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Journal of Clinical Microbiology, October 2008, p. 3222-3227, Vol. 46, No. 10
0095-1137/08/$08.00+0     doi:10.1128/JCM.01423-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.

Predominance of Methicillin-Resistant Staphylococcus aureus among Pathogens Causing Skin and Soft Tissue Infections in a Large Urban Jail: Risk Factors and Recurrence Rates {triangledown}

Michael Z. David,1* Connie Mennella,2,{dagger} Mohamed Mansour,2,{ddagger} Susan Boyle-Vavra,3 and Robert S. Daum3

Section of Infectious Diseases, Department of Medicine,1 Section of Infectious Diseases, Department of Pediatrics, The University of Chicago, Chicago, Illinois,3 Cermak Health Services, Cook County, Chicago, Illinois2

Received 24 July 2008/ Accepted 28 July 2008

In the 1990s, community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) strains emerged as pathogens outside of the health care environment. Epidemic foci of CA-MRSA infections were reported in jails and prisons, but risk factors for MRSA infection there are not known. All skin and soft tissue infections (SSTIs) cultured in the Cook County Jail in March 2004 to August 2005 were reviewed. Demographic and clinical risk factors were compared among patients with methicillin-susceptible S. aureus (MSSA) SSTIs and those with MRSA SSTIs. Antibiotic susceptibilities were recorded, and we performed multilocus sequence typing on a sample of MRSA isolates. There were 378 SSTIs from different patients requiring culture, of which 240 (63.5%) were of MRSA and 43 (11.4%) were of MSSA; 84.8% of S. aureus isolates were MRSA. MRSA- and MSSA-infected patients were similar with regard to age, gender, ethnicity, previous exposure to the jail, and comorbidities. In the 12 months prior to the index culture, MRSA patients were more likely to have received a β-lactam antibiotic (25% versus 9%; P = 0.02). Among 26 MRSA strains, 24 (92%) had the sequence type 8 (ST8) genotype. Within 6 months, 14% (95% confidence interval, 8.7% to 22.3%) of MRSA SSTI patients in the jail had a recurrent SSTI compared with 8.8% (95% confidence interval, 2.1% to 32.6%) of MSSA SSTI patients (P = 0.004). MRSA is the predominant cause of SSTIs requiring culture in the jail. Few risk factors differentiated MRSA from MSSA SSTIs, and detainee patients with MRSA SSTIs are at high risk for recurrent SSTIs.

* Corresponding author. Mailing address: Section of Infectious Diseases, Department of Medicine, The University of Chicago, 5841 S. Maryland Ave., MC 6054, Chicago, IL 60637. Phone: (773) 702-3904. Fax: (773) 702-1196. E-mail: mdavid{at}medicine.bsd.uchicago.edu

{triangledown} Published ahead of print on 6 August 2008.

{dagger} Present address: 6445 N. Knox Ave., Lincolnwood, IL 60712.

{ddagger} Present address: Hammond Clinic LLC, 7905 Calumet Ave., Munster, IN 46321.

Journal of Clinical Microbiology, October 2008, p. 3222-3227, Vol. 46, No. 10
0095-1137/08/$08.00+0     doi:10.1128/JCM.01423-08
Copyright © 2008, American Society for Microbiology. All Rights Reserved.



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