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Amy V. Groom, MPH; Darcy H. Wolsey, MPH; Timothy S. Naimi, MD,MPH; Kirk Smith, DVM,PhD; Sue Johnson, MS; Dave Boxrud, MS; Kristine A. Moore, MD,MPH; James E. Cheek, MD,MPH

JAMA. 2001;286:1201-1205.

Context  Until recently, methicillin-resistant Staphylococcus aureus (MRSA) infections have been acquired primarily in nosocomial settings. Four recent deaths due to MRSA infection in previously healthy children in the Midwest suggest that serious MRSA infections can be acquired in the community in rural as well as urban locations.

Objectives  To document the occurrence of community-acquired MRSA infections and evaluate risk factors for community-acquired MRSA infection compared with methicillin-susceptible S aureus (MSSA) infection.

Design  Retrospective cohort study with medical record review.

Setting  Indian Health Service facility in a rural midwestern American Indian community.

Patients  Patients whose medical records indicated laboratory-confirmed S aureus infection diagnosed during 1997.

Main Outcome Measures  Proportion of MRSA infections classified as community acquired based on standardized criteria; risk factors for community-acquired MRSA infection compared with those for community-acquired MSSA infection; and relatedness of MRSA strains, determined by pulsed-field gel electrophoresis (PFGE).

Results  Of 112 S aureus isolates, 62 (55%) were MRSA and 50 (45%) were MSSA. Forty-six (74%) of the 62 MRSA infections were classified as community acquired. Risk factors for community-acquired MRSA infections were not significantly different from those for community-acquired MSSA. Pulsed-field gel electrophoresis subtyping indicated that 34 (89%) of 38 community-acquired MRSA isolates were clonally related and distinct from nosocomial MRSA isolates found in the region.

Conclusions  Community-acquired MRSA may have replaced community-acquired MSSA as the dominant strain in this community. Antimicrobial susceptibility patterns and PFGE subtyping support the finding that MRSA is circulating beyond nosocomial settings in this and possibly other rural US communities.

Author Affiliations: National Epidemiology Program, Indian Health Service Headquarters, Albuquerque, NM (Mss Groom and Wolsey and Dr Cheek); Epidemiology Program Office, Centers for Disease Control and Prevention, Atlanta, Ga (Dr Naimi); Acute Disease Epidemiology Section (Drs Naimi and Smith) and Division of Public Health Laboratories (Ms Johnson and Mr Boxrud), Minnesota Department of Health, Minneapolis; and ICAN Inc, Eden Prairie, Minn (Dr Moore).

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