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Area Deprivation as a Risk Factor for Methicillin-resistant Staphylococcus aureus Infection in Pediatric Cystic Fibrosis

Oates, Gabriela R. PhD*,†; Harris, William T. MD*,†; Rowe, Steven M. MD, MSPH*,†,‡; Solomon, George M. MD†,‡; Dey, Suranjana MPH§; Zhu, Aowen PhD*; Hoover, Wynton C. MD*; Gutierrez, Hector H. MD*,†

The Pediatric Infectious Disease Journal: November 2019 - Volume 38 - Issue 11 - p e285–e289
doi: 10.1097/INF.0000000000002419
Original Studies
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Background: In US cystic fibrosis (CF) patients, methicillin-resistant Staphylococcus aureus (MRSA) rates have tripled in the past 2 decades. Known clinical risk factors include exposure to a healthcare setting, Pseudomonas aeruginosa and CF-related diabetes. Area-level socio-environmental exposures have not been evaluated. We explored the association of area-level deprivation with MRSA prevalence in a pediatric CF Center in the Southeastern United States.

Methods: Patients’ residential addresses were geocoded and linked to a composite Area Deprivation Index and Rural-Urban Commuting Area scores. The association of MRSA with Area Deprivation Index and Rural-Urban Commuting Area scores was evaluated using logistic regression with robust standard errors adjusted for sociodemographic covariates (age, sex, race, mother’s and father’s education and household income), clinical risk factors (P. aeruginosa, CF-related diabetes, hospitalizations and number of clinic visits) and clustering.

Results: The study included all pediatric patients (N = 231; mean age 12) at a single CF Center. MRSA was present in 44% of subjects. Higher area-level deprivation was correlated with rural residence, lack of parental college education and lower household income (P < 0.001 for each). In a multiple regression model fully adjusted for patient-level sociodemographic covariates, clinical risk factors and clustering, neighborhood deprivation was associated with more than 2-fold increase in the odds of having MRSA [OR 2.26 (1.14–4.45), P < 0.05].

Conclusions: Neighborhood deprivation is a risk factor for MRSA in pediatric CF, doubling the odds of infection. Community-level socioeconomic risk factors should be considered when developing prevention strategies and treatment plans for MRSA infection in pediatric patients with CF.

From the *Department of Pediatrics

Gregory Fleming James Cystic Fibrosis Research Center

Department of Medicine

§School of Medicine, University of Alabama, Birmingham, Alabama.

Accepted for publication June 21, 2019.

This study was supported by grants from the NIH (P30DK72482) and the CF Foundation (CC032).

The authors have no conflicts of interest to disclose.

G.R.O. conceived and designed the study, performed the analysis and interpreted the data, drafted the paper, approved the final version. W.T.H. interpreted the data, revised the draft critically for important intellectual content, approved the final version. S.M.R. interpreted the data, revised the draft critically for important intellectual content, approved the final version. G.M.S. facilitated the data collection, interpreted the data, revised the draft critically for important intellectual content, approved the final version. S.D. collected the data, contributed data or analysis tools, drafted the paper, approved the final version. A.Z. collected the data, contributed data or analysis tools, revised the draft critically, approved the final version. W.C.H. interpreted the data, revised the draft critically for important intellectual content, approved the final version. H.H.G. facilitated the data collection, interpreted the data, revised the draft critically for important intellectual content, approved the final version.

Address for correspondence: Gabriela Oates, PhD, Department of Pediatrics, Lowder 620, 1600 7th Avenue South, Birmingham, AL 35233-1711. E-mail: goates@uab.edu.

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.