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ARTICLE

A U.S. Population-Based Survey of Staphylococcus aureus Colonization

Philip L. Graham, III, MD, MSc; Susan X. Lin, DrPH; and Elaine L. Larson, PhD

7 March 2006 | Volume 144 Issue 5 | Pages 318-325

Background: The epidemiology of staphylococcal colonization and community-associated methicillin-resistant Staphylococcus aureus (MRSA) is changing, and little is known from the national perspective.

Objective: To describe the U.S. epidemiology of S. aureus nasal colonization, compare risk factors for colonization with methicillin-sensitive S. aureus (MSSA) versus MRSA, and compare antibiotic resistance patterns and genetic factors of colonizing strains of S. aureus.

Design: Secondary analysis of data from the National Health and Nutrition Examination Survey (NHANES), a stratified, multistage probability sample.

Setting: United States.

Participants: 2001–2002 NHANES participants older than 1 year of age.

Measurements: Colonization of MSSA and MRSA, risk factors for colonization, antimicrobial resistance, and percentage of isolates with selected genetic factors.

Results: The prevalence of colonization with S. aureus and with MRSA was 31.6% and 0.84%, respectively, in the noninstitutionalized U.S. population. People younger than 65 years of age, men, persons with less education, and persons with asthma were more likely to acquire S. aureus. Persons of black race and those of Mexican birth had lower risk for S. aureus colonization. Persons 65 years of age or older, women, persons with diabetes, and those who were in long-term care in the past year were more likely to have MRSA colonization. Hispanic persons had statistically significantly less risk than white persons. Isolates of MRSA with staphylococcal chromosomal cassette mec type IV (which is often associated with community-associated MRSA) were statistically significantly more likely to be sensitive to erythromycin, clindamycin, and ciprofloxacin.

Limitations: Colonizing isolates may be different from isolates associated with infection. Risk factors identified may differ from those associated with invasive disease. The 2001–2002 NHANES data are several years old and may not reflect the most recent changes in epidemiology, but they are the only national data available.

Conclusions: Characteristics of persons with MSSA and MRSA seem to differ. These findings may be useful for differentiating those who may be at risk for MRSA.

Editors' Notes Context Epidemiology and risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) in the U.S. population are poorly understood. Contribution Extrapolation of 2001–2002 National Health and Nutrition Examination Survey (NHANES) data indicates that 84 million noninstitutionalized persons in the U.S. population are colonized with MSSA and 2 million are colonized with MRSA. Long-term care facility residence, diabetes, and age 65 years or older are associated with MRSA colonization. Men are at greater risk for MSSA colonization, and women are at greater risk for MRSA colonization. Black persons and those of Mexican birth are at decreased risk for colonization. Implications Risk for MRSA colonization differs according to previously unrecognized population characteristics. —The Editors

 

Author and Article Information

From Columbia University and New York-Presbyterian Medical Center, New York, New York.

Grant Support: From a Mentored Clinical Research Scholar Grant (K12-RR017648) (Dr. Graham) and from the Center for Interdisciplinary Research on Antimicrobial Resistance (P20 RR020616), National Center for Research Resources, and National Institutes of Health (Drs. Lin and Larson).

Potential Financial Conflicts of Interest: None disclosed.

Corresponding Author: Philip L. Graham III, MD, MSc, Department of Pediatrics, Columbia University, 622 West 168th Street, PH 4 West, Room 463, New York, NY 10032; e-mail, pg143{at}columbia.edu.

Current Author Addresses: Dr. Graham: Department of Pediatrics, Columbia University, 622 West 168th Street, PH 4 West, Room 463, New York, NY 10032.

Drs. Lin and Larson: Columbia University School of Nursing, 617 West 168th Street, New York, NY 10032.

Author Contributions: Conception and design: P.L. Graham III, S.X. Lin, E.L. Larson.

Analysis and interpretation of the data: P.L. Graham III, S.X. Lin.

Drafting of the article: P.L. Graham III, S.X. Lin, E.L. Larson.

Critical revision of the article for important intellectual content: P.L. Graham III, S.X. Lin, E.L. Larson.

Final approval of the article: P.L. Graham III, S.X. Lin, E.L. Larson.

Statistical expertise: S.X. Lin.

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