Over the 8 year study period, the annual rate of individuals reported with CA-MRSA infection in northern Saskatchewan have dramatically increased from 8.2 per 10,000 population in 2001 to 142.6 per 10,000 in 2008, which is almost 10 times higher than all reported MRSA cases in neighboring northern Manitoba health regions [14
] and the province of Alberta [12
]. The reporting structure is similar between Saskatchewan and Alberta, but the Manitoba rates included both colonizations/infections and did not differentiate between HA- and CA-MRSA strains, which further highlights the rapid emergence and dissemination of CA-MRSA in northern Saskatchewan.
The majority of isolates were obtained from skin and soft tissue infections (78.2%), followed by ear (6.7%), urogenital (2.4%), respiratory (1.1%), and joint/blood infections (0.4%). A total of 11.2% of the infections were unspecified. Molecular typing of a subset of 404 isolates by pulsed-field gel electrophoresis revealed CMRSA7 to be the predominant strain type (92.3%) followed by CMRSA10 (4.7%). These results are similar to those previously described in specific northern Saskatchewan communities dealing with high rates of CA-MRSA infections [2
], suggesting clonal dissemination of CMRSA7 throughout the northern regions of the province.
To help address the rapid emergence and dissemination of CA-MRSA in northern Saskatchewan, a team of community members, healthcare professionals, educators and research scientists formed a team called NARP http://www.narp.ca
and established: 1) An active surveillance program in target northern Saskatchewan communities [2
]; 2) A case-control study to determine risk factors for the acquisition of CA-MRSA [3
]; and 3) A community, school, and health worker educational initiative through a collaboration of federal, provincial, regional and First Nations health authorities and laboratories.
Following implementation of this educational program, the rates of MRSA infections in the targeted communities have decreased nearly two-fold (243 to 129 infections/10,000 population) from 2006 to 2008, in comparison to other non-target northern communities in Saskatchewan where the rates have continued to increase (119 to 151 infections/10,000 population) over the same time period (Figure ). This decrease in CA-MRSA infections in the targeted communities was observed across all age groups examined and was not the result of reporting bias or a decrease in the number of laboratory tests.
Rates of CA-MRSA infections in NARP targeted communities following implementation of the NARP educational program, which began in 2006, in comparison to other northern communities in Saskatchewan.
It is important to note that this study was purely observational and therefore it is difficult to directly relate decreased CA-MRSA infections to the educational intervention. However, we did demonstrate positive knowledge translation of our educational materials using pre-/post-community surveys and a pocket chart to evaluate the Do Bugs Need Drugs program. The pre- (n = 94) and post-community (n = 87) surveys involved questions regarding the appropriate usage of antimicrobials, differences between bacterial and viral infections, and overall awareness of NARP. Improved responses to 19/20 questions were noted in the post-community education survey. This included for example significant improvements in responses for individuals who would request antibiotics from the doctor, or seek out another doctor, if they were not prescribed antibiotics for themselves or their children (p = 0.004-0.03) and the importance of not using left over antibiotics at home for new illnesses (p = < 0.001). The Do Bugs Need Drugs pocket chart collected data from kindergarten to grade 3 school aged children both pre- (n = 821) and post-education (n = 685) and demonstrated increased knowledge on the size of germs (p = < 0.001), when and how to wash your hands (p = < 0.001 and p = 0.004, respectively), and what kind of germs can be killed by antibiotics (p = 0.066).