September 03, 2019
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MRSA colonization common on intake at Chicago jail

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Kyle J. Popovich, MD, MS, FIDSA
Kyle J. Popovich

Almost 20% of men entering a large Chicago jail during a recent 2-year period were positive for MRSA upon intake, researchers reported.

Kyle J. Popovich, MD, MS, FIDSA, associate professor of infectious diseases at Rush University Medical Center, and colleagues explained in Clinical Infectious Diseases that community-associated MRSA (CA-MRSA) is a “significant pathogen” that may be more easily spread in settings with close person-to-person contact, such as urban jails, which have high detainee turnover.

“The prevalence of MRSA colonization entering a large inner-city jail is high, a finding that needs to be considered in understanding how inner-city jails contribute to spread of MRSA. Colonization risk factors provide clues to community reservoirs for MRSA that precede incarceration,” Popovich told Infectious Disease News.

Between January 2016 and December 2017, Popovich and colleagues enrolled men incarcerated at Cook County Jail within 72 hours of intake to identify community transmission networks for MRSA preceding incarceration. The study population was “enriched” with HIV-infected individuals enrolled from the jail HIV clinic, they wrote.

A photo of prison bars 
Many individuals enter jail already colonized with MRSA.
Source: Adobe Stock.

There were 800 incarcerations, with 718 unique individuals included in the final study population, among whom 91% had previously been in jail.

“Recidivism was common in this study, with the majority of individuals in the study having previously been in jail at some point in their life,” Popovich said. “The extent to which recidivism contributes to the community risks we identified in this study and how relevant recent incarceration is for MRSA risk remain to be determined.”

The prevalence of MRSA colonization at intake was 19%, and 58% were HIV infected. An analysis identified methamphetamine use, unstable housing, current/recent skin infection and recent injection drug as predictors of MRSA, whereas predictors among HIV patients were recent injection drug use, current skin infection and HIV care at an outpatient clinic “that emphasizes comprehensive care to the LGBTQ community.” Of the 31 detainees who had been seen at the outpatient clinic, 45% were colonized.

“The finding that recent injection drug use is associated with MRSA risk is particularly notable given the current opioid epidemic and literature suggesting that injection drug users are significantly more likely to develop invasive MRSA infections,” Popovich said.

“Using whole-genome sequencing and phylogenetic analysis, we observed that a strain type of MRSA (USA500) was associated with distinct social networks, with individuals harboring USA500 strains more likely to be HIV infected, men who have sex with men, and methamphetamine users,” Popovich added. “Interventions to reduce the risk of MRSA infection or MRSA spread to others could be directed at detainees entering the jail who are found to have community risk factors associated with pre-detention MRSA colonization.”

According to Popovich, it is unclear if the results from this study are generalizable, but the findings can serve as a blueprint for other jails looking to reduce the risk of MRSA, he said.

“Our study did highlight community risk factors associated with pre-detention MRSA colonization; these findings could serve as a starting point for another urban jail seeking to develop an intervention aimed at reducing the risk of MRSA infection or MRSA spread at their facility,” she said. “Each jail has unique infrastructure, resources, and detainee populations so findings might need to be adapted. So while likely too early for guidelines, our study results could be useful for helping to identify those at highest risk for MRSA colonization at entrance to the jail and for informing the next series of studies.” – by Marley Ghizzone

Disclosures: Popovich reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.