title: Methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococci in rural communities, western United States.
abstract: The impact and prevalence of antimicrobial drug resistance in rural community healthcare settings is uncertain. Prospective surveillance in 51 rural hospitals in Idaho and Utah examined the epidemiologic features of clinical cases of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Thirty-two cases of VRE were reported; for 6, the patient had no prior healthcare exposure or coexisting condition. Among the 724 MRSA cases available for evaluation, 405 (56%) were healthcare-associated (HA-MRSA), and 319 (44%) were community-associated (CA-MRSA). The characteristics of HA-MRSA and CA-MRSA patients with coexisting factors were similar, which suggests community transmission of healthcare strains. CA-MRSA cases without coexisting factors, however, demonstrated features previously reported for community strains. MRSA infections were substantially more frequent than VRE in rural communities in the western United States. Based on epidemiologic criteria, a large proportion of MRSA cases were community-associated. CA-MRSA rates were predictive of institutional MRSA rates.
authors.affiliation: Qualis Health, Boise, Idaho 83712-7756, USA. kurts@qualishealth.org
authors.forename: Kurt B
authors.initials: KB
authors.lastname: Stevenson
authors.forename: Katy
authors.initials: K
authors.lastname: Searle
authors.forename: Gregory J
authors.initials: GJ
authors.lastname: Stoddard
authors.forename: Matthew
authors.initials: M
authors.lastname: Samore
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D017714:Community-Acquired Infections; D016983:Enterococcus / Q000187:drug effects*; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D006780:Hospitals, Rural; D006801:Humans; D007061:Idaho / Q000453:epidemiology; D015994:Incidence; D008297:Male; D016106:Methicillin Resistance; D008826:Microbial Sensitivity Tests; D012424:Rural Population; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000187:drug effects*; D014589:Utah / Q000453:epidemiology; D020713:Vancomycin Resistance
chemical_list: D000900:Anti-Bacterial Agents