Staphylococcus aureus Colonization Among Household Contacts of Patients With Skin Infections: Risk Factors, Strain Discordance, and Complex Ecology

Miller, Loren G.; Eells, Samantha J.; Taylor, Alexis; David, Michael Z.; Ortiz, Nancy; Zychowski, Diana; Kumar, Neha; Cruz, Denise; Boyle-Vavra, Susan; Daum, Robert S.

doi:10.1093/cid/cis213

Cited by 109 publications

(143 citation statements)

References 58 publications

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“…None of his 4 household contacts and no other subject in our study of 350 households was colonized with an MSSA or MRSA ST398 isolate (24). As determined by PFGE, ST398 isolates from the Dallas County Jail, from New York State Prisons (30), from the patient in Chicago, and from northern Manhattan (22) all shared PFGE patterns with Ͼ80% identity by Dice coefficient analysis (Fig.…”

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confidence: 83%

Asymptomatic Carriage of Sequence Type 398, spa Type t571 Methicillin-Susceptible Staphylococcus aureus in an Urban Jail: a Newly Emerging, Transmissible Pathogenic Strain

et al. 2013

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Sequence type 398 (ST398) Staphylococcus aureus, frequently carried by livestock, has caused severe human infections and often carries transmissible antibiotic resistance genes. Among methicillin-susceptible S. aureus isolates colonizing Dallas County Jail detainees, 13.2% were ST398, spa type t571, and were genetically similar to human colonization isolates from New York, Chicago, and the Dominican Republic. Sequence type 398 (ST398) methicillin-resistant Staphylococcus aureus (MRSA) is often transmitted among livestock and animal handlers but is uncommonly associated with human disease in the United States (1). We unexpectedly identified ST398/t571 methicillin-sensitive S. aureus (MSSA) as the most common genetic background among MSSA isolates colonizing detainees in the Dallas County Jail. In this study, we compared the pulsed-field gel electrophoresis (PFGE) pulsotypes of isolates from the Dallas jail and from a single patient in Chicago with those of strains isolated in previous studies.Recognized first in Europe (2-9), ST398 MRSA has been isolated in the United States (10), Canada (11), and Latin America (12). ST398 methicillin-susceptible S. aureus (MSSA) isolates have been recovered from pigs (13), humans (14-17), and retail meat (18). Asymptomatic human colonization and infection with ST398 MSSA are rare in the United In January 2009, we screened the anterior nares and the hands of 928 detainees, housed in 68 divisions, called tanks, in the Dallas County Jail, for S. aureus carriage. Tanks had a capacity of 24 to 36 detainees. Detainees can interact with others within a single tank but have little interaction with those in other tanks. The study was approved by the Institutional Review Boards at the University of Chicago Medical Center and the University of Texas-Southwestern Medical Center. Recovered MSSA isolates were genotyped from subjects housed in a stratified random sample of 26 of the 68 tanks; all MRSA isolates were genotyped.In a separate study of S. aureus colonization among patients and household contacts (24), we also identified one patient in Chicago with ST398/t571 MSSA colonization.Multilocus sequence typing (MLST) (25), spa typing (26), PCR for the Panton-Valentine leukocidin (PVL) genes (27), and PFGE using Cfr9I digestion (22, 28) were performed. Antimicrobial susceptibilities were determined by automated testing (29).Among the 345 subjects in the 26 selected tanks, 110 (31.9%) carried MSSA. Of 158 MSSA isolates identified, 152 were available, and 34 MLST types were identified. Twenty isolates (13%) were ST398, the most common ST; all lacked PVL genes. Of the 345 subjects, the 16 (4.6%) who carried the 20 ST398 MSSA isolates were more likely than carriers of other MSSA genetic backgrounds to be female (P ϭ 0.0009) and older (P ϭ 0.01) ( Table 1).Among the 20 ST398 isolates, 18 were susceptible to ciprofloxacin, gentamicin, rifampin, and trimethoprim-sulfamethoxazole and resistant to clindamycin and erythromycin. The two other isolates differed in that one was susceptible to clindamyc...

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confidence: 83%

Asymptomatic Carriage of Sequence Type 398, spa Type t571 Methicillin-Susceptible Staphylococcus aureus in an Urban Jail: a Newly Emerging, Transmissible Pathogenic Strain

et al. 2013

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“…Indeed, many individuals with colonization in the throat or on the skin over the inguinal area have no colonization in the nasopharynx (5)(6)(7)(8). Small studies in the United States and elsewhere have demonstrated that S. aureus, and specifically the methicillin-resistant S. aureus (MRSA) genetic background USA300 can be found elsewhere on the body (reviewed in reference 4).…”

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confidence: 99%

High Staphylococcus aureus Colonization Prevalence among Patients with Skin and Soft Tissue Infections and Controls in an Urban Emergency Department

et al. 2015

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Staphylococcus aureus is a commensal species that can also be a formidable pathogen. In the United States, an epidemic of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections has been occurring for the last 15 years. In the context of a study in which we identified patients with skin and soft tissue infections (SSTIs) and randomized them to receive one of two antimicrobial treatment regimens, we assessed S. aureus colonization in the nares, throat, and perianal skin on the day of enrollment and 40 days after therapy. We compared the prevalence of colonization between the SSTI patients and an uninfected control population. A total of 144 subjects and 130 controls, predominantly African American, participated in this study, and 116 returned for a 40-day follow-up visit. Of the SSTI patients, 76% were colonized with S. aureus at enrollment, as were 65% of the controls. Patients were more likely than the controls to be colonized with USA300 MRSA (62/144 [43.1%] versus 11/130 [8.5%], respectively; P < 0.001). The nares were not the most common site of colonization. The colonization prevalence diminished somewhat after antibiotic treatment but remained high. The isolates that colonized the controls were more likely than those in the patients to be methicillin-susceptible S. aureus (MSSA) (74/84 [88.1%] versus 56/106 [52.8%], respectively; P < 0.001). In conclusion, the prevalence of S. aureus colonization among SSTI patients was high and often involved USA300 MRSA. The prevalence diminished somewhat with antimicrobial therapy but remained high at the 40-day follow-up visit. Control subjects were also colonized at a high prevalence but most often with a genetic background not associated with a clinical infection in this study. S. aureus is a commensal species and a pathogen. Plans for decolonization or eradication should take this distinction into account. Staphylococcus aureus is a commensal species that can be a formidable pathogen. It has been traditionally held that the primary site of colonization with the species is the nasopharynx (1) and repeatedly documented that 25% to 40% of the population is colonized in the nasopharynx by S. aureus. Colonization is asymptomatic, but colonized individuals may develop an active infection and do so more frequently than uncolonized individuals (2). The pathophysiological processes that result in infection among colonized individuals are poorly understood.Recently, the notion that the nasopharynx is the primary site of colonization has been challenged by the finding of a higher prevalence of colonization at other body sites, notably the oropharynx and even the inguinal area (3, 4). Indeed, many individuals with colonization in the throat or on the skin over the inguinal area have no colonization in the nasopharynx (5-8). Small studies in the United States and elsewhere have demonstrated that S. aureus, and specifically the methicillin-resistant S. aureus (MRSA) genetic background USA300 can be found elsewhere on the body (reviewed in reference 4).In ...

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“…In this study, 30 of the 55 (54.5%) S. aureus isolates were PVL-positive. Miller et al (3) in Torrance, California, also reported high PVL positivity (76%) in S. aureus causing SSTIs. However, other reports employing the same criteria showed lower prevalences of 15.1%, 15.79%, and 41.46% in Brazil, Egypt, and China, respectively (15,17,18).…”

Section: Discussionmentioning

confidence: 92%

“…Carriage of S. aureus is a risk factor for subsequent infection in various settings. Recent investigations suggest that nares-only screening may underestimate the prevalence of S. aureus colonization, and accurate determination requires sampling from other body sites (3). The spread of antibiotic resistance among strains of S. aureus has been dramatically elevated, such that methicillin-resistant S. aureus (MRSA) is recognized as a nosocomial pathogen worldwide.…”

Section: Introductionmentioning

confidence: 99%

Epidemiology and molecular characteristics of methicillin-resistantStaphylococcus aureus from skin and soft tissue infections in Shiraz, Iran

Mehrshad¹,

Haghkhah²,

Aghaei³

2017

Turk J Med Sci

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IntroductionAmong staphylococcal species, Staphylococcus aureus has been shown as a clinically relevant human pathogen, and in many individuals it may lead to asymptomatic colonization (1). Various infections from skin and soft tissue infections (SSTIs) to life-threatening infections like endovascular infections, pneumonia, septic arthritis, endocarditis, osteomyelitis, and sepsis are caused by this bacterium (2). Carriage of S. aureus is a risk factor for subsequent infection in various settings. Recent investigations suggest that nares-only screening may underestimate the prevalence of S. aureus colonization, and accurate determination requires sampling from other body sites (3). The spread of antibiotic resistance among strains of S. aureus has been dramatically elevated, such that methicillin-resistant S. aureus (MRSA) is recognized as a nosocomial pathogen worldwide. MRSA strains were once exclusively limited to hospital care; however, after outbreaks of infection in hospitals and health care facilities they have increasingly been detected among patients in the community who lack conventional risk factors for MRSA infection (4). MRSA represents a significant cause of morbidity and mortality in both hospital and community settings, which raises serious concerns in the treatment of staphylococcal infections; hence, the accurate and early determination of methicillin resistance is a necessity for the prognosis of S. aureus infections (5). Most MRSA and some methicillin-susceptible S. aureus (MSSA) isolates produce Panton-Valentine leukocidin (PVL), a pore-forming toxin consisting of two subunits S (LukE) and F (LukD) (6,7). It has become increasingly important as a virulence factor in necrotizing SSTIs such as furuncle and pneumonia (6). Both MSSA and community-associated MRSA can express PVL (8). Contrary to European countries (9), PVL-associated infections are increasing in some regions of Iran (10). This study aimed to assess the microbiological, epidemiological, and clinical features of purulent skin infections caused by S. aureus in Shiraz, southern Iran.Background/aim: Panton-Valentine leukocidin (PVL)-positive methicillin-resistant Staphylococcus aureus (MRSA) infections are increasing in some regions of Iran. The aim of the current study was to assess the epidemiology and molecular characteristics of S. aureus isolated from patients with skin infections in Shiraz, Iran.Materials and methods: Swab samples were obtained from patients admitted to the skin and burn units of hospitals. The medical records of each patient were collected via questionnaire. All staphylococcal isolates were collected and examined by conventional methods for detecting S. aureus strains. PCR was used to detect S. aureus harboring the mecA and pvl genes.Results: Out of 243 staphylococcal isolates, 55 (22.6%) S. aureus and 91 (37.4%) S. epidermidis were detected. Of the 45 patients, 21 (46.7%) were S. aureus carriers. The mecA gene was identified in 60% of S. aureus isolates, and the rest were sensitive to methicillin. Of the S. aur...

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Staphylococcus aureus Colonization Among Household Contacts of Patients With Skin Infections: Risk Factors, Strain Discordance, and Complex Ecology

Cited by 109 publications

References 58 publications

Asymptomatic Carriage of Sequence Type 398, spa Type t571 Methicillin-Susceptible Staphylococcus aureus in an Urban Jail: a Newly Emerging, Transmissible Pathogenic Strain

Asymptomatic Carriage of Sequence Type 398, spa Type t571 Methicillin-Susceptible Staphylococcus aureus in an Urban Jail: a Newly Emerging, Transmissible Pathogenic Strain

High Staphylococcus aureus Colonization Prevalence among Patients with Skin and Soft Tissue Infections and Controls in an Urban Emergency Department

Epidemiology and molecular characteristics of methicillin-resistantStaphylococcus aureus from skin and soft tissue infections in Shiraz, Iran

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