Staphylococcus aureus is a significant pathogen in human disease, particularly in hospitalized patients, where it causes severe infections despite antibiotic treatment. The rise of methicillin-resistant S. aureus (MRSA) has made infection prevention more challenging. Nasal carriage of S. aureus plays a key role in its epidemiology and pathogenesis. This review discusses the epidemiology of nasal carriage and its associated risks, emphasizing the need for further research to develop effective prevention strategies. Nasal carriage of S. aureus is common, with approximately 37.2% of the general population carrying it. Carriage patterns vary, with persistent carriers (20%), intermittent carriers (60%), and noncarriers (20%). Persistent carriage is more common in children and may protect against other strains during hospitalization. However, antibiotic treatment reduces this protective effect. Carriage rates are higher in certain groups, including those with diabetes, hemodialysis, CAPD, HIV, and intravascular device users. These higher rates may be due to repeated skin punctures or immunological defects in HIV patients. The molecular basis of nasal carriage involves adherence to epithelial cells, facilitated by adhesins and physicochemical interactions. S. aureus adheres better to nasal epithelial cells from carriers than noncarriers. Adherence to airway, bovine mammary gland, and endothelial/mesothelial cells is also studied. Factors such as fibronectin, teichoic acid, and surface proteins influence adherence. MRSA carriage is a significant risk factor for infections, with higher carriage rates in certain populations. Molecular typing techniques help identify strains and their clonality, aiding in infection control. Elimination strategies, such as mupirocin, have shown effectiveness in reducing nasal carriage, though resistance is rare. Studies show that mupirocin reduces carriage in 91% of stable carriers, with long-term efficacy observed. Surgical patients, hemodialysis patients, and those with intravascular devices are at higher risk for S. aureus infections due to nasal carriage. Infections are often endogenous, originating from the nasal flora. Elimination of carriage can reduce infection rates, but the effectiveness varies among populations. MRSA carriage poses a greater risk than methicillin-susceptible S. aureus (MSSA) due to resistance and virulence factors. The pathogenesis of endogenous infections involves spread from the nose to other sites, such as the skin or surgical sites. Elimination strategies, including mupirocin, are effective in reducing carriage and infection rates. Further research is needed to fully understand the mechanisms and develop optimal prevention strategies.Staphylococcus aureus is a significant pathogen in human disease, particularly in hospitalized patients, where it causes severe infections despite antibiotic treatment. The rise of methicillin-resistant S. aureus (MRSA) has made infection prevention more challenging. Nasal carriage of S. aureus plays a key role in its epidemiology and pathogenesis. This review discusses the epidemiology of nasal carriage and its associated risks, emphasizing the need for further research to develop effective prevention strategies. Nasal carriage of S. aureus is common, with approximately 37.2% of the general population carrying it. Carriage patterns vary, with persistent carriers (20%), intermittent carriers (60%), and noncarriers (20%). Persistent carriage is more common in children and may protect against other strains during hospitalization. However, antibiotic treatment reduces this protective effect. Carriage rates are higher in certain groups, including those with diabetes, hemodialysis, CAPD, HIV, and intravascular device users. These higher rates may be due to repeated skin punctures or immunological defects in HIV patients. The molecular basis of nasal carriage involves adherence to epithelial cells, facilitated by adhesins and physicochemical interactions. S. aureus adheres better to nasal epithelial cells from carriers than noncarriers. Adherence to airway, bovine mammary gland, and endothelial/mesothelial cells is also studied. Factors such as fibronectin, teichoic acid, and surface proteins influence adherence. MRSA carriage is a significant risk factor for infections, with higher carriage rates in certain populations. Molecular typing techniques help identify strains and their clonality, aiding in infection control. Elimination strategies, such as mupirocin, have shown effectiveness in reducing nasal carriage, though resistance is rare. Studies show that mupirocin reduces carriage in 91% of stable carriers, with long-term efficacy observed. Surgical patients, hemodialysis patients, and those with intravascular devices are at higher risk for S. aureus infections due to nasal carriage. Infections are often endogenous, originating from the nasal flora. Elimination of carriage can reduce infection rates, but the effectiveness varies among populations. MRSA carriage poses a greater risk than methicillin-susceptible S. aureus (MSSA) due to resistance and virulence factors. The pathogenesis of endogenous infections involves spread from the nose to other sites, such as the skin or surgical sites. Elimination strategies, including mupirocin, are effective in reducing carriage and infection rates. Further research is needed to fully understand the mechanisms and develop optimal prevention strategies.