Persistent Environmental Contamination with USA300 Methicillin-Resistant Staphylococcus aureus and Other Pathogenic Strain Types in Households with S. aureus Skin Infections

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Abstract
Objective.: To understand the genotypic spectrum of environmental contamination ofStaphylococcus aureusin households and its persistenceDesign.: Prospective longitudinal cohort investigation.Setting.: Index participants identified at 2 academic medical centers.Participants.: Adults and children withS. aureusskin infections and their household contacts in Los Angeles and Chicago.Methods.: Household fomites were surveyed for contamination at baseline and 3 months. All isolates underwent genetic typing.Results.: We enrolled 346 households, 88% of which completed the 3-month follow-up visit.S. aureusenvironmental contamination was 49% at baseline and 51% at 3 months. Among households with a USA300 methicillin-resistantS. aureus(MRSA) body infection isolate, environmental contamination with an indistinguishable MRSA strain was 58% at baseline and 63% at 3 months. Baseline factors associated with environmental contamination by the index subject’s infection isolate were body colonization by any household member with the index subject’s infection isolate at baseline (odds ratio [OR], 10.93 [95% confidence interval (CI), 5.75–20.79]), higher housing density (OR, 1.47 [95% CI, 1.10–1.96]), and more frequent household fomite cleaning (OR, 1.62 [95% CI, 1.16–2.27]). Household environmental contamination with the index subject’s infection strain at 3 months was associated with USA300 MRSA and a synergistic interaction between baseline environmental contamination and body colonization by any household member with the index subject’s infection strain.Conclusions.: We found that infectingS. aureusisolates frequently persisted environmentally in households 3 months after skin infection. Presence of pathogenicS. aureusstrain type in the environment in a household may represent a persistent reservoir that places household members at risk of future infection.Infect Control Hosp Epidemiol2014;35(11):1373–1382

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