Skin infection in children colonized with community-associated methicillin-resistant Staphylococcus aureus

Department of Pediatrics, 660 South Euclid Avenue, Campus Box 8116, Washington University School of Medicine, St. Louis, MO, USA 63110.
The Journal of infection (Impact Factor: 4.44). 09/2009; 59(6):394-401. DOI: 10.1016/j.jinf.2009.09.001
Source: PubMed


The relationship between community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) nasal colonization and subsequent infection in children is unknown. We sought to define risk factors for skin and soft tissue infection (SSTI) in community children.
A prior study measured S. aureus nasal colonization prevalence for 1300 community children. To detect subsequent SSTI in these children or a household member, surveys were administered 6 and 12 months following enrollment.
SSTIs were reported by 56/708 (8.1%) respondents during the initial 6-month interval. SSTI developed in 6/26 (23%) initially colonized with MRSA, 16/194 (8%) with methicillin-sensitive S. aureus colonization, and 34/474 (7%) not colonized with S. aureus (MRSA vs. not MRSA, univariate analysis, p = 0.014). In multivariable analysis, factors associated with SSTI included history of SSTI in the child during the year preceding enrollment (p < 0.01) and SSTI in household contacts during the follow-up interval (p<0.01); MRSA nasal colonization approached statistical significance (p = 0.08).
In the current era of community MRSA transmission, SSTI is a disease of households, with recurrences in index cases and occurrences among household contacts. Children with MRSA colonization may be at risk for subsequent SSTI. Further study of MRSA transmission dynamics in households and preventive strategies should receive high priority.

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    • "In the United States, approximately 30% and 1.5% of the population are colonized with methicillin-susceptible S. aureus (MSSA) [43] and MRSA, respectively, [43–45] with the most important site for colonization being the anterior nares (nostrils) [46]. While colonization itself does not harm the host, it is a risk factor for developing subsequent symptomatic infections [43, 47]. These colonized healthy persons categorized as persistent carriage and intermittent carriage serve as S. aureus careers and are able to transmit the bacterium to susceptible persons [46]. "
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    • "Expanded studies are necessary to trace the origin of various genotypes of S. aureus that infect human skin. The significance of nasal carriage of S. aureus as risk factor for human skin infection has been reported previously (42, 43). Tulloch (1954) reported that Staphylococci isolated from skin lesions in patients with chronic Staphylococcal skin infections were of the same phage-type as the Staphylococci isolated from anterior nares of the patients (44). "
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