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A population-based study of the epidemiology and clinical features of methicillin-resistant Staphylococcus aureus infection in Pennsylvania, 2001–2010

  • J. A. CASEY (a1), S. E. COSGROVE (a2) (a3), W. F. STEWART (a2) (a4), J. POLLAK (a1) and B. S. SCHWARTZ (a1) (a2) (a5) (a4)...

No U.S. general population-based study has characterized the epidemiology and risk factors, including skin and soft tissue infection (SSTI), for healthcare-associated (HA) and community-associated (CA) methicillin-resistant Staphylococcus aureus (MRSA). We estimated the incidence of HA- and CA-MRSA and SSTI over a 9-year period using electronic health record data from the Geisinger Clinic in Pennsylvania. MRSA cases were frequency-matched to SSTI cases and controls in a nested case-control analysis. Logistic regression was used to assess risk factors, while accounting for antibiotic administration. We identified 1713 incident CA- and 1506 HA-MRSA cases and 78 216 SSTI cases. On average, from 2005 to 2009, the annual incidence of CA-MRSA increased by 34%, HA-MRSA by 7%, and SSTI by 4%. Age, season, community socioeconomic deprivation, obesity, smoking, previous SSTI, and antibiotic administration were identified as independent risk factors for CA-MRSA.

Corresponding author
*Author for correspondence: Dr B. S. Schwartz, Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe Street, Room W7041, Baltimore, MD, 21205, USA. (Email:
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1. RL Skov , KS Jensen . Community-associated methicillin-resistant Staphylococcus aureus as a cause of hospital-acquired infections. Journal of Hospital Infection 2009; 73: 364370.

2. MZ David , RS Daum . Community-associated methicillin-resistant Staphylococcus aureus: epidemiology and clinical consequences of an emerging epidemic. Clinical Microbiology Reviews 2010; 23: 616687.

3. CA Morin , JL Hadler . Population-based incidence and characteristics of community-onset Staphylococcus aureus infections with bacteremia in 4 metropolitan Connecticut areas, 1998. Journal of Infectious Diseases 2001; 184: 10291034.

4. P Van De Griend , Community-associated methicillin-resistant Staphylococcus aureus, Iowa, USA. Emerging Infectious Diseases 2009; 15: 15821589.

5. WI El Atrouni , Temporal trends in the incidence of Staphylococcus aureus bacteremia in Olmsted County, Minnesota, 1998 to 2005: a population-based study. Clinical Infectious Diseases 2009; 49: e130138.

6. AJ Kallen , Health care-associated invasive MRSA infections, 2005–2008. The Journal of the American Medical Association 2010; 304: 641648.

7. FC Lessa , Comparison of incidence of bloodstream infection with methicillin-resistant Staphylococcus aureus between England and United States, 2006–2007. Clinical Infectious Diseases 2010; 51: 925928.

8. LA Tracy , Staphylococcus aureus infections in US veterans, Maryland, USA, 1999–2008. Emerging Infectious Diseases 2011; 17: 441448.

9. BF Buss , Population-based estimates of methicillin-resistant Staphylococcus aureus (MRSA) infections among high school athletes – Nebraska, 2006–2008. Journal of School Nursing 2009; 25: 282291.

11. NF Crum , Fifteen-year study of the changing epidemiology of methicillin-resistant Staphylococcus aureus. American Journal of Medicine 2006; 119: 943951.

12. CR Frei , Emergence of community-acquired methicillin-resistant Staphylococcus aureus skin and soft tissue infections as a common cause of hospitalization in United States children. Journal of Pediatric Surgery 2010; 45: 19671974.

14. V Schneider-Lindner , Antibacterial drugs and the risk of community-associated methicillin-resistant Staphylococcus aureus in children. Archives of Pediatrics and Adolescent Medicine 2011; 165: 11071114.

15. RM Klevens , Invasive methicillin-resistant Staphylococcus aureus infections in the United States. Journal of the American Medical Association 2007; 298: 17631771.

16. C Liu , A population-based study of the incidence and molecular epidemiology of methicillin-resistant Staphylococcus aureus disease in San Francisco, 2004–2005. Clinical Infectious Diseases 2008; 46: 16371646.

17. E Klein , DL Smith , R Laxminarayan . Community-associated methicillin-resistant Staphylococcus aureus in outpatients, United States, 1999–2006. Emerging Infectious Diseases 2009; 15: 19251930.

18. RM Mera , Increasing role of Staphylococcus aureus and community-acquired methicillin-resistant Staphylococcus aureus infections in the United States: a 10-year trend of replacement and expansion. Microbial Drug Resistance 2011; 17: 321328.

20. SK Fridkin , Methicillin-resistant Staphylococcus aureus disease in three communities. New England Journal of Medicine 2005; 352: 14361444.

21. BS Schwartz , Body Mass Index and the Built and Social Environments in Children and Adolescents Using Electronic Health Records. American Journal of Preventive Medicine 2011; 41: e17e28.

22. MA Morrison , JC Hageman , RM Klevens . Case definition for community-associated methicillin-resistant Staphylococcus aureus. Journal of Hospital Infection 2006; 62: 241.

23. AY Liu , Associations of the burden of coal abandoned mine lands with three dimensions of community context in Pennsylvania. ISRN Public Health 2012; 2012: 11.

24. AR Feinstein , RI Horwitz . An algebraic analysis of biases due to exclusion, susceptibility, and protopathic prescription in case-control research. Journal of Chronic Diseases 1981; 34: 393403.

25. H Huang , Comparisons of community-associated methicillin-resistant Staphylococcus aureus (MRSA) and hospital-associated MSRA infections in Sacramento, California. Journal of Clinical Microbiology 2006; 44: 24232427.

27. RM Klevens , Community-associated methicillin-resistant Staphylococcus aureus and healthcare risk factors. Emerging Infectious Diseases 2006; 12: 1991– 1993.

28. MJ Kuehnert , Methicillin-resistant Staphylococcus aureus hospitalizations, United States. Emerging Infectious Diseases 2005; 11: 868872.

29. TS Naimi , Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. Journal of the American Medical Association 2003; 290: 29762984.

30. V Schneider-Lindner , Antimicrobial drugs and community-acquired methicillin-resistant Staphy lococcus aureus, United Kingdom. Emerging Infec tious Diseases 2007; 13: 9941000.

34. JP Bagger , D Zindrou , KM Taylor . Postoperative infection with meticillin-resistant Staphylococcus aureus and socioeconomic background. Lancet 2004; 363: 706708.

35. AR Larsen , Emergence and characterization of community-associated methicillin-resistant Staphyloccocus aureus infections in Denmark, 1999 to 2006. Journal of Clinical Microbiology 2009; 47: 7378.

36. DJ Skiest , Prospective comparison of methicillin-susceptible and methicillin-resistant community-associated Staphylococcus aureus infections in hospitalized patients. Journal of Infection 2007; 54: 427434.

38. A Hankin , WW Everett . Are antibiotics necessary after incision and drainage of a cutaneous abscess? Annals of Emergency Medicine 2007; 50: 4951.

39. PM Rajendran , Randomized, double-blind, placebo-controlled trial of cephalexin for treatment of uncomplicated skin abscesses in a population at risk for community-acquired methicillin-resistant Staphylococcus aureus infection. Antimicrobial Agents and Chemotherapy 2007; 51: 40444048.

40. L Tognetti , Bacterial skin and soft tissue infections: review of the epidemiology, microbiology, aetiopathogenesis and treatment: A collaboration between dermatologists and infectivologists. Journal of the European Academy of Dermatology and Venereology. Published online: 7 January 2012. doi:10.1111/j.1468-3083.2011.04416.x.

41. CD Salgado , BM Farr , DP Calfee . Community-acquired methicillin-resistant Staphylococcus aureus: a meta-analysis of prevalence and risk factors. Clinical Infectious Diseases 2003; 36: 131139.

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Epidemiology & Infection
  • ISSN: 0950-2688
  • EISSN: 1469-4409
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