Risk factors for community-associated Staphylococcus aureus skin and soft tissue infections in children of Maui, Hawaii

The prevalence of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) infection, and Staphylococcus aureus (S. aureus) infection overall, has dramatically increased in the past 10 years. Native Hawaiians and Pacific Islanders (NHPI), and children are disproportionately affected by CA-MRSA infection. The epidemiologic triangle with emphasis on agent, environment, and host provides the framework for this investigation. The purpose of this case-control study was to identify risk factors for CA- S.aureus skin infections in children of Maui, Hawaii. NHPI participants were well represented as 58% of cases and 54% of controls. Survey data were obtained from clinic patients over an 8 month period. Chi-square analysis and logistic regression were used to identify significant risk factors. Significant risk factors predictive of infection among all participants were (a) skin abrasions or wounds, (b) household contact, and (c) overweight or obesity. Risk factors predictive of infection among NHPI were (a) skin abrasions or wounds, (b) antibiotic use within 6 months, (c) overweight or obesity, and (d) a history of eczema or other skin disorder. The role of overweight or obesity in S. aureus skin infections among NHPI was not identified in earlier studies and provides support for the recommendation that further education be aimed at this population. This research promotes positive social change by filling a crucial gap in establishing specific risk factors in this vulnerable population. Further research is needed to understand the role of eczema, antibiotic use, overweight and obesity, culture, and socioeconomic status in these infections. By elucidating areas most in need of proactive intervention, the transmission of S. aureus infections can be reduced.