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J Infect ; 54(4): 349-57, 2007 Apr.
Article in English | MEDLINE | ID: mdl-16989904

ABSTRACT

OBJECTIVES: We conducted a retrospective study to determine trends and characteristics of community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) in Hawaii. METHODS: We reviewed medical records of patients with MRSA infections during July 2001-June 2003 in four healthcare facilities. A case was defined as a patient with MRSA infection (colonization excluded), diagnosed in ambulatory settings or < or = 48 h after hospitalization, without previous MRSA or healthcare risk factors. Pulsed-field gel electrophoresis (PFGE) and typing of resistance and toxin genes was performed in 40 MRSA isolates. RESULTS: CA-MRSA infections increased from 28 (23% of MRSA infections) to 65 (32%) per quarter over the 2-year period (P<0.05). Pacific islanders accounted for 51% of 389 case-patients, but only 24% of the Hawaii population. In the pediatric hospital, Pacific Islanders represented 76% of 90 case-patients versus 35% of the hospital population. Hospital admission, required for 40% (154/389), was associated with prior antimicrobial treatment (P<0.01). The staphylococcal cassette chromosome mec type IV was detected in 38/40 isolates; 31 isolates carried Panton-Valentine leukocidin genes and 22 belonged to the same staphylococcal lineage. CONCLUSIONS: In Hawaii, prevention strategies for CA-MRSA infections should focus on Pacific Islanders. CA-MRSA infections in Hawaii appear to be related to strains causing disease throughout the United States.


Subject(s)
Community-Acquired Infections/epidemiology , Methicillin Resistance , Staphylococcal Infections/epidemiology , Staphylococcus aureus/drug effects , Adolescent , Adult , Aged , Aged, 80 and over , Anti-Bacterial Agents/pharmacology , Bacterial Toxins/genetics , Child , Child, Preschool , Chromosomes, Bacterial/genetics , Community-Acquired Infections/microbiology , Electrophoresis, Gel, Pulsed-Field , Exotoxins/genetics , Female , Hawaii/epidemiology , Humans , Incidence , Infant , Infant, Newborn , Leukocidins/genetics , Male , Methicillin Resistance/genetics , Microbial Sensitivity Tests , Middle Aged , Staphylococcal Infections/microbiology , Staphylococcus aureus/classification , Staphylococcus aureus/genetics , Staphylococcus aureus/pathogenicity
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