title: Factors associated with persistent colonisation with methicillin-resistant Staphylococcus aureus.
abstract: We conducted a prospective cohort study between 1 January 2010 and 31 December 2012 at five adult and paediatric academic medical centres to identify factors associated with persistent methicillin-resistant Staphylococcus aureus (MRSA) colonisation. Adults and children presenting to ambulatory settings with a MRSA skin and soft tissue infection (i.e. index cases), along with household members, performed self-sampling for MRSA colonisation every 2 weeks for 6 months. Clearance of colonisation was defined as two consecutive negative sampling periods. Subjects without clearance by the end of the study were considered persistently colonised and compared with those who cleared colonisation. Of 243 index cases, 48 (19·8%) had persistent colonisation and 110 (45·3%) cleared colonisation without recurrence. Persistent colonisation was associated with white race (odds ratio (OR), 4·90; 95% confidence interval (CI), 1·38-17·40), prior MRSA infection (OR 3·59; 95% CI 1·05-12·35), colonisation of multiple sites (OR 32·7; 95% CI 6·7-159·3). Conversely, subjects with persistent colonisation were less likely to have been treated with clindamycin (OR 0·28; 95% CI 0·08-0·99). Colonisation at multiple sites is a risk factor for persistent colonisation and may require more targeted decolonisation efforts. The specific effect of clindamycin on MRSA colonisation needs to be elucidated.
authors.affiliation: Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine, University of Pennsylvania,Philadelphia,USA.
authors.forename: V C
authors.initials: VC
authors.lastname: Cluzet
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania,Philadelphia,USA.
authors.forename: J S
authors.identifier: 0000-0002-3076-3186
authors.initials: JS
authors.lastname: Gerber
authors.affiliation: Department of Pathology and Laboratory Medicine,Perelman School of Medicine, University of Pennsylvania,Philadelphia,USA.
authors.forename: I
authors.initials: I
authors.lastname: Nachamkin
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania,Philadelphia,USA.
authors.forename: S E
authors.initials: SE
authors.lastname: Coffin
authors.affiliation: Department of Environmental Health Sciences,Johns Hopkins Bloomberg School of Public Health,Baltimore, MD,USA.
authors.forename: M F
authors.initials: MF
authors.lastname: Davis
authors.affiliation: Division of Infectious Diseases,Penn State Hershey Medical Center,Hershey,USA.
authors.forename: K G
authors.initials: KG
authors.lastname: Julian
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania,Philadelphia,USA.
authors.forename: T E
authors.initials: TE
authors.lastname: Zaoutis
authors.affiliation: Department of Medicine,Massachusetts General Hospital, Harvard Medical School,Boston,USA.
authors.forename: J P
authors.initials: JP
authors.lastname: Metlay
authors.affiliation: Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine, University of Pennsylvania,Philadelphia,USA.
authors.forename: D R
authors.initials: DR
authors.lastname: Linkin
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania,Philadelphia,USA.
authors.forename: P
authors.initials: P
authors.lastname: Tolomeo
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania,Philadelphia,USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Wise
authors.affiliation: Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania,Philadelphia,USA.
authors.forename: W B
authors.initials: WB
authors.lastname: Bilker
authors.affiliation: Department of Pathology and Laboratory Medicine,Perelman School of Medicine, University of Pennsylvania,Philadelphia,USA.
authors.forename: B
authors.initials: B
authors.lastname: Hu
authors.affiliation: Division of Infectious Diseases,Department of Medicine,Perelman School of Medicine, University of Pennsylvania,Philadelphia,USA.
authors.forename: E
authors.initials: E
authors.lastname: Lautenbach
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D002981:Clindamycin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008712:Methicillin / Q000494:pharmacology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000502:physiology*; D008875:Middle Aged; D010414:Pennsylvania / Q000453:epidemiology; D015995:Prevalence; D011446:Prospective Studies; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D002981:Clindamycin; D008712:Methicillin
keywords: MRSA colonisation; MRSA skin and soft tissue infections; Methicillin-resistant Staphylococcus aureus (MRSA); persistent MRSA colonisation