Racial Disparities in Invasive Methicillin-resistant Staphylococcus aureus Infections, 2005-2014

Nicole Gualandi, Yi Mu, Wendy M. Bamberg, Ghinwa Dumyati, Lee H. Harrison, Lindsey Lesher, Joelle Nadle, Sue Petit, Susan M. Ray, William Schaffner, John Townes, Mariana McDonald, Isaac See

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Abstract

Background Despite substantial attention to the individual topics, little is known about the relationship between racial disparities and antimicrobial-resistant and/or healthcare-associated infection trends, such as for methicillin-resistant Staphylococcus aureus (MRSA). Methods We analyzed Emerging Infections Program 2005-2014 surveillance data (9 US states) to determine whether reductions in invasive MRSA incidence (isolated from normally sterile body sites) affected racial disparities in rates. Case classification included hospital-onset (HO, culture >3 days after admission), healthcare-associated community onset (HACO, culture ≤3 days after admission and dialysis, hospitalization, surgery, or long-term care residence within 1 year prior), or community-associated (CA, all others). Negative binomial regression models were used to evaluate the adjusted rate ratio (aRR) of MRSA in black patients (vs in white patients) controlling for age, sex, and temporal trends. Results During 2005-2014, invasive HO and HACO (but not CA) MRSA rates decreased. Despite this, blacks had higher rates for HO (aRR, 3.20; 95% confidence interval [CI], 2.35-4.35), HACO (aRR, 3.84; 95% CI, 2.94-5.01), and CA (aRR, 2.78; 95% CI, 2.30-3.37) MRSA. Limiting the analysis to chronic dialysis patients reduced, but did not eliminate, the higher HACO MRSA rates among blacks (aRR, 1.83; 95% CI, 1.72-1.96), even though invasive MRSA rates among dialysis patients decreased during 2005-2014. These racial differences did not change over time. Conclusions Previous reductions in healthcare-associated MRSA infections have not affected racial disparities in MRSA rates. Improved understanding of the underlying causes of these differences is needed to develop effective prevention interventions that reduce racial disparities in MRSA infections.

Original languageEnglish (US)
Pages (from-to)1175-1181
Number of pages7
JournalClinical Infectious Diseases
Volume67
Issue number8
DOIs
StatePublished - Sep 28 2018

Fingerprint

Methicillin-Resistant Staphylococcus aureus
Infection
Confidence Intervals
Dialysis
Delivery of Health Care
Long-Term Care
Statistical Models
Cross Infection
Hospitalization
Incidence

Keywords

  • methicillin-resistant Staphylococcus aureus
  • racial disparities
  • social determinants of health

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Gualandi, N., Mu, Y., Bamberg, W. M., Dumyati, G., Harrison, L. H., Lesher, L., ... See, I. (2018). Racial Disparities in Invasive Methicillin-resistant Staphylococcus aureus Infections, 2005-2014. Clinical Infectious Diseases, 67(8), 1175-1181. https://doi.org/10.1093/cid/ciy277

Racial Disparities in Invasive Methicillin-resistant Staphylococcus aureus Infections, 2005-2014. / Gualandi, Nicole; Mu, Yi; Bamberg, Wendy M.; Dumyati, Ghinwa; Harrison, Lee H.; Lesher, Lindsey; Nadle, Joelle; Petit, Sue; Ray, Susan M.; Schaffner, William; Townes, John; McDonald, Mariana; See, Isaac.

In: Clinical Infectious Diseases, Vol. 67, No. 8, 28.09.2018, p. 1175-1181.

Research output: Contribution to journalArticle

Gualandi, N, Mu, Y, Bamberg, WM, Dumyati, G, Harrison, LH, Lesher, L, Nadle, J, Petit, S, Ray, SM, Schaffner, W, Townes, J, McDonald, M & See, I 2018, 'Racial Disparities in Invasive Methicillin-resistant Staphylococcus aureus Infections, 2005-2014', Clinical Infectious Diseases, vol. 67, no. 8, pp. 1175-1181. https://doi.org/10.1093/cid/ciy277
Gualandi, Nicole ; Mu, Yi ; Bamberg, Wendy M. ; Dumyati, Ghinwa ; Harrison, Lee H. ; Lesher, Lindsey ; Nadle, Joelle ; Petit, Sue ; Ray, Susan M. ; Schaffner, William ; Townes, John ; McDonald, Mariana ; See, Isaac. / Racial Disparities in Invasive Methicillin-resistant Staphylococcus aureus Infections, 2005-2014. In: Clinical Infectious Diseases. 2018 ; Vol. 67, No. 8. pp. 1175-1181.
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abstract = "Background Despite substantial attention to the individual topics, little is known about the relationship between racial disparities and antimicrobial-resistant and/or healthcare-associated infection trends, such as for methicillin-resistant Staphylococcus aureus (MRSA). Methods We analyzed Emerging Infections Program 2005-2014 surveillance data (9 US states) to determine whether reductions in invasive MRSA incidence (isolated from normally sterile body sites) affected racial disparities in rates. Case classification included hospital-onset (HO, culture >3 days after admission), healthcare-associated community onset (HACO, culture ≤3 days after admission and dialysis, hospitalization, surgery, or long-term care residence within 1 year prior), or community-associated (CA, all others). Negative binomial regression models were used to evaluate the adjusted rate ratio (aRR) of MRSA in black patients (vs in white patients) controlling for age, sex, and temporal trends. Results During 2005-2014, invasive HO and HACO (but not CA) MRSA rates decreased. Despite this, blacks had higher rates for HO (aRR, 3.20; 95{\%} confidence interval [CI], 2.35-4.35), HACO (aRR, 3.84; 95{\%} CI, 2.94-5.01), and CA (aRR, 2.78; 95{\%} CI, 2.30-3.37) MRSA. Limiting the analysis to chronic dialysis patients reduced, but did not eliminate, the higher HACO MRSA rates among blacks (aRR, 1.83; 95{\%} CI, 1.72-1.96), even though invasive MRSA rates among dialysis patients decreased during 2005-2014. These racial differences did not change over time. Conclusions Previous reductions in healthcare-associated MRSA infections have not affected racial disparities in MRSA rates. Improved understanding of the underlying causes of these differences is needed to develop effective prevention interventions that reduce racial disparities in MRSA infections.",
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AU - Harrison, Lee H.

AU - Lesher, Lindsey

AU - Nadle, Joelle

AU - Petit, Sue

AU - Ray, Susan M.

AU - Schaffner, William

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AU - See, Isaac

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N2 - Background Despite substantial attention to the individual topics, little is known about the relationship between racial disparities and antimicrobial-resistant and/or healthcare-associated infection trends, such as for methicillin-resistant Staphylococcus aureus (MRSA). Methods We analyzed Emerging Infections Program 2005-2014 surveillance data (9 US states) to determine whether reductions in invasive MRSA incidence (isolated from normally sterile body sites) affected racial disparities in rates. Case classification included hospital-onset (HO, culture >3 days after admission), healthcare-associated community onset (HACO, culture ≤3 days after admission and dialysis, hospitalization, surgery, or long-term care residence within 1 year prior), or community-associated (CA, all others). Negative binomial regression models were used to evaluate the adjusted rate ratio (aRR) of MRSA in black patients (vs in white patients) controlling for age, sex, and temporal trends. Results During 2005-2014, invasive HO and HACO (but not CA) MRSA rates decreased. Despite this, blacks had higher rates for HO (aRR, 3.20; 95% confidence interval [CI], 2.35-4.35), HACO (aRR, 3.84; 95% CI, 2.94-5.01), and CA (aRR, 2.78; 95% CI, 2.30-3.37) MRSA. Limiting the analysis to chronic dialysis patients reduced, but did not eliminate, the higher HACO MRSA rates among blacks (aRR, 1.83; 95% CI, 1.72-1.96), even though invasive MRSA rates among dialysis patients decreased during 2005-2014. These racial differences did not change over time. Conclusions Previous reductions in healthcare-associated MRSA infections have not affected racial disparities in MRSA rates. Improved understanding of the underlying causes of these differences is needed to develop effective prevention interventions that reduce racial disparities in MRSA infections.

AB - Background Despite substantial attention to the individual topics, little is known about the relationship between racial disparities and antimicrobial-resistant and/or healthcare-associated infection trends, such as for methicillin-resistant Staphylococcus aureus (MRSA). Methods We analyzed Emerging Infections Program 2005-2014 surveillance data (9 US states) to determine whether reductions in invasive MRSA incidence (isolated from normally sterile body sites) affected racial disparities in rates. Case classification included hospital-onset (HO, culture >3 days after admission), healthcare-associated community onset (HACO, culture ≤3 days after admission and dialysis, hospitalization, surgery, or long-term care residence within 1 year prior), or community-associated (CA, all others). Negative binomial regression models were used to evaluate the adjusted rate ratio (aRR) of MRSA in black patients (vs in white patients) controlling for age, sex, and temporal trends. Results During 2005-2014, invasive HO and HACO (but not CA) MRSA rates decreased. Despite this, blacks had higher rates for HO (aRR, 3.20; 95% confidence interval [CI], 2.35-4.35), HACO (aRR, 3.84; 95% CI, 2.94-5.01), and CA (aRR, 2.78; 95% CI, 2.30-3.37) MRSA. Limiting the analysis to chronic dialysis patients reduced, but did not eliminate, the higher HACO MRSA rates among blacks (aRR, 1.83; 95% CI, 1.72-1.96), even though invasive MRSA rates among dialysis patients decreased during 2005-2014. These racial differences did not change over time. Conclusions Previous reductions in healthcare-associated MRSA infections have not affected racial disparities in MRSA rates. Improved understanding of the underlying causes of these differences is needed to develop effective prevention interventions that reduce racial disparities in MRSA infections.

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