Exploration of individual and area level risk factors for invasive and non-invasive methicillin-resistant Staphylococcus aureus infections among children and adults in 8 Georgia counties, 2017 Open Access

Portela, Gerard (Spring 2020)

Permanent URL: https://etd.library.emory.edu/concern/etds/kw52j9119?locale=en



Staphylococcus aureus (SA) infection prevention and characterization have primarily focused on hospital- and community-associated methicillin-resistance in adults or children separately, without comparing invasive to non-invasive disease. How place-based factors contribute to risks for staphylococcal-related infections in adults and children are also not well characterized. Our study describes invasive and non-invasive MRSA and MSSA among children and adults by examining individual and area level data.


We analyzed Emerging Infections Program 2017 surveillance data for SA infections in 8 metro-Atlanta counties. Multivariable logistic regression models with random intercepts were used to compare risk factors of MRSA versus MSSA among invasive and skin/soft tissue infections (SSTIs) in both children and adults. Standardized incidence ratios (SIRs) were calculated using census tracts from georeferenced cases.


After considering patient demographics, children with MRSA SSTIs are more likely to be from areas with crowding (adjusted odds ratio [aOR] 1.44, 95% confidence interval [CI] 1.02-2.04); similar risk is observed in adults (aOR 1.39, 95% CI 1.18-1.65). Children with invasive MRSA are more likely to live in an area with a racial ethnic concentration (aOR 3.10, 95% CI 1.07-8.99), while increased proportions of no health insurance increase adult risk (aOR 4.05, 95% CI 1.09-15.14). MRSA hotspots were found in more densely populated areas with high proportions of black populations.


The risk of MRSA infections in children and adults are defined by unique area level sociodemographic characteristics. Public health interventions to reduce antibiotic resistant disease should focus resources among age groups in areas with risk factors identified in this study.

Table of Contents

Introduction 1

Methods 2

Results 7

Discussion 11

About this Master's Thesis

Rights statement
  • Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.
Subfield / Discipline
  • English
Research Field
Committee Chair / Thesis Advisor
Committee Members
Last modified

Primary PDF

Supplemental Files