colonization and their clinical implications require further investigation.

Keywords: MRSA colonization; NHANES; PSM; globulin; total protein.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Flowchart of the study participants.
Figure 2
Figure 2
Restricted cubic spline (RCS) plots of total protein (TP), globulin (GLB), and methicillin-resistant Staphylococcus aureus (MRSA) nasal colonization before and after propensity score matching (PSM). Panels (A, B) illustrate the RCS plots of TP and GLB in relation to MRSA colonization before PSM; panels (C, D) show the corresponding analyses after PSM.
Figure 3
Figure 3
Subgroup analysis stratified by demographic and clinical variables before and after propensity score matching (PSM). (A) Total protein (TP) and MRSA colonization, pre-PSM; (B) Globulin (GLB) and MRSA colonization, pre-PSM; (C) TP and MRSA colonization, post-PSM; (D) GLB and MRSA colonization, post-PSM.
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