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Review
, 23 (7), 437-44

Staphylococcus Aureus Infections: Transmission Within Households and the Community

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Review

Staphylococcus Aureus Infections: Transmission Within Households and the Community

Justin Knox et al. Trends Microbiol.

Abstract

Staphylococcus aureus, both methicillin susceptible and resistant, are now major community-based pathogens worldwide. The basis for this is multifactorial and includes the emergence of epidemic clones with enhanced virulence, antibiotic resistance, colonization potential, or transmissibility. Household reservoirs of these unique strains are crucial to their success as community-based pathogens. Staphylococci become resident in households, either as colonizers or environmental contaminants, increasing the risk for recurrent infections. Interactions of household members with others in different households or at community sites, including schools and daycare facilities, have a critical role in the ability of these strains to become endemic. Colonization density at these sites appears to have an important role in facilitating transmission. The integration of research tools, including whole-genome sequencing (WGS), mathematical modeling, and social network analysis, has provided additional insight into the transmission dynamics of these strains. Thus far, interventions designed to reduce recurrent infections among household members have had limited success, likely due to the multiplicity of potential sources for recolonization. The development of better strategies to reduce the number of household-based infections will depend on greater insight into the different factors that contribute to the success of these uniquely successful epidemic clones of S. aureus.

Keywords: Staphylococcus aureus; community-associated; household transmission.

Figures

Figure 1
Figure 1
Graphical display of how S. aureus, including MRSA, spreads through the community. Possible pathways for the spread of S. aureus in a neighborhood. Household members share close physical contact with each other, their household environments (e.g., kitchen sinks) and their pets. These same people interact with members of other households, such as extended family members, friends, and neighbors. They also interact with community sites, such as healthcare facilities, athletic facilities, and schools or day care facilities. Travel may also introduce new strains into the community. As ongoing transmission events, either directly from person to person or mediated through fomites, new strains are periodically introduced into households. This entry, diffusion and dissemination of strains also occur at the community level through the flow of people, animals and objects. Some community members are persistently colonized while others are only temporarily colonized, sometimes long enough to transmit to another person and other times they clear colonization before transmission occurs. These dynamics are also affected by external factors, such as weather patterns. Infection also plays a role in S. aureus transmission dynamics. Based on a combination of exposure, host susceptibility and strain virulence factors, infections occur among a relatively small percentage of community members, which in turn increases the risk of transmission and infection among other household members, as well as their contacts in the community. In the figure the arrows are weighted based on the relative likelihood of S. aureus transmission.
Figure 2
Figure 2
Transmission of the epidemic S. aureus strain ST8 (USA300) within and between households in Northern Manhattan based on sequence and epidemiological analysis. Upright red triangles indicate transmission within households. The size of the triangle corresponds with the number of isolates per household. Downward blue triangles indicate multiple unrelated ST8 isolates, and green highlights single ST8 isolate households. Linkages between households are shown as black lines (identical sequences), red lines (sequence and epidemiological connection), or green lines (epidemiological but no sequence link). Reprinted with permission from PNAS [41].

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