1887

Abstract

Homeless individuals face an elevated risk of methicillin-resistant (MRSA) infection. Identifying the prevalence and risk factors for MRSA nasal colonization may reduce infection risk. A cross-sectional study was conducted at a health clinic for homeless persons in Boston, MA, USA (=194). In-person interviews and nasal swab specimens were collected. MRSA isolates were genotyped using pulse-field gel electrophoresis (PFGE) and assessed for antibiotic susceptibility. The prevalence of MRSA nasal colonization was 8.3 %. Seventy-five percent of isolates reflected clonal similarity to USA300. USA100 (18.8 %) and USA500 (6.3 %) were also recovered. Resistance to erythromycin (81.3 %), levofloxacin (31.3 %) and clindamycin (23.1 %) was identified. Recent inpatient status, endocarditis, haemodialysis, heavy drinking, not showering daily and transience were positively associated with MRSA nasal colonization. Carriage of community-acquired MRSA strains predominated in this population, although nosocomial strains co-circulate. Attention to behavioural and hygiene-related risk factors, not typically included in MRSA prevention efforts, may reduce risk.

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2017-08-01
2024-04-25
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References

  1. Kluytmans-Vandenbergh MF, Kluytmans JA. Community-acquired methicillin-resistant Staphylococcus aureus: current perspectives. Clin Microbiol Infect 2006; 12:9–15 [View Article][PubMed]
    [Google Scholar]
  2. Dryden M. Complicated skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus: epidemiology, risk factors, and presentation. Surg Infect 2008; 9:s3–s10 [View Article][PubMed]
    [Google Scholar]
  3. David MZ, Daum RS. Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clin Microbiol Rev 2010; 23:616–687 [View Article][PubMed]
    [Google Scholar]
  4. Kowalski TJ, Berbari EF, Osmon DR. Epidemiology, treatment, and prevention of community-acquired methicillin-resistant Staphylococcus aureus infections. Mayo Clin Proc 2005; 80:1201–1208 [View Article][PubMed]
    [Google Scholar]
  5. Klein EY, Sun L, Smith DL, Laxminarayan R. The changing epidemiology of methicillin-resistant Staphylococcus aureus in the United States: a national observational study. Am J Epidemiol 2013; 177:666–674 [View Article][PubMed]
    [Google Scholar]
  6. Hidron AI, Kourbatova EV, Halvosa JS, Terrell BJ, Mcdougal LK et al. Risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital: emergence of community-associated MRSA nasal carriage. Clin Infect Dis 2005; 41:159–166 [View Article][PubMed]
    [Google Scholar]
  7. Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet 2014; 384:1529–1540 [View Article][PubMed]
    [Google Scholar]
  8. Beharry MS. Health issues in the homeless youth population. Pediatr Ann 2012; 41:154–156 [View Article][PubMed]
    [Google Scholar]
  9. D'Amore J, Hung O, Chiang W, Goldfrank L. The epidemiology of the homeless population and its impact on an urban emergency department. Acad Emerg Med 2001; 8:1051–1055 [View Article][PubMed]
    [Google Scholar]
  10. Landers TF, Harris RE, Wittum TE, Stevenson KB. Colonization with Staphylococcus aureus and methicillin-resistant S. aureus among a sample of homeless individuals, Ohio. Infect Control Hosp Epidemiol 2009; 30:801–803 [View Article][PubMed]
    [Google Scholar]
  11. Miller M, Cespedes C, Bhat M, Vavagiakis P, Klein RS et al. Incidence and persistence of Staphylococcus aureus nasal colonization in a community sample of HIV-infected and -uninfected drug users. Clin Infect Dis 2007; 45:343–346 [View Article][PubMed]
    [Google Scholar]
  12. Otter JA, French GL. Community-associated meticillin-resistant Staphylococcus aureus in injecting drug users and the homeless in south London. J Hosp Infect 2008; 69:198–200 [View Article][PubMed]
    [Google Scholar]
  13. Ottomeyer M, Graham CD, Legg AD, Cooper ES, Law CD et al. Prevalence of nasal colonization by methicillin-resistant Staphylococcus aureus in persons using a homeless shelter in Kansas city. Front Public Health 2016; 4:234 [CrossRef]
    [Google Scholar]
  14. Pan ES, Diep BA, Charlebois ED, Auerswald C, Carleton HA et al. Population dynamics of nasal strains of methicillin-resistant Staphylococcus aureus–and their relation to community-associated disease activity. J Infect Dis 2005; 192:811–818 [View Article][PubMed]
    [Google Scholar]
  15. Young DM, Harris HW, Charlebois ED, Chambers H, Campbell A et al. An epidemic of methicillin-resistant Staphylococcus aureus soft tissue infections among medically underserved patients. Arch Surg 2004; 139:947–953 [View Article][PubMed]
    [Google Scholar]
  16. Henry M, Cortes A, Morris S. The 2013 Annual Homeless Assessment Report (AHAR) to Congress Washington, DC: US Department of Housing and Urban Development; 2014
    [Google Scholar]
  17. Leibler JH, Zakhour CM, Gadhoke P, Gaeta JM. Zoonotic and vector-borne infections among urban homeless and marginalized people in the United States and Europe, 1990-2014. Vector Borne Zoonotic Dis 2016; 16:435–444 [View Article][PubMed]
    [Google Scholar]
  18. Donovan S, Shinseki EK. Homelessness is a public health issue. Am J Public Health 2013; 103:S180 [View Article][PubMed]
    [Google Scholar]
  19. Boivin JF, Roy E, Haley N, Galbaud du Fort G. The health of street youth: a canadian perspective. Can J Public Health 2005; 96:432–437[PubMed]
    [Google Scholar]
  20. Badiaga S, Raoult D, Brouqui P. Preventing and controlling emerging and reemerging transmissible diseases in the homeless. Emerg Infect Dis 2008; 14:1353–1359 [View Article][PubMed]
    [Google Scholar]
  21. Badiaga S, Menard A, Tissot Dupont H, Ravaux I, Chouquet D et al. Prevalence of skin infections in sheltered homeless. Eur J Dermatol 2005; 15:382–386[PubMed]
    [Google Scholar]
  22. Beijer U, Wolf A, Fazel S. Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis. Lancet Infect Dis 2012; 12:859–870 [View Article][PubMed]
    [Google Scholar]
  23. Cassone A. Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: a systematic review and meta-analysis. Pathog Glob Health 2012; 106:377 [View Article][PubMed]
    [Google Scholar]
  24. Raoult D, Foucault C, Brouqui P. Infections in the homeless. Lancet Infect Dis 2001; 1:77–84 [View Article][PubMed]
    [Google Scholar]
  25. Nyamathi A, Salem B, Marshall L, Idemundia F, Mata R et al. Substance use trends among younger vs. older homeless parolees. J Addict Dis 2014; 33:124–133 [View Article][PubMed]
    [Google Scholar]
  26. Ebright JR, Pieper B. Skin and soft tissue infections in injection drug users. Infect Dis Clin North Am 2002; 16:697–712 [View Article][PubMed]
    [Google Scholar]
  27. Bassetti S, Battegay M. Staphylococcus aureus infections in injection drug users: risk factors and prevention strategies. Infection 2004; 32:163–169 [View Article][PubMed]
    [Google Scholar]
  28. Vaneperen AS, Segreti J. Empirical therapy in methicillin-resistant Staphylococcus aureus infections: an up-to-date approach. J Infect Chemother 2016; 22:351–359 [View Article][PubMed]
    [Google Scholar]
  29. Safdar N, Bradley EA. The risk of infection after nasal colonization with Staphylococcus aureus. Am J Med 2008; 121:310–315 [View Article][PubMed]
    [Google Scholar]
  30. Ellis MW, Schlett CD, Millar EV, Crawford KB, Cui T et al. Prevalence of nasal colonization and strain concordance in patients with community-associated Staphylococcus aureus skin and soft-tissue infections. Infect Control Hosp Epidemiol 2014; 35:1251–1256 [View Article][PubMed]
    [Google Scholar]
  31. Clinical and Laboratory Standards Institute 2017; M100 from CLS. Available from http://clsi.org/m100/
  32. Goering RV. Pulsed field gel electrophoresis: a review of application and interpretation in the molecular epidemiology of infectious disease. Infect Genet Evol 2010; 10:866–875 [View Article][PubMed]
    [Google Scholar]
  33. Mcdougal LK, Steward CD, Killgore GE, Chaitram JM, Mcallister SK et al. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003; 41:5113–5120 [View Article][PubMed]
    [Google Scholar]
  34. National Institute on Alcohol Abuse and Alcoholism 2016; Drinking levels defined. Available from www.niaaa.nih.gov/alcohol-health/overview-alcohol-consumption/moderate-binge-drinking
  35. Gorwitz RJ, Kruszon-Moran D, Mcallister SK, Mcquillan G, Mcdougal LK et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis 2008; 197:1226–1234 [View Article][PubMed]
    [Google Scholar]
  36. Leung NS, Padgett P, Robinson DA, Brown EL. Prevalence and behavioural risk factors of Staphylococcus aureus nasal colonization in community-based injection drug users. Epidemiol Infect 2015; 143:2430–2439 [View Article][PubMed]
    [Google Scholar]
  37. Cooke FJ, Gkrania-Klotsas E, Howard JC, Stone M, Kearns AM et al. Clinical, molecular and epidemiological description of a cluster of community-associated methicillin-resistant Staphylococcus aureus isolates from injecting drug users with bacteraemia. Clin Microbiol Infect 2010; 16:921–926 [View Article][PubMed]
    [Google Scholar]
  38. Gilbert M, MacDonald J, Gregson D, Siushansian J, Zhang K et al. Outbreak in Alberta of community-acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness or incarceration. Can Med Assoc J 2006; 175:149–154 [View Article]
    [Google Scholar]
  39. Popovich KJ, Zawitz C, Weinstein RA, Grasso AE, Hotton AL et al. The intersecting epidemics of human immunodeficiency virus, community-associated methicillin-resistant Staphylococcus aureus, and incarceration. Open Forum Infect Dis 2015; 2:ofv148 [View Article][PubMed]
    [Google Scholar]
  40. Zervou FN, Zacharioudakis IM, Ziakas PD, Rich JD, Mylonakis E. Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus colonization in HIV infection: a meta-analysis. Clin Infect Dis 2014; 59:1302–1311 [View Article][PubMed]
    [Google Scholar]
  41. Lee CJ, Sankaran S, Mukherjee DV, Apa ZL, Hafer CA et al. Staphylococcus aureus oropharyngeal carriage in a prison population. Clin Infect Dis 2011; 52:775–778 [View Article][PubMed]
    [Google Scholar]
  42. Mukherjee DV, Herzig CT, Jeon CY, Lee CJ, Apa ZL et al. Prevalence and risk factors for Staphylococcus aureus colonization in individuals entering maximum-security prisons. Epidemiol Infect 2014; 142:484–493 [View Article][PubMed]
    [Google Scholar]
  43. Carrel M, Perencevich EN, David MZ. USA300 methicillin-resistant Staphylococcus aureus, United States, 2000-2013. Emerg Infect Dis 2015; 21:1973–1980 [View Article][PubMed]
    [Google Scholar]
  44. Klevens RM, Morrison MA, Fridkin SK, Reingold A, Petit S et al. Community-associated methicillin-resistant Staphylococcus aureus and healthcare risk factors. Emerg Infect Dis 2006; 12:1991–1993 [View Article][PubMed]
    [Google Scholar]
  45. Charlebois ED, Bangsberg DR, Moss NJ, Moore MR, Moss AR et al. Population-based community prevalence of methicillin-resistant Staphylococcus aureus in the urban poor of San Francisco. Clin Infect Dis 2002; 34:425–433 [View Article][PubMed]
    [Google Scholar]
  46. Gorwitz RJ. A review of community-associated methicillin-resistant Staphylococcus aureus skin and soft tissue infections. Pediatr Infect Dis J 2008; 27:1–7 [View Article][PubMed]
    [Google Scholar]
  47. Kumar R, Yadav BR, Singh RS. Antibiotic resistance and pathogenicity factors in Staphylococcus aureus isolated from mastitic Sahiwal cattle. J Biosci 2011; 36:175–188 [View Article][PubMed]
    [Google Scholar]
  48. Luteijn JM, Hubben GA, Pechlivanoglou P, Bonten MJ, Postma MJ. Diagnostic accuracy of culture-based and PCR-based detection tests for methicillin-resistant Staphylococcus aureus: a meta-analysis. Clin Microbiol Infect 2011; 17:146–154 [View Article][PubMed]
    [Google Scholar]
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