Evidence for Community Transmission of Community-Associated but Not Health-Care-Associated Methicillin-Resistant Staphylococcus Aureus Strains Linked to Social and Material Deprivation: Spatial Analysis of Cross-sectional Data
Identifying and tackling the social determinants of infectious diseases has become a public health priority following the recognition that individuals with lower socioeconomic status are disproportionately affected by infectious diseases. In many parts of the world, epidemiologically and genotypical...
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| Veröffentlicht in: | PLoS medicine 2016-01, Vol.13 (1), p.e1001944 |
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| creator | Tosas Auguet, Olga Betley, Jason R Stabler, Richard A Patel, Amita Ioannou, Avgousta Marbach, Helene Hearn, Pasco Aryee, Anna Goldenberg, Simon D Otter, Jonathan A Desai, Nergish Karadag, Tacim Grundy, Chris Gaunt, Michael W Cooper, Ben S Edgeworth, Jonathan D Kypraios, Theodore |
| description | Identifying and tackling the social determinants of infectious diseases has become a public health priority following the recognition that individuals with lower socioeconomic status are disproportionately affected by infectious diseases. In many parts of the world, epidemiologically and genotypically defined community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged to become frequent causes of hospital infection. The aim of this study was to use spatial models with adjustment for area-level hospital attendance to determine the transmission niche of genotypically defined CA- and health-care-associated (HA)-MRSA strains across a diverse region of South East London and to explore a potential link between MRSA carriage and markers of social and material deprivation.
This study involved spatial analysis of cross-sectional data linked with all MRSA isolates identified by three National Health Service (NHS) microbiology laboratories between 1 November 2011 and 29 February 2012. The cohort of hospital-based NHS microbiology diagnostic services serves 867,254 usual residents in the Lambeth, Southwark, and Lewisham boroughs in South East London, United Kingdom (UK). Isolates were classified as HA- or CA-MRSA based on whole genome sequencing. All MRSA cases identified over 4 mo within the three-borough catchment area (n = 471) were mapped to small geographies and linked to area-level aggregated socioeconomic and demographic data. Disease mapping and ecological regression models were used to infer the most likely transmission niches for each MRSA genetic classification and to describe the spatial epidemiology of MRSA in relation to social determinants. Specifically, we aimed to identify demographic and socioeconomic population traits that explain cross-area extra variation in HA- and CA-MRSA relative risks following adjustment for hospital attendance data. We explored the potential for associations with the English Indices of Deprivation 2010 (including the Index of Multiple Deprivation and several deprivation domains and subdomains) and the 2011 England and Wales census demographic and socioeconomic indicators (including numbers of households by deprivation dimension) and indicators of population health. Both CA-and HA-MRSA were associated with household deprivation (CA-MRSA relative risk [RR]: 1.72 [1.03-2.94]; HA-MRSA RR: 1.57 [1.06-2.33]), which was correlated with hospital attendance (Pearson correlation coefficient [PCC] |
| doi_str_mv | 10.1371/journal.pmed.1001944 |
| format | Article |
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This study involved spatial analysis of cross-sectional data linked with all MRSA isolates identified by three National Health Service (NHS) microbiology laboratories between 1 November 2011 and 29 February 2012. The cohort of hospital-based NHS microbiology diagnostic services serves 867,254 usual residents in the Lambeth, Southwark, and Lewisham boroughs in South East London, United Kingdom (UK). Isolates were classified as HA- or CA-MRSA based on whole genome sequencing. All MRSA cases identified over 4 mo within the three-borough catchment area (n = 471) were mapped to small geographies and linked to area-level aggregated socioeconomic and demographic data. Disease mapping and ecological regression models were used to infer the most likely transmission niches for each MRSA genetic classification and to describe the spatial epidemiology of MRSA in relation to social determinants. Specifically, we aimed to identify demographic and socioeconomic population traits that explain cross-area extra variation in HA- and CA-MRSA relative risks following adjustment for hospital attendance data. We explored the potential for associations with the English Indices of Deprivation 2010 (including the Index of Multiple Deprivation and several deprivation domains and subdomains) and the 2011 England and Wales census demographic and socioeconomic indicators (including numbers of households by deprivation dimension) and indicators of population health. Both CA-and HA-MRSA were associated with household deprivation (CA-MRSA relative risk [RR]: 1.72 [1.03-2.94]; HA-MRSA RR: 1.57 [1.06-2.33]), which was correlated with hospital attendance (Pearson correlation coefficient [PCC] = 0.76). HA-MRSA was also associated with poor health (RR: 1.10 [1.01-1.19]) and residence in communal care homes (RR: 1.24 [1.12-1.37]), whereas CA-MRSA was linked with household overcrowding (RR: 1.58 [1.04-2.41]) and wider barriers, which represent a combined score for household overcrowding, low income, and homelessness (RR: 1.76 [1.16-2.70]). CA-MRSA was also associated with recent immigration to the UK (RR: 1.77 [1.19-2.66]). For the area-level variation in RR for CA-MRSA, 28.67% was attributable to the spatial arrangement of target geographies, compared with only 0.09% for HA-MRSA. An advantage to our study is that it provided a representative sample of usual residents receiving care in the catchment areas. A limitation is that relationships apparent in aggregated data analyses cannot be assumed to operate at the individual level.
There was no evidence of community transmission of HA-MRSA strains, implying that HA-MRSA cases identified in the community originate from the hospital reservoir and are maintained by frequent attendance at health care facilities. In contrast, there was a high risk of CA-MRSA in deprived areas linked with overcrowding, homelessness, low income, and recent immigration to the UK, which was not explainable by health care exposure. Furthermore, areas adjacent to these deprived areas were themselves at greater risk of CA-MRSA, indicating community transmission of CA-MRSA. This ongoing community transmission could lead to CA-MRSA becoming the dominant strain types carried by patients admitted to hospital, particularly if successful hospital-based MRSA infection control programmes are maintained. These results suggest that community infection control programmes targeting transmission of CA-MRSA will be required to control MRSA in both the community and hospital. These epidemiological changes will also have implications for effectiveness of risk-factor-based hospital admission MRSA screening programmes.</description><identifier>ISSN: 1549-1676</identifier><identifier>ISSN: 1549-1277</identifier><identifier>EISSN: 1549-1676</identifier><identifier>DOI: 10.1371/journal.pmed.1001944</identifier><identifier>PMID: 26812054</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Adolescent ; Adult ; Aged ; Biology and life sciences ; Censuses ; Child ; Child, Preschool ; Community-Acquired Infections - diagnosis ; Community-Acquired Infections - epidemiology ; Community-Acquired Infections - psychology ; Control ; Copyright ; Cross Infection ; Cross-Sectional Studies ; Data Interpretation, Statistical ; Disease transmission ; Earth Sciences ; Ecology and Environmental Sciences ; Epidemiology ; Female ; Health aspects ; Health care ; Hospitals ; Humans ; Immigration ; Infant ; Infant, Newborn ; Infectious diseases ; Laboratories ; London - epidemiology ; Low income groups ; Male ; Management ; Maternal Deprivation ; Medicine and health sciences ; Metadata ; Methicillin-Resistant Staphylococcus aureus - isolation & purification ; Middle Aged ; Nosocomial infections ; Population ; Public health ; Research and Analysis Methods ; Social aspects ; Social Isolation - psychology ; Social Sciences ; Socioeconomic factors ; Spatial analysis ; Staphylococcal Infections - diagnosis ; Staphylococcal Infections - epidemiology ; Staphylococcal Infections - psychology ; Staphylococcus aureus ; Staphylococcus infections ; Young Adult</subject><ispartof>PLoS medicine, 2016-01, Vol.13 (1), p.e1001944</ispartof><rights>COPYRIGHT 2016 Public Library of Science</rights><rights>2016 Tosas Auguet et al 2016 Tosas Auguet et al</rights><rights>2016 Public Library of Science. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited: Strains Linked to Social and Material Deprivation: Spatial Analysis of Cross-sectional Data. PLoS Med 13(1): e1001944. doi:10.1371/journal.pmed.1001944</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c839t-9dd6aebedd4d723dd91ad9a02cb6221c58a2643742efe906e0b8f993379e9a543</citedby><cites>FETCH-LOGICAL-c839t-9dd6aebedd4d723dd91ad9a02cb6221c58a2643742efe906e0b8f993379e9a543</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4727805/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4727805/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,723,776,780,860,881,2096,2915,23845,27901,27902,53766,53768,79343,79344</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/26812054$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Tosas Auguet, Olga</creatorcontrib><creatorcontrib>Betley, Jason R</creatorcontrib><creatorcontrib>Stabler, Richard A</creatorcontrib><creatorcontrib>Patel, Amita</creatorcontrib><creatorcontrib>Ioannou, Avgousta</creatorcontrib><creatorcontrib>Marbach, Helene</creatorcontrib><creatorcontrib>Hearn, Pasco</creatorcontrib><creatorcontrib>Aryee, Anna</creatorcontrib><creatorcontrib>Goldenberg, Simon D</creatorcontrib><creatorcontrib>Otter, Jonathan A</creatorcontrib><creatorcontrib>Desai, Nergish</creatorcontrib><creatorcontrib>Karadag, Tacim</creatorcontrib><creatorcontrib>Grundy, Chris</creatorcontrib><creatorcontrib>Gaunt, Michael W</creatorcontrib><creatorcontrib>Cooper, Ben S</creatorcontrib><creatorcontrib>Edgeworth, Jonathan D</creatorcontrib><creatorcontrib>Kypraios, Theodore</creatorcontrib><title>Evidence for Community Transmission of Community-Associated but Not Health-Care-Associated Methicillin-Resistant Staphylococcus Aureus Strains Linked to Social and Material Deprivation: Spatial Analysis of Cross-sectional Data</title><title>PLoS medicine</title><addtitle>PLoS Med</addtitle><description>Identifying and tackling the social determinants of infectious diseases has become a public health priority following the recognition that individuals with lower socioeconomic status are disproportionately affected by infectious diseases. In many parts of the world, epidemiologically and genotypically defined community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged to become frequent causes of hospital infection. The aim of this study was to use spatial models with adjustment for area-level hospital attendance to determine the transmission niche of genotypically defined CA- and health-care-associated (HA)-MRSA strains across a diverse region of South East London and to explore a potential link between MRSA carriage and markers of social and material deprivation.
This study involved spatial analysis of cross-sectional data linked with all MRSA isolates identified by three National Health Service (NHS) microbiology laboratories between 1 November 2011 and 29 February 2012. The cohort of hospital-based NHS microbiology diagnostic services serves 867,254 usual residents in the Lambeth, Southwark, and Lewisham boroughs in South East London, United Kingdom (UK). Isolates were classified as HA- or CA-MRSA based on whole genome sequencing. All MRSA cases identified over 4 mo within the three-borough catchment area (n = 471) were mapped to small geographies and linked to area-level aggregated socioeconomic and demographic data. Disease mapping and ecological regression models were used to infer the most likely transmission niches for each MRSA genetic classification and to describe the spatial epidemiology of MRSA in relation to social determinants. Specifically, we aimed to identify demographic and socioeconomic population traits that explain cross-area extra variation in HA- and CA-MRSA relative risks following adjustment for hospital attendance data. We explored the potential for associations with the English Indices of Deprivation 2010 (including the Index of Multiple Deprivation and several deprivation domains and subdomains) and the 2011 England and Wales census demographic and socioeconomic indicators (including numbers of households by deprivation dimension) and indicators of population health. Both CA-and HA-MRSA were associated with household deprivation (CA-MRSA relative risk [RR]: 1.72 [1.03-2.94]; HA-MRSA RR: 1.57 [1.06-2.33]), which was correlated with hospital attendance (Pearson correlation coefficient [PCC] = 0.76). HA-MRSA was also associated with poor health (RR: 1.10 [1.01-1.19]) and residence in communal care homes (RR: 1.24 [1.12-1.37]), whereas CA-MRSA was linked with household overcrowding (RR: 1.58 [1.04-2.41]) and wider barriers, which represent a combined score for household overcrowding, low income, and homelessness (RR: 1.76 [1.16-2.70]). CA-MRSA was also associated with recent immigration to the UK (RR: 1.77 [1.19-2.66]). For the area-level variation in RR for CA-MRSA, 28.67% was attributable to the spatial arrangement of target geographies, compared with only 0.09% for HA-MRSA. An advantage to our study is that it provided a representative sample of usual residents receiving care in the catchment areas. A limitation is that relationships apparent in aggregated data analyses cannot be assumed to operate at the individual level.
There was no evidence of community transmission of HA-MRSA strains, implying that HA-MRSA cases identified in the community originate from the hospital reservoir and are maintained by frequent attendance at health care facilities. In contrast, there was a high risk of CA-MRSA in deprived areas linked with overcrowding, homelessness, low income, and recent immigration to the UK, which was not explainable by health care exposure. Furthermore, areas adjacent to these deprived areas were themselves at greater risk of CA-MRSA, indicating community transmission of CA-MRSA. This ongoing community transmission could lead to CA-MRSA becoming the dominant strain types carried by patients admitted to hospital, particularly if successful hospital-based MRSA infection control programmes are maintained. These results suggest that community infection control programmes targeting transmission of CA-MRSA will be required to control MRSA in both the community and hospital. These epidemiological changes will also have implications for effectiveness of risk-factor-based hospital admission MRSA screening programmes.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Biology and life sciences</subject><subject>Censuses</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Community-Acquired Infections - diagnosis</subject><subject>Community-Acquired Infections - epidemiology</subject><subject>Community-Acquired Infections - psychology</subject><subject>Control</subject><subject>Copyright</subject><subject>Cross Infection</subject><subject>Cross-Sectional Studies</subject><subject>Data Interpretation, Statistical</subject><subject>Disease transmission</subject><subject>Earth Sciences</subject><subject>Ecology and Environmental Sciences</subject><subject>Epidemiology</subject><subject>Female</subject><subject>Health aspects</subject><subject>Health care</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Immigration</subject><subject>Infant</subject><subject>Infant, Newborn</subject><subject>Infectious diseases</subject><subject>Laboratories</subject><subject>London - epidemiology</subject><subject>Low income groups</subject><subject>Male</subject><subject>Management</subject><subject>Maternal Deprivation</subject><subject>Medicine and health sciences</subject><subject>Metadata</subject><subject>Methicillin-Resistant Staphylococcus aureus - isolation & purification</subject><subject>Middle Aged</subject><subject>Nosocomial infections</subject><subject>Population</subject><subject>Public health</subject><subject>Research and Analysis Methods</subject><subject>Social aspects</subject><subject>Social Isolation - psychology</subject><subject>Social Sciences</subject><subject>Socioeconomic factors</subject><subject>Spatial analysis</subject><subject>Staphylococcal Infections - diagnosis</subject><subject>Staphylococcal Infections - epidemiology</subject><subject>Staphylococcal Infections - psychology</subject><subject>Staphylococcus aureus</subject><subject>Staphylococcus infections</subject><subject>Young Adult</subject><issn>1549-1676</issn><issn>1549-1277</issn><issn>1549-1676</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2016</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>DOA</sourceid><recordid>eNqVk99u0zAUxiMEYmPwBggiISG4SLFjJ465QKrKYJMGk9bBreXaJ61Hahfbmejr8iQ4azdaaRegXPjf7_t84nNOlj3HaIQJw--uXO-t7EarJegRRghzSh9kh7iivMA1qx_uzA-yJyFcIVRyxNHj7KCsG1yiih5mv4-vjQarIG-dzyduueytiev80ksbliYE42zu2r8nxTgEp4yMoPNZH_OvLuYnILu4KCbSw-7xF4gLo0zXGVtcQDAhShvzaZSrxbpzyinVh3zce0jDNHppbMjPjP2RpNHl08Gmy6VNRsnOD4uPsPLmWsYU1Pt8ukqTtDlOr7BO7jdhehdCEUANyCCQUT7NHrWyC_BsOx5l3z4dX05OirPzz6eT8VmhGsJjwbWuJcxAa6pZSbTmWGouUalmdVliVTWyrClhtIQWOKoBzZqWc0IYBy4rSo6ylxvfVeeC2KYnCMySinKM6kScbgjt5JVIv7KUfi2cNOJmw_m5kD4a1YGoQGPOa9RW5YySSnIiGW1mrCGUKcZI8vqwva2fpQpQYNMLdnum-yfWLMTcXQvKStagKhm82Rp497OHEEVKt4KukxZcP8TNSFPyBuGEvtqgc5lCM7Z1yVENuBjTClcENeUQUXEPNQcL6XpnoTVpe48f3cOnT8PSqHsFb_cEiYnwK85lH4I4nV78B_v139nz7_vs6x12cVP4wXX9UG9hH6QbUA0l6aG9Sw1GYmjg2woRQwOLbQMn2YvdtN6JbjuW_AExdUSy</recordid><startdate>20160101</startdate><enddate>20160101</enddate><creator>Tosas Auguet, Olga</creator><creator>Betley, Jason R</creator><creator>Stabler, Richard A</creator><creator>Patel, Amita</creator><creator>Ioannou, Avgousta</creator><creator>Marbach, Helene</creator><creator>Hearn, Pasco</creator><creator>Aryee, Anna</creator><creator>Goldenberg, Simon D</creator><creator>Otter, Jonathan A</creator><creator>Desai, Nergish</creator><creator>Karadag, Tacim</creator><creator>Grundy, Chris</creator><creator>Gaunt, Michael W</creator><creator>Cooper, Ben S</creator><creator>Edgeworth, Jonathan D</creator><creator>Kypraios, Theodore</creator><general>Public Library of Science</general><general>Public Library of Science (PLoS)</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>IOV</scope><scope>ISN</scope><scope>ISR</scope><scope>7QL</scope><scope>C1K</scope><scope>5PM</scope><scope>DOA</scope><scope>CZK</scope></search><sort><creationdate>20160101</creationdate><title>Evidence for Community Transmission of Community-Associated but Not Health-Care-Associated Methicillin-Resistant Staphylococcus Aureus Strains Linked to Social and Material Deprivation: Spatial Analysis of Cross-sectional Data</title><author>Tosas Auguet, Olga ; Betley, Jason R ; Stabler, Richard A ; Patel, Amita ; Ioannou, Avgousta ; Marbach, Helene ; Hearn, Pasco ; Aryee, Anna ; Goldenberg, Simon D ; Otter, Jonathan A ; Desai, Nergish ; Karadag, Tacim ; Grundy, Chris ; Gaunt, Michael W ; Cooper, Ben S ; Edgeworth, Jonathan D ; Kypraios, Theodore</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c839t-9dd6aebedd4d723dd91ad9a02cb6221c58a2643742efe906e0b8f993379e9a543</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2016</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Biology and life sciences</topic><topic>Censuses</topic><topic>Child</topic><topic>Child, Preschool</topic><topic>Community-Acquired Infections - diagnosis</topic><topic>Community-Acquired Infections - epidemiology</topic><topic>Community-Acquired Infections - psychology</topic><topic>Control</topic><topic>Copyright</topic><topic>Cross Infection</topic><topic>Cross-Sectional Studies</topic><topic>Data Interpretation, Statistical</topic><topic>Disease transmission</topic><topic>Earth Sciences</topic><topic>Ecology and Environmental Sciences</topic><topic>Epidemiology</topic><topic>Female</topic><topic>Health aspects</topic><topic>Health care</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Immigration</topic><topic>Infant</topic><topic>Infant, Newborn</topic><topic>Infectious diseases</topic><topic>Laboratories</topic><topic>London - epidemiology</topic><topic>Low income groups</topic><topic>Male</topic><topic>Management</topic><topic>Maternal Deprivation</topic><topic>Medicine and health sciences</topic><topic>Metadata</topic><topic>Methicillin-Resistant Staphylococcus aureus - isolation & purification</topic><topic>Middle Aged</topic><topic>Nosocomial infections</topic><topic>Population</topic><topic>Public health</topic><topic>Research and Analysis Methods</topic><topic>Social aspects</topic><topic>Social Isolation - psychology</topic><topic>Social Sciences</topic><topic>Socioeconomic factors</topic><topic>Spatial analysis</topic><topic>Staphylococcal Infections - diagnosis</topic><topic>Staphylococcal Infections - epidemiology</topic><topic>Staphylococcal Infections - psychology</topic><topic>Staphylococcus aureus</topic><topic>Staphylococcus infections</topic><topic>Young Adult</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Tosas Auguet, Olga</creatorcontrib><creatorcontrib>Betley, Jason R</creatorcontrib><creatorcontrib>Stabler, Richard A</creatorcontrib><creatorcontrib>Patel, Amita</creatorcontrib><creatorcontrib>Ioannou, Avgousta</creatorcontrib><creatorcontrib>Marbach, Helene</creatorcontrib><creatorcontrib>Hearn, Pasco</creatorcontrib><creatorcontrib>Aryee, Anna</creatorcontrib><creatorcontrib>Goldenberg, Simon D</creatorcontrib><creatorcontrib>Otter, Jonathan A</creatorcontrib><creatorcontrib>Desai, Nergish</creatorcontrib><creatorcontrib>Karadag, Tacim</creatorcontrib><creatorcontrib>Grundy, Chris</creatorcontrib><creatorcontrib>Gaunt, Michael W</creatorcontrib><creatorcontrib>Cooper, Ben S</creatorcontrib><creatorcontrib>Edgeworth, Jonathan D</creatorcontrib><creatorcontrib>Kypraios, Theodore</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Gale In Context: Opposing Viewpoints</collection><collection>Gale In Context: Canada</collection><collection>Gale In Context: Science</collection><collection>Bacteriology Abstracts (Microbiology B)</collection><collection>Environmental Sciences and Pollution Management</collection><collection>PubMed Central (Full Participant titles)</collection><collection>DOAJ Directory of Open Access Journals</collection><collection>PLoS Medicine</collection><jtitle>PLoS medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Tosas Auguet, Olga</au><au>Betley, Jason R</au><au>Stabler, Richard A</au><au>Patel, Amita</au><au>Ioannou, Avgousta</au><au>Marbach, Helene</au><au>Hearn, Pasco</au><au>Aryee, Anna</au><au>Goldenberg, Simon D</au><au>Otter, Jonathan A</au><au>Desai, Nergish</au><au>Karadag, Tacim</au><au>Grundy, Chris</au><au>Gaunt, Michael W</au><au>Cooper, Ben S</au><au>Edgeworth, Jonathan D</au><au>Kypraios, Theodore</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evidence for Community Transmission of Community-Associated but Not Health-Care-Associated Methicillin-Resistant Staphylococcus Aureus Strains Linked to Social and Material Deprivation: Spatial Analysis of Cross-sectional Data</atitle><jtitle>PLoS medicine</jtitle><addtitle>PLoS Med</addtitle><date>2016-01-01</date><risdate>2016</risdate><volume>13</volume><issue>1</issue><spage>e1001944</spage><pages>e1001944-</pages><issn>1549-1676</issn><issn>1549-1277</issn><eissn>1549-1676</eissn><abstract>Identifying and tackling the social determinants of infectious diseases has become a public health priority following the recognition that individuals with lower socioeconomic status are disproportionately affected by infectious diseases. In many parts of the world, epidemiologically and genotypically defined community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA) strains have emerged to become frequent causes of hospital infection. The aim of this study was to use spatial models with adjustment for area-level hospital attendance to determine the transmission niche of genotypically defined CA- and health-care-associated (HA)-MRSA strains across a diverse region of South East London and to explore a potential link between MRSA carriage and markers of social and material deprivation.
This study involved spatial analysis of cross-sectional data linked with all MRSA isolates identified by three National Health Service (NHS) microbiology laboratories between 1 November 2011 and 29 February 2012. The cohort of hospital-based NHS microbiology diagnostic services serves 867,254 usual residents in the Lambeth, Southwark, and Lewisham boroughs in South East London, United Kingdom (UK). Isolates were classified as HA- or CA-MRSA based on whole genome sequencing. All MRSA cases identified over 4 mo within the three-borough catchment area (n = 471) were mapped to small geographies and linked to area-level aggregated socioeconomic and demographic data. Disease mapping and ecological regression models were used to infer the most likely transmission niches for each MRSA genetic classification and to describe the spatial epidemiology of MRSA in relation to social determinants. Specifically, we aimed to identify demographic and socioeconomic population traits that explain cross-area extra variation in HA- and CA-MRSA relative risks following adjustment for hospital attendance data. We explored the potential for associations with the English Indices of Deprivation 2010 (including the Index of Multiple Deprivation and several deprivation domains and subdomains) and the 2011 England and Wales census demographic and socioeconomic indicators (including numbers of households by deprivation dimension) and indicators of population health. Both CA-and HA-MRSA were associated with household deprivation (CA-MRSA relative risk [RR]: 1.72 [1.03-2.94]; HA-MRSA RR: 1.57 [1.06-2.33]), which was correlated with hospital attendance (Pearson correlation coefficient [PCC] = 0.76). HA-MRSA was also associated with poor health (RR: 1.10 [1.01-1.19]) and residence in communal care homes (RR: 1.24 [1.12-1.37]), whereas CA-MRSA was linked with household overcrowding (RR: 1.58 [1.04-2.41]) and wider barriers, which represent a combined score for household overcrowding, low income, and homelessness (RR: 1.76 [1.16-2.70]). CA-MRSA was also associated with recent immigration to the UK (RR: 1.77 [1.19-2.66]). For the area-level variation in RR for CA-MRSA, 28.67% was attributable to the spatial arrangement of target geographies, compared with only 0.09% for HA-MRSA. An advantage to our study is that it provided a representative sample of usual residents receiving care in the catchment areas. A limitation is that relationships apparent in aggregated data analyses cannot be assumed to operate at the individual level.
There was no evidence of community transmission of HA-MRSA strains, implying that HA-MRSA cases identified in the community originate from the hospital reservoir and are maintained by frequent attendance at health care facilities. In contrast, there was a high risk of CA-MRSA in deprived areas linked with overcrowding, homelessness, low income, and recent immigration to the UK, which was not explainable by health care exposure. Furthermore, areas adjacent to these deprived areas were themselves at greater risk of CA-MRSA, indicating community transmission of CA-MRSA. This ongoing community transmission could lead to CA-MRSA becoming the dominant strain types carried by patients admitted to hospital, particularly if successful hospital-based MRSA infection control programmes are maintained. These results suggest that community infection control programmes targeting transmission of CA-MRSA will be required to control MRSA in both the community and hospital. These epidemiological changes will also have implications for effectiveness of risk-factor-based hospital admission MRSA screening programmes.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>26812054</pmid><doi>10.1371/journal.pmed.1001944</doi><oa>free_for_read</oa></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1549-1676 |
| ispartof | PLoS medicine, 2016-01, Vol.13 (1), p.e1001944 |
| issn | 1549-1676 1549-1277 1549-1676 |
| language | eng |
| recordid | cdi_plos_journals_1764349106 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; PubMed Central; Public Library of Science (PLoS) |
| subjects | Adolescent Adult Aged Biology and life sciences Censuses Child Child, Preschool Community-Acquired Infections - diagnosis Community-Acquired Infections - epidemiology Community-Acquired Infections - psychology Control Copyright Cross Infection Cross-Sectional Studies Data Interpretation, Statistical Disease transmission Earth Sciences Ecology and Environmental Sciences Epidemiology Female Health aspects Health care Hospitals Humans Immigration Infant Infant, Newborn Infectious diseases Laboratories London - epidemiology Low income groups Male Management Maternal Deprivation Medicine and health sciences Metadata Methicillin-Resistant Staphylococcus aureus - isolation & purification Middle Aged Nosocomial infections Population Public health Research and Analysis Methods Social aspects Social Isolation - psychology Social Sciences Socioeconomic factors Spatial analysis Staphylococcal Infections - diagnosis Staphylococcal Infections - epidemiology Staphylococcal Infections - psychology Staphylococcus aureus Staphylococcus infections Young Adult |
| title | Evidence for Community Transmission of Community-Associated but Not Health-Care-Associated Methicillin-Resistant Staphylococcus Aureus Strains Linked to Social and Material Deprivation: Spatial Analysis of Cross-sectional Data |
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