Community Associated Methicillin Resistant Staphylococcus aureus Among New York City Men Who have Sex with Men: Qualitative Research Findings and Implications for Public Health Practice
Academic literature has recorded increased microbial resistance in the United States and recent news media has adversely portrayed men who have sex with men (MSM) at increased risk for community associated methicillin resistant Staphylococcus aureus (CA-MRSA) transmission. CA-MRSA is a specific type of bacteria resistant to certain antibiotics, which limits treatment options for those needing clinical care. Infection can manifest as painful abscesses and can cause severe illness. With increased CA-MRSA infections overall, and attention given to MSM populations regarding CA-MRSA, as well as the fact that limited data on sociocultural factors that may facilitate transmission, we undertook a qualitative study to explore contextual influences that may fuel infection among MSM in New York City so that public health professionals can better recognize, and respond appropriately to, potential future outbreaks. In-depth interviews were used to qualitatively investigate perceptions and beliefs regarding transmission, as well as community understandings of treatment options. Participants included thirteen MSM who reported a previous CA-MRSA infection and nine community practitioners. A thematic content analysis of these interviews was conducted and data suggests that behaviors and exposures associated with transmission of CA-MRSA are common in certain MSM networks. Specifically, sociocultural influences and methamphetamine use activities were found to contribute to CA-MRSA transmission. We underscore the role of public health and health services practitioners in providing appropriate CA-MRSA awareness and education to MSM populations.
KeywordsMen who have sex with men (MSM) Methicillin resistant Staphylococcus aureus (MRSA) Qualitative methods Methamphetamine use
This research was funded by Pfizer Inc. (Grant #GA9000C5). The authors thank the following individuals for their contribution with data collection: Julia Elizabeth Sullivan, Kevin Malloy, Kathryn Salo, Aimee Julien, Damon Duquaine and Daniel Krieger. Our deepest gratitude goes to Jamie Sokol, Elizabeth Kilgore and Marci Layton for their support and guidance.
- 5.Carleton, H. A., Diep, B. A., Charlebois, E. D., Sensabaugh, G. F., & Perdreau-Remington, F. (2004). Community-adapted methicillin-resistant Staphylococcus aureus (MRSA): Population dynamics of an expanding community reservoir of MRSA. Journal of InfectiousDiseases, 190(10), 1730–1738.CrossRefGoogle Scholar
- 8.Schito, G. C. (2006). The importance of the development of antibiotic resistance in Staphylococcus aureus. Clinical Microbiology & Infection, 12(Suppl 1), 3–8.Google Scholar
- 9.Matouskova, I., & Janout, V. (2008). Current knowledge of methicillin-resistant Staphylococcus aureus and community-associated methicillin-resistant Staphylococcus aureus. Biomedical Papers-Olomouc, 152(2), 191–202.Google Scholar
- 11.Enright, M. C., Robinson, D. A., Randle, G., Feil, E. J., Grundmann, H., & Spratt, B. G. (2002). The evolutionary history of methicillin-resistant Staphylococcus aureus (MRSA). Proceedings of the National Academy of Sciences of the United States of America, 99(11), 7687–7692.PubMedCrossRefGoogle Scholar
- 13.Barton, M., Hawkes, M., Moore, D., Conly, J., Nicolle, L., Allen, U., et al. (2006). Guidelines for the prevention and management of community-associated methicillin-resistant Staphylococcus aureus: A perspective for Canadian health care practitioners. The Canadian Journal of Infectious Diseases & Medical Microbiology, 17(suppl C), 4C–24C.Google Scholar
- 14.Centers for Disease Control and Prevention. (2009). CA-MRSA: Clinician FAQs | CDC infection control in healthcare. Available at: http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_clinicians.html. Accessed April 14, 2011.
- 16.New York City Department of Health and Mental Hygiene. (2007). Health department proposes measure to require reporting of resistant staph infection in NYC. Available at: http://www.nyc.gov/html/doh/downloads/pdf/public/notice-statement-hc-art11-03-1007.pdf. Accessed April 14, 2011.
- 17.Centers for Disease Control and Prevention. (2010). Methicillin-resistant Staphylococcus aureus (MRSA) infections. Available at: http://www.cdc.gov/mrsa. Accessed April 14, 2011.
- 19.King, M. D., Humphrey, B. J., Wang, Y. F., Kourbatova, E. V., Ray, S. M., & Blumberg, H. M. (2006). Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Annals of Internal Medicine, 144(5), 309–317.PubMedGoogle Scholar
- 23.Lee, N. E., Taylor, M. M., Bancroft, E., Ruane, P. J., Morgan, M., McCoy, L., et al. (2005). Risk factors for community-associated methicillin-resistant Staphylococcus aureus skin infections among HIV-positive men who have sex with men. Clinical Infectious Diseases, 40(10), 1529–1534.PubMedCrossRefGoogle Scholar
- 26.Diep, B. A., Chambers, H. F., Graber, C. J., Szumowski, J. D., Miller, L. G., Han, L. L., et al. (2008). Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men. Annals of Internal Medicine, 148(4), 249–257.PubMedGoogle Scholar
- 27.Marx, M. A., Cook, H., Rehana, Z., Krieger, D., Yeung, A., Lue, Y., et al. (2008). Results of a case-control investigation of risk factors for CA–CA-MRSA in New York City, 2005–2007. In Annual conference on antimicrobial resistance, 2008, Bethesda, MD.Google Scholar
- 28.Galindo, G. R., & Whitcher, A. J. (2010). Networks of transmission: Exploring methicillin resistant Staphylococcus aureus among New York City men who have sex with men. Oral presentation at annual meeting of the American Public Health Association. Denver, CO.Google Scholar
- 29.Patton, M. Q. (1990). Qualitative evaluation and research methods (2nd ed.). Newbury Park, CA: Sage.Google Scholar
- 30.Muhr, T. (1997). Atlas.ti for Windows. Berlin: Scientific Software Development.Google Scholar
- 35.Ciccarone, R. M., Kim, M., Tice, A. D., Nakata, M., Effler, P., Jernigan, D. B., et al. (2010). Prevention of community-associated methicillin-resistant Staphylococcus aureus infection among Asian/Pacific Islanders: A qualitative assessment. Hawaii Medical Journal, 69(6), 142–144.PubMedGoogle Scholar
- 37.Kassem, I. I. (2002). Chinks in the armor: The role of the nonclinical environment in the transmission of Staphylococcus bacteria. American Journal of Infection Control 2011 Apr 20 [Epub ahead of print].Google Scholar
- 39.Newsweek. (2008). A new ‘Gay Disease’? A drug-resistant strain of staph is infecting some gay men, but experts say a lot of the media coverage got it wrong. Available at: http://www.newsweek.com/2008/01/17/a-new-gay-disease.html. Accessed April 14, 2011.
- 40.Centers for Disease Control and Prevention. (2010). Methicillin-resistant Staphylococcus aureus (MRSA). At: http://www.cdc.gov/ncidod/dhqp/ar_mrsa_ca_public.html (no longer available). Accessed April 24, 2010.
- 41.Los Angeles County Department of Public Health. (2005). Community associated methicillin-resistant Staphylococcus aureus: An emerging infectious disease in Los Angeles County. Available at: http://www.publichealth.lacounty.gov/acd/docs/MRSA-TPHJulAug05.pdf. Accessed July 19, 2011.
- 42.New York City Department of Health and Mental Hygiene. (2010). MRSA skin infection: Gay men. Available at: http://www.nyc.gov/html/doh/mrsa/html/info/gay_men.shtml. Accessed July 19, 2011.
- 43.Seattle and King County Public Health. (2008). Methicillin-resistant S. aureus (MRSA). Available at: http://www.kingcounty.gov/healthservices/health/communicable/diseases/MRSA-English.aspx. Accessed July 19, 2011.