Environmental contamination as a risk factor for intra-household Staphylococcus aureus transmission

PLoS One. 2012;7(11):e49900. doi: 10.1371/journal.pone.0049900. Epub 2012 Nov 13.

Abstract

Background: The household is a recognized community reservoir for Staphylococcus aureus. This study investigated potential risk factors for intra-household S. aureus transmission, including the contribution of environmental contamination.

Methods: We investigated intra-household S. aureus transmission using a sample of multiple member households from a community-based case-control study examining risk factors for CA-MRSA infection conducted in Northern Manhattan. During a home visit, index subjects completed a questionnaire. All consenting household members were swabbed, as were standardized environmental household items. Swabs were cultured for S. aureus. Positive isolates underwent further molecular characterization. Intra-household transmission was defined as having identical strains among two or more household members. Multiple logistic regression was used to identify independent risk factors for transmission.

Results: We enrolled 291 households: 146 index cases, 145 index controls and 687 of their household contacts. The majority of indexes were Hispanic (85%), low income (74%), and female (67%), with a mean age of 31 (range 1-79). The average size of case and control households was 4 people. S. aureus colonized individuals in 62% of households and contaminated the environment in 54% of households. USA300 was the predominant clinical infection, colonizing and environmental strain. Eighty-one households had evidence of intra-household transmission: 55 (38%) case and 26 (18%) control households (P<.01). Environmental contamination with a colonizing or clinical infection strain (aOR: 5.4 [2.9-10.3] P<.01) and the presence of a child under 5 (aOR: 2.3 [1.2-4.5] P = .02) were independently associated with transmission. In separate multivariable models, environmental contamination was associated with transmission among case (aOR 3.3, p<.01) and control households (aOR 27.2, p<.01).

Conclusions: Environmental contamination with a colonizing or clinical infection strain was significantly and independently associated with transmission in a large community-based sample. Environmental contamination should be considered when treating S. aureus infections, particularly among households with multiple infected members.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Case-Control Studies
  • Child
  • Child, Preschool
  • Colony Count, Microbial
  • Demography
  • Environmental Microbiology*
  • Environmental Pollution / analysis*
  • Family Characteristics*
  • Female
  • Humans
  • Infant
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Risk Factors
  • Staphylococcal Infections / microbiology*
  • Staphylococcal Infections / transmission*
  • Staphylococcus aureus / isolation & purification
  • Staphylococcus aureus / physiology*
  • Young Adult