title: Risk factors for community-associated methicillin-resistant Staphylococcus aureus colonisation in a large metropolitan area in Greece: An epidemiological study using two case definitions.
abstract: The aim of this study was to evaluate the epidemiology and characteristics and to identify modifiable risk factors for community-associated (CA) MRSA colonisation in a region with high prevalence. A large patient population (n=2280) from two tertiary care centres in Athens (Greece) was evaluated. Demographics and potential risk factors for CA-MRSA colonisation were recorded prospectively. Presence of the Panton-Valentine Leukocidin (PVL) toxin and mecA gene was determined in all MRSA isolates. Two definitions for CA-MRSA were applied. Univariate and multivariate analyses to identify predictors of previously unknown CA-MRSA colonisation were performed. In total, 120 (5.3%) MRSA carriers were identified; in 67 the isolates were classified as CA-MRSA using criteria based on the CDC definition, compared with 35 based on a definition including PVL toxin positivity. Factors significantly associated with previously unknown CA-MRSA carriage (CDC definition) included being a child or adolescent (OR=3.6, 95% CI 1.5-8.6), belonging to the family of an index case (OR=2.4, 95% CI 1.2-4.8), and presence of any co-morbidity (OR=1.7, 95% CI 1.04-2.8) or chronic skin disease (OR=3.6, 95% CI=2.2-6.1). In multivariate analysis, presence of any co-morbidity was the only significant predictor (OR=4.9, 95% CI 1.07-22.5; P=0.04). No easily modifiable risk factor for previously unknown CA-MRSA colonisation was identified. The CDC-based epidemiological definition for CA-MRSA appears to be more sensitive in detection of CA-MRSA colonisation than a purely molecular definition based on presence of the PVL gene.
authors.affiliation: Fourth Department of Internal Medicine, Attikon General Hospital, Athens University Medical School, Athens, Greece.
authors.forename: Sotirios
authors.initials: S
authors.lastname: Tsiodras
authors.affiliation: First Department of Propaedeutic Medicine, Laikon General Hospital, Athens University Medical School, Athens, Greece.
authors.forename: George L
authors.initials: GL
authors.lastname: Daikos
authors.affiliation: Departments of Infectious Diseases and Microbiology, Royal Prince Alfred Hospital, Sydney, Australia; Infection Control Program, University of Geneva Hospitals and Medical Faculty, 4 rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland.
authors.forename: Andie
authors.initials: A
authors.lastname: Lee
authors.affiliation: Fourth Department of Internal Medicine, Attikon General Hospital, Athens University Medical School, Athens, Greece.
authors.forename: Diamantis
authors.initials: D
authors.lastname: Plachouras
authors.affiliation: Fourth Department of Internal Medicine, Attikon General Hospital, Athens University Medical School, Athens, Greece.
authors.forename: Anastasia
authors.initials: A
authors.lastname: Antoniadou
authors.affiliation: Fourth Department of Internal Medicine, Attikon General Hospital, Athens University Medical School, Athens, Greece.
authors.forename: Fani
authors.initials: F
authors.lastname: Ploiarchopoulou
authors.affiliation: First Department of Propaedeutic Medicine, Laikon General Hospital, Athens University Medical School, Athens, Greece.
authors.forename: Mina
authors.initials: M
authors.lastname: Psichogiou
authors.affiliation: Fourth Department of Internal Medicine, Attikon General Hospital, Athens University Medical School, Athens, Greece.
authors.forename: George
authors.initials: G
authors.lastname: Petrikkos
authors.affiliation: Infection Control Program, University of Geneva Hospitals and Medical Faculty, 4 rue Gabrielle Perret-Gentil, 1211 Geneva 14, Switzerland. Electronic address: stephan.harbarth@hcuge.ch.
authors.forename: Stephan
authors.initials: S
authors.lastname: Harbarth
keywords: Centers for Disease Control and Prevention; Co-morbidities; Community acquired; Hospital acquired; MRSA