title: Emergence of community-associated methicillin resistant Staphylococcus aureus in Hawaii, 2001-2003.
abstract: OBJECTIVE
  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.
authors.affiliation: Division of Healthcare Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, US Department of Health and Human Services, Atlanta, GA 30333, USA. cge3@cdc.gov <cge3@cdc.gov>
authors.forename: Concepcion F
authors.initials: CF
authors.lastname: Estivariz
authors.forename: Sarah Y
authors.initials: SY
authors.lastname: Park
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Hageman
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Dvorin
authors.forename: Marian M
authors.initials: MM
authors.lastname: Melish
authors.forename: Rose
authors.initials: R
authors.lastname: Arpon
authors.forename: Pat
authors.initials: P
authors.lastname: Coon
authors.forename: Susan
authors.initials: S
authors.lastname: Slavish
authors.forename: Mary
authors.initials: M
authors.lastname: Kim
authors.forename: Linda K
authors.initials: LK
authors.lastname: McDougal
authors.forename: Bette
authors.initials: B
authors.lastname: Jensen
authors.forename: Sigrid
authors.initials: S
authors.lastname: McAllister
authors.forename: David
authors.initials: D
authors.lastname: Lonsway
authors.forename: George
authors.initials: G
authors.lastname: Killgore
authors.forename: Paul E
authors.initials: PE
authors.lastname: Effler
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Jernigan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001427:Bacterial Toxins / Q000235:genetics; D002648:Child; D002675:Child, Preschool; D002876:Chromosomes, Bacterial / Q000235:genetics; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology; D016521:Electrophoresis, Gel, Pulsed-Field; D005098:Exotoxins / Q000235:genetics; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007223:Infant; D007231:Infant, Newborn; D007956:Leukocidins / Q000235:genetics; D008297:Male; D016106:Methicillin Resistance / Q000235:genetics; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology; D013211:Staphylococcus aureus / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000472:pathogenicity
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin