Epidemiology and Infection

Original Papers


Surveillance for severe community-associated methicillin-resistant Staphylococcus aureus infection

P. WIERSMAa1a2 c1, M. TOBIN D'ANGELOa2, W. R. DALEYa3, J. TUTTLEa2, K. E. ARNOLDa2, S. M. RAYa5, J. L. LADSONa4, S. N. BULENSa2 and C. L. DRENZEKa2

a1 Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA

a2 Georgia Division of Public Health, Atlanta, GA, USA

a3 Centers for Disease Control and Prevention, Atlanta, GA, USA

a4 Georgia Emerging Infections Program, Atlanta, GA, USA

a5 Emory School of Medicine, Atlanta, GA, USA


Community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) has rapidly emerged in the USA as a cause of severe infections in previously healthy persons without traditional risk factors. We describe the epidemiology of severe CA-MRSA disease in the state of Georgia, USA and analyse the risk of death associated with three different clinical syndromes of CA-MRSA disease – pneumonia, invasive disease, and skin and soft-tissue infections (SSTIs). A total of 1670 cases of severe CA-MRSA disease were reported during 2005–2007. The case-fatality rate was 3·4%; sex and race of fatal and non-fatal cases did not differ significantly. While CA-MRSA pneumonia and invasive disease were less common than SSTIs, they were about 15 times more likely to result in death [risk ratio 16·69, 95% confidence interval (CI) 10·28–27·07 and 13·98, 95% CI 7·74–25·27, respectively]. When controlling for age and the presence of other clinical syndromes the odds of death in patients manifesting specific severe CA-MRSA syndromes was highest in those with pneumonia (odds ratio 11·34). Possible risk factors for severe CA-MRSA SSTI and pneumonia included the draining of lesions without medical assistance and an antecedent influenza-like illness.

(Accepted February 16 2009)

(Online publication April 15 2009)


c1 Author for correspondence: Dr P. Wiersma, 5120 Geneva PI, Dulles, VA 20189, USA. (Email: Petra.wiersma@gmail.com)