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Clin Infect Dis. 2015 May 15;60(10):1489-96. doi: 10.1093/cid/civ075. Epub 2015 Feb 3.

Duration of Colonization and Determinants of Earlier Clearance of Colonization With Methicillin-Resistant Staphylococcus aureus.

Author information

1
Division of Infectious Diseases, Department of Medicine.
2
Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology Department of Pediatrics Division of Infectious Diseases, Children's Hospital of Philadelphia.
3
Department of Pathology and Laboratory Medicine.
4
Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston.
5
Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.
6
Division of Infectious Diseases, Penn State Hershey Medical Center.
7
Department of Biology, Lincoln University, Pennsylvania.
8
Division of Infectious Diseases, Department of Medicine Philadelphia Veterans Administration Medical Center.
9
Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology Department of Dermatology, Perelman School of Medicine, University of Pennsylvania.
10
Department of Emergency Medicine, Thomas Jefferson University Hospital, Philadelphia.
11
Section of Emergency Medicine, Children's Hospital Colorado, Aurora.
12
Department of Emergency Medicine, Penn Presbyterian Medical Center.
13
Center for Clinical Epidemiology and Biostatistics.
14
Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology.
15
Division of Infectious Diseases, Department of Medicine Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology.

Abstract

BACKGROUND:

The duration of colonization and factors associated with clearance of methicillin-resistant Staphylococcus aureus (MRSA) after community-onset MRSA skin and soft-tissue infection (SSTI) remain unclear.

METHODS:

We conducted a prospective cohort study of patients with acute MRSA SSTI presenting to 5 adult and pediatric academic hospitals from 1 January 2010 through 31 December 2012. Index patients and household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as negative MRSA surveillance cultures during 2 consecutive sampling periods. A Cox proportional hazards regression model was developed to identify determinants of clearance of colonization.

RESULTS:

Two hundred forty-three index patients were included. The median duration of MRSA colonization after SSTI diagnosis was 21 days (95% confidence interval [CI], 19-24), and 19.8% never cleared colonization. Treatment of the SSTI with clindamycin was associated with earlier clearance (hazard ratio [HR], 1.72; 95% CI, 1.28-2.30; P < .001). Older age (HR, 0.99; 95% CI, .98-1.00; P = .01) was associated with longer duration of colonization. There was a borderline significant association between increased number of household members colonized with MRSA and later clearance of colonization in the index patient (HR, 0.85; 95% CI, .71-1.01; P = .06).

CONCLUSIONS:

With a systematic, regular sampling protocol, duration of MRSA colonization was noted to be shorter than previously reported, although 19.8% of patients remained colonized at 6 months. The association between clindamycin and shorter duration of colonization after MRSA SSTI suggests a possible role for the antibiotic selected for treatment of MRSA infection.

KEYWORDS:

MRSA colonization; MRSA decolonization; MRSA skin and soft-tissue infection; methicillin-resistant Staphylococcus aureus (MRSA)

PMID:
25648237
PMCID:
PMC4490328
DOI:
10.1093/cid/civ075
[Indexed for MEDLINE]
Free PMC Article

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