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Neglect of skin wounds and the risk of becoming a Staphylococcus aureus nasal carrier: a cohort study.

Levine H, Kayouf R, Rozhavski V, Sela T, Rajuan-Galor I, Ferber AT, Yona S, Gorochovski O, Halperin T, Hartal M - BMC Public Health (2015)

Bottom Line: Current prevention programs are ineffective, antibiotic resistance is rising and risk factors for becoming a carrier are incompletely understood.None of the socio-demographic characteristics was a risk factor for becoming a carrier while the risk was lower in the winter (Odds ratio [OR] = 0.42; 95% confidence interval [CI]: 0.23-0.78, p < 0.01) and spring (OR = 0.46; 0.26-0.81, p < 0.01) seasons compared to the summer season.Neglect of skin wounds in practice and attitude was a risk factor for becoming a carrier (OR = 2.40; 1.13-5.12, p = 0.02), as well as neglect in practice or attitude (OR = 1.86; 1.04-3.34, p = 0.04) compared to no neglect when controlled for season.

View Article: PubMed Central - PubMed

Affiliation: Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel. hlevine@hadassah.org.il.

ABSTRACT

Background: Nasal carriers of Staphylococcus aureus have an increased risk of acquiring skin and soft tissue infections, which could manifest as outbreaks, especially in crowded settings. Current prevention programs are ineffective, antibiotic resistance is rising and risk factors for becoming a carrier are incompletely understood. We aimed to examine whether a behavior, the neglect of skin wounds, is a risk factor for becoming a Staphylococcus aureus carrier during training.

Methods: We conducted a field-based cohort study among male infantry trainees in three seasons in Israel during 2011-12. Participants underwent anterior nares cultures and answered structured questionnaires on potential risk factors on two occasions: before and 3 weeks after start of training (N = 542). Attitudes and practices toward neglect of skin wounds were defined as perseverance in training at all costs, despite having a wound. Samples were processed within 18 hours for identification of Staphylococcus aureus. Univariable and multivariable logistic regression analyses were performed to assess risk factors for becoming a carrier.

Results: Carriage prevalence increased by 43.3% during training, from 33.2% to 47.6% (p < 0.01). One-fourth (25.4%) of those with a negative culture before training became carriers. None of the socio-demographic characteristics was a risk factor for becoming a carrier while the risk was lower in the winter (Odds ratio [OR] = 0.42; 95% confidence interval [CI]: 0.23-0.78, p < 0.01) and spring (OR = 0.46; 0.26-0.81, p < 0.01) seasons compared to the summer season. Neglect of skin wounds in practice and attitude was a risk factor for becoming a carrier (OR = 2.40; 1.13-5.12, p = 0.02), as well as neglect in practice or attitude (OR = 1.86; 1.04-3.34, p = 0.04) compared to no neglect when controlled for season. The preventable fraction in the population attributed to neglect of skin wounds was 33%.

Conclusions: Neglect of skin wounds is an independent, common and strong risk factor for becoming a Staphylococcus aureus carrier during training. This preventable behavior should not be ignored and should be addressed in public health programs during training and in other settings. Further research on behavioral determinants of Staphylococcus aureus carriage and infection is warranted.

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Related in: MedlinePlus

Staphylococcal aureus carriage prevalence by season, before and three weeks after start of training (N = 542)a. aIncrease in carriage prevalence during training was significant (p < 0.01) for each season
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Fig1: Staphylococcal aureus carriage prevalence by season, before and three weeks after start of training (N = 542)a. aIncrease in carriage prevalence during training was significant (p < 0.01) for each season

Mentions: Carriage prevalence increased during training by 43.3 % (95 % CI: 24-66 %, p < 0.01), from 33.2 % to 47.6 %. In each of the three seasons, carriage prevalence increased during training (p < 0.01), most notably in the summer, by 76.8 %, from 29.9 % to 52.9 % (see Fig. 1).Fig 1


Neglect of skin wounds and the risk of becoming a Staphylococcus aureus nasal carrier: a cohort study.

Levine H, Kayouf R, Rozhavski V, Sela T, Rajuan-Galor I, Ferber AT, Yona S, Gorochovski O, Halperin T, Hartal M - BMC Public Health (2015)

Staphylococcal aureus carriage prevalence by season, before and three weeks after start of training (N = 542)a. aIncrease in carriage prevalence during training was significant (p < 0.01) for each season
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4526198&req=5

Fig1: Staphylococcal aureus carriage prevalence by season, before and three weeks after start of training (N = 542)a. aIncrease in carriage prevalence during training was significant (p < 0.01) for each season
Mentions: Carriage prevalence increased during training by 43.3 % (95 % CI: 24-66 %, p < 0.01), from 33.2 % to 47.6 %. In each of the three seasons, carriage prevalence increased during training (p < 0.01), most notably in the summer, by 76.8 %, from 29.9 % to 52.9 % (see Fig. 1).Fig 1

Bottom Line: Current prevention programs are ineffective, antibiotic resistance is rising and risk factors for becoming a carrier are incompletely understood.None of the socio-demographic characteristics was a risk factor for becoming a carrier while the risk was lower in the winter (Odds ratio [OR] = 0.42; 95% confidence interval [CI]: 0.23-0.78, p < 0.01) and spring (OR = 0.46; 0.26-0.81, p < 0.01) seasons compared to the summer season.Neglect of skin wounds in practice and attitude was a risk factor for becoming a carrier (OR = 2.40; 1.13-5.12, p = 0.02), as well as neglect in practice or attitude (OR = 1.86; 1.04-3.34, p = 0.04) compared to no neglect when controlled for season.

View Article: PubMed Central - PubMed

Affiliation: Braun School of Public Health and Community Medicine, Hebrew University-Hadassah, Jerusalem, Israel. hlevine@hadassah.org.il.

ABSTRACT

Background: Nasal carriers of Staphylococcus aureus have an increased risk of acquiring skin and soft tissue infections, which could manifest as outbreaks, especially in crowded settings. Current prevention programs are ineffective, antibiotic resistance is rising and risk factors for becoming a carrier are incompletely understood. We aimed to examine whether a behavior, the neglect of skin wounds, is a risk factor for becoming a Staphylococcus aureus carrier during training.

Methods: We conducted a field-based cohort study among male infantry trainees in three seasons in Israel during 2011-12. Participants underwent anterior nares cultures and answered structured questionnaires on potential risk factors on two occasions: before and 3 weeks after start of training (N = 542). Attitudes and practices toward neglect of skin wounds were defined as perseverance in training at all costs, despite having a wound. Samples were processed within 18 hours for identification of Staphylococcus aureus. Univariable and multivariable logistic regression analyses were performed to assess risk factors for becoming a carrier.

Results: Carriage prevalence increased by 43.3% during training, from 33.2% to 47.6% (p < 0.01). One-fourth (25.4%) of those with a negative culture before training became carriers. None of the socio-demographic characteristics was a risk factor for becoming a carrier while the risk was lower in the winter (Odds ratio [OR] = 0.42; 95% confidence interval [CI]: 0.23-0.78, p < 0.01) and spring (OR = 0.46; 0.26-0.81, p < 0.01) seasons compared to the summer season. Neglect of skin wounds in practice and attitude was a risk factor for becoming a carrier (OR = 2.40; 1.13-5.12, p = 0.02), as well as neglect in practice or attitude (OR = 1.86; 1.04-3.34, p = 0.04) compared to no neglect when controlled for season. The preventable fraction in the population attributed to neglect of skin wounds was 33%.

Conclusions: Neglect of skin wounds is an independent, common and strong risk factor for becoming a Staphylococcus aureus carrier during training. This preventable behavior should not be ignored and should be addressed in public health programs during training and in other settings. Further research on behavioral determinants of Staphylococcus aureus carriage and infection is warranted.

Show MeSH
Related in: MedlinePlus