Body site colonization in patients with community-associated methicillin-resistant Staphylococcus aureus and other types of S. aureus skin infections

Yang, Eric; Tan, Jennifer; Eells, Samantha J.; Rieg, Günter; Tagudar, G.; Miller, Loren G.

doi:10.1111/j.1469-0691.2009.02836.x

Cited by 155 publications

(130 citation statements)

References 20 publications

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“…We considered whether diaper rash or younger age in patients wearing diapers were associated with CA-MRSA infection, but there were few diaper rashes in our study population and no relationship between age and infections in the groin or buttock area. The association between infections in the buttock or groin area and CA-MRSA may be due to other factors that facilitate colonization of MRSA over MSSA [30].…”

Section: Continuedmentioning

confidence: 99%

Epidemiologic Similarities in Pediatric Community-Associated Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus in the San Francisco Bay Area

Hsiang

Shiau

Nadle³

et al. 2012

Journal of the Pediatric Infectious Diseases Society

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Section: Continuedmentioning

confidence: 99%

Epidemiologic Similarities in Pediatric Community-Associated Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus in the San Francisco Bay Area

Hsiang

Shiau

Nadle³

et al. 2012

Journal of the Pediatric Infectious Diseases Society

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“…One possible explanation for this observation is that CA-MRSA strains might preferentially colonize at nonnasal body sites. The throat and groin have been implicated as important sites of S. aureus and MRSA colonization among certain patient populations (8,9), and other studies have suggested that colonization patterns of CA-MRSA strains may be distinct from those of health care-associated MRSA strains (10,11). The epidemiology of community-associated S. aureus colonization and its role in subsequent infection are not well characterized in the United States.…”

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confidence: 99%

Staphylococcus aureus Colonization and Strain Type at Various Body Sites among Patients with a Closed Abscess and Uninfected Controls at U.S. Emergency Departments

et al. 2015

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d Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) is a prevalent cause of skin and soft tissue infections (SSTI), but the association between CA-MRSA colonization and infection remains uncertain. We studied the carriage frequency at several body sites and the diversity of S. aureus strains from patients with and without SSTI. Specimens from the nares, throat, rectum, and groin of case subjects with a closed skin abscess (i.e., without drainage) and matched control subjects without a skin infection (n ‫؍‬ 147 each) presenting to 10 U.S. emergency departments were cultured using broth enrichment; wound specimens were cultured from abscess cases. Methicillin resistance testing and spa typing were performed for all S. aureus isolates. S. aureus was found in 85/147 (57.8%) of abscesses; 49 isolates were MRSA, and 36 were methicillin-susceptible S. aureus (MSSA). MRSA colonization was more common among cases (59/147; 40.1%) than among controls (27/147; 18.4%) overall (P < 0.001) and at each body site; no differences were observed for MSSA. S. aureus-infected subjects were usually (75/85) colonized with the infecting strain; among MRSA-infected subjects, this was most common in the groin. The CC8 lineage accounted for most of both infecting and colonizing isolates, although more than 16 distinct strains were identified. Nearly all MRSA infections were inferred to be USA300. There was more diversity among colonizing than infecting isolates and among those isolated from controls versus cases. CC8 S. aureus is a common colonizer of persons with and without skin infections. Detection of S. aureus colonization, and especially MRSA, may be enhanced by extranasal site culture. Staphylococcus aureus frequently causes invasive and life-threatening infections. While historically common in patients with significant health care exposure, community-associated methicillin-resistant S. aureus (CA-MRSA) has emerged as an important cause of disease (1). CA-MRSA is the most common cause of skin and soft tissue infections (SSTI) among people presenting to emergency departments (EDs) in much of the United States, most of which are caused by a single MRSA strain, pulsed-field type USA300 (2). S. aureus colonization with methicillin-susceptible S. aureus (MSSA) is common in the general population, especially in the anterior nares (3). Studies of MRSA pathogenesis in health care settings have demonstrated that nasal colonization typically precedes and is a risk factor for infection (4); therefore, prevention strategies in health care often involve decolonization, especially before invasive surgical procedures (5).Despite the increasing prevalence of CA-MRSA infections, nasal colonization with MRSA has been infrequently detected during CA-MRSA outbreaks or in nationally representative prevalence surveys (6, 7). One possible explanation for this observation is that CA-MRSA strains might preferentially colonize at nonnasal body sites. The throat and groin have been implicated as important sites of S. aureus and MRSA c...

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“…Indeed, many individuals with colonization in the throat or on the skin over the inguinal area have no colonization in the nasopharynx (5)(6)(7)(8). Small studies in the United States and elsewhere have demonstrated that S. aureus, and specifically the methicillin-resistant S. aureus (MRSA) genetic background USA300 can be found elsewhere on the body (reviewed in reference 4).…”

mentioning

confidence: 99%

High Staphylococcus aureus Colonization Prevalence among Patients with Skin and Soft Tissue Infections and Controls in an Urban Emergency Department

et al. 2015

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Staphylococcus aureus is a commensal species that can also be a formidable pathogen. In the United States, an epidemic of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) infections has been occurring for the last 15 years. In the context of a study in which we identified patients with skin and soft tissue infections (SSTIs) and randomized them to receive one of two antimicrobial treatment regimens, we assessed S. aureus colonization in the nares, throat, and perianal skin on the day of enrollment and 40 days after therapy. We compared the prevalence of colonization between the SSTI patients and an uninfected control population. A total of 144 subjects and 130 controls, predominantly African American, participated in this study, and 116 returned for a 40-day follow-up visit. Of the SSTI patients, 76% were colonized with S. aureus at enrollment, as were 65% of the controls. Patients were more likely than the controls to be colonized with USA300 MRSA (62/144 [43.1%] versus 11/130 [8.5%], respectively; P < 0.001). The nares were not the most common site of colonization. The colonization prevalence diminished somewhat after antibiotic treatment but remained high. The isolates that colonized the controls were more likely than those in the patients to be methicillin-susceptible S. aureus (MSSA) (74/84 [88.1%] versus 56/106 [52.8%], respectively; P < 0.001). In conclusion, the prevalence of S. aureus colonization among SSTI patients was high and often involved USA300 MRSA. The prevalence diminished somewhat with antimicrobial therapy but remained high at the 40-day follow-up visit. Control subjects were also colonized at a high prevalence but most often with a genetic background not associated with a clinical infection in this study. S. aureus is a commensal species and a pathogen. Plans for decolonization or eradication should take this distinction into account. Staphylococcus aureus is a commensal species that can be a formidable pathogen. It has been traditionally held that the primary site of colonization with the species is the nasopharynx (1) and repeatedly documented that 25% to 40% of the population is colonized in the nasopharynx by S. aureus. Colonization is asymptomatic, but colonized individuals may develop an active infection and do so more frequently than uncolonized individuals (2). The pathophysiological processes that result in infection among colonized individuals are poorly understood.Recently, the notion that the nasopharynx is the primary site of colonization has been challenged by the finding of a higher prevalence of colonization at other body sites, notably the oropharynx and even the inguinal area (3, 4). Indeed, many individuals with colonization in the throat or on the skin over the inguinal area have no colonization in the nasopharynx (5-8). Small studies in the United States and elsewhere have demonstrated that S. aureus, and specifically the methicillin-resistant S. aureus (MRSA) genetic background USA300 can be found elsewhere on the body (reviewed in reference 4).In ...

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Body site colonization in patients with community-associated methicillin-resistant Staphylococcus aureus and other types of S. aureus skin infections

Cited by 155 publications

References 20 publications

Epidemiologic Similarities in Pediatric Community-Associated Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus in the San Francisco Bay Area

Epidemiologic Similarities in Pediatric Community-Associated Methicillin-Resistant and Methicillin-Sensitive Staphylococcus aureus in the San Francisco Bay Area

Staphylococcus aureus Colonization and Strain Type at Various Body Sites among Patients with a Closed Abscess and Uninfected Controls at U.S. Emergency Departments

High Staphylococcus aureus Colonization Prevalence among Patients with Skin and Soft Tissue Infections and Controls in an Urban Emergency Department

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