RT Journal
A1 Groom AV, Wolsey DH, Naimi TS, et al
T1 COmmunity-acquired methicillin-resistant staphylococcus aureus in a rural american indian community
JF JAMA
JO JAMA
YR 2001
FD September 12
VO 286
IS 10
SP 1201
OP 1205
DO 10.1001/jama.286.10.1201
UL http://dx.doi.org/10.1001/jama.286.10.1201
AB 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.