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Nasal Carriage of Methicillin-Resistant Staphylococcus aureus in an American Indian Population

  • Richard Leman (a1) (a2), Francisco Alvarado-Ramy (a1) (a3), Sean Pocock (a4), Neil Barg (a5), Molly Kellum (a3), Sigrid McAllister (a3), James Cheek (a2) and Matthew Kuehnert (a3)...


Background and Objective:

Although reports of methicillin-resistant Staphylococcus aureus (MRSA) infections without healthcare exposure are increasing, population-based data regarding nasal colonization are lacking. We assessed the prevalence of and risk factors for community-associated MRSA nasal carriage in patients of a rural outpatient clinic.


A cross-sectional population survey was conducted through random sample and stratification by community of residence. Recent healthcare exposure (ie, hospitalization, dialysis, or healthcare occupation) and other risk factors for MRSA carriage were assessed. Cultures of the nares were performed. Community-associated MRSA was defined as MRSA carriage without healthcare exposure.


A predominantly American Indian community in Washington.


Those receiving healthcare from an Indian Health Service clinic.


Of 1,311 individuals identified for study, 475 (36%) participated. Unsatisfactory culture specimens resulted in exclusion of 6 participants. In all, 128 (27.3%) of 469 participants had S. aureus. Nine (1.9%) of 469 had MRSA carriage; of these, 5 had community-associated MRSA (5 of 469; overall community-associated MRSA carriage rate, 1.1%). MRSA carriage was associated with antimicrobial use in the previous year (risk ratio [RR], 7.2; P = .04) and residence in a household of more than 7 individuals (RR, 4.5; P= .03). Pulsed-field gel electrophoresis indicated that 5 (55%) of 9 MRSA carriage isolates were closely related, including 3 (60%) of 5 that were community associated.


Prevalence of community-associated MRSA colonization was approximately 1% in this rural, American Indian population. Community-associated MRSA colonization was associated with recent antimicrobial use and larger household.


Corresponding author

Oregon Health Services, Health Promotion and Chronic Disease Prevention Program, 800 NE Oregon St., Suite 730, Portland, OR 97232


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1.Herold, BC, Immergluck, LC, Maranan, MC, et al.Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998;279:593598.
2.Moreno, F, Crisp, C, Jorgenson, JH, Patterson, JE. Methicillin-resistant Staphylococcus aureus as a community organism. Clin Infect Dis 1995;21:13081312.
3.Groom, AV, Wolsey, DH, Naimi, TS, et al.Emergence of community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. JAMA 2001;286:12011205.
4.Landen, M, McCumber, B, Asam, E, Egeland, GM. Outbreak of boils in an Alaskan village: a case-control study. West J Med 2000;172:235239.
5.Baggett, HC, Hennessy, T, Leman, R, et al.Outbreak of community-acquired methicillin-resistant Staphylococcus aureus (MRSA) skin infections among Alaska Natives-southwestern Alaska, 2000. Presented at the Epidemie Intelligence Service Conference; April 23, 2001; Atlanta, GA.
6.Centers for Disease Control and Prevention. Four pediatrie deaths from community-acquired methicillin-resistant Staphylococcus aureus: Minnesota and North Dakota, 1997-1999. MMWR 1999;48:707710.
7.Griffith, SP. Indian Health Service embraces the electronic medical record. In: Indian Health Service. Successful Strategies for Increasing Direct Health Care Quality, Accessibility, and Economy for American Indians and Alaska Natives. Rockville, MD: Department of Health and Human Services; 1997:4749. IHS publication no. 95-85016.
8.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests, ed. 7. Wayne, PA: National Committee for Clinical Laboratory Standards; 2000. Approved standard M2-A7.
9.National Committee for Clinical Laboratory Standards. Methods for Dilution Antimicrobial Susceptibility Tests for Bacteria That Grow Aerobically. Wayne, PA: National Committee for Clinical Laboratory Standards; 2000. Approved standard M7-A5.
10.Maslow, JN, Slutsky, AM, Arbeit, RD. Application of pulsed-field gel electrophoresis to molecular epidemiology. In: Persing, DH, Smith, TF, Tenover, FC, White, TJ, eds. Diagnostic Molecular Microbiology: Principles and Applications. Washington, DC: American Society for Microbiology; 1993:563572.
11.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:22332239.
12.Dean, AG, Dean, JA, Coulombier, D, et al.Epi Info, Version 6: A Word Processing, Database, and Statistics Program for Public Health on IBM-Compatible Microcomputers. Atlanta, GA: Centers for Disease Control and Prevention; 1996.
13.Levy, PS, Lemeshow, S. Sampling of Populations: Methods and Applications. New York: John Wiley and Sons; 1991.
14.Charlebois, ED, Bangsberg, DR, Moss, NJ, et al.Population-based community prevalence of methicillin-resistant Staphylococcus aureus in the urban poor of San Francisco. Clin Infect Dis 2002;34:425433.
15.Shahin, R, Johnson, IL, Jamieson, F, McGreer, A, Tolkin, J, Ford-Jones, FL. Methicillin-resistant Staphylococcus aureus carriage in a childeare center following a case of disease. Arch Pediatr Adolesc Med 1999;153:864868.
16.Adcock, PM, Pastor, P, Medley, F, Patterson, JE, Murphy, TV. Methicillin-resistant Staphylococcus aureus in two child care centers. J Infect Dis 1999;179:1952.
17.Lindenmayer, J, Schoenfeld, S, O'Grady, R, Carney, JK. Methicillin-resistant Staphylococcus aureus in a high school wrestling team and the surrounding community. Arch Intern Med 1998;158:895899.
18.Kainer, M, Sohn, A, Cruz, A, et al.Bath towels, body shaving, and turf burns: an outbreak of methicillin-resistant Staphylococcus aureus in a college football team-Pennsylvania, 2000. Presented at the Epidemie Intelligence Service Conference; April 23, 2001; Atlanta, GA.
19.Troillet, N, Carmeli, Y, Samore, MH, et al.Carriage of methicillin-resistant Staphylococcus aureus at hospital admission. Infect Control Hosp Epidemiol 1998;19:181185.
20.Maguire, GP, Arthur, AD, Boustead, PJ, Dwyer, B, Currie, BJ. Clinical experience and outeomes of community-acquired and nosocomial methicillin-resistant Staphylococcus aureus in a northern Australian hospital. J Hosp Infect 1998;38:273281.
21.Warshawsky, B, Hussain, Z, Gregson, D, et al.Hospital and community-based surveillance of methicillin-resistant Staphylococcus aureus: previous hospitalization is the major risk factor. Infect Control Hosp Epidemiol 2000;21:724727.
22.Shopsin, B, Mathema, B, Martinez, J, et al.Prevalence of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in the community. J Infect Dis 2000;182:359362.


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