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Outbreak in Alberta of community-acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness or incarceration

From the Canadian Field Epidemiology Program (Gilbert, Siushansian), Public Health Agency of Canada, Ottawa, Ont.; the Centre for Antimicrobial Resistance (Zhang, Laupland, Conly), Calgary Laboratory Services (Gregson, Zhang, Elsayed, Laupland, Conly), Calgary Health Region (MacDonald, Gregson, Zhang, Elsayed, Laupland, T. Louie, M. Louie, Hope, Gillespie, Nielsen, Wheeler, Conly) and the Departments of Pathology and Laboratory Medicine (Gregson, Zhang, Elsayed, Laupland, T. Louie, M. Louie, Conly), Medicine (Gregson, Zhang, Laupland, T. Louie, M. Louie, Conly), Microbiology and Infectious Diseases (Zhang, Elsayed, T. Louie, M. Louie, Conly) and Community Health Sciences (MacDonald, Laupland), University of Calgary, Calgary; Alberta Provincial Laboratory for Public Health (M. Louie), Alberta Health and Wellness (Honish, Keays), Edmonton, Alta.; and the National Microbiological Laboratory (Mulvey), Public Health Agency of Canada, Winnipeg, Man.

Correspondence to: Dr. John Conly, Department of Medicine, Centre for Antimicrobial Resistance, University of Calgary, Calgary Health Region, and Calgary Laboratory Services, Calgary AB T2N 2T9; fax 403 944-1095; jconly{at}ucalgary.ca

Background: The USA300 strain of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) can cause severe infection and is increasingly recognized as a cause of community outbreaks. In 2004, an outbreak was identified in the Calgary Health Region (CHR).

Methods: MRSA isolates were identified with standard methods at a central regional laboratory and typed via pulsed-field gel electrophoresis (PFGE). Isolates were tested by PCR for mecA, Panton–Valentine leukocidin (PVL), SCCmec, and spa genes. Cases were defined as such if a clinical isolate of the USA300 strain was noted between January 1 and September 30, 2004, and the patient had lived or traveled in CHR within 2 years before symptom onset. Demographic, clinical and risk data on all such cases were collected from several sources for statistical analysis. A case was defined as high-risk if the patient had a history of drug use, homelessness or incarceration.

Results: Of 40 isolates with the USA300 PFGE pattern, all tested positive for PVL, SCCmec type IVa and spa type 008. Almost all infections (39/40, 98%) involved skin and soft tissues, except for 1 death from necrotizing hemorrhagic pneumonia; a notable proportion (38%) required hospital admission or intravenous antimicrobial therapy. The outbreak centred on the high-risk population in CHR (70%; risk ratio 169.4, 95% confidence interval 86.1–333.0).

Interpretation: People with histories of illicit drug use, homelessness or recent incarceration were at highest risk for infection with CA-MRSA. The emergence and spread of this virulent strain has important implications for treatment and public health in Canada.

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