Methicillin‐resistant Staphylococcus aureus skin and soft tissue infections in young people in custody in New South Wales

Abstract

Incarcerated Australian youth have high rates of MRSA SSTIs, comparable to rates in US adult inmates, but with different molecular subtypes. At particular risk of MRSA infection are Indigenous youth, those with recent antibiotic use and those presenting with a collection. Many MRSA infections present at custodial admission, making surveillance and containment important, along with avoidance of unnecessary antibiotics and hand hygiene. Panton-Valentine leukocidin-positive MRSA predominates and is known for causing flu-associated necrotising pneumonia. Albeit a rare outcome, the seasonal influenza vaccination should be mandatory for youth in custody and custodial staff.

The burden of atopic dermatitis and bacterial skin infections among urban‐living Indigenous children and young people in high‐income countries: A systematic review

“…All studies were set in Oceania with a predominant temperate climate—six from Australia and three from New Zealand (Table 3). Using the Degree of Urbanization, seven studies were conducted in “cities” and one in “towns/suburbs.” 24 The ninth study was set across nine juvenile custodial centers, considered to be a simulated urban environment (based on population size/density and infrastructure) for the purpose of this SR 25 . Epidemiologic data on BSI specific for urban‐living Indigenous CYP was available in the six included Australian studies (unpublished data for one 26 ).…”

“…aureus (CA‐MRSA) skin infections, 32 group A streptococcal (GAS) detection in skin swabs and primary acute rheumatic fever (ARF) hospitalizations. The final study investigated a prospective cohort of incarcerated youth presenting to custodial health centers with SSTI 25 …”

“…All studies were set in Oceania with a predominant temperate climate—six from Australia and three from New Zealand (Table 3 ). Using the Degree of Urbanization, seven studies were conducted in “cities” and one in “towns/suburbs.” 24 The ninth study was set across nine juvenile custodial centers, considered to be a simulated urban environment (based on population size/density and infrastructure) for the purpose of this SR. 25 Epidemiologic data on BSI specific for urban‐living Indigenous CYP was available in the six included Australian studies (unpublished data for one 26 ). While the three included New Zealand studies were set in an urban environment, place of residence was not reported; hence, it is estimated a proportion (up to 25%) of these participants may be rural‐living.…”

“…Aboriginal custodial admissions, compared with nine per 1000 non-Aboriginal custodial admissions; with SSTIs in Aboriginal youth almost six times more likely to be due to MRSA than in non-Aboriginal youth (AOR 5.92, 95% CI 2.03-17.21). 25 Urban-living M aori CYP in New Zealand had a three times higher annual incidence of CA-S.aureus SSTI (1488/100,000 population) compared with 552/100,000 for "all youth," 28 and four times greater GAS detection in swabs compared with European/other ethnicities (RR 4.0; 95% CI 3.9-4.2)-highest in those under five years and most socioeconomically deprived. 27 Linking GAS skin swab data with primary ARF hospitalization data, urban M aori youth were 30 times more likely to be…”

“…25 Proportion data were available in six studies: 24,[26][27][28]30,32 prevalence data in one, 29 and incidence data in four. 25,27,28,31 Proportion data are summarized in Table 4, revealing urban-living Indigenous CYP to be over-represented for all measures of BSI compared with their proportion of the background population. For urban-living Australian Aboriginal CYP, the median rate ratio for BSI incidence was 4.5 times higher than non-Aboriginal CYP.…”