Abstract
BackgroundAntibiotic-resistant Staphylococcus aureus infections have increased dramatically in the community, yet S. aureus nasal colonization has remained stable. The objectives of this study were to determine if S. aureus colonization is a useful proxy measure to study disease transmission and infection in community settings, and to identify potential community reservoirs.Methodology/Principal FindingsRandomly selected households in Northern Manhattan, completed a structured social network questionnaire and provided nasal swabs that were typed by pulsed field gel electrophoresis to identify S. aureus colonizing strains. The main outcome measures were: 1) colonization with S. aureus; and 2) recent serious skin infection. Risk factor analyses were conducted at both the individual and the household levels; logistic regression models identified independent risks for household colonization and infection.Results321 surveyed households contained 914 members. The S. aureus prevalence was 25% and MRSA was 0.4%. More than 40% of households were colonized. Recent antibiotic use was the only significant correlate for household colonization (p = .002). Seventy-eight (24%) households reported serious skin infection. In contrast with colonization, five of the six risk factors that increased the risk of skin infection in the household at the univariate level remained independently significant in multivariable analysis: international travel, sports participation, surgery, antibiotic use and towel sharing. S. aureus colonization was not significantly associated with serious skin infection in any analysis. Among multiperson households with more than one person colonized, 50% carried the same strain.Conclusions/SignificanceThe lack of association between S. aureus nasal colonization and serious skin infection underscores the need to explore alternative venues or body sites that may be crucial to transmission. Moreover, the magnitude of colonization and infection within the household suggests that households are an underappreciated and substantial community reservoir.
Highlights
In the past decade there has been a dramatic increase in community-associated (CA) Staphylococcus aureus infections, many due to methicillin-resistant strains [1,2].With the exception of S. aureus outbreaks in high-risk settings, little is known about the reservoirs or settings through which individuals in the community are exposed to S. aureus
Male gender was significantly associated with S. aureus nasal colonization
Self reported health Excellent/Good aMissing 5. bThe top five reasons for hospitalization were cardiovascular disease (17%), infections (14%), childbirth (13%), respiratory conditions (12%), and surgeries (12%). doi:10.1371/journal.pone.0006708.t002. This population based survey is the first to integrate household level data and molecular epidemiology and finds significant and independent relationships linking community, health-related and hygiene exposures with serious skin infection at both the individual and the household level. This finding was not replicated in analyses that examined the relationship between these same exposures and S. aureus nasal colonization
Summary
In the past decade there has been a dramatic increase in community-associated (CA) Staphylococcus aureus infections, many due to methicillin-resistant strains [1,2].With the exception of S. aureus outbreaks in high-risk settings, little is known about the reservoirs or settings through which individuals in the community are exposed to S. aureus. To date community-based studies have yielded conflicting results on the role of S. aureus nasal colonization as a risk factor for subsequent infection [5,6,7,8]. There are two main environmental risk factors relevant to the community setting that contribute to S. aureus transmission: incomplete or ineffective hygienic practices and a high prevalence of S. aureus. If these factors are considered in the community setting, two separate lines of inquiry are established. The objectives of this study were to determine if S. aureus colonization is a useful proxy measure to study disease transmission and infection in community settings, and to identify potential community reservoirs
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
