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Interindividual Contacts and Carriage of Methicillin-Resistant Staphylococcus aureus: A Nested Case-Control Study

Published online by Cambridge University Press:  20 April 2015

Thomas Obadia ,
Lulla Opatowski ,
Laura Temime ,
Jean-Louis Herrmann ,
Éric Fleury ,
Pierre-Yves Boëlle  and
Didier Guillemot
Thomas Obadia*
Affiliation:
Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, F-75013, Paris, France
Lulla Opatowski
Affiliation:
INSERM, UMR 1181 “Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases” (B2PHI), F-75015 Paris, France Institut Pasteur, UMR 1181, B2PHI, F-75015 Paris, France Univ. Versailles St Quentin, UMR 1181, B2PHI, F-78180 Montigny-le-Bretonneux, France
Laura Temime
Affiliation:
Laboratoire MESuRS, Conservatoire National des Arts et Métiers, 75003, Paris, France
Jean-Louis Herrmann
Affiliation:
INSERM, U1173, UFR Simone Veil, Versailles-Saint-Quentin University, 78180 Saint-Quentin en Yvelines, France AP-HP, Hôpital Raymond Poincaré, Service de Microbiologie, F-92380, Garches, France
Éric Fleury
Affiliation:
ENS de Lyon, Université de Lyon, Laboratoire de l’Informatique du Parallélisme (UMR CNRS 5668–ENS de Lyon–UCB Lyon 1), IXXI Rhône Alpes Complex Systems Institute, France INRIA–Institut National de Recherche en Informatique et en Automatique, France
Pierre-Yves Boëlle
Affiliation:
Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, F-75013, Paris, France INSERM, UMR_S 1136, Institut Pierre Louis d’Epidémiologie et de Santé Publique, F-75013, Paris, France AP-HP, Hôpital Saint-Antoine, Département de Santé Publique, F-75571, Paris, France
Didier Guillemot
Affiliation:
INSERM, UMR 1181 “Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases” (B2PHI), F-75015 Paris, France Institut Pasteur, UMR 1181, B2PHI, F-75015 Paris, France Univ. Versailles St Quentin, UMR 1181, B2PHI, F-78180 Montigny-le-Bretonneux, France AP-HP, Raymond Poincare Hospital, F-92380 Garches, France
*
Address correspondence to Thomas Obadia, INSERM U1136, 27 rue Chaligny, 75571 Paris CEDEX 12, France ([email protected]).
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Abstract

BACKGROUND

Reducing the spread of multidrug-resistant bacteria in hospitals remains a challenge. Current methods are screening of patients, isolation, and adherence to hygiene measures among healthcare workers (HCWs). More specific measures could rely on a better characterization of the contacts at risk of dissemination.

OBJECTIVE

To quantify how close-proximity interactions (CPIs) affected Staphylococcus aureus dissemination.

DESIGN

Nested case-control study.

SETTING

French long-term care facility in 2009.

PARTICIPANTS

Patients (n=329) and HCWs (n=261).

METHODS

We recorded CPIs using electronic devices together with S. aureus nasal carriage during 4 months in all participants. Cases consisted of patients showing incident S. aureus colonization and were paired to 8 control patients who did not exhibit incident colonization at the same date. Conditional logistic regression was used to quantify associations between incidence and exposure to demographic, network, and carriage covariables.

RESULTS

The local structure of contacts informed on methicillin-resistant S. aureus (MRSA) carriage acquisition: CPIs with more HCWs were associated with incident MRSA colonization in patients (odds ratio [OR], 1.10 [95% CI, 1.04–1.17] for 1 more HCW), as well as longer CPI durations (1.03 [1.01–1.06] for a 1-hour increase). Joint analysis of carriage and contacts showed increased carriage acquisition in case of CPI with another colonized individual (OR, 1.55 [1.14–2.11] for 1 more HCW). Global network measurements did not capture associations between contacts and carriage.

CONCLUSIONS

Electronically recorded CPIs inform on the risk of MRSA carriage, warranting more study of in-hospital contact networks to design targeted intervention strategies.

Infect. Control Hosp. Epidemiol. 2015;36(8):922–929

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 8 , August 2015 , pp. 922 - 929
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

*

E.F., P.-Y.B., and D.G. equally contributed to this work.

†

Members of the Individual-Based Investigation of Resistance Dissemination(i-Bird) Study Group are listed at the end of the text.

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