title: Community-associated methicillin-resistant Staphylococcus aureus skin infections in a religious community.
abstract: In September 2004, an outbreak of community-associated methicillin-resistant Staphylococcus aureus (MRSA) skin and soft tissue infections (SSTI) was reported among members of a religious community. We conducted a retrospective cohort study on all 175 community members; performed a nasal carriage survey, and environmental swab testing. We identified 24 MRSA cases (attack rate 14%). In multivariate analysis, sauna use [odds ratio (OR) 19.1, 95% confidence interval (CI) 2.7-206.1] and antimicrobial use within 12 months before infection (OR 11.7, 95% CI 2.9-47.6) were risk factors for infection. MRSA nasal carriage rate was 0.6% (1/174). Nine of 10 clinical isolates and an isolate from an administrative office within the community had the pulsed-field gel electrophoresis type USA300. Targeted hygiene improvement, wound care, and environmental cleaning were implemented. We describe the first reported outbreak of MRSA SSTI in a religious community. Adherence to appropriate personal and environmental hygiene might be critical factors in controlling transmission.
authors.affiliation: Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. fcoronado@cdc.gov
authors.forename: F
authors.initials: F
authors.lastname: Coronado
authors.forename: J A
authors.initials: JA
authors.lastname: Nicholas
authors.forename: B J
authors.initials: BJ
authors.lastname: Wallace
authors.forename: D J
authors.initials: DJ
authors.lastname: Kohlerschmidt
authors.forename: K
authors.initials: K
authors.lastname: Musser
authors.forename: D J
authors.initials: DJ
authors.lastname: Schoonmaker-Bopp
authors.forename: S M
authors.initials: SM
authors.lastname: Zimmerman
authors.forename: A R
authors.initials: AR
authors.lastname: Boller
authors.forename: D B
authors.initials: DB
authors.lastname: Jernigan
authors.forename: M A
authors.initials: MA
authors.lastname: Kacica
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000517:prevention & control; D004196:Disease Outbreaks; D005260:Female; D006801:Humans; D006920:Hygiene; D007223:Infant; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D009297:Nasal Mucosa / Q000382:microbiology; D012067:Religion; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000517:prevention & control; D013207:Staphylococcal Skin Infections / Q000453:epidemiology* / Q000517:prevention & control