Abstract
BackgroundCommunity-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are spreading, but the source of infections in non-epidemic settings remains poorly defined.MethodsWe carried out a community-based, case-control study investigating socio-demographic risk factors and infectious reservoirs associated with MRSA infections. Case patients presented with CA-MRSA infections to a New York hospital. Age-matched controls without infections were randomly selected from the hospital's Dental Clinic patient population. During a home visit, case and control subjects completed a questionnaire, nasal swabs were collected from index respondents and household members and standardized environmental surfaces were swabbed. Genotyping was performed on S. aureus isolates.ResultsWe enrolled 95 case and 95 control subjects. Cases more frequently reported diabetes mellitus and a higher number of skin infections among household members. Among case households, 53 (56%) were environmentally contaminated with S. aureus, compared to 36 (38%) control households (p = .02). MRSA was detected on fomites in 30 (32%) case households and 5 (5%; p<.001) control households. More case patients, 20 (21%) were nasally colonized with MRSA than were control indexes, 2 (2%; p<.001). In a subgroup analysis, the clinical isolate (predominantly USA300), was more commonly detected on environmental surfaces in case households with recurrent MRSA infections (16/36, 44%) than those without (14/58, 24%, p = .04).ConclusionsThe higher frequency of environmental contamination of case households with S. aureus in general and MRSA in particular implicates this as a potential reservoir for recolonization and increased risk of infection. Environmental colonization may contribute to the community spread of epidemic strains such as USA300.
Highlights
The dramatic increase in skin and soft tissue infections caused by Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) remains a major public health issue [1,2], often afflicting young, healthy individuals [3,4]
Nasal colonization appears to be less of a risk factor for infections [12,13,14], which is in contrast to hospital-acquired strains, where nasal MRSA carriage has clearly been established as a risk factor for subsequent infections with the same strain [15,16]
There were no significant differences between case patients and control participants regarding their demographic characteristics and healthcare exposures (Table 1), or their household and community exposures (Table 2)
Summary
The dramatic increase in skin and soft tissue infections caused by CA-MRSA remains a major public health issue [1,2], often afflicting young, healthy individuals [3,4] These strains have become endemic in many communities worldwide [1,5]. Nasal colonization appears to be less of a risk factor for infections [12,13,14], which is in contrast to hospital-acquired strains, where nasal MRSA carriage has clearly been established as a risk factor for subsequent infections with the same strain [15,16] This would suggest a role for other body sites [17] or perhaps the environment [14] as reservoirs for acquisition and subsequent S. aureus infections. Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections are spreading, but the source of infections in non-epidemic settings remains poorly defined
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