• Am. J. Med. · Nov 2006

    Fifteen-year study of the changing epidemiology of methicillin-resistant Staphylococcus aureus.

    • Nancy F Crum, Rachel U Lee, Scott A Thornton, O Colin Stine, Mark R Wallace, Chris Barrozo, Ananda Keefer-Norris, Sharon Judd, and Kevin L Russell.
    • Infectious Diseases Division, Naval Medical Center San Diego, San Diego, Calif 92134-1005, USA. NFCrum@nmcsd.med.navy.mil
    • Am. J. Med. 2006 Nov 1; 119 (11): 943-51.

    PurposeThe study's purpose was to elucidate the evolutionary, microbiologic, and clinical characteristics of methicillin-resistant Staphylococcus aureus (MRSA) infections.MethodsMRSA cases from military medical facilities in San Diego, from 1990 to 2004, were evaluated and categorized as community-acquired or nosocomial. Sequence type, staphylococcal chromosomal cassette gene type, and Panton-Valentine leukocidin gene status were determined for a subset of isolates.ResultsOver the 15-year period, 1888 cases of MRSA were identified; 65% were community acquired. The incidence (155 infections/100000 person-year in 2004) and household-associated cases rapidly increased since 2002. Among persons with community-acquired MRSA, 16% were hospitalized and only 17% were initially given an effective antibiotic. Community-acquired MRSA cases compared with nosocomial MRSA cases were more often soft-tissue and less often urinary, lung, or bloodstream infections (P<.001). Patients with community-acquired MRSA were younger (22 vs 64 years, P<.001) and less likely to have concurrent medical conditions (9% vs 98%, P<.001). Clindamycin resistance increased among community-acquired MRSA isolates during 2003 and 2004 compared with previous years (79% vs 13%, P<.001). Genetically, nosocomial MRSA isolates were significantly different than those acquired in the community. Although community-acquired MRSA isolates were initially diverse by 2004, one strain (staphylococcal chromosomal cassette type IV, sequence type 8, Panton-Valentine leukocidin gene positive) became the predominant isolate.ConclusionsCommunity-acquired and intrafamilial MRSA infections have increased rapidly since 2002. Our 15 years of surveillance revealed the emergence of distinct community-acquired MRSA strains that were genetically unrelated to nosocomial MRSA isolates from the same community.

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