title: An outbreak of community-onset methicillin-resistant Staphylococcus aureus skin infections in southwestern Alaska.
abstract: OBJECTIVE
  We investigated a large outbreak of community-onset methicillin-resistant Staphylococcus aureus (MRSA) infections in southwestern Alaska to determine the extent of these infections and whether MRSA isolates were likely community acquired.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Rural southwestern Alaska.
  
  
  METHODS
  All patients with a history of culture-confirmed S. aureus infection from March 1, 1999, through August 10, 2000.
  
  
  RESULTS
  More than 80% of culture-confirmed S. aureus infections were methicillin resistant, and 84% of MRSA infections involved skin or soft tissue; invasive disease was rare. Most (77%) of the patients with MRSA skin infections had community-acquired MRSA (no hospitalization, surgery, dialysis, indwelling line or catheter, or admission to a long-term-care facility in the 12 months before infection). Patients with MRSA skin infections were more likely to have received a prescription for an antimicrobial agent in the 180 days before infection than were patients with methicillin-susceptible S. aureus skin infections.
  
  
  CONCLUSIONS
  Our findings indicate that the epidemiology of MRSA in rural southwestern Alaska has changed and suggest that the emergence of community-onset MRSA in this region was not related to spread of a hospital organism. Treatment guidelines were developed recommending that beta-lactam antimicrobial agents not be used as a first-line therapy for suspected S. aureus infections.
authors.affiliation: Arctic Investigations Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Anchorage, Alaska 99508, USA.
authors.forename: Henry C
authors.initials: HC
authors.lastname: Baggett
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Hennessy
authors.forename: Richard
authors.initials: R
authors.lastname: Leman
authors.forename: Cindy
authors.initials: C
authors.lastname: Hamlin
authors.forename: Dana
authors.initials: D
authors.lastname: Bruden
authors.forename: Alisa
authors.initials: A
authors.lastname: Reasonover
authors.forename: Patricia
authors.initials: P
authors.lastname: Martinez
authors.forename: Jay C
authors.initials: JC
authors.lastname: Butler
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000413:Alaska / Q000453:epidemiology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D012189:Retrospective Studies; D012424:Rural Population; D013207:Staphylococcal Skin Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents