Prevalence of USA300 Strain Type of Methicillin-Resistant Staphylococcus aureus among Patients with Nasal Colonization Identified with Active Surveillance

Freitas, Eduardo Almeida; Harris, Rebecca M.; Blake, Ruth K.; Salgado, Cassandra D.

doi:10.1086/651672

Cited by 35 publications

(21 citation statements)

References 31 publications

(23 reference statements)

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“…The reason for this difference appears to be that invasive MRSA rates among black children aged ≤2 years increased, while rates among older black persons decreased. One retrospective hospital cohort study identified African American race and younger age as risk factors for USA300 MRSA nasal colonization, the most prevalent strain type of CA MRSA [18]. A recent analysis suggests that racial differences in invasive CA MRSA rates are due to socioeconomic factors, which may include decreased availability and affordability of medical care, increased crowding, and higher poverty rates [19].…”

Section: Discussionmentioning

confidence: 99%

Racial Disparities in Invasive Methicillin-resistant Staphylococcus aureus Infections, 2005–2014

Gualandi

Bamberg

et al. 2018

Clinical Infectious Diseases

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Background. Despite substantial attention to the individual topics, little is known about the relationship between racial disparities and antimicrobial-resistant and/or healthcare-associated infection trends, such as for methicillin-resistant Staphylococcus aureus (MRSA). Methods. We analyzed Emerging Infections Program 2005–2014 surveillance data (9 US states) to determine whether reductions in invasive MRSA incidence (isolated from normally sterile body sites) affected racial disparities in rates. Case classification included hospital-onset (HO, culture >3 days after admission), healthcare-associated community onset (HACO, culture <3 days after admission and dialysis, hospitalization, surgery, or long-term care residence within 1 year prior), or community-associated (CA, all others). Negative binomial regression models were used to evaluate the adjusted rate ratio (aRR) of MRSA in black patients (vs in white patients) controlling for age, sex, and temporal trends. Results. During 2005–2014, invasive HO and HACO (but not CA) MRSA rates decreased. Despite this, blacks had higher rates for HO (aRR, 3.20; 95% confidence interval [CI], 2.35–4.35), HACO (aRR, 3.84; 95% CI, 2.94–5.01), and CA (aRR, 2.78; 95% CI, 2.30–3.37) MRSA. Limiting the analysis to chronic dialysis patients reduced, but did not eliminate, the higher HACO MRSA rates among blacks (aRR, 1.83; 95% CI, 1.72–1.96), even though invasive MRSA rates among dialysis patients decreased during 2005–2014. These racial differences did not change over time. Conclusions. Previous reductions in healthcare-associated MRSA infections have not affected racial disparities in MRSA rates. Improved understanding of the underlying causes of these differences is needed to develop effective prevention interventions that reduce racial disparities in MRSA infections.

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Section: Discussionmentioning

confidence: 99%

Racial Disparities in Invasive Methicillin-resistant Staphylococcus aureus Infections, 2005–2014

Gualandi

Bamberg

et al. 2018

Clinical Infectious Diseases

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“…In contrast, we found USA300 MRSA to be more common than other strains in the nares and at all body sites of control subjects. A previous study examining MRSA nasal colonization among hospitalized patients found that 24% of MRSA nasal isolates were USA300 and that the proportion of USA300 increased from 2005 to 2007 (29).…”

Section: Discussionmentioning

confidence: 98%

Staphylococcus aureus Colonization and Strain Type at Various Body Sites among Patients with a Closed Abscess and Uninfected Controls at U.S. Emergency Departments

et al. 2015

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d Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a prevalent cause of skin and soft tissue infections (SSTI), but the association between CA-MRSA colonization and infection remains uncertain. We studied the carriage frequency at several body sites and the diversity of S. aureus strains from patients with and without SSTI. Specimens from the nares, throat, rectum, and groin of case subjects with a closed skin abscess (i.e., without drainage) and matched control subjects without a skin infection (n ‫؍‬ 147 each) presenting to 10 U.S. emergency departments were cultured using broth enrichment; wound specimens were cultured from abscess cases. Methicillin resistance testing and spa typing were performed for all S. aureus isolates. S. aureus was found in 85/147 (57.8%) of abscesses; 49 isolates were MRSA, and 36 were methicillin-susceptible S. aureus (MSSA). MRSA colonization was more common among cases (59/147; 40.1%) than among controls (27/147; 18.4%) overall (P < 0.001) and at each body site; no differences were observed for MSSA. S. aureus-infected subjects were usually (75/85) colonized with the infecting strain; among MRSA-infected subjects, this was most common in the groin. The CC8 lineage accounted for most of both infecting and colonizing isolates, although more than 16 distinct strains were identified. Nearly all MRSA infections were inferred to be USA300. There was more diversity among colonizing than infecting isolates and among those isolated from controls versus cases. CC8 S. aureus is a common colonizer of persons with and without skin infections. Detection of S. aureus colonization, and especially MRSA, may be enhanced by extranasal site culture. Staphylococcus aureus frequently causes invasive and life-threatening infections. While historically common in patients with significant health care exposure, community-associated methicillin-resistant S. aureus (CA-MRSA) has emerged as an important cause of disease (1). CA-MRSA is the most common cause of skin and soft tissue infections (SSTI) among people presenting to emergency departments (EDs) in much of the United States, most of which are caused by a single MRSA strain, pulsed-field type USA300 (2). S. aureus colonization with methicillin-susceptible S. aureus (MSSA) is common in the general population, especially in the anterior nares (3). Studies of MRSA pathogenesis in health care settings have demonstrated that nasal colonization typically precedes and is a risk factor for infection (4); therefore, prevention strategies in health care often involve decolonization, especially before invasive surgical procedures (5).Despite the increasing prevalence of CA-MRSA infections, nasal colonization with MRSA has been infrequently detected during CA-MRSA outbreaks or in nationally representative prevalence surveys (6, 7). One possible explanation for this observation is that CA-MRSA strains might preferentially colonize at nonnasal body sites. The throat and groin have been implicated as important sites of S. aureus and MRSA c...

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“…The USA300 strain type of MRSA is capable of spreading rapidly 13 and has been associated with African-American race. 14 Another explanation is differential access to health care in minority races 15 and therefore delays in presentation. A previous study examining health care disparities documented longer LOS among minority children with appendicitis.…”

Section: Discussionmentioning

confidence: 99%

Factors Associated With High Resource Utilization in Pediatric Skin and Soft Tissue Infection Hospitalizations

Lopez¹,

Cruz²,

Kowalkowski

et al. 2013

Hospital Pediatrics

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OBJECTIVE To describe factors associated with prolonged lengths of stay (LOS) and increased charges for pediatric skin and soft tissue infection (SSTI) hospitalizations. METHODS This study was a cross-sectional analysis of pediatric SSTI hospital discharges in 2009 within the Healthcare Cost and Utilization Project Kids' Inpatient Database. Outcomes were prolonged LOS (>75th percentile) and increased hospital charges (>75th percentile). Multivariate logistic regression controlling for patient and hospital level factors was conducted for 2009 data to assess associations among variables. RESULTS The 75th percentile for LOS was 3 days. Infants had higher odds of prolonged LOS than other age groups (<1 year: 1; 1–4 years: 0.70 [95% confidence interval (CI): 0.64–0.76]; 5–12 years: 0.69 [95% CI: 0.63–0.76]; 13–18 years: 1.01 [95% CI: 0.91–1.10]), as did all minority groups compared with white subjects (black subjects: 1.23 [95% CI: 1.09–1.38]; Hispanic subjects: 1.33 [95% CI: 1.20–1.47]; and other races: 1.30 [95% CI: 1.12–1.50]). Public payers compared with private payers (odds ratio: 1.17 [95% CI: 1.10–1.26]) also had increased odds of prolonged LOS. The 75th percentile for charges was $14 317. The adolescent-aged category had higher odds of charges >75th percentile compared with the age category <1 year (odds ratio: 1.54 [95% CI: 1.36–1.74]). All racial/ethnic minorities had higher odds of charges >75th percentile compared with white subjects (black subjects: 1.38 [95% CI: 1.17–1.62]; Hispanic subjects: 1.90 [95% CI: 1.59–2.26]; and other races: 1.26 [95% CI: 1.06–1.50]). CONCLUSIONS Vulnerable populations, including infants, racial/ethnic minorities, and publicly insured children, had higher odds of increased resource utilization during hospitalizations for SSTIs. The findings of this study provide potential targets for future preventive and public health interventions.

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Prevalence of USA300 Strain Type of Methicillin-Resistant Staphylococcus aureus among Patients with Nasal Colonization Identified with Active Surveillance

Cited by 35 publications

References 31 publications

Racial Disparities in Invasive Methicillin-resistant Staphylococcus aureus Infections, 2005–2014

Racial Disparities in Invasive Methicillin-resistant Staphylococcus aureus Infections, 2005–2014

Staphylococcus aureus Colonization and Strain Type at Various Body Sites among Patients with a Closed Abscess and Uninfected Controls at U.S. Emergency Departments

Factors Associated With High Resource Utilization in Pediatric Skin and Soft Tissue Infection Hospitalizations

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