The Relationship Between Obesity and Recurrent Methicillin-resistant Staphylococcus aureus (MRSA) Infection Among Individuals with Initial Invasive Community-Associated MRSA Infection: A Pilot Study Open Access

Parr, Alyssa Michelle (2013)

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Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infections have been increasing in incidence over the past decade, and while some studies have looked at recurrence in skin and soft tissue CA-MRSA infections, there is no current literature on recurrence for invasive CA-MRSA infections. Obesity has been linked to skin and soft tissue infections as well as recurrent skin and soft tissue MRSA infections, and might have an impact on invasive MRSA infections as well. This pilot study aimed to examine the relationship between obesity and recurrent invasive MRSA infections among individuals with an initial CA-MRSA infection in the year prior. Data were obtained from the Active Bacterial Core surveillance (ABCs) system of the Center for Disease Control and Prevention's Emerging Infections Program from 2005-2011. A case-control study was performed for initial CA-MRSA infections between 2006-2010, comparing cases, defined as individuals with an initial invasive CA-MRSA infection that went on to have a second invasive MRSA infection in the year following the initial infection (recurrence), and controls, defined as individuals with invasive CA-MRSA infection who did not go on to have recurrence. There were 253 cases and 2,876 controls identified, for a total sample size of 3,129, indicating an average recurrence incidence of 8% annually. Multivariate modeling revealed a significant relationship between obesity and recurrence (OR 1.84, 95% CI 1.26-2.69, p-value=0.0016), after controlling for age, diabetes, bacteremia, pneumonia, osteomyelitis, urinary tract infection, endocarditis, bursitis, and surgical incision infection. Confounding assessment led to a simpler model that again showed a significant relationship between obesity and recurrence (OR 1.99, 95% CI 1.40-2.86, p=0.0002). Since recurrence is assumed to be rare, this indicates that the risk of recurrent invasive MRSA infections among individuals with an initial invasive CA-MRSA infection is twice the risk of recurrence among non-obese individuals. Given the high prevalence of obesity in the United States and the evidence for increasing incidence of CA-MRSA, this pilot study should help generate hypotheses for future studies examining the relationship between obesity and recurrence in CA-MRSA infections. In particular, these preliminary results emphasize the need for further analysis using several variables introduced in 2010 to the ABCs invasive MRSA surveillance case report form, such as BMI.

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