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Persistent Environmental Contamination with USA300 Methicillin-Resistant Staphylococcus aureus and Other Pathogenic Strain Types in Households with S. aureus Skin Infections

  • Samantha J. Eells (a1) (a2) (a3), Michael Z. David (a4) (a5), Alexis Taylor (a5), Nancy Ortiz (a1), Neha Kumar (a5), Julia Sieth (a5), Susan Boyle-Vavra (a5), Robert S. Daum (a5) (a6) and Loren G. Miller (a1) (a2) (a6)...

Abstract

Objective.

To understand the genotypic spectrum of environmental contamination of Staphylococcus aureus in households and its persistence

Design.

Prospective longitudinal cohort investigation.

Setting.

Index participants identified at 2 academic medical centers.

Participants.

Adults and children with S. aureus skin infections and their household contacts in Los Angeles and Chicago.

Methods.

Household fomites were surveyed for contamination at baseline and 3 months. All isolates underwent genetic typing.

Results.

We enrolled 346 households, 88% of which completed the 3-month follow-up visit. S. aureus environmental contamination was 49% at baseline and 51% at 3 months. Among households with a USA300 methicillin-resistant S. aureus (MRSA) body infection isolate, environmental contamination with an indistinguishable MRSA strain was 58% at baseline and 63% at 3 months. Baseline factors associated with environmental contamination by the index subject’s infection isolate were body colonization by any household member with the index subject’s infection isolate at baseline (odds ratio [OR], 10.93 [95% confidence interval (CI), 5.75–20.79]), higher housing density (OR, 1.47 [95% CI, 1.10–1.96]), and more frequent household fomite cleaning (OR, 1.62 [95% CI, 1.16–2.27]). Household environmental contamination with the index subject’s infection strain at 3 months was associated with USA300 MRSA and a synergistic interaction between baseline environmental contamination and body colonization by any household member with the index subject’s infection strain.

Conclusions.

We found that infecting S. aureus isolates frequently persisted environmentally in households 3 months after skin infection. Presence of pathogenic S. aureus strain type in the environment in a household may represent a persistent reservoir that places household members at risk of future infection.

Infect Control Hosp Epidemiol 2014;35(11):1373–1382

Copyright

Corresponding author

MPH, Division of Infectious Diseases, Clinical Outcomes Research Unit, Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, 1124 West Carson Street, Box 466, Torrance, CA 90502 (lgmiller@ucla.edu).

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