Hawaii medical care facilities have the nation's highest infection rate for a dangerous, drug-resistant staph germ.
In Hawaii, 91 of 1,000 patients at hospitals, rehabilitation centers and long-term care facilities had contracted the superbug during a national survey conducted last fall.
That compares to the national average of 46 per 1,000 patients.
Maine, New York and South Carolina also reported high rates of infection.
The germ, called Methicillin-resistant Staphylococcus aureus, can't be tamed by certain common antibiotics.
It is potentially fatal and can be spread by touch.
It is associated with sometimes-horrific skin infections, but it also causes blood infections, pneumonia and other illnesses.
The germ typically thrives in health care settings where people have open wounds. But in recent years, "community-associated" outbreaks have occurred among prisoners, children and athletes, with the germ spreading through skin contact or shared items such as towels.
The study surveyed 1,200 institutions across the country. The results were reported at the annual meeting of the Association for Professionals in Infection Control and Epidemiology June 25-28 in San Jose, Calif.
Susan Slavish, infection prevention and control coordinator at the Queen's Medical Center, said she has seen drug-resistant staph increase every year during her 35 years in infection control in Hawaii.
But it was a surprise that Hawaii led the nation with the highest prevalence of patients with the superbug in the survey, she said.
The study said about 34 per 1,000 were infected with the superbug, meaning they had skin or blood infections or some other clinical symptom. And 12 per 1,000 were "colonized," meaning they had the bug but no illness.
The infection can be treated with other antibiotics. Health care workers can prevent spread of the bug through hand-washing and equipment decontamination, and by wearing gloves and gowns and by separating infected people from other patients.
Alan Tice, a part-time University of Hawaii professor, is leading a research and education program to deepen understanding of the issue.
The program involves sampling sea water for the organism near Waikiki and Ala Moana, looking for alternate forms of treatment such as topical antibiotics and developing new detection systems for bad strains of staph.