Spatial relationships among public places frequented by families plagued by methicillin-resistant Staphylococcus aureus

Abstract

ObjectiveTo understand factors associated with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) acquisition and infection, we mapped public places (including personal service establishments, fitness centers, pools, schools, and daycares) visited by members of households affected by CA-MRSA skin and soft tissue infection.ResultsFrom January 2012 to October 2015, households of children with CA-MRSA SSTI in metropolitan St. Louis were enrolled in the HOME: Household Observation of MRSA in the Environment study. Addresses of public places visited within 3 months of enrollment were reported by 671 participants and were analyzed using a geographic information system (GIS). The Nearest Neighbor Tool in ArcGIS assessed clustering of public places within the study region. Public places were significantly clustered within the study area compared to the expected distance between locations (p < 0.001). Additionally, one-third (48/150) of participating households visited at least one public place in common with other households. No significant relationship between participants visiting the public places within 3 months of enrollment and subsequent colonization or SSTI were found. Understanding community behavior is critical to informing public health initiatives to reduce the prevalence of CA-MRSA infections.

Geographic surveillance of community associated MRSA infections in children using electronic health record data

“…4). The geographic boundary correlation with race makeup of a geographic area among children with CA-MRSA infections has not been previously reported; previous spatial analyses of CA-MRSA have focused primarily with MRSA colonization of environment or household members, or the hospital’s physical boundaries [52, 53].

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Comparative Effectiveness Study of Home-Based Interventions to Prevent CA-MRSA Infection Recurrence

“…This study’s results likely reflect unmeasured and uncontrolled variables, including application and effectiveness of bioburden reduction and microbial dynamics in an open system (44, 48, 49, 62). Additionally, there were significantly more MRSA+ wounds in EXP vs UC.…”

“…It is possible that high study rates of I&D plus oral antibiotics contributed to the lower than expected SSTI recurrence rate. One recruitment site, a large public hospital ED, predominated, which might explain a lower than expected recurrence (44) since treatments used there have been demonstrated effective in preventing treatment failure and SSTI recurrence (10, 17, 45, 46); thus suggesting a statistical floor effect hindered detection of differences in recurrence. Similarly, the low event rates of household and environmental outcomes reduced the study’s power to detect significant treatment effects.…”

“…The environmental persistence of S. aureus and as a colonizer despite active eradication efforts is well-documented and multifactorial (9, 44, 47-49) and likely modulated by interactions inside the household and surrounding community (10, 19, 50-53). Overall, the percent of households with no environmental contamination increased substantially (from 3.2% to 39.7%).…”

“…Note: No significant differences at baseline were observed between experimental and control groups at an alpha (2-tailed) = 0.05 Note: No significant differences at baseline were observed between experimental and control groups at an alpha (2-tailed) = 0.05 Table 1c. Occupational and Social Exposures for Study Participants at Baseline Total Experimental Usual Care OCCUPATIONAL EXPOSURE, n (%) Healthcare Employee 0 (0) (0) 0 (0) Nursing Home Employee 1 (0.8) 1 (1.6) 0 (0) Daycare Center Employee 2 (1.7) 1 (1.6) 1 (1.8) Correctional Facility Employee 1 (0.8) 1 (1.6) 0 (0) Animal Facility Employee 1 (0.8) 1 (1.6) 0 (0) ENVIRONMENTAL EXPOSURES, n (%) Handwashes per Day: 0-1 times 0 (0) 0 (0) 0 (0) 2-3 times 11 (9.2) 6 (9.5) 5 (8.9) 4-6 times 44 1 Prospective recurrence is defined as report of a new SSTI in the 6-month period following the initial (baseline) infection for which the participant was recruited. EHR-based outcomes were assessed at 6-months post-baseline and include the time period 12 months prior and 6 months after the baseline infection.…”