Program Schedule

299
Duration of Colonization with Methicillin-resistant Staphylococcus aureus and Determinants of More Rapid Clearance of Colonization

Session: Poster Abstract Session: MRSA and VRE
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC
Posters
  • duration_IDWeekposter_print.pdf (6.0 MB)
  • Background: Factors associated with duration of methicillin-resistant Staphylococcus aureus (MRSA) colonization in the community setting are unknown.  The objective of this study was to assess the duration of MRSA colonization and factors associated with termination of colonization among subjects presenting with MRSA acute skin and soft tissue infection (SSTI). 

    Methods: A prospective cohort study was conducted from January 1, 2010 through December 31, 2012 at five academic medical centers.  Patients presenting with acute SSTI (i.e. index cases) and their household members were followed with serial surveillance cultures for MRSA colonization every two weeks for six months.  Duration of colonization was calculated using a Kaplan-Meier estimate.  A Cox proportional hazards regression model was developed to identify factors associated with termination of colonization with MRSA.

    Results: Median duration of MRSA colonization among index cases was 36 days (inter-quartile range [IQR] 21-91 days). Fifty-three index cases (19.4%) remained colonized with MRSA at the end of the study period. Factors associated with more rapid termination of MRSA colonization included: treatment of the MRSA SSTI with clindamycin (adjusted hazard ratio (HR), 1.55; 95% confidence interval (CI), 1.16-2.07; P=0.003) and non-white race (HR, 1.43; 95% CI, 1.08-1.89; P=0.01). Neither presence of family members under the age of 18 nor MRSA colonization in household members at study entry were associated with duration of MRSA colonization (HR, 1.17; 95% CI, 0.87-1.56; P=0.30 and HR, 0.91 95% CI, 0.74-1.10; P=0.33, respectively).

    Conclusion: Among individuals with an acute MRSA SSTI, duration of colonization with MRSA was shorter than has been reported in other studies, due perhaps to a more systematic sampling approach; however, approximately 20% of subjects remained colonized at the end of six months. The association between clindamycin and shorter duration of MRSA colonization may indicate a unique role for this antibiotic in treatment of MRSA SSTI. Interestingly, presence of colonization in a household member was not significantly associated with duration of colonization. Future studies of household decolonization should look at the impact of this on duration of colonization in the index case.

    Valerie C. Cluzet, MD1, Jeffrey S. Gerber, MD, PhD2, Irving Nachamkin, DrPH, MPH3, Joshua Metlay, MD, PhD4, Theoklis Zaoutis, MD, MSCE5, Kathleen G. Julian, MD6, David Royer, PhD7, Darren R. Linkin, MD, MSCE8, Susan E. Coffin, MD, MPH9, David J. Margolis, MD, PhD1, Judd E. Hollander, MD1, Rakesh D. Mistry, MD, MS10, Laurence J. Gavin, MD1, Pam Tolomeo, MPH1, Jacqueleen Wise1, Mary K. Wheeler, MBE11, Warren Bilker, PhD5, Xiaoyan Han, MS11, Baofeng Hu1, Neil O. Fishman, MD1, Ebbing Lautenbach, MD, MPH, MSCE8 and The CDC Prenvention Epicenters Program, (1)University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, (2)Department of Pediatrics, Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (3)Department of Pathology and Laboratory Medicine, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, (4)Medicine, Harvard Medical School, Boston, MA, (5)Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Perelman School of Medicine, Philadelphia, PA, (6)Penn State Hershey Medical Center, Hershey, PA, (7)Lincoln University, Lincoln University, PA, (8)University of Pennsylvania School of Medicine, Philadelphia, PA, (9)Division of Infectious Diseases, The Children's Hospital of Philadelphia, Philadelphia, PA, (10)Children’s Hospital Colorado, Aurora, CO, (11)Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA

    Disclosures:

    V. C. Cluzet, None

    J. S. Gerber, None

    I. Nachamkin, None

    J. Metlay, None

    T. Zaoutis, Merck: Investigator, Research grant
    Merck: Consultant, Consulting fee
    Pfizer: Consultant, Consulting fee
    Astellas: Consultant, Consulting fee

    K. G. Julian, None

    D. Royer, None

    D. R. Linkin, None

    S. E. Coffin, None

    D. J. Margolis, None

    J. E. Hollander, None

    R. D. Mistry, None

    L. J. Gavin, None

    P. Tolomeo, None

    J. Wise, None

    M. K. Wheeler, None

    W. Bilker, None

    X. Han, None

    B. Hu, None

    N. O. Fishman, None

    E. Lautenbach, None

    See more of: MRSA and VRE
    See more of: Poster Abstract Session

    Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

    Sponsoring Societies:

    © 2014, idweek.org. All Rights Reserved.

    Follow IDWeek