Valerie C Cluzet1, Jeffrey S Gerber2, Irving Nachamkin3, Joshua P Metlay4, Theoklis E Zaoutis2, Meghan F Davis5, Kathleen G Julian6, David Royer7, Darren R Linkin8, Susan E Coffin2, David J Margolis9, Judd E Hollander10, Rakesh D Mistry11, Laurence J Gavin12, Pam Tolomeo13, Jacqueleen A Wise13, Mary K Wheeler13, Warren B Bilker14, Xiaoyan Han14, Baofeng Hu3, Neil O Fishman1, Ebbing Lautenbach15. 1. Division of Infectious Diseases, Department of Medicine. 2. Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology Department of Pediatrics Division of Infectious Diseases, Children's Hospital of Philadelphia. 3. Department of Pathology and Laboratory Medicine. 4. Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston. 5. Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland. 6. Division of Infectious Diseases, Penn State Hershey Medical Center. 7. Department of Biology, Lincoln University, Pennsylvania. 8. Division of Infectious Diseases, Department of Medicine Philadelphia Veterans Administration Medical Center. 9. Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology Department of Dermatology, Perelman School of Medicine, University of Pennsylvania. 10. Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia. 11. Section of Emergency Medicine, Children's Hospital Colorado, Aurora. 12. Department of Emergency Medicine, Penn Presbyterian Medical Center. 13. Center for Clinical Epidemiology and Biostatistics. 14. Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology. 15. Division of Infectious Diseases, Department of Medicine Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology.
Abstract
BACKGROUND: The duration of colonization and factors associated with clearance of methicillin-resistant Staphylococcus aureus (MRSA) after community-onset MRSA skin and soft-tissue infection (SSTI) remain unclear. METHODS: We conducted a prospective cohort study of patients with acute MRSA SSTI presenting to 5 adult and pediatric academic hospitals from 1 January 2010 through 31 December 2012. Index patients and household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as negative MRSA surveillance cultures during 2 consecutive sampling periods. A Cox proportional hazards regression model was developed to identify determinants of clearance of colonization. RESULTS: Two hundred forty-three index patients were included. The median duration of MRSA colonization after SSTI diagnosis was 21 days (95% confidence interval [CI], 19-24), and 19.8% never cleared colonization. Treatment of the SSTI with clindamycin was associated with earlier clearance (hazard ratio [HR], 1.72; 95% CI, 1.28-2.30; P < .001). Older age (HR, 0.99; 95% CI, .98-1.00; P = .01) was associated with longer duration of colonization. There was a borderline significant association between increased number of household members colonized with MRSA and later clearance of colonization in the index patient (HR, 0.85; 95% CI, .71-1.01; P = .06). CONCLUSIONS: With a systematic, regular sampling protocol, duration of MRSA colonization was noted to be shorter than previously reported, although 19.8% of patients remained colonized at 6 months. The association between clindamycin and shorter duration of colonization after MRSA SSTI suggests a possible role for the antibiotic selected for treatment of MRSA infection.
BACKGROUND: The duration of colonization and factors associated with clearance of methicillin-resistant Staphylococcus aureus (MRSA) after community-onset MRSA skin and soft-tissue infection (SSTI) remain unclear. METHODS: We conducted a prospective cohort study of patients with acute MRSA SSTI presenting to 5 adult and pediatric academic hospitals from 1 January 2010 through 31 December 2012. Index patients and household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as negative MRSA surveillance cultures during 2 consecutive sampling periods. A Cox proportional hazards regression model was developed to identify determinants of clearance of colonization. RESULTS: Two hundred forty-three index patients were included. The median duration of MRSA colonization after SSTI diagnosis was 21 days (95% confidence interval [CI], 19-24), and 19.8% never cleared colonization. Treatment of the SSTI with clindamycin was associated with earlier clearance (hazard ratio [HR], 1.72; 95% CI, 1.28-2.30; P < .001). Older age (HR, 0.99; 95% CI, .98-1.00; P = .01) was associated with longer duration of colonization. There was a borderline significant association between increased number of household members colonized with MRSA and later clearance of colonization in the index patient (HR, 0.85; 95% CI, .71-1.01; P = .06). CONCLUSIONS: With a systematic, regular sampling protocol, duration of MRSA colonization was noted to be shorter than previously reported, although 19.8% of patients remained colonized at 6 months. The association between clindamycin and shorter duration of colonization after MRSA SSTI suggests a possible role for the antibiotic selected for treatment of MRSA infection.
Authors: Marcela Rodriguez; Patrick G Hogan; Melissa Krauss; David K Warren; Stephanie A Fritz Journal: J Pediatric Infect Dis Soc Date: 2013-02-11 Impact factor: 3.164
Authors: Andrew E Simor; Elizabeth Phillips; Allison McGeer; Ana Konvalinka; Mark Loeb; H Rosalyn Devlin; Alex Kiss Journal: Clin Infect Dis Date: 2006-12-14 Impact factor: 9.079
Authors: M Garrouste-Orgeas; J F Timsit; H Kallel; A Ben Ali; M F Dumay; B Paoli; B Misset; J Carlet Journal: Infect Control Hosp Epidemiol Date: 2001-11 Impact factor: 3.254
Authors: Nicholas A Turner; Batu K Sharma-Kuinkel; Stacey A Maskarinec; Emily M Eichenberger; Pratik P Shah; Manuela Carugati; Thomas L Holland; Vance G Fowler Journal: Nat Rev Microbiol Date: 2019-04 Impact factor: 60.633
Authors: Erica S Shenoy; Hang Lee; Taige Hou; Winston Ware; Erin E Ryan; David C Hooper; Rochelle P Walensky Journal: Infect Control Hosp Epidemiol Date: 2016-03-29 Impact factor: 3.254
Authors: Justin Knox; Sean B Sullivan; Julia Urena; Maureen Miller; Peter Vavagiakis; Qiuhu Shi; Anne-Catrin Uhlemann; Franklin D Lowy Journal: JAMA Intern Med Date: 2016-06-01 Impact factor: 21.873
Authors: J H Shahbazian; P D Hahn; S Ludwig; J Ferguson; P Baron; A Christ; K Spicer; P Tolomeo; A M Torrie; W B Bilker; V C Cluzet; B Hu; K Julian; I Nachamkin; S C Rankin; D O Morris; E Lautenbach; M F Davis Journal: Appl Environ Microbiol Date: 2017-10-31 Impact factor: 4.792
Authors: Meghan F Davis; Ana M Misic; Daniel O Morris; John T Moss; Pam Tolomeo; Daniel P Beiting; Irving Nachamkin; Ebbing Lautenbach; Shelley C Rankin Journal: Vet Microbiol Date: 2015-09-24 Impact factor: 3.293