Abstract
BackgroundThe household is a recognized community reservoir for Staphylococcus aureus. This study investigated potential risk factors for intra-household S. aureus transmission, including the contribution of environmental contamination.MethodsWe investigated intra-household S. aureus transmission using a sample of multiple member households from a community-based case-control study examining risk factors for CA-MRSA infection conducted in Northern Manhattan. During a home visit, index subjects completed a questionnaire. All consenting household members were swabbed, as were standardized environmental household items. Swabs were cultured for S. aureus. Positive isolates underwent further molecular characterization. Intra-household transmission was defined as having identical strains among two or more household members. Multiple logistic regression was used to identify independent risk factors for transmission.ResultsWe enrolled 291 households: 146 index cases, 145 index controls and 687 of their household contacts. The majority of indexes were Hispanic (85%), low income (74%), and female (67%), with a mean age of 31 (range 1–79). The average size of case and control households was 4 people. S. aureus colonized individuals in 62% of households and contaminated the environment in 54% of households. USA300 was the predominant clinical infection, colonizing and environmental strain. Eighty-one households had evidence of intra-household transmission: 55 (38%) case and 26 (18%) control households (P<.01). Environmental contamination with a colonizing or clinical infection strain (aOR: 5.4 [2.9–10.3] P<.01) and the presence of a child under 5 (aOR: 2.3 [1.2–4.5] P = .02) were independently associated with transmission. In separate multivariable models, environmental contamination was associated with transmission among case (aOR 3.3, p<.01) and control households (aOR 27.2, p<.01).ConclusionsEnvironmental contamination with a colonizing or clinical infection strain was significantly and independently associated with transmission in a large community-based sample. Environmental contamination should be considered when treating S. aureus infections, particularly among households with multiple infected members.
Highlights
Numerous studies have documented the role of the household as a community reservoir for Staphylococcus aureus [1,2,3,4]
Studies of household transmission of S. aureus, including those that focus on the spread of healthcare-associated methicillinresistant S. aureus (MRSA) and, more recently, those that examined the spread of community-associated (CA) S. aureus, have identified a number of risk factors associated with transmission
We recently reported that among individuals with a MRSA infection, household environmental contamination with the clinical infection strain was associated with an increased risk of antecedent infection [21]
Summary
Numerous studies have documented the role of the household as a community reservoir for Staphylococcus aureus [1,2,3,4]. After a household member becomes infected, high levels of S. aureus colonization and infection often occur among other household members [5,6,7,8]. Studies of household transmission of S. aureus, including those that focus on the spread of healthcare-associated methicillinresistant S. aureus (MRSA) and, more recently, those that examined the spread of community-associated (CA) S. aureus, have identified a number of risk factors associated with transmission. In contrast with infections in the healthcare setting [16], the limited number of published studies on household transmission suggest that nasal carriage of S. aureus is not always associated with transmission [17]. This study investigated potential risk factors for intra-household S. aureus transmission, including the contribution of environmental contamination
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