Emergence of community-associated methicillin resistant Staphylococcus aureus in Hawaii, 2001-2003.
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.
Estivariz
Concepcion F
CF
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>
Park
Sarah Y
SY
Hageman
Jeffrey C
JC
Dvorin
Jeffrey
J
Melish
Marian M
MM
Arpon
Rose
R
Coon
Pat
P
Slavish
Susan
S
Kim
Mary
M
McDougal
Linda K
LK
Jensen
Bette
B
McAllister
Sigrid
S
Lonsway
David
D
Killgore
George
G
Effler
Paul E
PE
Jernigan
Daniel B
DB
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
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin