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. 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

Valerie C Cluzet  1 , Jeffrey S Gerber  2 , Irving Nachamkin  3 , Joshua P Metlay  4 , Theoklis E Zaoutis  2 , Meghan F Davis  5 , Kathleen G Julian  6 , David Royer  7 , Darren R Linkin  8 , Susan E Coffin  2 , David J Margolis  9 , Judd E Hollander  10 , Rakesh D Mistry  11 , Laurence J Gavin  12 , Pam Tolomeo  13 , Jacqueleen A Wise  13 , Mary K Wheeler  13 , Warren B Bilker  14 , Xiaoyan Han  14 , Baofeng Hu  3 , Neil O Fishman  1 , Ebbing Lautenbach  15
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Duration of Colonization and Determinants of Earlier Clearance of Colonization With Methicillin-Resistant Staphylococcus aureus

Valerie C Cluzet et al. Clin Infect Dis. .

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).

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Figures

Figure 1.
Figure 1.
Flow chart for study subjects. Abbreviation: MRSA, methicillin-resistant Staphylococcus aureus.
Figure 2.
Figure 2.
Kaplan–Meier curve of duration of colonization with methicillin-resistant Staphylococcus aureus (MRSA) after diagnosis and treatment of MRSA skin and soft-tissue infection.
Figure 3.
Figure 3.
Kaplan–Meier curve of duration of colonization with methicillin-resistant Staphylococcus aureus (MRSA) after confirmation of MRSA carriage.
See this image and copyright information in PMC

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