Staphylococcus aureus Colonization in Children With Community-Associated Staphylococcus aureus Skin Infections and Their Household Contacts

Fritz, Stephanie A.; Hogan, Patrick G.; Hayek, Genevieve; Eisenstein, Kimberly A.; Rodriguez, Marcela; Krauss, Melissa J.; Garbutt, Jane; Fraser, Victoria J.

doi:10.1001/archpediatrics.2011.900

Cited by 62 publications

(62 citation statements)

References 38 publications

(35 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…This is also supported by a recent study which found relatively high rates of colonization with both MRSA and MSSA among household contacts of children with community-associated skin infection (30). Another limitation of this study is that findings may not be generalizable to all MRSA strains, since most were a single strain, USA300.…”

Section: Discussionsupporting

confidence: 64%

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

View full text Add to dashboard Cite

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...

show abstract

Section: Discussionsupporting

confidence: 64%

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

View full text Add to dashboard Cite

show abstract

“…MRSA surveillance included the assessment of only a single anatomical site, the patients' nares, which could have reduced sensitivity compared to multiple-site sampling. While many other studies of MRSA in the NICU have performed surveillance similarly (7,11,12), multiple-site sampling (nares, umbilicus, conjunctiva, groin) could have potentially improved detection (34,35). MRSA swabs were not incubated in broth, which might have resulted in reduced sensitivity.…”

Section: Discussionmentioning

confidence: 99%

Clinical and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit in the Decade following Implementation of an Active Detection and Isolation Program

et al. 2015

View full text Add to dashboard Cite

1, 2). The National Nosocomial Infections Surveillance System observed a Ͼ300% increase in the incidence of late-onset MRSA infections in NICUs, from 0.7 to 3.1 infections/10,000 patient days, between 1995 and 2004 (3). Unique host and environmental factors, including immature immune systems, high frequency of contact with health care providers (4), exposure to numerous invasive procedures, NICU overcrowding and understaffing (5, 6), and prolonged hospitalization (7), make NICU patients at especially high risk of becoming colonized and infected with MRSA. Since colonization with MRSA is a risk factor for development of MRSA infection, prevention of MRSA transmission within the NICU is critical (7,8). Many NICUs have implemented active detection and isolation (ADI) programs, which involve surveillance to rapidly identify affected patients, followed by cohorting and isolation with standard contact precautions, in attempts to prevent MRSA transmission and reduce infection rates.Several large NICUs have published reports regarding the clinical epidemiology of neonatal MRSA following implementation of surveillance, transmission prevention, and/or decolonization strategies (7,(9)(10)(11)(12). Some also incorporated molecular analyses in their studies, including antibiotic susceptibility testing (9, 10), strain typing (9, 11, 12), genotyping (9, 12), and/or Panton-Valentine leukocidin gene detection (9,12). No studies have comprehensively examined all of those molecular features of MRSA and additionally assessed the presence or absence of genes encoding proteins for a variety of staphylococcal toxins and potential virulence factors over an extensive time period following implementation of an ADI program in an NICU.In response to the appearance of MRSA in the NICU at YaleNew Haven Children's Hospital (YNHCH)

show abstract

“…This complex ecology has yet to be fully described. Nonnasal sites are colonized by MRSA (20)(21)(22)(23). Significant differences in colonization patterns between MRSA and MSSA have been reported.…”

Section: Discussionmentioning

confidence: 99%

“…Significant differences in colonization patterns between MRSA and MSSA have been reported. For example, MRSA has been shown to more frequently colonize inguinal folds than the anterior nares, while MSSA has been shown to more frequently colonize the anterior nares (20,21). Chlorhexidine use may impact these nonnasal anatomic sites and, subsequently, interfere with overall MRSA ecology.…”

Section: Discussionmentioning

confidence: 99%

Frequent Use of Chlorhexidine-Based Body Wash Associated with a Reduction in Methicillin-Resistant Staphylococcus aureus Nasal Colonization among Military Trainees

Millar

Chen

Schlett

et al. 2015

Antimicrob Agents Chemother

View full text Add to dashboard Cite

In a field-based trial among military trainees, personal hygiene measures, including chlorhexidine (CHG) body wash, did not prevent overall and methicillin-resistant Staphylococcus aureus (MRSA) skin and soft-tissue infections (SSTI). We conducted a secondary analysis of anterior nares cultures obtained during the trial to evaluate the impact of hygiene measures on Staphylococcus aureus colonization. A cluster-randomized trial for SSTI prevention was conducted among U.S. Army infantry trainees from May 2010 to January 2012. There were three study groups with incrementally increasing education-and hygiene-based components: standard (S), enhanced standard (ES), and CHG. Anterior nares cultures were obtained from participants to determine the prevalence of S. aureus colonization. A total of 1,706 participants (469 S, 597 ES, and 640 CHG) without SSTI were included in the colonization analysis. Of those randomized to the CHG group, 360 (56.3%) reported frequent use of body wash. Frequent use of body wash had no effect on overall S. aureus colonization (53.3% versus 56.8% among infrequent/nonusers; P ‫؍‬ 0.25). MRSA colonization prevalence was marginally lower among frequent users (2.5% versus 4.7%; P ‫؍‬ 0.07). In multivariable analysis, the odds of MRSA colonization were lower among frequent users (odds ratio [ Skin and soft-tissue infections (SSTI), especially those caused by methicillin-resistant Staphylococcus aureus (MRSA), have become increasingly common in communities. Individuals in congregate settings (e.g., athletes, inmates, and military personnel) are known to be at increased risk for SSTI (1-3). Among military personnel, infection rates are highest in trainees (4, 5). Because SSTI can interrupt training cycles and compromise operational readiness, effective SSTI prevention strategies for military populations are critically needed.In the absence of a vaccine for Staphylococcus aureus, hygienebased measures (e.g., hand washing, appropriate wound care, environmental disinfection, and patient education) comprise the current strategy for stemming SSTI outbreaks and preventing new cases of disease (1,3,6). As colonization has a demonstrated role in the pathogenesis and transmission of S. aureus, elimination of the carrier state with topical and systemic agents also has been employed as a prevention strategy (7-10). Nevertheless, the optimal method to prevent SSTI in congregate settings remains unknown.To date, two field-based randomized controlled trials for SSTI prevention, both using chlorhexidine gluconate (CHG), have been conducted among U.S. military trainees (11,12). Among recruits attending Officer Candidate School at Marine Corps Base, Quantico, Virginia, a thrice-weekly application of CHG-impregnated body cloths over a 6-week period did not reduce rates of SSTI (11). With respect to colonization, however, an analysis of nasal/axillary swabs showed a significant reduction in MRSA acquisition rates among CHG-randomized participants compared to the control (3.3% versus 6.5%; P ϭ 0.004) (13). More import...

show abstract

Staphylococcus aureus Colonization in Children With Community-Associated Staphylococcus aureus Skin Infections and Their Household Contacts

Cited by 62 publications

References 38 publications

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

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

Clinical and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus in a Neonatal Intensive Care Unit in the Decade following Implementation of an Active Detection and Isolation Program

Frequent Use of Chlorhexidine-Based Body Wash Associated with a Reduction in Methicillin-Resistant Staphylococcus aureus Nasal Colonization among Military Trainees

Contact Info

Product

Resources

About