title: Epidemiological and biological determinants of Staphylococcus aureus clinical infection in New York State maximum security prisons.
abstract: BACKGROUND
  Large outbreaks of Staphylococcus aureus (SA) infections have occurred in correctional facilities across the country. We aimed to define the epidemiological and microbiological determinants of SA infection in prisons to facilitate development of prevention strategies for this underserved population.
  
  
  METHODS
  We conducted a case-control study of SA infection at 2 New York State maximum security prisons. SA-infected inmates were matched with 3 uninfected controls. Subjects had cultures taken from sites of infection and colonization (nose and throat) and were interviewed via structured questionnaire. SA isolates were characterized by spa typing. Bivariate and multivariable analyses were conducted using conditional logistic regression.
  
  
  RESULTS
  Between March 2011 and January 2013, 82 cases were enrolled and matched with 246 controls. On bivariate analysis, the use of oral and topical antibiotics over the preceding 6 months was strongly associated with clinical infection (OR, 2.52; P < .001 and 4.38, P < .001, respectively). Inmates with clinical infection had 3.16 times the odds of being diabetic compared with inmates who did not have clinical infection (P < .001). Concurrent nasal and/or oropharyngeal colonization was also associated with an increased odds of infection (OR, 1.46; P = .002). Among colonized inmates, cases were significantly more likely to carry the SA clone spa t008 (usually representing the epidemic strain USA300) compared to controls (OR, 2.52; P = .01).
  
  
  CONCLUSIONS
  Several inmate characteristics were strongly associated with SA infection in the prison setting. Although many of these factors were likely present prior to incarceration, they may help medical staff identify prisoners for targeted prevention strategies.
authors: Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons.
authors: Benjamin A
authors: BA
authors: Miko
authors: Department of Epidemiology, Mailman School of Public Health, Columbia University.
authors: Montina
authors: M
authors: Befus
authors: Department of Epidemiology, Mailman School of Public Health, Columbia University Columbia University School of Nursing, New York.
authors: Carolyn T A
authors: CT
authors: Herzig
authors: Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons.
authors: Dhritiman V
authors: DV
authors: Mukherjee
authors: Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons.
authors: Zoltan L
authors: ZL
authors: Apa
authors: Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons.
authors: Ruo Yu
authors: RY
authors: Bai
authors: Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons.
authors: Joshua P
authors: JP
authors: Tanner
authors: New York State Department of Corrections and Community Supervision, Albany, New York.
authors: Dana
authors: D
authors: Gage
authors: New York State Department of Corrections and Community Supervision, Albany, New York.
authors: Maryann
authors: M
authors: Genovese
authors: New York State Department of Corrections and Community Supervision, Albany, New York.
authors: Carl J
authors: CJ
authors: Koenigsmann
authors: Department of Epidemiology, Mailman School of Public Health, Columbia University Columbia University School of Nursing, New York.
authors: Elaine L
authors: EL
authors: Larson
authors: Division of Infectious Diseases, Department of Medicine, College of Physicians and Surgeons.
authors: Franklin D
authors: FD
authors: Lowy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002353:Carrier State; D016022:Case-Control Studies; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D009666:Nose / Q000382:microbiology; D009960:Oropharynx / Q000382:microbiology; D015995:Prevalence; D011329:Prisoners / Q000706:statistics & numerical data*; D011330:Prisons; D012044:Regression Analysis; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology* / Q000517:prevention & control; D013211:Staphylococcus aureus / Q000235:genetics / Q000302:isolation & purification* / Q000472:pathogenicity; D011795:Surveys and Questionnaires; D013997:Time Factors; D055815:Young Adult
keywords: bacterial infections; incarceration; infection control; molecular epidemiology