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Abstract

Background: In 2015, Bristol (South West England) experienced a large increase in cases of meticillin-resistant (MRSA) infection in people who inject drugs (PWID).

Aim: We aimed to characterise and estimate the prevalence of MRSA colonisation among PWID in Bristol and test evidence of a clonal outbreak.

Methods: PWID recruited through an unlinked-anonymous community survey during 2016 completed behavioural questionnaires and were screened for MRSA. Univariable logistic regression examined associations with MRSA colonisation. Whole-genome sequencing used lineage-matched MRSA isolates, comparing PWID (screening and retrospective bacteraemia samples from 2012-2017) with non-PWID (Bristol screening) in Bristol and national reference laboratory database samples.

Results: The MRSA colonisation prevalence was 8.7% (13/149) and was associated with frequently injecting in public places (odds ratio (OR): 5.5; 95% confidence interval (CI):1.34–22.70), recent healthcare contact (OR: 4.3; 95% CI: 1.34–13.80) and injecting in groups of three or more (OR: 15.8; 95% CI: 2.51–99.28). People reporting any one of: injecting in public places, injection site skin and soft tissue infection or hospital contact accounted for 12/13 MRSA positive cases (sensitivity 92.3%; specificity 51.5%). Phylogenetic analysis identified a dominant clade associated with infection and colonisation among PWID in Bristol belonging to ST5-SCCmecIVg.

Conclusions: MRSA colonisation in Bristol PWID is substantially elevated compared with general population estimates and there is evidence of clonal expansion, community-based transmission and increased infection risk related to the colonising strain. Targeted interventions, including community screening and suppression therapy, education and basic infection control are needed to reduce MRSA infections in PWID.

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/content/10.2807/1560-7917.ES.2019.24.13.1800124
2019-03-28
2024-11-23
http://instance.metastore.ingenta.com/content/10.2807/1560-7917.ES.2019.24.13.1800124
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Clonal expansion of community-associated meticillin-resistant Staphylococcus aureus (MRSA) in people who inject drugs (PWID): prevalence, risk factors and molecular epidemiology, Bristol, United Kingdom, 2012 to 2017
<p class="citation"> <span>Citation style for this article:</span> <span class="meta-value authors"> <a href="/search?value1=Simon+Packer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Packer Simon</a>, <a href="/search?value1=Bruno+Pichon&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Pichon Bruno</a>, <a href="/search?value1=Stephen+Thompson&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Thompson Stephen</a>, <a href="/search?value1=Jane+Neale&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Neale Jane</a>, <a href="/search?value1=Jacquelyn+Njoroge&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Njoroge Jacquelyn</a>, <a href="/search?value1=Rachel+M+Kwiatkowska&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kwiatkowska Rachel M</a>, <a href="/search?value1=Isabel+Oliver&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Oliver Isabel</a>, <a href="/search?value1=Maggie+Telfer&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Telfer Maggie</a>, <a href="/search?value1=Michel+Doumith&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Doumith Michel</a>, <a href="/search?value1=Camillus+Buunaaisie&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Buunaaisie Camillus</a>, <a href="/search?value1=Ellen+Heinsbroek&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Heinsbroek Ellen</a>, <a href="/search?value1=Noreen+Hopewell-Kelly&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hopewell-Kelly Noreen</a>, <a href="/search?value1=Monica+Desai&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Desai Monica</a>, <a href="/search?value1=Vivian+Hope&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hope Vivian</a>, <a href="/search?value1=Owen+Martin+Williams&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Williams Owen Martin</a>, <a href="/search?value1=Angela+Kearns&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Kearns Angela</a>, <a href="/search?value1=Mathew+Hickman&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Hickman Mathew</a>, <a href="/search?value1=Maya+Gobin&option1=author&noRedirect=true" class="nonDisambigAuthorLink">Gobin Maya</a></span>. Clonal expansion of community-associated meticillin-resistant Staphylococcus aureus (MRSA) in people who inject drugs (PWID): prevalence, risk factors and molecular epidemiology, Bristol, United Kingdom, 2012 to 2017. <a href="/content/ecdc">Euro Surveill.</a> 2019;24(13):pii=1800124. <a href="https://doi.org/10.2807/1560-7917.ES.2019.24.13.1800124" title="doi link" target="_blank">https://doi.org/10.2807/1560-7917.ES.2019.24.13.1800124</a> <span class="ES_Article_citation"> <span class="generated">Received</span>: 12 Mar 2018;&nbsp;&nbsp; <span class="generated">Accepted</span>: 14 Oct 2018 </span> </p>
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