Staphylococcus aureus Colonization Among Household Contacts of Patients With Skin Infections: Risk Factors, Strain Discordance, and Complex Ecology
Staphylococcus aureus Colonization Among Household Contacts of Patients With Skin Infections: Risk Factors, Strain Discordance, and Complex Ecology
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DOI：
10.1093/cid/cis213
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发表时间：
2012-06-01
影响因子：
11.8
通讯作者：
Daum, Robert S.
中科院分区：
文献类型：
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作者：
Miller, Loren G.;Eells, Samantha J.;Daum, Robert S.
背景。USA300耐甲氧西林金黄色葡萄球菌（MRSA）的遗传背景已迅速成为美国社区相关金黄色葡萄球菌感染的主要原因，然而，金黄色葡萄球菌家庭传播的流行病学特征尚不清楚。我们对洛杉矶和芝加哥患有金黄色葡萄球菌皮肤感染的成人和儿童及其家庭接触者进行了横断面研究。调查了受试者鼻腔、口咽和腹股沟区域金黄色葡萄球菌的定植情况以及金黄色葡萄球菌疾病的危险因素。所有分离株均进行遗传分型。我们纳入了1162人（350名索引患者和812名家庭成员）。最常见的感染分离物特征为ST8/SCCmec IV， PVL+ MRSA (USA300)（53%）。金黄色葡萄球菌定殖40%（137/350）的指数患者和50%（405/812）的家庭接触者。如果只进行鼻腔调查，将会遗漏48%的金黄色葡萄球菌和51%的MRSA定植者。65%的家庭存在金黄色葡萄球菌遗传背景，26%的家庭接触者的MRSA分离株与患者感染的MRSA菌株类型不一致。与指数菌株类型定植的家庭接触者独立相关的因素（P < 0.05）是近期皮肤感染、近期使用头孢氨苄和USA300遗传背景。在我们的研究人群中，与其他金黄色葡萄球菌遗传背景相比，USA300 MRSA在家庭成员中更具传染性。应变分布复杂；bbbb1金黄色葡萄球菌遗传背景存在于许多家庭。金黄色葡萄球菌的非殖民化策略可能需要解决鼻外定植和根除金黄色葡萄球菌遗传背景的后果，这些遗传背景通常与感染相关。
Background. The USA300 methicillin resistant Staphylococcus aureus (MRSA) genetic background has rapidly emerged as the predominant cause of community-associated S. aureus infections in the U. S. However, epidemiologic characteristics of S. aureus household transmission are poorly understood.Methods. We performed a cross-sectional study of adults and children with S. aureus skin infections and their household contacts in Los Angeles and Chicago. Subjects were surveyed for S. aureus colonization of the nares, oropharynx, and inguinal region and risk factors for S. aureus disease. All isolates underwent genetic typing.Results. We enrolled 1162 persons (350 index patients and 812 household members). The most common infection isolate characteristic was ST8/SCCmec IV, PVL+ MRSA (USA300) (53%). S. aureus colonized 40% (137/350) of index patients and 50% (405/812) of household contacts. A nares-only survey would have missed 48% of S. aureus and 51% of MRSA colonized persons. Sixty-five percent of households had >1 S. aureus genetic background identified and 26% of MRSA isolates in household contacts were discordant with the index patients' infecting MRSA strain type. Factors independently associated (P < .05) with the index strain type colonizing household contacts were recent skin infection, recent cephalexin use, and USA300 genetic background.Conclusions. In our study population, USA300 MRSA appeared more transmissible among household members compared with other S. aureus genetic backgrounds. Strain distribution was complex; >1 S. aureus genetic background was present in many households. S. aureus decolonization strategies may need to address extra-nasal colonization and the consequences of eradicating S. aureus genetic backgrounds infrequently associated with infection.