Duration of colonization and determinants of earlier clearance of colonization with methicillin-resistant staphylococcus aureus

Valerie C. Cluzet, Jeffrey S. Gerber, Irving Nachamkin, Joshua P. Metlay, Theoklis E. Zaoutis, Meghan F. Davis, Kathleen G. Julian, David Royer, Darren R. Linkin, Susan E. Coffin, David J. Margolis, Judd E. Hollander, Rakesh D. Mistry, Laurence J. Gavin, Pam Tolomeo, Jacqueleen A. Wise, Mary K. Wheeler, Warren B. Bilker, Xiaoyan Han, Baofeng HuNeil O. Fishman, Ebbing Lautenbach

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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.

Original languageEnglish (US)
Pages (from-to)1489-1496
Number of pages8
JournalClinical Infectious Diseases
Volume60
Issue number10
DOIs
StatePublished - May 15 2015

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Methicillin-Resistant Staphylococcus aureus
Soft Tissue Infections
Skin
Confidence Intervals
Clindamycin
Pediatric Hospitals
Proportional Hazards Models
Cohort Studies
Prospective Studies
Anti-Bacterial Agents
Therapeutics

All Science Journal Classification (ASJC) codes

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Cluzet, V. C., Gerber, J. S., Nachamkin, I., Metlay, J. P., Zaoutis, T. E., Davis, M. F., ... Lautenbach, E. (2015). Duration of colonization and determinants of earlier clearance of colonization with methicillin-resistant staphylococcus aureus. Clinical Infectious Diseases, 60(10), 1489-1496. https://doi.org/10.1093/cid/civ075
Cluzet, Valerie C. ; Gerber, Jeffrey S. ; Nachamkin, Irving ; Metlay, Joshua P. ; Zaoutis, Theoklis E. ; Davis, Meghan F. ; Julian, Kathleen G. ; Royer, David ; Linkin, Darren R. ; Coffin, Susan E. ; Margolis, David J. ; Hollander, Judd E. ; Mistry, Rakesh D. ; Gavin, Laurence J. ; Tolomeo, Pam ; Wise, Jacqueleen A. ; Wheeler, Mary K. ; Bilker, Warren B. ; Han, Xiaoyan ; Hu, Baofeng ; Fishman, Neil O. ; Lautenbach, Ebbing. / Duration of colonization and determinants of earlier clearance of colonization with methicillin-resistant staphylococcus aureus. In: Clinical Infectious Diseases. 2015 ; Vol. 60, No. 10. pp. 1489-1496.
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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.",
author = "Cluzet, {Valerie C.} and Gerber, {Jeffrey S.} and Irving Nachamkin and Metlay, {Joshua P.} and Zaoutis, {Theoklis E.} and Davis, {Meghan F.} and Julian, {Kathleen G.} and David Royer and Linkin, {Darren R.} and Coffin, {Susan E.} and Margolis, {David J.} and Hollander, {Judd E.} and Mistry, {Rakesh D.} and Gavin, {Laurence J.} and Pam Tolomeo and Wise, {Jacqueleen A.} and Wheeler, {Mary K.} and Bilker, {Warren B.} and Xiaoyan Han and Baofeng Hu and Fishman, {Neil O.} and Ebbing Lautenbach",
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Cluzet, VC, Gerber, JS, Nachamkin, I, Metlay, JP, Zaoutis, TE, Davis, MF, Julian, KG, Royer, D, Linkin, DR, Coffin, SE, Margolis, DJ, Hollander, JE, Mistry, RD, Gavin, LJ, Tolomeo, P, Wise, JA, Wheeler, MK, Bilker, WB, Han, X, Hu, B, Fishman, NO & Lautenbach, E 2015, 'Duration of colonization and determinants of earlier clearance of colonization with methicillin-resistant staphylococcus aureus', Clinical Infectious Diseases, vol. 60, no. 10, pp. 1489-1496. https://doi.org/10.1093/cid/civ075

Duration of colonization and determinants of earlier clearance of colonization with methicillin-resistant staphylococcus aureus. / Cluzet, Valerie C.; Gerber, Jeffrey S.; Nachamkin, Irving; Metlay, Joshua P.; Zaoutis, Theoklis E.; Davis, Meghan F.; Julian, Kathleen G.; Royer, David; Linkin, Darren R.; Coffin, Susan E.; Margolis, David J.; Hollander, Judd E.; Mistry, Rakesh D.; Gavin, Laurence J.; Tolomeo, Pam; Wise, Jacqueleen A.; Wheeler, Mary K.; Bilker, Warren B.; Han, Xiaoyan; Hu, Baofeng; Fishman, Neil O.; Lautenbach, Ebbing.

In: Clinical Infectious Diseases, Vol. 60, No. 10, 15.05.2015, p. 1489-1496.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Duration of colonization and determinants of earlier clearance of colonization with methicillin-resistant staphylococcus aureus

AU - Cluzet, Valerie C.

AU - Gerber, Jeffrey S.

AU - Nachamkin, Irving

AU - Metlay, Joshua P.

AU - Zaoutis, Theoklis E.

AU - Davis, Meghan F.

AU - Julian, Kathleen G.

AU - Royer, David

AU - Linkin, Darren R.

AU - Coffin, Susan E.

AU - Margolis, David J.

AU - Hollander, Judd E.

AU - Mistry, Rakesh D.

AU - Gavin, Laurence J.

AU - Tolomeo, Pam

AU - Wise, Jacqueleen A.

AU - Wheeler, Mary K.

AU - Bilker, Warren B.

AU - Han, Xiaoyan

AU - Hu, Baofeng

AU - Fishman, Neil O.

AU - Lautenbach, Ebbing

PY - 2015/5/15

Y1 - 2015/5/15

N2 - 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.

AB - 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.

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U2 - 10.1093/cid/civ075

DO - 10.1093/cid/civ075

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C2 - 25648237

AN - SCOPUS:84929190247

VL - 60

SP - 1489

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JO - Clinical Infectious Diseases

JF - Clinical Infectious Diseases

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