Abstract
Background
Staphylococcus aureus is the leading cause of skin and soft tissue infections (SSTIs). To develop interventions to prevent recurrent infections, household attributes and individual practices influencing S. aureus colonization must be discerned.
Methods
Households of healthy children with methicillin-resistant S. aureus (MRSA) SSTI (n = 150; 671 participants) were interviewed regarding health history, activities, and hygiene practices. S. aureus colonization was assessed in household members, and recovered isolates were typed by repetitive sequence-based PCR.
Results
The number of unique strain types in a household (median 1, range 0–7) correlated with the number of colonized individuals (p < 0.001). The MRSA infecting strain type colonized a household member in 57% of 91 households with an available infecting strain, and was the most common strain type recovered in 45% of these households. In multivariable models, household MRSA colonization burden (p < 0.001), sharing a bedroom with MRSA-colonized individuals (p = 0.03), renting dwelling (p = 0.048), and warmer seasons (p = 0.02) were associated with increased MRSA colonization. Increasing age (p = 0.02), bathing at least daily (p = 0.01), and antibacterial soap use (p = 0.03) correlated with reduced MRSA colonization.
Conclusions
This study identified practices that correlate with MRSA colonization, which will inform physician counseling and multifaceted interventions among MRSA-affected households to mitigate MRSA in the community.
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Acknowledgements
We thank Meghan Wallace and Angela Shupe for their assistance with molecular strain typing. For their assistance in patient referral, we acknowledge Mary Bixby, RN, Cardinal Glennon Children’s Hospital; Rachel Orscheln, MD, Washington University; Jennifer Seigel, RN, PNP, and the St. Louis Children’s Hospital Pediatric Ambulatory Wound Service staff; and Jane Garbutt, MB, ChB, Sherry Dodd, and the physicians and staff of participating Washington University Pediatric and Adolescent Ambulatory Research Consortium practices, including Mercy Clinic Pediatrics – Union and Washington, Johnson Pediatric Center, Heartland Pediatrics, Forest Park Pediatrics, Tots Thru Teens, Pediatric Healthcare Unlimited, Northwest Pediatrics, Esse Health Pediatric & Adolescent Medicine – Watson Road, Fenton Pediatrics, Blue Fish Pediatrics, and Southwest Pediatrics. We appreciate the thoughtful review of this manuscript by David Hunstad, MD. This work was supported by the Children’s Discovery Institute of Washington University and St. Louis Children’s Hospital [to S.A.F.]; National Institutes of Health/National Institute of Allergy and Infectious Diseases [grant number K23-AI091690 to S.A.F.]; the National Center for Advancing Translational Sciences at the National Institutes of Health [grant number UL1-TR002345 to S.A.F.]; the Agency for Healthcare Research and Quality [grant numbers R01-HS021736, R01-HS024269 to S.A.F.]; and the Burroughs Wellcome Foundation Investigators in the Pathogenesis of Infectious Disease Award [to J.B.W.]. The computational analysis was partially funded by DARPA Big Mechanism program under ARO contract W911NF1410333 [to A.R.]; by NIH grants R01HL122712, 1P50MH094267, U01HL108634 [to A.R.]; and a gift from Liz and Kent Dauten [to A.R.]. These funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.
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Mork, R.L., Hogan, P.G., Muenks, C.E. et al. Comprehensive modeling reveals proximity, seasonality, and hygiene practices as key determinants of MRSA colonization in exposed households. Pediatr Res 84, 668–676 (2018). https://doi.org/10.1038/s41390-018-0113-x
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DOI: https://doi.org/10.1038/s41390-018-0113-x
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