title: Risk factors for recurrent colonization with methicillin-resistant Staphylococcus aureus in community-dwelling adults and children.
abstract: OBJECTIVE To identify risk factors for recurrent methicillin-resistant Staphylococcus aureus (MRSA) colonization. DESIGN Prospective cohort study conducted from January 1, 2010, through December 31, 2012. SETTING Five adult and pediatric academic medical centers. PARTICIPANTS Subjects (ie, index cases) who presented with acute community-onset MRSA skin and soft-tissue infection. METHODS Index cases and all household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as 2 consecutive sampling periods with negative surveillance cultures. Recurrent colonization was defined as any positive MRSA surveillance culture after clearance. Index cases with recurrent MRSA colonization were compared with those without recurrence on the basis of antibiotic exposure, household demographic characteristics, and presence of MRSA colonization in household members. RESULTS The study cohort comprised 195 index cases; recurrent MRSA colonization occurred in 85 (43.6%). Median time to recurrence was 53 days (interquartile range, 36-84 days). Treatment with clindamycin was associated with lower risk of recurrence (odds ratio, 0.52; 95% CI, 0.29-0.93). Higher percentage of household members younger than 18 was associated with increased risk of recurrence (odds ratio, 1.01; 95% CI, 1.00-1.02). The association between MRSA colonization in household members and recurrent colonization in index cases did not reach statistical significance in primary analyses. CONCLUSION A large proportion of patients initially presenting with MRSA skin and soft-tissue infection will have recurrent colonization after clearance. The reduced rate of recurrent colonization associated with clindamycin may indicate a unique role for this antibiotic in the treatment of such infection.
authors: 1Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Valerie C
authors: VC
authors: Cluzet
authors: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine, University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Jeffrey S
authors: JS
authors: Gerber
authors: 5Department of Pathology and Laboratory Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Irving
authors: I
authors: Nachamkin
authors: 6Department of Medicine,Massachusetts General Hospital,Harvard Medical School,Boston,Massachusetts.
authors: Joshua P
authors: JP
authors: Metlay
authors: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine, University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Theoklis E
authors: TE
authors: Zaoutis
authors: 7Department of Environmental Health Sciences,Johns Hopkins Bloomberg School of Public Health,Baltimore,Maryland.
authors: Meghan F
authors: MF
authors: Davis
authors: 8Division of Infectious Diseases,Penn State Hershey Medical Center,Hershey,Pennsylvania.
authors: Kathleen G
authors: KG
authors: Julian
authors: 1Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Darren R
authors: DR
authors: Linkin
authors: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine, University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Susan E
authors: SE
authors: Coffin
authors: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine, University of Pennsylvania,Philadelphia,Pennsylvania.
authors: David J
authors: DJ
authors: Margolis
authors: 11Department of Emergency Medicine,Thomas Jefferson University Hospital,Philadelphia,Pennsylvania.
authors: Judd E
authors: JE
authors: Hollander
authors: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine, University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Warren B
authors: WB
authors: Bilker
authors: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine, University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Xiaoyan
authors: X
authors: Han
authors: 12Section of Emergency Medicine,Children's Hospital Colorado,Aurora,Colorado.
authors: Rakesh D
authors: RD
authors: Mistry
authors: 13Department of Emergency Medicine,Penn Presbyterian Medical Center,Philadelphia,Pennsylvania.
authors: Laurence J
authors: LJ
authors: Gavin
authors: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine, University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Pam
authors: P
authors: Tolomeo
authors: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine, University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Jacqueleen A
authors: JA
authors: Wise
authors: 2Center for Clinical Epidemiology and Biostatistics,Perelman School of Medicine, University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Mary K
authors: MK
authors: Wheeler
authors: 5Department of Pathology and Laboratory Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Baofeng
authors: B
authors: Hu
authors: 1Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Neil O
authors: NO
authors: Fishman
authors: 14Department of Biology,Lincoln University,Pennsylvania.
authors: David
authors: D
authors: Royer
authors: 1Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine,University of Pennsylvania,Philadelphia,Pennsylvania.
authors: Ebbing
authors: E
authors: Lautenbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D005191:Family Characteristics; D005260:Female; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D017192:Skin Diseases, Bacterial / Q000382:microbiology*; D018461:Soft Tissue Infections / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin