TABLE 8.

Indigenous populations and CA-MRSAa

EthnicityYrStudy summarySettingReference(s)
Native Americans (United States)199774% (46/62) of isolates identified in a review of MRSA infections at an Indian Health Service facility were CA-MRSA (i.e., obtained from an outpatient or <48 h after admission from an inpatient, no history of hospitalization, renal dialysis, or residence in an LTCF in the previous yr, and no documentation of i.v. drug use); the percentage of S. aureus isolates that were MRSA in this community increased from 4% in 1989 to 10% in 1993, 25% in 1994, and 57% in 1997Rural Midwestern Native American community 349
20011.9% (9/468) of patients had asymptomatic carriage of MRSA; 56% (5/9) were CA-MRSA (i.e., taken from a patient without inpatient health care exposure, hemodialysis, or occupation in a health care facility in the previous year); 5 of the 9 (56%) MRSA isolates were closely related by PFGE typing; 8/9 (89%) isolates were susceptible to all non-β-lactam antibiotics tested with the exception of erythromycin (3/9 were resistant to erythromycin)Predominantly Native American community, Washington State 526
Native Alaskans (United States)1996, 2000Outbreaks of MRSA SSTIs; causative isolates were predominantly ST1, ST30, or ST59, all were PVL+, and all carried SCCmec type IVRemote Native Alaskan villages, southwestern Alaska 36, 37, 504
Australian Aboriginal people and PIs2004MRSA colonization in 14 of 92 (15%) children in nose, throat, or skin wounds; 6/14 (43%) carried PVL+ ST93 strains, and 2/14 (14%) carried PVL+ ST30 strains; 5/14 (36%) carried PVL-negative ST5 strains; 14/15 (93%) were susceptible to all tested non-β-lactam antibioticsIndigenous community, schoolchildren in grades 1-7, Queensland, Australia 958
2000-20038 cases (4 pediatric and 4 adults) of severe invasive infections with either ST93 or ST30 PVL+ MRSA isolates obtained <48 h after admission, with no health care exposure or antibiotics in previous 12 months; 5/8 (63%) patients were PIs or of Aboriginal ethnicity3 large hospitals, Southeast Queensland, Australia 720
1991-1995Community-acquired WA-MRSA (i.e., Western Australian strain, defined by antibiotic susceptibilities) infections were more likely to occur in Aboriginals than in non-Aboriginals (RR, 25.9; 95% CI, 12.51-53.47)Royal Darwin Hospital, Northern Territory, Australia 573
1997-199835 gentamicin-susceptible MRSA isolates from infections; 23 were community acquired; 17/23 (74%) patients had no health care exposure; 10/17 (59%) were PIs, and 1/17 (6%) was Aboriginal; all 11 isolates from PIs or Australian Aboriginal people were of the same pulsotypesClinical microbiology laboratory, 4 hospitals, Brisbane metropolitan area, Queensland, Australia 672
1998-2001Of 15 episodes of community-onset MRSA bacteremia (i.e., patients with isolates cultured <48 h after admission, with no indwelling catheter, and with no history of hospitalization or stay in an LTCF in previous 90 days) in 14 patients, 12/14 (86%) patients self-identified as being Aboriginal, while 25% of the population served by the hospital was Aborginal; 10 isolates carried SCCmec type IVRoyal Darwin Hospital, Northern Territory, Australia 647
2004-2005Case-cohort study of 100 non-MDR MRSA (i.e., resistant to ≤2 tested non-β-lactam antibiotics) infections compared with matched MSSA-infected patients (2:1) and MDR MRSA-infected patients (1:1); Aboriginal or Torres Strait Islanders had an odds ratio of non-MDR MRSA infection compared with MDR MRSA infection of 3.9 (95% CI, 1.16-16.92) upon univariate analysis; this was not significant upon multinomial logistic regression8 hospitals, southeast Queensland, Australia 642
2001-2002100 gentamicin-susceptible MRSA infections of 98 patients; 20 patients were PIs (60% had ST30 SCCmec type IV isolates), and 10 were Aboriginal (80% had ST93 PVL+, SCCmec type IV isolates); all 3 episodes of bacteremia were in Aboriginal children with an ST93 strain; PIs and Aboriginals each accounted for <2% of the population of New South WalesPediatric teaching hospital, New South Wales, Australia 352
2005-200689% (98/104) of infections caused by non-MDR MRSA isolates (i.e., isolates resistant to <3 non-β-lactam antibiotics tested) were of Aboriginal peopleAlice Springs Hospital, Alice Springs, Northern Territory, Australia 861
Canadian FN1990-1992259 MRSA infections of 135 inpatients in 36 mo; 85 patients had MRSA cultured <72 h after admission (community acquired); CA-MRSA patients were younger, more likely to have a rural residence, and more likely to be of FN ethnicity than HA-MRSA patients; 62% of CA-MRSA infections were in FN, and 14% of HA-MRSA infections were in FN (P < 0.001)Five tertiary care hospitals in Winnipeg, Manitoba, Saskatoon, Saskatchewan, Calgary, Alberta, and Edmonton, Alberta, Canada 263
2006-2007Outbreak of 43 CA-MRSA infections; 95% of isolates were USA400; for 5- to 9- and 20- to 29-yr-old populations, the cumulative incidence was 26/1,000; the outbreak accounted for 80% of reported MRSA cases in the provinceRemote Inuit community with population of 2,000 in Nunavut, Canada 203
2003-2006Rising rates of MRSA cases reported from clinics serving FN communities, reaching an incidence of 8 to 16/10,000 in areas of 2 regional health authoritiesNorthern Manitoba, Canada 507
1995-2002279 FN patients with MRSA infection or colonization; their isolates were more likely to be susceptible to erythromycin, clindamycin, TMP-SMX, and ciprofloxacin, more likely to be resistant to mupirocin, and more likely to have a pulsotype similar to USA300 (CMRSA-5) than MRSA isolates from non-FN patients; 61% of FN inpatients vs 33% of non-FN patients had a clinical MRSA infection; FN patients were 6-fold-more likely to have a CA-MRSA infection than non-FN patients38 hospitals, inpatients, Canada 684
PIs2001-200351% of 346 CA-MRSA infections (CDC criteria) were of PIs, while only 24% of the state population was PIs in 2001; 92% of the infections studied were SSTIs4 health care facilities, Hawaii 131, 270
1996-200080% of samples from Samoan or PI patients (4/5) vs 12% of non-Samoan/non-PI patients (4/34) with S. aureus SSTIs were MRSASurveillance, family practice clinic, Anchorage, AK 125
1997-1998Case series of 74 CA-MRSA infections (i.e., no previous contact with hospital or nursing home); disproportionate no. of cases in people from the South Pacific (e.g., Tonga and Western Samoa)Hospitals in Brisbane, Canberra, Melbourne, and Sydney, Australia 178
1993-2004Review of 58 pediatric S. aureus sepsis cases; isolates from all 7 MRSA (12%) cases were cultured <48 h after admission, and all 7 patients were PIs or MaoriHospital pediatric ICU in Auckland, New Zealand 605
1992-1996Case series of 10 MRSA infections in inpatients with onset in the community (excluding nursing home residents, those hospitalized in the previous 6 mo, or those with isolates cultured >48 h after admission); 2/10 (20%) patients were from American SamoaTripler Army Medical Center, Hawaii 333
1998Chart review of all 9 non-MDR MRSA isolates (susceptible to erythromycin, tetracycline, ciprofloxacin, gentamicin, rifampin, fusidic acid, and vancomycin) obtained in 2 months; all patients were Polynesians, and all had severe SSTIsClinical microbiology laboratory serving public hospitals, South Western Sydney Area Health Service, Australia 337
1998-199926 non-MDR MRSA infections; 29% (7/24) of non-MDR MRSA vs 0% (0/9) of MDR MRSA infections were in people born in Samoa, Tonga, or New Zealand; 44% of non-MDR MRSA vs 0% of MDR MRSA infections were CA-MRSA (i.e., no hospitalization, surgery, or residential care in previous 12 mo and no chronic disease)Patients at emergency or dermatology departments at hospitals, South Western Sydney Area Health Service, Australia 338
2000-200139% (17/44) of infections with non-MDR MRSA occurred in patients from the Southwest Pacific Islands, while 3% of the general population was from these islands; 16/17 (94%) infections in PIs were community acquired (i.e., cultured <48 h after admission and in patients with no health care contact in the previous 12 mo and no chronic illness); 7 isolates were the “Pacific Island strain” by PFGEIpswich Hospital, Queensland, Australia 645
  • a Abbreviations: FN, First Nations; LTCF, long-term care facility; PI, Pacific Islander.