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Subcutaneous Infection of Methicillin Resistant Staphylococcus Aureus (MRSA)
Published on: February 9, 2011
Methicillin-resistant Staphylococcus aureus-associated hospitalizations among the American Indian and Alaska native
Kathy K Byrd1, Robert C Holman, Michael G Bruce
1Epidemic 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
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.
Insights
Methicillin-resistant Staphylococcus aureus (MRSA) hospitalizations significantly increased among American Indians and Alaska Natives (AI/ANs) served by Indian Health Service facilities. Clinicians should suspect MRSA, particularly with skin infections, in this population.
Area of Science:
- Infectious Diseases
- Epidemiology
- Public Health
Background:
- American Indians and Alaska Natives (AI/ANs) have experienced documented outbreaks of methicillin-resistant Staphylococcus aureus (MRSA) infection.
- No prior national studies have examined MRSA infection prevalence within the AI/AN population.
- This study describes MRSA-associated hospitalizations among AI/ANs receiving care within Indian Health Service (IHS) facilities nationwide.
Purpose of the Study:
- To determine the rate of MRSA-associated hospitalizations among AI/ANs utilizing IHS healthcare.
- To analyze trends and demographic factors associated with MRSA hospitalizations in AI/ANs.
- To compare MRSA hospitalization rates in AI/ANs to the general US population.
Main Methods:
- Utilized Indian Health Service National Patient Information Reporting System hospital discharge data (1996-2005).
- Examined MRSA-associated hospitalization rates by year, age, sex, and region.
- Compared AI/AN rates to the general US population using Nationwide Inpatient Sample data (2003-2005).
Main Results:
- MRSA-associated hospitalization rates increased significantly from 4.6 to 50.6 per 100,000 AI/ANs between study periods (P<.01).
- By 2005, MRSA accounted for the majority (52%) of all Staphylococcus aureus-associated hospitalizations.
- Skin and soft-tissue infections were the most common MRSA-associated diagnosis (59%).
Conclusions:
- MRSA-associated hospitalizations have markedly increased among AI/ANs within the IHS system.
- A high index of suspicion for MRSA is warranted in AI/AN patients, especially those with skin and soft-tissue infections.
- These findings highlight the need for targeted public health interventions and clinical awareness for MRSA in this population.
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