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Volume 15, Number 10—October 2009

Community-Associated Methicillin-Resistant Staphylococcus aureus, Iowa, USA

Philip Van De Griend, Loreen A. HerwaldtComments to Author , Bret Alvis, Mary DeMartino, Kristopher Heilmann, Gary Doern, Patricia Winokur, Diana DeSalvo Vonstein, and Daniel Diekema
Author affiliations: The University of Iowa Carver College of Medicine, Iowa City, Iowa, USA (P. Van De Griend, L.A. Herwaldt, B. Alvis, K. Heilmann, G. Doern, P. Winokur, D. Diekema); The University of Iowa Hygienic Lab, Iowa City (M. DeMartino); The University of Iowa College of Public Health, Iowa City (L.A. Herwaldt); The University of Iowa Hospitals and Clinics, Iowa City (L.a. Herwaldt, D. Diekema); The Iowa City Veterans Administration Medical Center, Iowa City (P. Winokur, D.D. Vonstein, D. Diekema)

Main Article

Table 1

Descriptive epidemiology of invasive MRSA in Iowa, USA, 1999–2005*

Characteristic† Total no. (%), N = 1,323 USA type
p value
No. (%) USA300/400, n = 26 No. (%) other,‡ n = 1,297
Mean age, y 67.8 (SD = 17.6) 46.0 (SD = 22.0) 68.2 (SD = 17.2) <0.0001
Female gender 550 (41.6) 9 (34.6) 541 (42.7) 0.549
Inpatient stay 1,124 (85.0) 24 (92.3) 1,100 (84.8) 1.000
ICU admission 221 (16.7) 4 (15.4) 217 (16.7) 0.764
Nosocomial infection
346 (26.2)
5 (19.2)
341 (26.3)
Specimen type <0.0001
Blood 1,256 (94.9) 25 (96.2) 1,231 (94.9)
CSF 9 (0.7) 0 9 (0.7)
Joint fluid 33 (2.5) 1 (3.9) 32 (2.5)
Pleural fluid 8 (0.6) 0 8 (0.6)
6 (0.5)
0 (0.0)
6 (0.5)

Iowa region 0.054
1 32 (2.4) 1 (3.9) 31 (2.4)
2 370 (28.0) 10 (38.5) 360 (27.8)
3 335 (25.3) 2 (7.7) 333 (25.7)
4 272 (20.6) 4 (15.4) 268 (20.7)
5 140 (10.6) 5 (19.2) 135 (10.4)
63 (4.8)
4 (15.4)
59 (4.5)


*MRSA, methicillin-resistant Staphylococcus aureus; ICU, intensive care unit; CSF, cerebrospinal fluid; PVL, Panton-Valentine leukocidin; SCCmec IV, staphylococcal chromosomal cassette mec type IV; ND, not done for all isolates.
†The number of patients missing data on specific variables: age = 13; gender = 11; inpatient = 85; ICU = 356; nosocomial = 358; specimen type = 11; Iowa Department of Public Health Reporting Region = 11.
‡Of the subset of isolates that were typed (N = 180), 173 (96%) were USA100. The remainder clustered with USA200 (3), USA500 (2), or did not match an existing USA type.

Main Article

  1. Barber  M. Methicillin-resistant staphylococci. J Clin Pathol. 1961;14:38593. DOIPubMedGoogle Scholar
  2. Marshall  C, Wesselingh  S, McDonald  M, Spelman  D. Control of endemic MRSA—what is the evidence? A personal view. J Hosp Infect. 2004;56:25368. DOIPubMedGoogle Scholar
  3. Diekema  DJ, Pfaller  MA, Schmitz  FJ, Smayevsky  J, Bell  J, Jones  RN, Survey of infections due to Staphylococcus species: frequency of occurrence and antimicrobial susceptibility of isolates collected in the United States, Canada, Latin America, Europe, and the western Pacific region for the SENTRY antimicrobial surveillance program, 1997–1999. Clin Infect Dis. 2001;32(Suppl 2):S11432. DOIPubMedGoogle Scholar
  4. Herold  BC, Immergluck  LC, Maranan  MC, Lauderdale  DS, Gaskin  RE, Boyle-Vavra  S, Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA. 1998;279:5938. DOIPubMedGoogle Scholar
  5. Chambers  HF. The changing epidemiology of Staphylococcus aureus? Emerg Infect Dis. 2001;7:17882. DOIPubMedGoogle Scholar
  6. Hidron  AI, Kourbatova  EV, Halvosa  JS, Terrell  BJ, McDougal  LK, Tenover  FC, Risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital: emergence of community-associated MRSA nasal carriage. Clin Infect Dis. 2005;41:15966. DOIPubMedGoogle Scholar
  7. Naimi  TS, LeDell  KH, Como-Sabetti  K, Borchardt  SM, Boxrud  DJ, Etienne  J, Comparison of community and health care–associated methicillin-resistant Staphylococcus aureus infection. JAMA. 2003;290:297684. DOIPubMedGoogle Scholar
  8. Vandenesch  F, Naimi  T, Enright  MC, Lina  G, Nimmo  GR, Heffernan  H, Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis. 2003;9:97884. DOIPubMedGoogle Scholar
  9. Centers for Disease Control and Prevention. Infectious disease and dermatologic conditions in evacuees and rescue workers after Hurricane Katrina—multiple states, August–September, 2005. MMWR Morb Mortal Wkly Rep. 2005;54:9614.PubMedGoogle Scholar
  10. Centers for Disease Control and Prevention. Methicillin-resistant Staphylococcus aureus infections in correctional facilities—Georgia, California, and Texas, 2001–2003. MMWR Morb Mortal Wkly Rep. 2003;52:9925.PubMedGoogle Scholar
  11. McDougal  LK, Steward  CD, Killgore  GE, Chaitram  JM, McAllister  SK, Tenover  FC. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol. 2003;41:511320. DOIPubMedGoogle Scholar
  12. Soderquist  B, Berglund  C, Stralin  K. Community-acquired pneumonia and bacteremia caused by an unusual methicillin-resistant Staphylococcus aureus (MRSA) strain with sequence type 36, staphylococcal cassette chromosome mec type IV and Panton-Valentine leukocidin genes. Eur J Clin Microbiol Infect Dis. 2006;25:6046. DOIPubMedGoogle Scholar
  13. Baba  T, Takeuchi  F, Kuroda  M, Yuzawa  H, Aoki  K, Oguchi  A, Genome and virulence determinants of high virulence community-acquired MRSA. Lancet. 2002;359:181927. DOIPubMedGoogle Scholar
  14. Miller  LG, Perdreau-Remington  F, Rieg  G, Mehdi  S, Perlroth  J, Bayer  AS, Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med. 2005;352:144553. DOIPubMedGoogle Scholar
  15. Moran  GJ, Krishnadasan  A, Gorwitz  RJ, Fosheim  GE, McDougal  LK, Carey  RB, Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355:66674. DOIPubMedGoogle Scholar
  16. Labandeira-Rey  M, Couzon  F, Boisset  S, Brown  EL, Bes  M, Benito  Y, Staphylococcus aureus Panton-Valentine leukocidin causes necrotizing pneumonia. Science. 2007;315:11303. DOIPubMedGoogle Scholar
  17. Voyich  JM, Otto  M, Mathema  B, Braughton  KR, Whitney  AR, Welty  D, Is Panton-Valentine leukocidin the major virulence determinant in community-associated methicillin-resistant Staphylococcus aureus disease? J Infect Dis. 2006;194:176170. DOIPubMedGoogle Scholar
  18. Fridkin  SK, Hageman  JC, Morrison  M, Sanza  LT, Como-Sabetti  K, Jernigan  JA, Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med. 2005;352:143644. DOIPubMedGoogle Scholar
  19. Gonzalez  BE, Rueda  AM, Shelburne  SA III, Musher  DM, Hamill  RJ, Hulten  KG. Community-associated strains of methicillin-resistant Staphylococcus aureus as the cause of healthcare-associated infection. Infect Control Hosp Epidemiol. 2006;27:10516. DOIPubMedGoogle Scholar
  20. Hageman  JC, Uyeki  TM, Francis  JS, Jernigan  DB, Wheeler  JG, Bridges  CB, Severe community-acquired pneumonia due to Staphylococcus aureus, 2003–04 influenza season. Emerg Infect Dis. 2006;12:8949. DOIPubMedGoogle Scholar
  21. Seybold  U, Kourbatova  EV, Johnson  JG, Halvosa  SJ, Wang  YF, King  MD, Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care–associated blood stream infections. Clin Infect Dis. 2006;42:64756. DOIPubMedGoogle Scholar
  22. Klevens  RM, Morrison  MA, Nadle  J, Petit  S, Gershman  K, Ray  S, Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA. 2007;298:176371. DOIPubMedGoogle Scholar
  23. Han  LL, McDougal  LK, Gorwitz  RJ, Mayer  KH, Patel  JB, Sennott  JM, High frequencies of clindamycin and tetracycline resistance in methicillin-resistant Staphylococcus aureus pulsed-field type USA300 isolates collected at a Boston ambulatory health center. J Clin Microbiol. 2007;45:13502. DOIPubMedGoogle Scholar
  24. Francis  JS, Doherty  MC, Lopatin  U, Johnston  CP, Sinha  G, Ross  T, Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes. Clin Infect Dis. 2005;40:1007. DOIPubMedGoogle Scholar
  25. Iowa Antibiotic Resistance Surveillance Program [homepage on the Internet]. 2006 [cited 2009 Jul 24]. Available from
  26. Diseases reportable to the Iowa Department of Public Health [homepage on the Internet]. 2004 [cited 2008 Jul 24]. Available from
  27. Clinical and Laboratory Standards Institute [homepage on the Internet]. 2006 [cited 2008 Jul 24]. Available from
  28. Diekema  DJ, Pfaller  MA, Turnidge  J, Verhoef  J, Bell  J, Fluit  AC, Genetic relatedness of multidrug-resistant, methicillin (oxacillin)-resistant Staphylococcus aureus bloodstream isolates from SENTRY antimicrobial resistance surveillance centers worldwide, 1998. Microb Drug Resist. 2000;6:21321. DOIPubMedGoogle Scholar
  29. Oliveira  DC. Lencastre Hd. Multiplex PCR strategy for rapid identification of structural types and variants of the mec element in methicillin-resistant Staphylococcus aureus. Antimicrob Agents Chemother. 2002;46:215561. DOIPubMedGoogle Scholar
  30. Lina  G, Piemont  Y, Godail-Gamot  F, Bes  M, Peter  MO, Gauduchon  V, Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. Clin Infect Dis. 1999;29:112832. DOIPubMedGoogle Scholar
  31. Diep  BA, Chambers  HF, Graber  CJ, Szumowski  JD, Miller  LG, Han  LL, Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men. Ann Intern Med. 2008;148:24957.PubMedGoogle Scholar
  32. Kaplan  SL, Hulten  KG, Gonzalez  BE, Hammerman  WA, Lamberth  L, Versalovic  J, Three-year surveillance of community-acquired Staphylococcus aureus infections in children. Clin Infect Dis. 2005;40:178591. DOIPubMedGoogle Scholar
  33. de Neeling  AJ, van den Broek  MJ, Spalburg  EC, van Santen-Verheuvel  MG, Dam-Deisz  WD, Boshuizen  HC, High prevalence of methicillin resistant Staphylococcus aureus in pigs. Vet Microbiol. 2007;122:36672. DOIPubMedGoogle Scholar
  34. Armand-Lefevre  L, Ruimy  R, Andremont  A. Clonal comparison of Staphylococcus aureus isolates from healthy pig farmers, human controls, and pigs. Emerg Infect Dis. 2005;11:7114. DOIPubMedGoogle Scholar
  35. Voss  A, Loeffen  F, Bakker  J, Klaassen  C, Wulf  M. Methicillin-resistant Staphylococcus aureus in pig farming. Emerg Infect Dis. 2005;11:19656. DOIPubMedGoogle Scholar
  36. Khanna  T, Friendship  R, Dewey  C, Weese  JS. Methicillin resistant Staphylococcus aureus colonization in pigs and pig farmers. Vet Microbiol. 2007;128:29803. DOIPubMedGoogle Scholar
  37. Guardabassi  L, Stegger  M, Skov  R. Retrospective detection of methicillin resistant and susceptible Staphylococcus aureus ST398 in Danish slaughter pigs. Vet Microbiol. 2007;122:3846. DOIPubMedGoogle Scholar
  38. Chickering  HT, Park  H Jr. Staphylococcus aureus pneumonia. JAMA. 1919;72:61726. DOIGoogle Scholar
  39. Ellis  MW, Hospenthal  DR, Dooley  DP, Gray  PJ, Murray  CK. Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis. 2004;39:9719. DOIPubMedGoogle Scholar
  40. Lescure  FX, Biendo  M, Douadi  Y, Schmit  JL, Eveillard  M. Changing epidemiology of methicillin-resistant Staphylococcus aureus and effects on cross-transmission in a teaching hospital. Eur J Clin Microbiol Infect Dis. 2006;25:2057. DOIPubMedGoogle Scholar

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