Major article
Prevalence, risk factors, and molecular epidemiology of methicillin-resistant Staphylococcus aureus among newly arrested men in Baltimore, Maryland

https://doi.org/10.1016/j.ajic.2008.05.005Get rights and content

Background

Outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) within prison populations seemingly attest to its spread within the corrections industry; however, the extent of MRSA colonization on arrest is unknown.

Methods

This study determined the prevalence and risk factors of S aureus on arrest. Nasal swabs from 602 newly arrested men were evaluated. Risk factors were assessed through self-report. Molecular characterization of each isolate was completed.

Results

The prevalence of S aureus nasal colonization was 40.4% (243/602). MRSA colonization was found in 15.8% (95/602) of the total population and in 39.1% (95/243) of the total S aureus isolates. Twenty-three skin infections were identified; of these, 11 (47.8%) were S aureus infections, with methicillin-susceptible S aureus (MSSA) in accounting for 3 cases (13.1%) and MRSA accounting for 8 cases (34.8%). In 2 cases (25%) of MRSA wound infection, the nasal colonizing strain was MSSA. By pulsed-field gel electrophoresis, 76 of 95 (80%) nasal isolates were found to be USA300 or related subtypes, with the other 19 (20%) being non-USA300 strains. The Panton-Valentine leukocidin gene was identified in 38 (97.4%) USA300 isolates and in 6 (31.6%) non-USA 300 isolates.

Conclusion

MRSA colonization is far greater in this sample than in the general public. USA300 subtypes are highly prevalent. History of previous arrest was not associated with increased MRSA prevalence. MRSA risk factors differed significantly between those with and without a history of previous arrest.

Section snippets

Study setting

The study was conducted in the Central Booking Intake Facility in Baltimore, MD from August to December 2006. Central Booking, the main intake center for persons arrested in Baltimore City, processes on average 175 new arrestees per day. The researcher was given access between 1 pm and 11 pm 5 days a week.

Subject selection

Subjects were eligible for participation by meeting the following criteria: arrested less than 24 hours before enrollment, male, age 21 years and older, and processed at the Central Booking

Demographics

A total of 678 persons were approached for participation. The enrolled sample comprised 602 arrested males, each of whom provided a nasal swab and wound culture if applicable. Demographic data also were collected on 67 of 75 (89.3%) persons who declined to participate but agreed to collection of demographic information. The remaining 8 subjects refused any participation. Demographic characteristics of the 2 groups were compared to evaluate bias in sample selection. The 2 samples were equivalent

Discussion

This is the first surveillance study to investigate S aureus and MRSA colonization at the time of arrest to identify the prevalence and risk profiles of persons entering a large city jail system. The prevalences of both S aureus (40.4%) and MRSA (15.8%) among nasal isolates were substantially greater than those estimated from the largest and most representative community analysis of the prevalence of MRSA colonization conducted to date, which noted S aureus and MRSA colonization prevalences of

References (33)

  • Y.H. Huang et al.

    Clonal spread of SCCmec type IV methicillin-resistant Staphylococcus aureus between community and hospital

    Clin Microbiol Infect

    (2007)
  • T. Baba et al.

    Genome and virulence determinants of high-virulence community-acquired MRSA

    Lancet

    (2002)
  • E. Charlebois et al.

    Population-based community prevalence of methicillin-resistant Staphylococcus aureus in the urban poor of San Francisco

    Clin Infect Dis

    (2003)
  • Centers for Disease Control and Prevention

    Outbreaks of community-associated MRSA skin infections—Los Angeles County, California, 2002–2003

    MMWR Morb Mortal Wkly Rep

    (2003)
  • Centers for Disease Control and Prevention

    MRSA infections among competitive sports participants—Colorado, Indiana, Pennsylvania and Los Angeles, 2000–2003

    MMWR Morb Mortal Wkly Rep

    (2003)
  • B.C. Herold et al.

    Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk

    JAMA

    (1998)
  • P.M. Adcock et al.

    MRSA in two child-care centers

    J Infect Dis

    (1998)
  • A.V. Groom et al.

    CA-MRSA in a rural American Indian community

    JAMA

    (2001)
  • H.C. Baggett et al.

    An outbreak of community-onset MRSA skin infections in southwestern Alaska

    Infect Control Hosp Epidemiol

    (2003)
  • A. Borer et al.

    CA-MRSA in institutionalized adults with developmental disabilities

    Emerg Infect Dis

    (2002)
  • N.F. Crum-Cianflone et al.

    Increasing rates of community-acquired methicillin-resistant Staphylococcus aureus infections among HIV-infected persons

    Int J STD AIDS

    (2007)
  • S. Bratu et al.

    A population-based study examining the emergence of community-associated methicillin-resistant Staphylococcus aureus UDA300 in New York City

    Ann Clin Microbiol Antimicrob

    (2006)
  • M.M. Mwangi et al.

    Tracking the in vivo evolution of multidrug resistance in Staphylococcus aureus by whole-genome sequencing

    Proc Natl Acad Sci U S A

    (2007)
  • L. Saiman et al.

    Hospital transmission of community-acquired methicillin-resistant Staphylococcus aureus among postpartum women

    Clin Infect Dis

    (2003)
  • S. Bratu et al.

    Community-associated methicillin-resistant Staphylococcus aureus in hospital nursery and maternity units

    Emerg Infec Dis

    (2005)
  • Centers for Disease Control and Prevention

    Methicillin-resistant Staphylococcus aureus infections in correctional facilities—Georgia, California, and Texas, 2001–2003

    MMWR Morb Mortal Wkly Rep

    (2003)
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