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Risk Factors for Recurrent Colonization With Methicillin-Resistant Staphylococcus aureus in Community-Dwelling Adults and Children

Published online by Cambridge University Press:  14 April 2015

Valerie C. Cluzet ,
Jeffrey S. Gerber ,
Irving Nachamkin ,
Joshua P. Metlay ,
Theoklis E. Zaoutis ,
Meghan F. Davis ,
Kathleen G. Julian ,
Darren R. Linkin ,
Susan E. Coffin  and
David J. Margolis
...Show all authors
Valerie C. Cluzet*
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Jeffrey S. Gerber
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Irving Nachamkin
Affiliation:
Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Joshua P. Metlay
Affiliation:
Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
Theoklis E. Zaoutis
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Meghan F. Davis
Affiliation:
Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Kathleen G. Julian
Affiliation:
Division of Infectious Diseases, Penn State Hershey Medical Center, Hershey, Pennsylvania
Darren R. Linkin
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Philadelphia Veterans Administration Medical Center, Philadelphia, Pennsylvania
Susan E. Coffin
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Pediatrics, Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
David J. Margolis
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Judd E. Hollander
Affiliation:
Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Xiaoyan Han
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Rakesh D. Mistry
Affiliation:
Section of Emergency Medicine, Children’s Hospital Colorado, Aurora, Colorado
Laurence J. Gavin
Affiliation:
Department of Emergency Medicine, Penn Presbyterian Medical Center, Philadelphia, Pennsylvania
Pam Tolomeo
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Jacqueleen A. Wise
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Mary K. Wheeler
Affiliation:
Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Baofeng Hu
Affiliation:
Department of Pathology and Laboratory Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
Neil O. Fishman
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
David Royer
Affiliation:
Department of Biology, Lincoln University, Pennsylvania
Ebbing Lautenbach
Affiliation:
Division of Infectious Diseases, Department of Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
*
Address correspondence to Valerie Cluzet, MD, Division of Infectious Diseases, Department of Medicine, Hospital of the University of Pennsylvania, 3400 Spruce St, 3rd Fl, Silverstein Building, Ste E, Philadelphia, PA 19104 (valeriec@mail.med.upenn.edu).
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Abstract

OBJECTIVE

To identify risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization.

DESIGN

Prospective cohort study conducted from January 1, 2010, through December 31, 2012.

SETTING

Five adult and pediatric academic medical centers.

PARTICIPANTS

Subjects (ie, index cases) who presented with acute community-onset MRSA skin and soft-tissue infection.

METHODS

Index cases and all household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as 2 consecutive sampling periods with negative surveillance cultures. Recurrent colonization was defined as any positive MRSA surveillance culture after clearance. Index cases with recurrent MRSA colonization were compared with those without recurrence on the basis of antibiotic exposure, household demographic characteristics, and presence of MRSA colonization in household members.

RESULTS

The study cohort comprised 195 index cases; recurrent MRSA colonization occurred in 85 (43.6%). Median time to recurrence was 53 days (interquartile range, 36–84 days). Treatment with clindamycin was associated with lower risk of recurrence (odds ratio, 0.52; 95% CI, 0.29–0.93). Higher percentage of household members younger than 18 was associated with increased risk of recurrence (odds ratio, 1.01; 95% CI, 1.00–1.02). The association between MRSA colonization in household members and recurrent colonization in index cases did not reach statistical significance in primary analyses.

CONCLUSION

A large proportion of patients initially presenting with MRSA skin and soft-tissue infection will have recurrent colonization after clearance. The reduced rate of recurrent colonization associated with clindamycin may indicate a unique role for this antibiotic in the treatment of such infection.

Infect. Control Hosp. Epidemiol. 2015;36(7):786–793

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 7 , July 2015 , pp. 786 - 793
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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