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Clonal expansion of community-associated methicillin-resistant Staphylococcus aureus in people who inject drugs from 2012 to 2017: prevalence, risk factors and molecular epidemiology Eurosurveillance

Packer, S, Pichon, B, Thompson, S, Neale, J, Njoroge, J, Kwiatkowska, R, Oliver, I, Doumith, M, Telfer, M, Buunaaisie, C, Ellen, H, Hopewell-Kelly, N, Desai, M, Hope, VD, Williams, M, Kearns, A, Hickman, M and Gobin, M Clonal expansion of community-associated methicillin-resistant Staphylococcus aureus in people who inject drugs from 2012 to 2017: prevalence, risk factors and molecular epidemiology Eurosurveillance. Eurosurveillance. ISSN 1560-7917 (Accepted)

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Abstract

Introduction: In 2015, Bristol (South West England) experienced a large increase in cases of methicillin-resistant Staphylococcus aureus (MRSA) infection in people who inject drugs (PWID). We characterised and estimated the prevalence of MRSA colonisation among PWID in Bristol and tested evidence of a clonal outbreak using whole-genome sequencing (WGS).
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. Phylogenetic analysis used lineage-matched MRSA isolates, comparing PWID (screening and retrospective bacteraemia samples) with non-PWID (Bristol screening) in Bristol, and national reference laboratory database samples.
Results: The MRSA colonisation prevalence was 8.7% (13/149) and was associated with frequently injecting in public places(OR:5.5, 95%CI:1.34-22.70), recent healthcare contact (4.3, 95%CI:1.34-13.80) and injecting in groups of three or more (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 ST5-22 SCCmecIVg.
Conclusions: This is the first study to combine WGS and epidemiological data to investigate an increase in MRSA among PWID. MRSA colonisation in Bristol PWID is substantially elevated compared to general population estimates (<0.1%-1.5%) 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.

Item Type: Article
Subjects: R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine
R Medicine > RA Public aspects of medicine > RA0421 Public health. Hygiene. Preventive Medicine > RA0440 Study and Teaching. Research
Divisions: Public Health Institute
Publisher: European Centre for DIsease Prevention and Control
Date Deposited: 04 Dec 2018 12:36
Last Modified: 04 Dec 2018 12:43
URI: http://researchonline.ljmu.ac.uk/id/eprint/9768

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