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Do Public Housing and Incarceration Amplify Transmission?

Bala Hota, MD, MPH; Charlotte Ellenbogen, MD; Mary K. Hayden, MD; Alla Aroutcheva, MD, PhD; Thomas W. Rice, PhD; Robert A. Weinstein, MD

Arch Intern Med. 2007;167(10):1026-1033.

Background  Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have emerged among patients without health care–associated risk factors. Understanding the epidemiology of CA-MRSA is critical for developing control measures.

Methods  At a 464-bed public hospital in Chicago and its more than 100 associated clinics, surveillance of soft tissue, abscess fluid, joint fluid, and bone cultures for S aureus was performed. We estimated rates of infection and geographic and other risks for CA-MRSA through laboratory-based surveillance and a case-control study.

Results  The incidence of CA-MRSA skin and soft tissue infections increased from 24.0 cases per 100 000 people in 2000 to 164.2 cases per 100 000 people in 2005 (relative risk, 6.84 [2005 vs 2000]). Risk factors were incarceration (odds ratio [OR], 1.92; 95% confidence interval [CI], 1.00-3.67), African American race/ethnicity (OR, 1.91; 95% CI, 1.28-2.87), and residence at a group of geographically proximate public housing complexes (OR, 2.50; 95% CI, 1.25-4.98); older age was inversely related (OR, 0.89; 95% CI, 0.82-0.96 [for each decade increase]). Of 73 strains tested, 79% were pulsed-field gel electrophoresis type USA300.

Conclusions  Clonal CA-MRSA infection has emerged among Chicago's urban poor. It has occurred in addition to, not in place of, methicillin-susceptible S aureus infection. Epidemiological analysis suggests that control measures could focus initially on core groups that have contributed disproportionately to risk, although CA-MRSA becomes endemic as it disseminates within communities.

Author Affiliations: Division of Infectious Diseases, Department of Medicine, Rush University Medical Center (Drs Hota, Ellenbogen, Hayden, Aroutcheva, and Weinstein) and Division of Infectious Diseases, Department of Medicine, John H. Stroger, Jr Hospital of Cook County (Drs Hota, Aroutcheva, Rice, and Weinstein), Chicago, Ill.

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