Risk Factors for Spread of Staphylococcus aureus in Prisons.

描述(申请人提供)：以社区为基础的金黄色葡萄球菌感染急剧上升，许多是由于耐甲氧西林金黄色葡萄球菌(MRSA)，已成为一个重要的公共卫生问题。这项提案将把重点放在囚犯身上，这是一个受到关注有限的高危群体。以前的研究检查了监狱爆发，但没有解决几个关键问题。这些问题包括金黄色葡萄球菌在监狱环境中的定植作用，金黄色葡萄球菌是如何引入监狱的，以及在非流行监狱环境中金黄色葡萄球菌的持久性和传播方式是什么。我们的长期目标是制定战略，防止和控制金黄色葡萄球菌在监狱系统内以及类似拥挤环境中的传播。我们的具体目标如下。1)我们将确定金黄色葡萄球菌菌株在监狱内的传播模式。将对囚犯进行横断面分析，以确定金黄色葡萄球菌定植和/或感染的流行率。将审查指定活动、环境暴露、囚犯接触及其空间接近在金黄色葡萄球菌传播中的作用。将检查与金黄色葡萄球菌特定克隆优势有关的细菌因素。2)我们将确定与监狱内临床感染发展相关的因素。一组培养证实金黄色葡萄球菌感染的囚犯将在嵌套病例对照研究中进行研究，以确定监狱中导致症状感染的因素。3)我们将确定在囚犯收容和释放时与定居和/或感染金黄色葡萄球菌有关的风险因素。新的监狱囚犯将接受面谈，培养他们的文化，并审查他们的监狱/监狱记录。将确定预测金黄色葡萄球菌在抵达时定植/感染的风险因素。因为每年有60万名囚犯被释放到社区，他们可以成为葡萄球菌传播的重要宿主。因此，还将评估释放时金黄色葡萄球菌的定殖率，并检查导致释放时定殖率的因素。这项提议提供了一个无与伦比的机会来检查监狱环境中金黄色葡萄球菌(包括耐甲氧西林金黄色葡萄球菌)的传播。监狱工作人员与调查人员正在进行的合作是独一无二的，方法方法的结合也是独一无二的，这将使我们能够审查监狱中结合空间特征的网络的作用。与公共卫生相关：这项提案将把重点放在囚犯身上，这是一个感染这些疾病的风险特别高的群体。这项研究将调查金黄色葡萄球菌是如何在该人群中传播的。

DESCRIPTION (provided by applicant): The dramatic rise in community-based S. aureus infections, many due to methicillin resistant S. aureus (MRSA), has become an important public health problem. This proposal will focus on prisoners, a high-risk group that has received limited attention. Prior studies have examined prison outbreaks without addressing several critical questions. These questions include the role of S. aureus colonization in the prison environment, how S. aureus is introduced into prisons and what the modalities of S. aureus persistence and transmission are in the nonepidemic prison setting. Our long term goal is to develop strategies that will prevent and control transmission of S. aureus within the prison system as well as in similar crowded environments. Our specific aims are the following. 1) We will identify patterns of S. aureus strain transmission within the prison. A cross-sectional analysis of prisoners will be performed to determine the prevalence of S. aureus colonization and/or infection. The role of assigned activities, environmental exposures, prisoner contacts and their spatial proximity in S. aureus transmission will be examined. Bacterial factors associated with the predominance of particular clones of S. aureus will be examined. 2) We will determine the factors associated with the development of clinical infections within the prison. A subset of inmates with culture proven S. aureus infections will be studied in a nested case-control study to determine factors contributing to symptomatic infection in the prison. 3) We will identify risk factors associated with colonization and/or infection with S. aureus at prisoner intake and at release. New prison inmates will be interviewed cultured and their prison/jail records reviewed. Risk factors predictive of S. aureus colonization/infection on arrival will be identified. Because >600,000 prisoners are released into the community each year, they can serve as an important reservoir for staphylococcal transmission. Therefore, S. aureus colonization at the time of release will also be assessed and factors contributing to colonization at release will be examined. This proposal provides an unparalleled opportunity to examine transmission of S. aureus (including MRSA) within the prison setting. The ongoing collaboration of prison personnel with the investigators is unique as is the integration of methodological approaches that will allow us to examine the roles of networks coupled with spatia characteristics in prisons. PUBLIC HEALTH RELEVANCE: This proposal will focus on prisoners, a group at particularly high risk for these infections. The study will investigate how S. aureus is transmitted in this population.