Illicit Drug Use and USA300 MRSA | CDC EID

EID Journal Home > Volume 16, Number 9–September 2010

Volume 16, Number 9–September 2010
MEDSCAPE CME ACTIVITY
Illicit Drug Use and Risk for USA300 Methicillin-Resistant Staphylococcus aureus Infections with Bacteremia
Medscape, LLC is pleased to provide online continuing medical education (CME) for this journal article, allowing clinicians the opportunity to earn CME credit. This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education through the joint sponsorship of Medscape, LLC and Emerging Infectious Diseases. Medscape, LLC is accredited by the ACCME to provide continuing medical education for physicians. Medscape, LLC designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credits™. Physicians should only claim credit commensurate with the extent of their participation in the activity. All other clinicians completing this activity will be issued a certificate of participation. To participate in this journal CME activity: (1) review the learning objectives and author disclosures; (2) study the education content; (3) take the post-test and/or complete the evaluation at http://cme.medscape.com/viewpublication/30063; (4) view/print certificate.

Learning Objectives
Upon completion of this activity, participants will be able to:

•Examine the association of illicit drug use with USA300 MRSA infection, including risk factors for acquisition and transmission.
•Describe characteristics of illicit drug users who acquire MRSA and the changing pattern of risk from 2004 to 2008 in the United States with implications for management and prevention.


Medscape CME Editor
Carol Snarey, MA, Copyeditor, Emerging Infectious Diseases. Disclosure: Carol Snarey has disclosed no relevant financial relationships.

Medscape CME Author
Desiree Lie, MD, MSED, Clinical Professor of Family Medicine, Director of Research and Faculty Development, University of California, Irvine at Orange, California. Disclosure: D&eactue;sir&eactue;e Lie, MD, MSEd, has disclosed the following relevant financial relationship: served as a nonproduct speaker for "Topics in Health" for Merck Speaker Services.

Authors
Disclosures: Disclosures: Kristen M. Kreisel, PhD; O. Colin Stine, PhD; Michelle D. Shardell, PhD; Alan J. Lesse, MD; Fred M. Gordin, MD; and Mary-Claire Roghmann, MD, MS, have disclosed no relevant financial relationships. J. Kristie Johnson, PhD, has disclosed the following relationships: received grants for clinical research from Becton, Dickinson and Company. Eli N. Perencevich, MD, MS, has disclosed the following relationships: received grants for clinical support from Pfizer Inc. Michael W. Climo, MD, has disclosed the following relationships: served as an advisor or consultant for Biosynexus Incorporated; received grants for clinical research from Biosynexus Incorporated.

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EID Journal Home > Volume 16, Number 9–September 2010

Volume 16, Number 9–September 2010
Research
Illicit Drug Use and Risk for USA300 Methicillin-Resistant Staphylococcus aureus Infections with Bacteremia
Kristen M. Kreisel, J. Kristie Johnson, O. Colin Stine, Michelle D. Shardell, Eli N. Perencevich, Alan J. Lesse, Fred M. Gordin, Michael W. Climo, and Mary-Claire Roghmann

Author affiliations: University of Maryland, Baltimore, Maryland, USA (K.M. Kreisel, J.K. Johnson, O.C. Stine, M.D. Shardell, E.N. Perencevich, M.-C. Roghmann); VA Maryland Health Care System, Baltimore (K.M. Kreisel, E.N. Perencevich, M.-C. Roghmann); VA Western New York Healthcare System, Buffalo, New York, USA (A.J. Lesse); University at Buffalo, Buffalo (A.J. Lesse); Washington DC VA Medical Center, Washington, DC, USA (F.M. Gordin); George Washington University, Washington (F.M. Gordin); Hunter Holmes McGuire VA Medical Center, Richmond, VA, USA (M.W. Climo); and Medical College of Virginia at Virginia Commonwealth University, Richmond (M.W. Climo)

Suggested citation for this article

Abstract
To assess the association of illicit drug use and USA300 methicillin-resistant Staphylococcus aureus (MRSA) bacteremia, a multicenter study was conducted at 4 Veterans Affairs medical centers during 2004–2008. The study showed that users of illicit drugs were more likely to have USA300 MRSA bacteremia (in contrast to bacteremia caused by other S. aureus strains) than were patients who did not use illicit drugs (adjusted relative risk 3.0; 95% confidence interval 1.9–4.4). The association of illicit drug use with USA300 MRSA bacteremia decreased over time (p = 0.23 for trend). Notably, the proportion of patients with USA300 MRSA bacteremia who did not use illicit drugs increased over time. This finding suggests that this strain has spread from users of illicit drugs to other populations.

Infections caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) are increasing. Outbreaks have been described in a variety of populations, including sports teams, men who have sex with men, prisoners, and children (1 – 10 ). The USA300 MRSA clone has been recognized as the most common strain causing CA-MRSA infections (11).

CA-MRSA was first reported in illicit drug users in Detroit in 1980 (12). The drug-using population has been identified as a reservoir of CA-MRSA (13). Because of the repeated injection or inhalation of drugs, the opportunity for a person to cause and spread infection with one’s own colonizing strain is multiplied (13,14). Skin and soft tissue infections are the most common infections in illicit drug users; the USA300 MRSA strain is the cause of up to 75% of these infections (13–15). Once this strain colonizes or otherwise infects a person, it can then enter the patient’s bloodstream and become a potentially life-threatening bloodstream infection.

If admitted to the hospital, illicit drug–using patients with a USA300 MRSA infection complicated by bacteremia serve as a potential reservoir for transmission to other patient populations. This mechanism may be contributing to the replacement of other MRSA strains typically associated with nosocomial infections by USA300 MRSA and may aid this strain in becoming the predominant isolate causing MRSA infections in both healthcare and community settings (16,17). The objective of this study was to evaluate the association of illicit drug use with USA300 MRSA bacteremia and whether the association is static or has changed over a 5-year period as the USA300 MRSA epidemic has progressed.


open here to see the full-text:
Illicit Drug Use and USA300 MRSA | CDC EID

Suggested Citation for this Article
Suggested citation for this article: Kreisel KM, Johnson JK, Stine OC, Shardell MD, Perencevich EN, Lesse AJ, et al. Illicit drug use and risk for USA300 methicillin-resistant Staphylococcus aureus infections with bacteremia. Emerg Infect Dis [serial on the Internet]. 2010 Sep [date cited]. Available from http://www.cdc.gov/EID/content/16/9/1419.htm

DOI: 10.3201/eid1609.091802