Division of Infectious Diseases, Rush University Medical Center/Cook County Health, Chicago, Illinois, USA.
Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Chicago, Illinois, USA.
Clin Infect Dis. 2020 Jul 11;71(2):323-331. doi: 10.1093/cid/ciz818.
Jails may facilitate spread of methicillin-resistant Staphylococcus aureus (MRSA) in urban areas. We examined MRSA colonization upon entrance to a large urban jail to determine if there are MRSA transmission networks preceding incarceration.
Males incarcerated in Cook County Jail (Chicago) were enrolled, with enrichment for people living with human immunodeficiency virus (PLHIV), within 72 hours of intake. Surveillance cultures assessed prevalence of MRSA colonization. Whole-genome sequencing (WGS) identified preincarceration transmission networks.We examined methicillin-resistant Staphylococcus aureus (MRSA) isolates to determine if there are transmission networks that precede incarceration. A large proportion of individuals enter jail colonized with MRSA. Molecular epidemiology and colonization risk factors provide clues to community reservoirs for MRSA.
There were 718 individuals (800 incarcerations) enrolled; 58% were PLHIV. The prevalence of MRSA colonization at intake was 19%. In multivariate analysis, methamphetamine use, unstable housing, current/recent skin infection, and recent injection drug use were predictors of MRSA. Among PLHIV, recent injection drug use, current skin infection, and HIV care at outpatient clinic A that emphasizes comprehensive care to the lesbian, gay, bisexual, transgender community were predictors of MRSA. Fourteen (45%) of 31 detainees with care at clinic A had colonization. WGS revealed that this prevalence was not due to clonal spread in clinic but rather to an intermingling of distinct community transmission networks. In contrast, genomic analysis supported spread of USA500 strains within a network. Members of this USA500 network were more likely to be PLHIV (P < .01), men who have sex with men (P < .001), and methamphetamine users (P < .001).
A large proportion of individuals enter jail colonized with MRSA. Molecular epidemiology and colonization risk factors provide clues to identify colonized detainees entering jail and potential community reservoirs of MRSA.
监狱可能会促进耐甲氧西林金黄色葡萄球菌（MRSA）在城市地区的传播。我们在进入大型城市监狱时检查了 MRSA 的定植情况，以确定在入狱之前是否存在 MRSA 传播网络。
在摄入后 72 小时内，将被监禁在库克县监狱（芝加哥）的男性囚犯纳入研究，同时对艾滋病毒感染者（PLHIV）进行了富集。监测培养评估了 MRSA 定植的流行率。全基因组测序（WGS）确定了入狱前的传播网络。我们检查了耐甲氧西林金黄色葡萄球菌（MRSA）分离株，以确定是否存在入狱前的传播网络。很大一部分人进入监狱时就已经定植了 MRSA。分子流行病学和定植危险因素为 MRSA 的社区储库提供了线索。
共纳入 718 人（800 次监禁）；58%为 PLHIV。入院时 MRSA 定植率为 19%。在多变量分析中，使用冰毒、不稳定的住房、当前/近期皮肤感染和近期注射吸毒是 MRSA 的预测因素。在 PLHIV 中，最近注射吸毒、当前皮肤感染以及在强调向女同性恋、男同性恋、双性恋、跨性别社区提供全面护理的门诊诊所 A 接受艾滋病毒护理是 MRSA 的预测因素。在诊所 A 接受护理的 31 名被拘留者中有 14 人（45%）定植。WGS 显示，这种流行率不是由于诊所内的克隆传播，而是由于不同的社区传播网络相互混合。相比之下，基因组分析支持 USA500 菌株在网络内的传播。该 USA500 网络的成员更有可能是 PLHIV（P <.01）、男男性接触者（P <.001）和冰毒使用者（P <.001）。
很大一部分人进入监狱时就已经定植了 MRSA。分子流行病学和定植危险因素为确定进入监狱的定植被拘留者和 MRSA 的潜在社区储库提供了线索。
