title: Methicillin-resistant Staphylococcus aureus-associated hospitalizations among the American Indian and Alaska native population.
abstract: BACKGROUND
  American Indians and Alaska Natives (AI/ANs) have had documented outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) infection but, to our knowledge, no studies have examined MRSA infection among this population nationally. We describe MRSA-associated hospitalizations among the approximately 1.6 million AI/ANs who receive care at Indian Health Service health care facilities nationwide.
  
  
  METHODS
  We used hospital discharge data from the Indian Health Service National Patient Information Reporting System to determine the rate of MRSA-associated hospitalizations among AI/ANs who used Indian Health Service health care in 1996-2005 and in the comparison periods 1996-1998 and 2003-2005. Hospitalization rates among AI/ANs were examined by year, age group, sex, and region. MRSA-associated diagnoses were also examined. Rate comparisons were performed using Poisson regression analysis. Comparison of rates to those of the general United States population was made for 2003-2005 by means of the Nationwide Inpatient Sample.
  
  
  RESULTS
  Between comparison periods, the rate of MRSA-associated hospitalization increased from 4.6 to 50.6 hospitalizations per 100,000 AI/ANs (P<.01), with increases in both sexes, all age groups, and all regions. By 2005, MRSA was the causative organism for the majority (52%) of all S. aureus-associated hospitalizations. The most common associated diagnosis was skin and soft-tissue infection, which accounted for 59% of MRSA-associated diagnoses. In 2003-2005, the age-adjusted rate among AI/ANs was 58.8 hospitalizations per 100,000 persons, compared with 84.7 hospitalizations per 100,000 persons in the general US population.
  
  
  CONCLUSIONS
  MRSA-associated hospitalizations have increased significantly among AI/ANs served by Indian Health Service health care facilities. Clinicians should have a high index of suspicion for MRSA infection in AI/ANs, especially in those with a diagnosis of skin and soft-tissue infection.
authors.affiliation: Epidemic Intelligence Service, Division of Applied Public Health Training, Epidemiology Program Office, United States Department of Health and Human Services (USDHHS), Atlanta, GA, USA. gdn8@cdc.gov
authors.forename: Kathy K
authors.initials: KK
authors.lastname: Byrd
authors.forename: Robert C
authors.initials: RC
authors.lastname: Holman
authors.forename: Michael G
authors.initials: MG
authors.lastname: Bruce
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Hennessy
authors.forename: Jay D
authors.initials: JD
authors.lastname: Wenger
authors.forename: Dana L
authors.initials: DL
authors.lastname: Bruden
authors.forename: Dana L
authors.initials: DL
authors.lastname: Haberling
authors.forename: Claudia
authors.initials: C
authors.lastname: Steiner
authors.forename: James E
authors.initials: JE
authors.lastname: Cheek
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D015994:Incidence; D007198:Indians, North American; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult