As the epidemiology of infections with methicillin-resistant Staphylococcus aureus
(MRSA) changes, accurate information on the scope and magnitude of MRSA infections
in the US population is needed.
To describe the incidence and distribution of invasive MRSA disease in 9 US communities
and to estimate the burden of invasive MRSA infections in the United States in 2005.
Active, population-based surveillance for invasive MRSA in 9 sites participating in
the Active Bacterial Core surveillance (ABCs)/Emerging Infections Program Network
from July 2004 through December 2005. Reports of MRSA were investigated and classified
as either health care-associated (either hospital-onset or community-onset) or community-associated
(patients without established health care risk factors for MRSA).
Incidence rates and estimated number of invasive MRSA infections and in-hospital deaths
among patients with MRSA in the United States in 2005; interval estimates of incidence
excluding 1 site that appeared to be an outlier with the highest incidence; molecular
characterization of infecting strains.
There were 8987 observed cases of invasive MRSA reported during the surveillance period.
Most MRSA infections were health care-associated: 5250 (58.4%) were community-onset
infections, 2389 (26.6%) were hospital-onset infections; 1234 (13.7%) were community-associated
infections, and 114 (1.3%) could not be classified. In 2005, the standardized incidence
rate of invasive MRSA was 31.8 per 100,000 (interval estimate, 24.4-35.2). Incidence
rates were highest among persons 65 years and older (127.7 per 100,000; interval estimate,
92.6-156.9), blacks (66.5 per 100,000; interval estimate, 43.5-63.1), and males (37.5
per 100,000; interval estimate, 26.8-39.5). There were 1598 in-hospital deaths among
patients with MRSA infection during the surveillance period. In 2005, the standardized
mortality rate was 6.3 per 100,000 (interval estimate, 3.3-7.5). Molecular testing
identified strains historically associated with community-associated disease outbreaks
recovered from cultures in both hospital-onset and community-onset health care-associated
infections in all surveillance areas.
Invasive MRSA infection affects certain populations disproportionately. It is a major
public health problem primarily related to health care but no longer confined to intensive
care units, acute care hospitals, or any health care institution.