Dataset Information

Prevalence of nasal colonization and strain concordance in patients with community-associated Staphylococcus aureus skin and soft-tissue infections.

ABSTRACT:

Objective

Determine the prevalence and relatedness of Staphylococcus aureus anterior nares colonization in individuals with community-associated staphylococcal skin and soft-tissue infection (SSTI).

Design

Observational cohort.

Setting

US Army soldiers undergoing infantry training.

Participants

Trainees who developed SSTI from May 2010 to January 2012.

Methods

Participants underwent anterior nares culture at the time of presentation for purulent SSTI. We determined the prevalence of S. aureus nasal colonization and strain relatedness between colonizing and clinical isolates with pulsed-field gel electrophoresis (PFGE).

Results

We enrolled 1,203 SSTI participants, of whom 508 had culture-confirmed S. aureus SSTI. Overall, 70% (357/508) were colonized with S. aureus. Phenotypically, concordant colonization was more common with methicillin-susceptible S. aureus (MSSA; 56%; 122/218) than methicillin-resistant S. aureus (MRSA) SSTI (41%; 118/290; P < .01). With PFGE, 48% (121 of 254) of clinical-colonizing pairs were indistinguishable, and concordant colonization was more common with MRSA (53%; 92/173) than MSSA SSTI (36%; 29/81; P < .01). Restricting analysis to concomitant MRSA-MRSA or MSSA-MSSA pairs, 92% (92/100) of MRSA SSTI were indistinguishable, and 40% (29/72) MSSA SSTI were indistinguishable (P < .01). All 92 MRSA pairs were USA300.

Conclusions

On the phenotypic level, concordant anterior nares colonization with incident staphylococcal SSTI is more common in MSSA than MRSA; however, the opposite is observed when accounting for molecular typing, and MRSA SSTI displays greater concordance. USA300 was responsible for strain concordance with MRSA SSTI. Studies are needed to examine the roles of nasal and extra-nasal carriage, colonization preceding infection, and increased virulence in the pathogenesis of MRSA SSTI.

Trial registration

ClinicalTrials.gov identifier: NCT01105767.

SUBMITTER: Ellis MW

PROVIDER: S-EPMC5824647 | biostudies-literature | 2014 Oct

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Prevalence of nasal colonization and strain concordance in patients with community-associated Staphylococcus aureus skin and soft-tissue infections.

Ellis Michael W MW Schlett Carey D CD Millar Eugene V EV Crawford Katrina B KB Cui Tianyuan T Lanier Jeffrey B JB Tribble David R DR

Infection control and hospital epidemiology 20140819 10

<h4>Objective</h4>Determine the prevalence and relatedness of Staphylococcus aureus anterior nares colonization in individuals with community-associated staphylococcal skin and soft-tissue infection (SSTI).<h4>Design</h4>Observational cohort.<h4>Setting</h4>US Army soldiers undergoing infantry training.<h4>Participants</h4>Trainees who developed SSTI from May 2010 to January 2012.<h4>Methods</h4>Participants underwent anterior nares culture at the time of presentation for purulent SSTI. We deter ...[more]

PMID: 25203178

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Project description:ImportanceThe longitudinal association among persistent Staphylococcus aureus colonization, household environmental contamination, and recurrent skin and soft tissue infection (SSTI) is largely unexplored to date.ObjectivesTo identify factors associated with persistent S aureus colonization and recurrent SSTI in households with children with community-associated methicillin-resistant S aureus (MRSA) SSTI.Design, setting, and participantsThis 12-month prospective cohort study included 150 children with community-associated MRSA SSTI, 542 household contacts, and 154 pets enrolled from January 3, 2012, through October 20, 2015. A total of 5 quarterly home visits were made to 150 households in the St Louis, Missouri, region. Statistical analysis was performed from September 18, 2018, to January 7, 2020.ExposuresCovariates used in S aureus strain persistence and interval SSTI models included S aureus colonization and contamination measures, personal hygiene and sharing habits, health history, activities external to the home, and household characteristics (eg, cleanliness, crowding, home ownership, and pets). Serial samples to detect S aureus were collected from household members at 3 anatomic sites, from pets at 2 anatomic sites, and from environmental surfaces at 21 sites.Main outcomes and measuresMolecular epidemiologic findings of S aureus isolates were assessed via repetitive-sequence polymerase chain reaction. Individual persistent colonization was defined as colonization by an identical strain for 2 consecutive samplings. Longitudinal, multivariable generalized mixed-effects logistic regression models were used to assess factors associated with persistent S aureus personal colonization, environmental contamination, and interval SSTI.ResultsAmong 692 household members in 150 households, 326 (47%) were male and 366 (53%) were female, with a median age of 14.82 years (range, 0.05-82.25 years). Of 540 participants completing all 5 samplings, 213 (39%) were persistently colonized with S aureus, most often in the nares and with the strain infecting the index patient at enrollment. Nine pets (8%) were persistently colonized with S aureus. Participants reporting interval intranasal mupirocin application were less likely to experience persistent colonization (odds ratio [OR], 0.44; 95% credible interval [CrI], 0.30-0.66), whereas increasing strain-specific environmental contamination pressure was associated with increased individual persistent colonization (OR, 1.17; 95% CrI, 1.06-1.30). Strains with higher colonization pressure (OR, 1.47; 95% CrI, 1.25-1.71) and MRSA strains (OR, 1.57; 95% CrI, 1.16-2.19) were more likely to persist. Seventy-six index patients (53%) and 101 household contacts (19%) reported interval SSTIs. Individuals persistently colonized with MRSA (OR, 1.56; 95% CrI, 1.17-2.11), those with a history of SSTI (OR, 2.55; 95% CrI, 1.88-3.47), and index patients (OR, 1.54; 95% CrI, 1.07-2.23) were more likely to report an interval SSTI.Conclusions and relevanceThe study findings suggest that recurrent SSTI is associated with persistent MRSA colonization of household members and contamination of environmental surfaces. Future studies may elucidate the effectiveness of specific combinations of personal decolonization and environmental decontamination efforts in eradicating persistent strains and mitigating recurrent SSTIs.

Dataset Information

Prevalence of nasal colonization and strain concordance in patients with community-associated Staphylococcus aureus skin and soft-tissue infections.

Objective

Design

Setting

Participants

Methods

Results

Conclusions

Trial registration

Publications

Prevalence of nasal colonization and strain concordance in patients with community-associated Staphylococcus aureus skin and soft-tissue infections.

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