Showing papers by "Timothy S. Naimi published in 2001"
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TL;DR: CAMRSA infections were identified throughout Minnesota; although most isolates were genetically related and susceptible to multiple antimicrobials, they were generally nonsusceptible to initial empirical therapy.
Abstract: Methicillin-resistant Staphylococcus aureus (MRSA) has emerged among patients in the general population who do not have established risk factors for MRSA. Records from 10 Minnesota health facilities were reviewed to identify cases of MRSA infection that occurred during 1996-1998 and to identify which cases were community acquired. Susceptibility testing and pulsed-field gel electrophoresis (PFGE) subtyping were performed on available isolates. A total of 354 patients (median age, 16 years) with community-acquired MRSA (CAMRSA) infection were identified. Most case patients (299 [84%]) had skin infections, and 103 (29%) were hospitalized. More than 90% of isolates were susceptible to all antimicrobial agents tested, with the exception of beta-lactams and erythromycin. Of 334 patients treated with antimicrobial agents, 282 (84%) initially were treated with agents to which their isolates were nonsusceptible. Of 174 Minnesota isolates tested, 150 (86%) belonged to 1 PFGE clonal group. CAMRSA infections were identified throughout Minnesota; although most isolates were genetically related and susceptible to multiple antimicrobials, they were generally nonsusceptible to initial empirical therapy.
391 citations
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TL;DR: Antimicrobial susceptibility patterns and PFGE subtyping support the finding that MRSA is circulating beyond nosocomial settings in this and possibly other rural US communities.
Abstract: ContextUntil 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.ObjectivesTo 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.DesignRetrospective cohort study with medical record review.SettingIndian Health Service facility in a rural midwestern American Indian
community.PatientsPatients whose medical records indicated laboratory-confirmed S aureus infection diagnosed during 1997.Main Outcome MeasuresProportion 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).ResultsOf 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.ConclusionsCommunity-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.
387 citations