title: Invasive CA-MRSA in northwestern Ontario: a 2-year prospective study.
abstract: BACKGROUND
  Northwestern Ontario has a documented high rate of skin and soft-tissue infections due to community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Recently, invasive illness from this common pathogen has become a serious clinical problem in the region. We sought to better understand this trend of invasive CA-MRSA.
  
  
  METHODS
  We prospectively studied cases of positive CA-MRSA bacteremia in 2012 and 2013. We examined genetic typing, comorbidities and outcomes.
  
  
  RESULTS
  Twenty-three cases of CA-MRSA bacteremia were treated during the 2-year study period. Intravenous drug use accounted for only 17% of cases. One death and 2 cases of endocarditis occurred.
  
  
  CONCLUSIONS
  High rates of CA-MRSA in skin and soft-tissue infections, combined with poor living conditions and poor access to potable water, may account for most of these cases of CA-MRSA bacteremia. Social determinants of health are relevant when common resistant bacterial isolates become associated with life-threatening illness.
authors.affiliation: Division of Clinical Sciences, Northern Ontario School of Medicine, Sioux Lookout, Ont.
authors.forename: Mike
authors.initials: M
authors.lastname: Kirlew
authors.affiliation: Anishnaabe Bimaadiziwin Research Unit, Sioux Lookout Meno Ya Win Health Centre; Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.
authors.forename: Sara
authors.initials: S
authors.lastname: Rea
authors.affiliation: Anishnaabe Bimaadiziwin Research Unit, Sioux Lookout Meno Ya Win Health Centre; Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.
authors.forename: Annette
authors.initials: A
authors.lastname: Schroeter
authors.affiliation: Laboratory Services, Microbiology, Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ont.
authors.forename: Donna
authors.initials: D
authors.lastname: Makahnouk
authors.affiliation: Infection Control, Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ont.
authors.forename: Marsha
authors.initials: M
authors.lastname: Hamilton
authors.affiliation: Sioux Lookout Meno Ya Win Health Centre, Sioux Lookout, Ont.
authors.forename: Nicole
authors.initials: N
authors.lastname: Brunton
authors.affiliation: Anishnaabe Bimaadiziwin Research Unit, Sioux Lookout Meno Ya Win Health Centre; Sioux Lookout First Nations Health Authority, Sioux Lookout, Ont.
authors.forename: Jill
authors.initials: J
authors.lastname: Muileboom
authors.affiliation: Division of Infectious Diseases, Ottawa Hospital; Faculty of Medicine, University of Ottawa, Ottawa, Ont.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Schreiber
authors.affiliation: Division of Infectious Diseases, Ottawa Hospital; Faculty of Medicine, University of Ottawa, Ottawa, Ont.
authors.forename: Raphael
authors.initials: R
authors.lastname: Saginur
authors.affiliation: Division of Clinical Sciences, Northern Ontario School of Medicine, Sioux Lookout, Ont.
authors.forename: Len
authors.initials: L
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D000328:Adult; D016470:Bacteremia / Q000453:epidemiology / Q000382:microbiology; D002648:Child; D017714:Community-Acquired Infections; D005260:Female; D006801:Humans; D007198:Indians, North American; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D011446:Prospective Studies; D012424:Rural Population; D064890:Social Determinants of Health; D013203:Staphylococcal Infections / Q000453:epidemiology*; D013207:Staphylococcal Skin Infections / Q000453:epidemiology / Q000382:microbiology; D055815:Young Adult