Staphylococcus aureus skin infection recurrences among household members: an examination of host, behavioral, and pathogen-level predictors.

Autor:	Miller LG; Division of Infectious Diseases, Harbor-University of California, Los Angeles (UCLA) Medical Center, and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance., Eells SJ; Division of Infectious Diseases, Harbor-University of California, Los Angeles (UCLA) Medical Center, and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance., David MZ; Section of Infectious Diseases and Global Health, Department of Medicine Section of Infectious Diseases, Department of Pediatrics, University of Chicago, Illinois., Ortiz N; Division of Infectious Diseases, Harbor-University of California, Los Angeles (UCLA) Medical Center, and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance., Taylor AR; Section of Infectious Diseases, Department of Pediatrics, University of Chicago, Illinois., Kumar N; Section of Infectious Diseases, Department of Pediatrics, University of Chicago, Illinois., Cruz D; Division of Infectious Diseases, Harbor-University of California, Los Angeles (UCLA) Medical Center, and Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance., Boyle-Vavra S; Section of Infectious Diseases, Department of Pediatrics, University of Chicago, Illinois., Daum RS; Section of Infectious Diseases, Department of Pediatrics, University of Chicago, Illinois.
Jazyk:	angličtina
Zdroj:	Clinical infectious diseases : an official publication of the Infectious Diseases Society of America [Clin Infect Dis] 2015 Mar 01; Vol. 60 (5), pp. 753-63. Date of Electronic Publication: 2014 Nov 26.
DOI:	10.1093/cid/ciu943
Abstrakt:	Background: Many patients suffer from recurrent Staphylococcus aureus infections, but there are few data examining recurrence predictors. Methods: We followed adults and children after treatment for S. aureus skin infections and their household contacts in Los Angeles and Chicago. We surveyed subjects for S. aureus body colonization, household fomite contamination, and behavioral and clinical factors at baseline and 3 and 6 months later. Using repeated measures modeling, we examined host, pathogen, behavioral, and clinical factors associated with recurrence. Results: Among 330 index subjects, 182 (55%) were infected with an isolate of the USA300 methicillin-resistant S. aureus (MRSA) genetic background. Recurrences occurred in 39% by month 3 and 51% by month 6. Among 588 household contacts, 10% reported a skin infection by month 3 and 13% by month 6. Among index subjects, recurrence was associated with (P < .05) Los Angeles site, diabetes, recent hospitalization, recent skin infection, recent cephalexin use, and household S. aureus or MRSA fomite contamination; recurrence was inversely associated with recent contact sports participation. In the multivariate model, independent predictors of recurrence in index patients were recent hospitalization, household MRSA fomite contamination, and lack of recent contact sports participation. Among household contacts, independent predictors of subsequent skin infection were Chicago site, antibiotic use in the prior year, and skin infection in the prior 3 months. Conclusions: In our longitudinal study, patients with a S. aureus skin infection were more likely to suffer a recurrence if household fomites were MRSA contaminated. Interventions to prevent recurrence may be enhanced by decontamination of household fomites. (© The Author 2014. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)
Databáze:	MEDLINE
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