Clonal expansion of community-associated meticillin-resistant Staphylococcus aureus (MRSA) in people who inject drugs (PWID): prevalence, risk factors and molecular epidemiology, Bristol, United Kingdom, 2012 to 2017.
Adult
Bacteremia
/ epidemiology
Community-Acquired Infections
/ epidemiology
Cross-Sectional Studies
Female
Humans
Male
Methicillin-Resistant Staphylococcus aureus
/ drug effects
Molecular Epidemiology
Molecular Typing
Phylogeny
Prevalence
Retrospective Studies
Risk Factors
Staphylococcal Infections
/ epidemiology
Substance Abuse, Intravenous
/ complications
Surveys and Questionnaires
United Kingdom
/ epidemiology
Whole Genome Sequencing
Community acquired infections
Community acquired infections epidemiology
Community acquired infections microbiology
Drug users
Injecting drug use
Intravenous
Intravenous: complications
Intravenous: microbiology
MRSA
Meticillin-Resistant Staphylococcus aureus
Sepsis
Sequence Analysis, DNA
Staphylococcal Infections/transmission
Staphylococcal epidemiology
Substance Abuse
Substance-Related Disorders/complications
Substance-Related Disorders/microbiology
United Kingdom
Whole-genome sequencing
Journal
Euro surveillance : bulletin Europeen sur les maladies transmissibles = European communicable disease bulletin
ISSN: 1560-7917
Titre abrégé: Euro Surveill
Pays: Sweden
ID NLM: 100887452
Informations de publication
Date de publication:
Mar 2019
Mar 2019
Historique:
entrez:
4
4
2019
pubmed:
4
4
2019
medline:
16
7
2020
Statut:
ppublish
Résumé
In 2015, Bristol (South West England) experienced a large increase in cases of meticillin-resistant We aimed to characterise and estimate the prevalence of MRSA colonisation among PWID in Bristol and test evidence of a clonal outbreak. PWID recruited through an unlinked-anonymous community survey during 2016 completed behavioural questionnaires and were screened for MRSA. Univariable logistic regression examined associations with MRSA colonisation. Whole-genome sequencing used lineage-matched MRSA isolates, comparing PWID (screening and retrospective bacteraemia samples from 2012-2017) with non-PWID (Bristol screening) in Bristol and national reference laboratory database samples. The MRSA colonisation prevalence was 8.7% (13/149) and was associated with frequently injecting in public places (odds ratio (OR): 5.5; 95% confidence interval (CI):1.34-22.70), recent healthcare contact (OR: 4.3; 95% CI: 1.34-13.80) and injecting in groups of three or more (OR: 15.8; 95% CI: 2.51-99.28). People reporting any one of: injecting in public places, injection site skin and soft tissue infection or hospital contact accounted for 12/13 MRSA positive cases (sensitivity 92.3%; specificity 51.5%). Phylogenetic analysis identified a dominant clade associated with infection and colonisation among PWID in Bristol belonging to ST5-SCCmecIVg. MRSA colonisation in Bristol PWID is substantially elevated compared with general population estimates and there is evidence of clonal expansion, community-based transmission and increased infection risk related to the colonising strain. Targeted interventions, including community screening and suppression therapy, education and basic infection control are needed to reduce MRSA infections in PWID.
Sections du résumé
BACKGROUND
BACKGROUND
In 2015, Bristol (South West England) experienced a large increase in cases of meticillin-resistant
AIM
OBJECTIVE
We aimed to characterise and estimate the prevalence of MRSA colonisation among PWID in Bristol and test evidence of a clonal outbreak.
METHODS
METHODS
PWID recruited through an unlinked-anonymous community survey during 2016 completed behavioural questionnaires and were screened for MRSA. Univariable logistic regression examined associations with MRSA colonisation. Whole-genome sequencing used lineage-matched MRSA isolates, comparing PWID (screening and retrospective bacteraemia samples from 2012-2017) with non-PWID (Bristol screening) in Bristol and national reference laboratory database samples.
RESULTS
RESULTS
The MRSA colonisation prevalence was 8.7% (13/149) and was associated with frequently injecting in public places (odds ratio (OR): 5.5; 95% confidence interval (CI):1.34-22.70), recent healthcare contact (OR: 4.3; 95% CI: 1.34-13.80) and injecting in groups of three or more (OR: 15.8; 95% CI: 2.51-99.28). People reporting any one of: injecting in public places, injection site skin and soft tissue infection or hospital contact accounted for 12/13 MRSA positive cases (sensitivity 92.3%; specificity 51.5%). Phylogenetic analysis identified a dominant clade associated with infection and colonisation among PWID in Bristol belonging to ST5-SCCmecIVg.
CONCLUSIONS
CONCLUSIONS
MRSA colonisation in Bristol PWID is substantially elevated compared with general population estimates and there is evidence of clonal expansion, community-based transmission and increased infection risk related to the colonising strain. Targeted interventions, including community screening and suppression therapy, education and basic infection control are needed to reduce MRSA infections in PWID.
Identifiants
pubmed: 30940316
doi: 10.2807/1560-7917.ES.2019.24.13.1800124
pmc: PMC6446509
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Subventions
Organisme : Wellcome Trust
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/K023233/1
Pays : United Kingdom
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