Spatial relationships among public places frequented by families plagued by methicillin-resistant Staphylococcus aureus

Abstract

Objective: To understand factors associated with community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) acquisition and infection, we mapped public places (including personal service establishments, fitness centers, pools, schools, and daycares) visited by members of households affected by CA-MRSA skin and soft tissue infection.

Results: From January 2012 to October 2015, households of children with CA-MRSA SSTI in metropolitan St. Louis were enrolled in the HOME: Household Observation of MRSA in the Environment study. Addresses of public places visited within 3 months of enrollment were reported by 671 participants and were analyzed using a geographic information system (GIS). The Nearest Neighbor Tool in ArcGIS assessed clustering of public places within the study region. Public places were significantly clustered within the study area compared to the expected distance between locations (p < 0.001). Additionally, one-third (48/150) of participating households visited at least one public place in common with other households. No significant relationship between participants visiting the public places within 3 months of enrollment and subsequent colonization or SSTI were found. Understanding community behavior is critical to informing public health initiatives to reduce the prevalence of CA-MRSA infections.

Keywords: Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA); Geographic information systems (GIS); Staphylococcus aureus.

Fig. 1

a Frequency of use of the 28 most common public places visited by multiple households. The spatial relationship among all public places visited by more than one household as reported by participants in the study is depicted. Category of public place is indicated by the color of the circle. Size of the circles on the map reflects the number of households that had at least one member visit the location (range 2–6 households). Base map retrieved via ESRI ArcGIS from OpenStreetMap. b Display of public places visited by multiple households. The spatial relationship between select households visiting the same public places as reported by study participants is depicted. Circles represent households (each household ID represented by a capital letter). A line connecting two circles indicates that at least one member of the household ID in each circle visited the same public place. Category of public place is indicated by the color of the line. Brackets indicate that a member of the household visited the same location as a member of each household enclosed within the brackets (e.g., household B attended the same swimming pool as households D, J, and Y). Households T and W both visited two of the same nail salons (indicated by two purple lines between these households). Forty-eight households visited public places that were also visited by at least one other study household. Twenty-six households are included in the figure as they are the households with the most public locations in common