Community-associated methicillin-resistant Staphylococcus aureus is prevalent in wounds of community-based injection drug users

• Published in: Epidemiology and infection Vol. 138; no. 5; pp. 713 - 720
• Main Authors: LLOYD-SMITH, E., HULL, M. W., TYNDALL, M. W., ZHANG, R., WOOD, E., MONTANER, J. S. G., KERR, T., ROMNEY, M. G.
• Format: Journal Article
• Language: English
• Published: Cambridge, UK Cambridge University Press 01.05.2010
• Subjects: Abscesses; Adult; Anti-Bacterial Agents - pharmacology; Antibiotic resistance; Antibiotics; Bacterial Toxins - genetics; Cocaine; Community-Acquired Infections - epidemiology; Community-Acquired Infections - microbiology; Comorbidity; Confidence intervals; Drug Users; Exotoxins - genetics; Female; Heroin; Humans; Infections; infectious disease epidemiology; Infectious diseases; Injection; injection drug users (IDUs); Injections; Leukocidins - genetics; Male; Methicillin Resistance; Methicillin resistant staphylococcus aureus; Methicillin-Resistant Staphylococcus aureus - isolation & purification; Microbial Sensitivity Tests; Microbiology; Missing data; Prevalence; Skin; Soft tissue infections; Staphylococcal Infections - epidemiology; Staphylococcal Infections - microbiology; Staphylococcus aureus; Staphylococcus infections; Substance Abuse, Intravenous - complications; Variables; Wound Infection - epidemiology; Wound Infection - microbiology; United States > US; infectious disease epidemiology; microbiology; soft tissue infections; injection drug users (IDUs); Antibiotic resistance
• ISSN: 0950-2688; 1469-4409; 1469-4409
• DOI: 10.1017/S0950268810000464

Injection drug users (IDUs) have an elevated risk for carriage of Staphylococcus aureus, including methicillin-resistant S. aureus (MRSA). Cutaneous injection-related infections are common in IDUs but detailed studies are few. Based on a subsample of 218 individuals from a community-recruited cohort of IDUs at a supervised injection facility, we investigated the microbiology and related antibiotic susceptibility profiles of isolates from 59 wounds. Twenty-seven percent of subjects had at least one wound and 25 (43%) were culture positive for S. aureus alone [14 MRSA and 11 (19%) methicillin-susceptible (MSSA) isolates]. Sixteen of 18 MRSA isolates were classified as community associated (CA) by the presence of genes encoding for PVL. MRSA and MSSA occurred in mixed infection with other organisms on three and six occasions, respectively. All CA-MRSA isolates were susceptible to tetracycline, vancomycin and linezolid but only 13% were susceptible to clindamycin compared to 63% of MSSA isolates. The frequency of CA-MRSA is a cause for concern in wound infection in the IDU setting.