Genomic Analysis of Community Transmission Networks for MRSA Among Females Entering a Large Inner-city Jail

Abstract

Background It is unclear if there are differences in MRSA risk between sexes in high-risk populations. Methods Females incarcerated at the Cook County Jail were enrolled within 72 hours of intake. Surveillance cultures (nares, throat, groin) were collected to determine prevalence of MRSA colonization. A survey was administered to identify colonization predictors. Univariate and multivariate analyses were performed to identify predictors of colonization at intake. Genomic sequencing was performed on MRSA colonization and archived clinical isolates. Results 250 women were enrolled (70% AA, 15% Hispanic) with 70% previously in jail. The prevalence of MRSA colonization at intake was 20%, with 42% of those colonized solely in the throat or groin. Univariate predictors of MRSA colonization at entrance were illicit drug use, unstable housing, engaging in anal sex, recent exchange of sex for drugs/money, and a higher number of recent sexual partners. With multivariate adjustment for race/ethnicity, use of needles for illicit drugs was a significant predictor of MRSA. Use of illicit drugs was also associated with inclusion in a genomic cluster. Nares colonization was significantly associated with not being in a genomic cluster (18.8% vs 78.6%, p<0.001), whereas exclusive extra-nasal colonization was associated (OR 15.89, p<0.001). Conclusion We found that a high proportion (20%) of females entered jail colonized with MRSA, suggesting that previously reported sex disparities of a lower risk in women may not apply to high-risk populations. Our findings suggest high-risk activities or venues in the community for MRSA, with potential for directing sex-specific interventions.

SHEA/IDSA/APIC Practice Recommendation: Strategies to prevent methicillin-resistant Staphylococcus aureus transmission and infection in acute-care hospitals: 2022 Update

“…Therefore, community exposures (eg, injection drug use, correctional-facility exposure, crowding, and unstable housing) need to be considered as risk factors. [27][28][29][30] 3. Reservoir for MRSA transmission in acute-care facilities a.…”

Examining Antimicrobial Stewardship Program Implementation in Carceral Settings

“…As a result, incarceration is viewed as a well-recognized risk factor for MRSA infection. 5,6,7,8,9,10,11 Antimicrobial stewardship programs (ASPs) are evidence-based interventions designed to optimize antimicrobial usage and to decrease the emergence of new AMR pathogens while reducing harm caused by unnecessary antimicrobial use and improving patient outcomes. 12,13,14 The US Federal Bureau of Prisons, a system of 121 prisons housing about 200 000 people, developed and implemented an ASP program that led to a 26% decrease in antimicrobial use from fiscal year 2010 to fiscal year 2015.…”