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Pediatric Infectious Disease Journal:
doi: 10.1097/INF.0b013e31822256c3
Original Studies

Risk Factors for Household Transmission of Community-associated Methicillin-resistant Staphylococcus aureus

Nerby, Jessica M. MPH, CLS*; Gorwitz, Rachel MD, MPH†; Lesher, Lindsey MPH*; Juni, Billie MS‡; Jawahir, Selina BS‡; Lynfield, Ruth MD*; Harriman, Kathleen PhD, MPH*

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Abstract

Background: Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a community pathogen. Community-associated (CA) MRSA infections have occurred among multiple members of a household. We describe the incidence of and risk factors for MRSA colonization among household contacts of children with CA-MRSA infections.

Methods: MRSA-infected children <18 years of age who lacked established healthcare-associated MRSA risk factors were identified through surveillance at 12 Minnesota hospital laboratories. Nasal swab specimens and information on medical history and hygiene behaviors were collected from case-patients and enrolled household contacts during home visits. S. aureus isolates obtained from nasal cultures were screened for oxacillin resistance.

Results: In all, 236 households consisting of 236 case-patients and 712 household contacts were enrolled. Home visits were conducted on an average of 69 days after the onset of symptom in case-patients (range: 16–178 days). Twenty-nine (13%) case-patients and 82 (12%) household contacts had MRSA nasal colonization. Nasal MRSA colonization in ≥1 household contact occurred in 58 (25%) households. Household contacts who assisted the case-patient to bathe or who shared balms/ointments/lotion with the case-patient were more likely to be colonized (P < 0.01, P < 0.05), whereas those who reported using antibacterial versus nonantibacterial soap for hand washing were less likely to be colonized (P < 0.05) with MRSA clonally related to the case-patient infection isolate.

Conclusions: Only 13% of case-patients had MRSA nasal colonization on an average of 69 days after their initial MRSA infection. CA-MRSA colonization may be short-lived or may occur at non-nasal sites. One quarter of households had at least one household contact colonized with MRSA. Modifiable behaviors, such as sharing personal items, may contribute to transmission.

© 2011 by Lippincott Williams & Wilkins, Inc.

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