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Risk factors for pediatric community-acquired methicillin-resistant staphylococcus aureus (MRSA)
AEP Vol. 14, No. 8 September 2004: 592–624
ABSTRACTS (ACE)
inability to give informed consent, severity of psychosis, or patient refusal. doi:10.1016/j.annepidem.2004.07.057 INFECTIOUS DISEASE P059 SEXUAL BEHAVIOR AND RISK PERCEPTIONS RELATED TO HIV INFECTION AMONG COLLEGE STUDENTS Su-I Hou, Department of Health Promotion and Behavior, College of Education, University of Georgia, Athens, GA PURPOSE: To assess behavioral determinants (sexual behavior stage, partner numbers, partner types, condom use, and sexual orientation) on risk perceptions related to HIV infection among college students. HIV risk perception has been shown to be significantly related to prior HIV testing behavior; however, current knowledge of determinants related to HIV risk perceptions among college students has been limited. Understanding how behavior risk factors influencing HIV risk perception can play a critical role for developing effective HIV prevention and education programs. METHODS: A Web-based survey was administered during spring 2003 at one of the major universities in the southeastern United States. RESULTS: A total of 440 college students participated in the study: mean age 21 (SD Z 2.48), 75% female, 88% heterosexual. Mean of the ‘‘perceived risk of HIV’’ scale (3-item), rated on fivepoint Liker scale, was used to classify students into low versus high risk perception groups (mean Z 6.40). Sexual behavior stage index grouped students as ‘‘no to any sex’’ (16.7%), ‘‘yes to oral sex only’’ (17.2%), ‘‘yes to both oral and vaginal sex’’ (43.0%), and ‘‘yes to oral and (vaginal) and anal sex’’ (23.2%). Logistic regression, with sexual behavior stage index, number of partner index (oral C vaginal C anal), types of partner index (someone as injection drug user, with multiple partners, or paid for sex), condom use index, and sexual orientation as independent variables, was used to predict HIV risk perception. Results indicated that the full model of the combined five predictors was statistically reliable in distinguishing between students with high versus low risk perception (X(5) Z 23.162, P ! 0.001), which correctly classified 84.0% of the students. Wald statistics indicated that number of partners index (odds ratio Z 1.459, 95% confidence interval Z 1.08, 1.97) had a statistical significant coefficient (P Z 0.014). CONCLUSION: Despite risky sexual behaviors prevalent among college students, the overall perception of HIV infection was low. Results suggest that educational messages addressing the number of partners and its relationship with actual risk of HIV infection could be an effective strategy to increase risk perception. doi:10.1016/j.annepidem.2004.07.058
P060S RISK FACTORS FOR PEDIATRIC COMMUNITY-ACQUIRED METHICILLINRESISTANT STAPHYLOCOCCUS AUREUS (MRSA) Kessler, R Sanderson, H Stockwell, Y Wu, Department of Epidemiology & Biostatistics, University of South Florida, Tampa, FL
613
PURPOSE: A chart review of children under 18 years of age with a positive Staphylococcus aureus culture within the first 72 hours after admission or as an outpatient was conducted at All Children’s Hospital St. Petersburg, FL, from January 2002 to August 2003. A cross-sectional study was conducted to determine the demographic characteristics and risk factors associated with development of a methicillin-resistant S. aureus (MRSA) infection and provide physicians with a model to assess their patients’ risks. METHODS: The medical charts were reviewed and the pertinent data were entered into a Microsoft Access database. The outcome assessed was a positive S. aureus culture as an outpatient or within 72 hours of becoming an inpatient. The exposure data collected consisted of age, race or ethnicity, gender, preexisting medical conditions, previous antibiotic use, previous hospitalization, community worn device, home health care, immunotherapy, and previous MRSA infection. After data entry was completed, statistical analysis using SAS and Epi Info was conducted to calculate frequencies, crude odds ratios (OR), and 95% confidence intervals (CI). The presence of effect modification was assessed and adjustment for confounding was performed. RESULTS: A total of 672 charts were reviewed and the following results were found. Blacks were at a higher risk of developing MRSA infection (OR Z 2.98, 95% CI Z 2.51, 3.45). Race was found to be an effect modifier for MRSA infection and previous antibiotic use (P Z 0.02). After stratification by race, the results were adjusted for confounding. In whites, previous MRSA infection (OR Z 2.86, 95% CI Z 1.16, 7.05), home health care (OR Z 4.37, 95% CI Z 1.55, 12.32), and previous hospitalization (OR Z 2.00, 95% CI Z 1.14, 3.50) were significant risk factors for the development of MRSA infection. In blacks, only previous antibiotic use (OR Z 5.13, 95% CI Z 1.75, 15.08) was significantly associated with the development of MRSA infection. CONCLUSION: It is possible for a physician to identify the presence of their patients’ risk according to the risk factor profiles of pediatric patients, in order to determine the likelihood of resistant infection and treat that patient accordingly in order to prevent the progression of the infection. doi:10.1016/j.annepidem.2004.07.059
P061 HIGH INCIDENCE OF HUMAN WEST NILE VIRUS INFECTION AND RISK OF MORTALITY, 2003; HIGH PLAINS/PANHANDLE, TX RD Warner, RC Kimbrough, K Condon, T Ward, JL Alexander, JR Pierce Jr, KM McDonald, Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, TX PURPOSE: We seek to explain the high incidence of human West Nile Virus (WNV) infection, and risk of morbidity and mortality, reported from the Panhandle and South Plains regions of Texas in 2003, compared with the rest of the state. A 10-fold increase in human WNV meningoencephalitis cases was reported from this area in 2003, compared with 2002. Information gained will be used to improve area health education, disease surveillance, and medical treatment efforts in a largely medically underserved region. METHODS: Descriptive techniques and measures characterized the 2003 human WNV cases by person and place within the 41
ABSTRACTS (ACE)
inability to give informed consent, severity of psychosis, or patient refusal. doi:10.1016/j.annepidem.2004.07.057 INFECTIOUS DISEASE P059 SEXUAL BEHAVIOR AND RISK PERCEPTIONS RELATED TO HIV INFECTION AMONG COLLEGE STUDENTS Su-I Hou, Department of Health Promotion and Behavior, College of Education, University of Georgia, Athens, GA PURPOSE: To assess behavioral determinants (sexual behavior stage, partner numbers, partner types, condom use, and sexual orientation) on risk perceptions related to HIV infection among college students. HIV risk perception has been shown to be significantly related to prior HIV testing behavior; however, current knowledge of determinants related to HIV risk perceptions among college students has been limited. Understanding how behavior risk factors influencing HIV risk perception can play a critical role for developing effective HIV prevention and education programs. METHODS: A Web-based survey was administered during spring 2003 at one of the major universities in the southeastern United States. RESULTS: A total of 440 college students participated in the study: mean age 21 (SD Z 2.48), 75% female, 88% heterosexual. Mean of the ‘‘perceived risk of HIV’’ scale (3-item), rated on fivepoint Liker scale, was used to classify students into low versus high risk perception groups (mean Z 6.40). Sexual behavior stage index grouped students as ‘‘no to any sex’’ (16.7%), ‘‘yes to oral sex only’’ (17.2%), ‘‘yes to both oral and vaginal sex’’ (43.0%), and ‘‘yes to oral and (vaginal) and anal sex’’ (23.2%). Logistic regression, with sexual behavior stage index, number of partner index (oral C vaginal C anal), types of partner index (someone as injection drug user, with multiple partners, or paid for sex), condom use index, and sexual orientation as independent variables, was used to predict HIV risk perception. Results indicated that the full model of the combined five predictors was statistically reliable in distinguishing between students with high versus low risk perception (X(5) Z 23.162, P ! 0.001), which correctly classified 84.0% of the students. Wald statistics indicated that number of partners index (odds ratio Z 1.459, 95% confidence interval Z 1.08, 1.97) had a statistical significant coefficient (P Z 0.014). CONCLUSION: Despite risky sexual behaviors prevalent among college students, the overall perception of HIV infection was low. Results suggest that educational messages addressing the number of partners and its relationship with actual risk of HIV infection could be an effective strategy to increase risk perception. doi:10.1016/j.annepidem.2004.07.058
P060S RISK FACTORS FOR PEDIATRIC COMMUNITY-ACQUIRED METHICILLINRESISTANT STAPHYLOCOCCUS AUREUS (MRSA) Kessler, R Sanderson, H Stockwell, Y Wu, Department of Epidemiology & Biostatistics, University of South Florida, Tampa, FL
613
PURPOSE: A chart review of children under 18 years of age with a positive Staphylococcus aureus culture within the first 72 hours after admission or as an outpatient was conducted at All Children’s Hospital St. Petersburg, FL, from January 2002 to August 2003. A cross-sectional study was conducted to determine the demographic characteristics and risk factors associated with development of a methicillin-resistant S. aureus (MRSA) infection and provide physicians with a model to assess their patients’ risks. METHODS: The medical charts were reviewed and the pertinent data were entered into a Microsoft Access database. The outcome assessed was a positive S. aureus culture as an outpatient or within 72 hours of becoming an inpatient. The exposure data collected consisted of age, race or ethnicity, gender, preexisting medical conditions, previous antibiotic use, previous hospitalization, community worn device, home health care, immunotherapy, and previous MRSA infection. After data entry was completed, statistical analysis using SAS and Epi Info was conducted to calculate frequencies, crude odds ratios (OR), and 95% confidence intervals (CI). The presence of effect modification was assessed and adjustment for confounding was performed. RESULTS: A total of 672 charts were reviewed and the following results were found. Blacks were at a higher risk of developing MRSA infection (OR Z 2.98, 95% CI Z 2.51, 3.45). Race was found to be an effect modifier for MRSA infection and previous antibiotic use (P Z 0.02). After stratification by race, the results were adjusted for confounding. In whites, previous MRSA infection (OR Z 2.86, 95% CI Z 1.16, 7.05), home health care (OR Z 4.37, 95% CI Z 1.55, 12.32), and previous hospitalization (OR Z 2.00, 95% CI Z 1.14, 3.50) were significant risk factors for the development of MRSA infection. In blacks, only previous antibiotic use (OR Z 5.13, 95% CI Z 1.75, 15.08) was significantly associated with the development of MRSA infection. CONCLUSION: It is possible for a physician to identify the presence of their patients’ risk according to the risk factor profiles of pediatric patients, in order to determine the likelihood of resistant infection and treat that patient accordingly in order to prevent the progression of the infection. doi:10.1016/j.annepidem.2004.07.059
P061 HIGH INCIDENCE OF HUMAN WEST NILE VIRUS INFECTION AND RISK OF MORTALITY, 2003; HIGH PLAINS/PANHANDLE, TX RD Warner, RC Kimbrough, K Condon, T Ward, JL Alexander, JR Pierce Jr, KM McDonald, Department of Family and Community Medicine, Texas Tech University Health Sciences Center, Lubbock, TX PURPOSE: We seek to explain the high incidence of human West Nile Virus (WNV) infection, and risk of morbidity and mortality, reported from the Panhandle and South Plains regions of Texas in 2003, compared with the rest of the state. A 10-fold increase in human WNV meningoencephalitis cases was reported from this area in 2003, compared with 2002. Information gained will be used to improve area health education, disease surveillance, and medical treatment efforts in a largely medically underserved region. METHODS: Descriptive techniques and measures characterized the 2003 human WNV cases by person and place within the 41