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Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Epidemiology

Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Epidemiology
Author:
Deverick J Anderson, MD, MPH
Section Editor:
Denis Spelman, MBBS, FRACP, FRCPA, MPH
Deputy Editor:
Keri K Hall, MD, MS
Literature review current through: May 2024.
This topic last updated: Jul 21, 2022.

INTRODUCTION — Methicillin-resistant Staphylococcus aureus (MRSA) was described shortly after the introduction of methicillin in 1961; subsequently, several outbreaks of MRSA were reported in the early 1960s [1,2]. MRSA has spread worldwide over the past decades and is now known to be prevalent in both humans and in various animal species.

Methicillin resistance is mediated by PBP-2a, a penicillin-binding protein encoded by the mecA gene that permits the organism to grow and divide in the presence of methicillin and other beta-lactam antibiotics. The mecA gene is located on a mobile genetic element called staphylococcal chromosome cassette (SCCmec). (See "Methicillin-resistant Staphylococcus aureus (MRSA): Microbiology and laboratory detection".)

A single clone probably accounted for most MRSA isolates recovered during the 1960s; by 2004, six major MRSA clones emerged worldwide, labeled as SCCmec I to VI [3-7]. Dissemination of resistance was mediated by horizontal transfer of the mecA gene and related regulatory sequences [8].

The epidemiology and clinical manifestations of MRSA infection in adults will be reviewed here. Prevention, control, and treatment of MRSA infections in adults are discussed separately. (See "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Prevention and control" and "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Treatment of bacteremia" and "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Treatment of skin and soft tissue infections" and "Epidemiology of Staphylococcus aureus bacteremia in adults".)

EPIDEMIOLOGY — Health care-associated methicillin-resistant S. aureus (HA-MRSA) and community-associated methicillin-resistant S. aureus (CA-MRSA) differ with respect to their clinical and molecular epidemiology.

Health care-associated MRSA infection — HA-MRSA is defined as MRSA infection that occurs >48 hours following hospitalization (hospital-onset, HA-MRSA, formerly "nosocomial") or MRSA infection that occurs outside of the hospital within 12 months of exposure to health care (eg, history of surgery, hospitalization, dialysis, or residence in a long-term care facility; community-onset, HA-MRSA) [9]. HA-MRSA is associated with severe, invasive disease, including skin and soft tissue infection, bloodstream infection (BSI), and pneumonia [9-13]. In fact, MRSA is the leading cause of surgical site infection in both tertiary and community hospitals [14,15]. HA-MRSA strains tend to have multidrug resistance and carry staphylococcal cassette chromosome (SCCmec) type II [16]. They are typified by a USA100 or USA200 pulse-field electrophoresis (PFGE) pattern [17]. (See "Methicillin-resistant Staphylococcus aureus (MRSA): Microbiology and laboratory detection".)

HA-MRSA has been a problem in hospital settings since the 1960s; there has since been a progressive increase in the prevalence of antimicrobial resistance in hospital-acquired S. aureus infections [10,18,19]. In a United States surveillance report of over 24,000 cases of hospital-acquired S. aureus BSIs, isolates with methicillin resistance increased from 22 to 57 percent between 1995 and 2001 [10]. In the United States between 2005 and 2012, rates of hospital-onset MRSA bloodstream infection decreased by 17 percent annually [20]. Between 2005 and 2017, United States Department of Veterans Affairs medical centers experienced a 43 percent decline in S. aureus infections following introduction of a multifaceted infection control intervention; most reductions were explained by a 55 percent decrease in MRSA [21].

Worldwide, HA-MRSA prevalence varies considerably, from <1 percent in Scandinavia to up to 40 percent in Japan, Israel, and elsewhere in Europe [22,23].

MRSA is one of the few pathogens routinely implicated in nearly every type of hospital-acquired infection. This is related in part to the organism's capacity for biofilm formation on invasive, foreign devices such as endotracheal tubes and urinary and endovascular catheters [24]. Biofilm facilitates MRSA survival and multiplication on these surfaces, prolonging the duration of organism exposure to antibiotics as well as promoting the potential opportunity for transfer of antibiotic resistance genes between organisms [25].

Risk factors for HA-MRSA infection include antibiotic use, prolonged hospitalization, intensive care, hemodialysis, MRSA colonization, and proximity to others with MRSA colonization or infection [26-28]. Risk of MRSA infection related to antibiotic use, hemodialysis, and colonization are discussed in further detail below. (See 'Risk factors' below and 'Colonization' below.)

Risk factors associated with postdischarge MRSA infection include MRSA colonization, discharge to a nursing home, presence of a chronic wound, and discharge with a central venous catheter or other invasive device [29]. (See "Epidemiology of Staphylococcus aureus bacteremia in adults".)

Patients with MRSA infection have higher mortality, longer hospital stays, and higher health care costs than patients with methicillin-susceptible S. aureus (MSSA) infection [13,30-33]. For example, two meta-analyses including data on approximately 4000 patients demonstrated that patients with BSI due to MRSA were 1.5- to 2.0-fold more likely to die than patients with BSI due to MSSA [13,34]. Patients with infection due to MRSA also have higher rates of acute renal failure, hemodynamic instability, and prolonged ventilator dependency than patients with infection due to MSSA [30].

Community-associated MRSA infection — CA-MRSA is defined as MRSA infection that occurs in the absence of health care exposure [9]. CA-MRSA is most often associated with skin and soft tissue infections in young, otherwise healthy individuals [25]. Most CA-MRSA strains are sensitive to non-beta-lactam antibiotics, although a multidrug-resistant isolate has been described among men who have sex with men [35,36]. This strain contains the pUSA03 plasmid and carries resistance genes for beta-lactams, fluoroquinolones, tetracycline, macrolides, clindamycin, and mupirocin [36].

Most CA-MRSA strains frequently carry SCCmec type IV or V and frequently carry genes for the cytotoxin Panton-Valentine leukocidin that confers enhanced virulence [36-41]. Most CA-MRSA are typified by a USA300 or USA400 pulse-field electrophoresis pattern. (See "Methicillin-resistant Staphylococcus aureus (MRSA): Microbiology and laboratory detection".)

CA-MRSA was initially reported among injection drug users in the early 1980s [42] and has since become the most frequent cause of skin and soft tissue infections (SSTIs) presenting to United States emergency departments and ambulatory clinics [43,44]. This was illustrated by a prospective study of 422 patients with SSTIs seen in emergency departments in August 2004; S. aureus was implicated in 76 percent of cases, 97 percent of these isolates were the CA-MRSA USA300 strain, and 98 percent possessed the Panton-Valentine leukocidin toxin gene [43]. USA300 appears to be more transmissible among household members than other S. aureus genetic backgrounds [45]. SSTI due to USA300 is a risk factor for bloodstream infection due to USA300, as is use of an antimicrobial with activity against MRSA in the preceding 30 days [46].

Community outbreaks have been reported in multiple settings, including native and aboriginal communities, sports teams, childcare centers, military personnel, men who have sex with men, and prison inmates and guards [35,47-62]. These observations have led to identification of risk factors for CA-MRSA. These include skin trauma (eg, lacerations, abrasions, tattoos, injection drug use), cosmetic body shaving, incarceration, sharing equipment that is not cleaned or laundered between users, and close contact with others who have MRSA colonization or infection [25,47,49,51-58,63-65]. Animals can also carry MRSA and function as a source of transmission [66-70]. However, the preceding risk factors have poor predictive values as many patients with CA-MRSA have no risk factors [71].

Skin and soft tissue remain the predominant sites of CA-MRSA infection, although MRSA can also cause invasive, severe disease such as necrotizing pneumonia, osteomyelitis, urinary tract infection, infective endocarditis, and sepsis (with or without Waterhouse-Friderichsen syndrome) [25,59,72-77]. (See "Epidemiology, pathogenesis, and microbiology of community-acquired pneumonia in adults", section on 'S. aureus'.)

Evolving epidemiologic observations — Patients can develop MRSA colonization in the community and manifest infection in the hospital; however, patients can also develop MRSA colonization in the hospital and manifest infection in the community [71,78-83]. In one study including more than 400 patients with S. aureus bacteremia, hospital-onset bloodstream infections were caused by community-acquired USA300 strains that had colonized patients while they were residing in the community prior to hospitalization [84]. In two other studies, the opposite phenomenon was observed. In one study including more than 200 patients who received hospital care and developed new MRSA infection within 18 months of their hospital discharge, 49 percent of cases occurred while in the community [85]. Similarly, in another series of 102 patients with CA-MRSA infections, 29 percent had molecular typing consistent with HA-MRSA [82].

CA-MRSA strains may also cause hospital-onset, health care-associated infections, since patients who become colonized with CA-MRSA strains in the community may require hospitalization and transmit such strains to other hospitalized patients or develop infection while hospitalized (eg, following surgery or insertion of an invasive device) [86]. In a review of 352 patients with HA-MRSA, the proportion of isolates with CA-MRSA molecular typing increased from 17 to 56 percent between 1999 and 2004 [81].

There is evidence that CA-MRSA may be replacing traditional hospital-acquired strains in some regions. In one study that included molecular typing of 208 isolates from hospital-onset HA-MRSA BSIs between 2000 and 2006, community-acquired strains were responsible for an increasing proportion of cases (24 to 49 percent), even though the total number of MRSA BSIs was stable [87]. A subsequent analysis of 60 hospital-onset MRSA bloodstream infections suggests that the majority of "hospital-onset" infections caused by USA 300 MRSA strains were due to colonizing strains acquired in the community before hospitalization [84].

Rates of invasive HA-MRSA infections declined steadily between 2005 and 2017. The incidence of MRSA infection in hospitalized patients declined from 114 to 94 cases per 10,000 hospitalizations [88]. Rates of decline in HA-MRSA infections began to slow in 2017 [20] and subsequently increased again during the coronavirus disease 2019 (COVID-19) pandemic [89].

Hospital admissions related to MRSA skin and soft tissue infections have also declined since 2010, while the proportion of cases due to methicillin- and penicillin-sensitive S. aureus strains has increased [90-92].

MRSA colonization — Colonization with S. aureus increases risk for staphylococcal infection following invasive medical or surgical procedures. Screening of hospital patients has focused on the nares, which are the primary colonization site for this pathogen. However, some individuals have MRSA colonization of the throat only, so routine nasal screening can miss colonization in some patients. For example, one study found that 12 percent of S. aureus carriers had throat carriage of S. aureus without concurrent positive nasal cultures [93].

Approximately 7 percent of patients in United States hospitals are colonized with MRSA [94]. In a study by National Health and Nutrition Examination Survey (NHANES) in the early 2000s, the percent of MRSA-colonized individuals carried a PFGE type associated with community transmission was relatively low (19 percent), suggesting that CA-MRSA may cause disease in the absence of prior nasal colonization and/or that CA-MRSA favors other sites of colonization (such as the skin, throat, or gastrointestinal tract) [95]. Among health care workers, the prevalence of MRSA nasal colonization is 4 to 15 percent [96,97].

The duration of colonization is variable [98-102]. One systematic review including 1804 patients noted median time to clearance of MRSA colonization of 88 weeks [100].

Issues related to decolonization are discussed further separately. (See "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Prevention and control", section on 'Targeted decolonization'.)

RISK FACTORS — Risk factors for health care-associated MRSA (HA-MRSA) and community-associated MRSA (CA-MRSA) are described above (table 1). More detailed discussions related to antibiotic use, HIV-infected individuals, hemodialysis, long-term care facilities, and injection drug users will be reviewed in this section.

Antibiotic use — MRSA probably arose due to antibiotic selective pressure [1,24]. Antibiotic use (particularly cephalosporin and fluoroquinolone use) strongly correlates with the risk for MRSA colonization and infection [5,11,16,103-107].

In a case-control study including 1981 cases of MRSA, the risk for MRSA increased with the number of antimicrobial agents; the odds ratios (OR) for MRSA diagnosis in patients who were prescribed 1, 2 to 3, or ≥4 antimicrobial drugs were 1.57, 2.46, and 6.24, respectively. The highest risk was for fluoroquinolones (OR 3.37) [106].

Cephalosporins were implicated in a case-control study of 387 patients with S. aureus infection (half with MRSA and half with methicillin-susceptible S. aureus [MSSA]); patients who had received cephalosporins for ≥5 days were three times more likely to acquire MRSA than those who had not received cephalosporins [104,105].

HIV infection — HIV-infected individuals are at increased risk for MRSA colonization and infection [108-113]. In a case-control surveillance study of MRSA colonization among 726 patients, HIV was an important risk factor for colonization (OR 3.3) [108]. HIV is also a risk factor for MRSA infection; in a retrospective study of 3455 HIV patients, the incidence of MRSA infection was nearly 5 per 100 patient-years; the incidence of MRSA infection had increased sixfold between 2000 and 2003 [109]. The primary sites of these infections were skin and soft tissue (83 percent). Risk factors included advanced immunosuppression (CD4 count <50 cells/microL), high plasma HIV RNA (>100,000 copies/microL), and lack of antiretroviral therapy.

Injection drug use — In one report summarizing data from six Emerging Infections Program sites in the United States between 2005 and 2016; injection drug users were 16 times more likely to develop an invasive MRSA infection than noninjection users; infections included bacteremia, endocarditis, and osteomyelitis [65]. The proportion of invasive MRSA cases that occurred among injection drug users increased from 4 to 9 percent over the last five years of the study.

Presence of an indwelling hemodialysis catheter — Patients with long-term catheters for hemodialysis access are at significantly higher risk for invasive catheter-related infections due to MRSA and other pathogens. For example, in a review of 5287 cases of invasive MRSA infection during 2005, 15 percent occurred in dialysis patients; in fact, the incidence of invasive MRSA infection was 100 times higher among dialysis patients than in the general population (45 versus 0.4 per 1000 patients) [114]. Between 2005 and 2011, however, there was a significant decrease in incidence of invasive MRSA among dialysis patients (from 6.5 to 4.2 cases per 100 dialysis patients) [115].

Residence in a long-term care facility — HA-MRSA is prevalent among residents of long-term care facilities [116]. For example, S. aureus accounted for about 15 percent of acquired infections in a five-year observational study of a 120-bed nursing facility; roughly half were due to MRSA. In addition, MRSA-colonized residents are frequently transferred between hospitals and long-term care facilities, creating an ongoing circuit of MRSA transmission in areas where these organisms are prevalent.

TRANSMISSION — Health care-associated MRSA (HA-MRSA) strains are most commonly transmitted to patients via the transiently contaminated hands of health care workers. Hospitalized patients may also acquire HA-MRSA from contaminated environmental surfaces. In contrast, community-associated MRSA (CA-MRSA) strains are most often transmitted by direct contact with a colonized or infected individual.

However, individuals in the community may also acquire CA-MRSA by contact with contaminated fomites used by an affected individual. Among 188 household contacts of 148 patients known to be colonized with MRSA prior to hospital discharge, 19 percent acquired MRSA colonization, though none developed MRSA infection [98]. Household environmental contamination is also associated with a risk of recurrent infection [117]. Older age and providing health care to the discharged patient were associated with MRSA acquisition. Adherence to infection control measures is critical for interrupting MRSA transmission. (See "Infection prevention: Precautions for preventing transmission of infection" and "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Prevention and control".)

MRSA transmission from pets such as dogs and cats to humans may also occur as can transmission from food animals to farm workers [118,119].

Whole genome sequencing (WGS) has shed significant light on the transmission dynamics of MRSA [120-125]. In fact, real-time application of whole genome sequencing is increasingly used as a tool to identify transmission within hospitals [126].

●An analysis of 37 MRSA acquisitions among patients admitted to the ICU used WGS to conclude that only 7 (19 percent) were transmissions from other colonized patients [121].

●Investigation of 685 MRSA isolates from 610 patients in London demonstrated that sequence-type clusters could be identified across hospital and outpatient settings [123].

●An evaluation of more than 2200 MRSA isolates from more than 1400 patients in the east of England suggested that confirmed transmission of MRSA is still more likely to occur in the hospital setting; of 173 clusters of acquisition, 68 percent occurred among patients with hospitals contact alone and 16 percent occurred among patients with both hospital and community contact [124].

●In a study of 413 MRSA isolates from 66 intensive care unit (ICU) patients in a single hospital, multiple separate MRSA infection clusters due to identical strains occurred between and within ICUs, illustrating that MRSA transmission occurs among patients, health care workers, and the environment [125].

Colonization — Individuals colonized with MRSA serve as a reservoir for transmission. MRSA can colonize the skin and nares of hospitalized patients, health care workers, and healthy individuals (up to 7 percent) [28,108,127-129].

Colonization increases the risk for MRSA infection [18,130]. In a study of 758 patients for whom nares cultures were obtained on hospital admission [18], the rate of MRSA infection in the year following admission was substantially higher among those with baseline MRSA colonization than those without colonization (19 versus 2 percent, respectively).

Colonization can occur in the following ways [1,131]:

●Contact with contaminated wounds or dressings of infected patients

●Contact with another individual's colonized intact skin

●Contact with contaminated inanimate objects

●Inhalation of aerosolized droplets from chronic nasal carriers

The anterior nares is the most common site of MRSA colonization [131-134]. Individuals with nasal MRSA carriage transmit MRSA more readily in the setting of concomitant sinus infection or upper respiratory infection [135,136]. A majority of individuals with nasal colonization are also colonized on other areas of intact skin including the hands, axillae, perineum, and umbilicus (in infants) [131,133,137-139].

Other potential sites of MRSA colonization include surgical wounds, decubitus ulcers, intravascular catheter sites and other invasive devices, throat, sputum, stool, and the genitourinary tract. In one study of 71 hospitalized patients with S. aureus colonization, 67 percent had colonization of the gastrointestinal tract, which was associated with increased frequency of S. aureus skin colonization [140]. The durability of MRSA colonization can vary from a few days or weeks to up to several years [132,141]. In one prospective cohort study of 78 patients with MRSA colonization, the median duration of colonization was 8.5 months [142]. Patients with breaks in skin were more likely to have longer duration of MRSA colonization than patients with intact skin (odds ratio 4.3, p = 0.004).

The natural history of MRSA and methicillin-susceptible S. aureus (MSSA) colonization was evaluated in a 10-week prospective observational study of 812 soldiers [143]. Baseline colonization rates with MRSA were lower than MSSA (3 versus 28 percent), but subsequent development of infection was higher among those with MRSA than MSSA colonization (38 versus 3 percent). The rate of CA-MRSA colonization fell to under 2 percent at 10-week follow-up.

Individual MRSA colonization is an important risk factor for subsequent development of MRSA infection [28]. In a review of 758 hospitalized patients, MRSA colonization was observed in 3.4 percent of admissions and acquired in an additional 3 percent; the rates of MRSA infection within one year in these groups were 19 and 25 percent (relative risks 9.5 and 13 compared with patients with no colonization or MSSA colonization, respectively) [28]. Previously colonized patients should be considered to be at risk of continued carriage for at least four years [144]. Among 1564 MRSA carriers, the prevalence of colonization was observed to decrease rapidly to 48 percent at one year; thereafter, rates of colonization remained high for prolonged periods, as 21 percent remained colonized at four years.

Environmental contamination — MRSA-contaminated surfaces can serve as reservoirs for MRSA transmission [145-147]. In a prospective culture survey of a 200-bed hospital, cultures obtained from the hospital room inanimate surfaces of MRSA-infected patients were positive more frequently in the setting of wound infections or urinary tract infections than in the setting of MRSA infection at other sites (36 versus 6 percent) [145]. In another study, environmental surfaces in the rooms of patients with heavy gastrointestinal MRSA colonization and diarrhea were contaminated in 59 percent of cases [148].

MRSA may also be transmissible between health care workers via medical equipment. In a study of cultures from 200 stethoscope ear tips, 80 percent were contaminated with microorganisms. Among the positive cultures, 58 percent were Staphylococcus species and 17 percent were MRSA [146].

Issues related to environmental cleaning are discussed further separately. (See "Methicillin-resistant Staphylococcus aureus (MRSA) in adults: Prevention and control", section on 'Environmental cleaning'.)

INFORMATION FOR PATIENTS — UpToDate offers two types of patient education materials, "The Basics" and "Beyond the Basics." The Basics patient education pieces are written in plain language, at the 5th to 6th grade reading level, and they answer the four or five key questions a patient might have about a given condition. These articles are best for patients who want a general overview and who prefer short, easy-to-read materials. Beyond the Basics patient education pieces are longer, more sophisticated, and more detailed. These articles are written at the 10th to 12th grade reading level and are best for patients who want in-depth information and are comfortable with some medical jargon.

Here are the patient education articles that are relevant to this topic. We encourage you to print or e-mail these topics to your patients. (You can also locate patient education articles on a variety of subjects by searching on "patient info" and the keyword(s) of interest.)

●Beyond the Basics topic (see "Patient education: Methicillin-resistant Staphylococcus aureus (MRSA) (Beyond the Basics)")

SUMMARY

●Health care-associated methicillin-resistant Staphylococcus aureus (HA-MRSA) is associated with severe, invasive disease in hospitalized patients. (See 'Health care-associated MRSA infection' above.)

●Community-associated methicillin-resistant S. aureus (CA-MRSA) is most often associated with skin and soft tissue infections in young, healthy individuals with no recent health care exposure. (See 'Community-associated MRSA infection' above.)

●Though convenient epidemiologic terms, the line between "health care-associated" and "community-associated" MRSA is significantly blurred. Patients can develop MRSA colonization in one realm and develop manifestations of infection in another or simply introduce MRSA in the second realm. (See 'Evolving epidemiologic observations' above.)

●Risk factors for infection due to HA-MRSA include antibiotic use, prolonged hospitalization, intensive care, invasive devices, hemodialysis, MRSA colonization, and proximity to others with MRSA colonization or infection. (See 'Health care-associated MRSA infection' above.)

●Additional risk factors for CA-MRSA infection include skin trauma (eg, lacerations, abrasions, tattoos, injection drug use), cosmetic body shaving, incarceration, HIV infection, and sharing equipment that is not cleaned or laundered between users. (See 'Community-associated MRSA infection' above and 'Risk factors' above.)

●MRSA transmission occurs via contact with a colonized individual or a contaminated fomite. (See 'Transmission' above.)

  1. BARBER M. Methicillin-resistant staphylococci. J Clin Pathol 1961; 14:385.
  2. Benner EJ, Kayser FH. Growing clinical significance of methcillin-resistant Staphylococcus aureus. Lancet 1968; 2:741.
  3. Kreiswirth B, Kornblum J, Arbeit RD, et al. Evidence for a clonal origin of methicillin resistance in Staphylococcus aureus. Science 1993; 259:227.
  4. Crisóstomo MI, Westh H, Tomasz A, et al. The evolution of methicillin resistance in Staphylococcus aureus: similarity of genetic backgrounds in historically early methicillin-susceptible and -resistant isolates and contemporary epidemic clones. Proc Natl Acad Sci U S A 2001; 98:9865.
  5. Enright MC, Robinson DA, Randle G, et al. The evolutionary history of methicillin-resistant Staphylococcus aureus (MRSA). Proc Natl Acad Sci U S A 2002; 99:7687.
  6. Ito T, Ma XX, Takeuchi F, et al. Novel type V staphylococcal cassette chromosome mec driven by a novel cassette chromosome recombinase, ccrC. Antimicrob Agents Chemother 2004; 48:2637.
  7. Oliveira DC, Tomasz A, de Lencastre H. The evolution of pandemic clones of methicillin-resistant Staphylococcus aureus: identification of two ancestral genetic backgrounds and the associated mec elements. Microb Drug Resist 2001; 7:349.
  8. Archer GL, Niemeyer DM, Thanassi JA, Pucci MJ. Dissemination among staphylococci of DNA sequences associated with methicillin resistance. Antimicrob Agents Chemother 1994; 38:447.
  9. Klevens RM, Morrison MA, Nadle J, et al. Invasive methicillin-resistant Staphylococcus aureus infections in the United States. JAMA 2007; 298:1763.
  10. Wisplinghoff H, Bischoff T, Tallent SM, et al. Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study. Clin Infect Dis 2004; 39:309.
  11. Boyce JM. Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: microbiology, epidemiology, and preventive measures. Infect Control Hosp Epidemiol 1992; 13:725.
  12. Klevens RM, Edwards JR, Tenover FC, et al. Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003. Clin Infect Dis 2006; 42:389.
  13. Cosgrove SE, Sakoulas G, Perencevich EN, et al. Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis. Clin Infect Dis 2003; 36:53.
  14. Anderson DJ, Sexton DJ, Kanafani ZA, et al. Severe surgical site infection in community hospitals: epidemiology, key procedures, and the changing prevalence of methicillin-resistant Staphylococcus aureus. Infect Control Hosp Epidemiol 2007; 28:1047.
  15. Hidron AI, Edwards JR, Patel J, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008; 29:996.
  16. Naimi TS, LeDell KH, Como-Sabetti K, et al. Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection. JAMA 2003; 290:2976.
  17. McDougal LK, Steward CD, Killgore GE, et al. Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database. J Clin Microbiol 2003; 41:5113.
  18. National Nosocomial Infections Surveillance System. National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004. Am J Infect Control 2004; 32:470.
  19. Styers D, Sheehan DJ, Hogan P, Sahm DF. Laboratory-based surveillance of current antimicrobial resistance patterns and trends among Staphylococcus aureus: 2005 status in the United States. Ann Clin Microbiol Antimicrob 2006; 5:2.
  20. Kourtis AP, Hatfield K, Baggs J, et al. Vital Signs: Epidemiology and Recent Trends in Methicillin-Resistant and in Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections - United States. MMWR Morb Mortal Wkly Rep 2019; 68:214.
  21. Jones M, Jernigan JA, Evans ME, et al. Vital Signs: Trends in Staphylococcus aureus Infections in Veterans Affairs Medical Centers - United States, 2005-2017. MMWR Morb Mortal Wkly Rep 2019; 68:220.
  22. Sader HS, Streit JM, Fritsche TR, Jones RN. Antimicrobial susceptibility of gram-positive bacteria isolated from European medical centres: results of the Daptomycin Surveillance Programme (2002-2004). Clin Microbiol Infect 2006; 12:844.
  23. Voss A, Milatovic D, Wallrauch-Schwarz C, et al. Methicillin-resistant Staphylococcus aureus in Europe. Eur J Clin Microbiol Infect Dis 1994; 13:50.
  24. Shorr AF. Epidemiology of staphylococcal resistance. Clin Infect Dis 2007; 45 Suppl 3:S171.
  25. Fridkin SK, Hageman JC, Morrison M, et al. Methicillin-resistant Staphylococcus aureus disease in three communities. N Engl J Med 2005; 352:1436.
  26. Thompson RL, Cabezudo I, Wenzel RP. Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus. Ann Intern Med 1982; 97:309.
  27. Boyce JM. Methicillin-resistant Staphylococcus aureus. Detection, epidemiology, and control measures. Infect Dis Clin North Am 1989; 3:901.
  28. Davis KA, Stewart JJ, Crouch HK, et al. Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection. Clin Infect Dis 2004; 39:776.
  29. Epstein L, Mu Y, Belflower R, et al. Risk Factors for Invasive Methicillin-Resistant Staphylococcus aureus Infection After Recent Discharge From an Acute-Care Hospitalization, 2011-2013. Clin Infect Dis 2016; 62:45.
  30. Blot SI, Vandewoude KH, Hoste EA, Colardyn FA. Outcome and attributable mortality in critically Ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus. Arch Intern Med 2002; 162:2229.
  31. Cosgrove SE, Qi Y, Kaye KS, et al. The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges. Infect Control Hosp Epidemiol 2005; 26:166.
  32. Reed SD, Friedman JY, Engemann JJ, et al. Costs and outcomes among hemodialysis-dependent patients with methicillin-resistant or methicillin-susceptible Staphylococcus aureus bacteremia. Infect Control Hosp Epidemiol 2005; 26:175.
  33. Abramson MA, Sexton DJ. Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs? Infect Control Hosp Epidemiol 1999; 20:408.
  34. Whitby M, McLaws ML, Berry G. Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis. Med J Aust 2001; 175:264.
  35. Diep BA, Chambers HF, Graber CJ, et al. Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men. Ann Intern Med 2008; 148:249.
  36. Diep BA, Gill SR, Chang RF, et al. Complete genome sequence of USA300, an epidemic clone of community-acquired meticillin-resistant Staphylococcus aureus. Lancet 2006; 367:731.
  37. Baba T, Takeuchi F, Kuroda M, et al. Genome and virulence determinants of high virulence community-acquired MRSA. Lancet 2002; 359:1819.
  38. Diep BA, Carleton HA, Chang RF, et al. Roles of 34 virulence genes in the evolution of hospital- and community-associated strains of methicillin-resistant Staphylococcus aureus. J Infect Dis 2006; 193:1495.
  39. Ma XX, Ito T, Tiensasitorn C, et al. Novel type of staphylococcal cassette chromosome mec identified in community-acquired methicillin-resistant Staphylococcus aureus strains. Antimicrob Agents Chemother 2002; 46:1147.
  40. Tenover FC, McDougal LK, Goering RV, et al. Characterization of a strain of community-associated methicillin-resistant Staphylococcus aureus widely disseminated in the United States. J Clin Microbiol 2006; 44:108.
  41. King MD, Humphrey BJ, Wang YF, et al. Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections. Ann Intern Med 2006; 144:309.
  42. Saravolatz LD, Markowitz N, Arking L, et al. Methicillin-resistant Staphylococcus aureus. Epidemiologic observations during a community-acquired outbreak. Ann Intern Med 1982; 96:11.
  43. Moran GJ, Krishnadasan A, Gorwitz RJ, et al. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med 2006; 355:666.
  44. Hersh AL, Chambers HF, Maselli JH, Gonzales R. National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections. Arch Intern Med 2008; 168:1585.
  45. Miller LG, Eells SJ, Taylor AR, et al. Staphylococcus aureus colonization among household contacts of patients with skin infections: risk factors, strain discordance, and complex ecology. Clin Infect Dis 2012; 54:1523.
  46. Tattevin P, Schwartz BS, Graber CJ, et al. Concurrent epidemics of skin and soft tissue infection and bloodstream infection due to community-associated methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2012; 55:781.
  47. Groom AV, Wolsey DH, Naimi TS, et al. Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community. JAMA 2001; 286:1201.
  48. Byrd KK, Holman RC, Bruce MG, et al. Methicillin-resistant Staphylococcus aureus-associated hospitalizations among the American Indian and Alaska native population. Clin Infect Dis 2009; 49:1009.
  49. Kazakova SV, Hageman JC, Matava M, et al. A clone of methicillin-resistant Staphylococcus aureus among professional football players. N Engl J Med 2005; 352:468.
  50. Nguyen DM, Mascola L, Brancoft E. Recurring methicillin-resistant Staphylococcus aureus infections in a football team. Emerg Infect Dis 2005; 11:526.
  51. Begier EM, Frenette K, Barrett NL, et al. A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns. Clin Infect Dis 2004; 39:1446.
  52. Centers for Disease Control and Prevention (CDC). Methicillin-resistant staphylococcus aureus infections among competitive sports participants--Colorado, Indiana, Pennsylvania, and Los Angeles County, 2000-2003. MMWR Morb Mortal Wkly Rep 2003; 52:793.
  53. Herold BC, Immergluck LC, Maranan MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk. JAMA 1998; 279:593.
  54. Adcock PM, Pastor P, Medley F, et al. Methicillin-resistant Staphylococcus aureus in two child care centers. J Infect Dis 1998; 178:577.
  55. Campbell KM, Vaughn AF, Russell KL, et al. Risk factors for community-associated methicillin-resistant Staphylococcus aureus infections in an outbreak of disease among military trainees in San Diego, California, in 2002. J Clin Microbiol 2004; 42:4050.
  56. Aiello AE, Lowy FD, Wright LN, Larson EL. Meticillin-resistant Staphylococcus aureus among US prisoners and military personnel: review and recommendations for future studies. Lancet Infect Dis 2006; 6:335.
  57. From the Centers for Disease Control and Prevention. Public health dispatch: outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin infections--Los Angeles County, California, 2002-2003. JAMA 2003; 289:1377.
  58. Centers for Disease Control and Prevention (CDC). Methicillin-resistant Staphylococcus aureus skin or soft tissue infections in a state prison--Mississippi, 2000. MMWR Morb Mortal Wkly Rep 2001; 50:919.
  59. Gilbert M, MacDonald J, Gregson D, et al. Outbreak in Alberta of community-acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness or incarceration. CMAJ 2006; 175:149.
  60. Lowy FD, Aiello AE, Bhat M, et al. Staphylococcus aureus colonization and infection in New York State prisons. J Infect Dis 2007; 196:911.
  61. Turbeville SD, Cowan LD, Greenfield RA. Infectious disease outbreaks in competitive sports: a review of the literature. Am J Sports Med 2006; 34:1860.
  62. Karanika S, Kinamon T, Grigoras C, Mylonakis E. Colonization With Methicillin-resistant Staphylococcus aureus and Risk for Infection Among Asymptomatic Athletes: A Systematic Review and Metaanalysis. Clin Infect Dis 2016; 63:195.
  63. Centers for Disease Control and Prevention (CDC). Methicillin-resistant Staphylococcus aureus skin infections among tattoo recipients--Ohio, Kentucky, and Vermont, 2004-2005. MMWR Morb Mortal Wkly Rep 2006; 55:677.
  64. Miko BA, Befus M, Herzig CT, et al. Epidemiological and biological determinants of Staphylococcus aureus clinical infection in New York State maximum security prisons. Clin Infect Dis 2015; 61:203.
  65. Jackson KA, Bohm MK, Brooks JT, et al. Invasive Methicillin-Resistant Staphylococcus aureus Infections Among Persons Who Inject Drugs - Six Sites, 2005-2016. MMWR Morb Mortal Wkly Rep 2018; 67:625.
  66. Baptiste KE, Williams K, Willams NJ, et al. Methicillin-resistant staphylococci in companion animals. Emerg Infect Dis 2005; 11:1942.
  67. Sing A, Tuschak C, Hörmansdorfer S. Methicillin-resistant Staphylococcus aureus in a family and its pet cat. N Engl J Med 2008; 358:1200.
  68. Centers for Disease Control and Prevention (CDC). Methicillin-resistant Staphylococcus aureus skin infections from an elephant calf--San Diego, California, 2008. MMWR Morb Mortal Wkly Rep 2009; 58:194.
  69. Wardyn SE, Forshey BM, Farina SA, et al. Swine Farming Is a Risk Factor for Infection With and High Prevalence of Carriage of Multidrug-Resistant Staphylococcus aureus. Clin Infect Dis 2015; 61:59.
  70. Larsen J, Petersen A, Larsen AR, et al. Emergence of Livestock-Associated Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Denmark. Clin Infect Dis 2017; 65:1072.
  71. Miller LG, Perdreau-Remington F, Bayer AS, et al. Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection: a prospective investigation. Clin Infect Dis 2007; 44:471.
  72. Vayalumkal JV, Whittingham H, Vanderkooi O, et al. Necrotizing pneumonia and septic shock: suspecting CA-MRSA in patients presenting to Canadian emergency departments. CJEM 2007; 9:300.
  73. Stankovic C, Mahajan PV, Asmar BI. Methicillin-resistant Staphylococcus aureus as a cause of community-acquired pneumonia. Curr Infect Dis Rep 2007; 9:223.
  74. Gillet Y, Vanhems P, Lina G, et al. Factors predicting mortality in necrotizing community-acquired pneumonia caused by Staphylococcus aureus containing Panton-Valentine leukocidin. Clin Infect Dis 2007; 45:315.
  75. Francis JS, Doherty MC, Lopatin U, et al. Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes. Clin Infect Dis 2005; 40:100.
  76. Centers for Disease Control and Prevention (CDC). Severe methicillin-resistant Staphylococcus aureus community-acquired pneumonia associated with influenza--Louisiana and Georgia, December 2006-January 2007. MMWR Morb Mortal Wkly Rep 2007; 56:325.
  77. Wang JL, Chen SY, Wang JT, et al. Comparison of both clinical features and mortality risk associated with bacteremia due to community-acquired methicillin-resistant Staphylococcus aureus and methicillin-susceptible S. aureus. Clin Infect Dis 2008; 46:799.
  78. Bancroft EA. Antimicrobial resistance: it's not just for hospitals. JAMA 2007; 298:1803.
  79. Calfee DP, Durbin LJ, Germanson TP, et al. Spread of methicillin-resistant Staphylococcus aureus (MRSA) among household contacts of individuals with nosocomially acquired MRSA. Infect Control Hosp Epidemiol 2003; 24:422.
  80. Seybold U, Kourbatova EV, Johnson JG, et al. Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections. Clin Infect Dis 2006; 42:647.
  81. Maree CL, Daum RS, Boyle-Vavra S, et al. Community-associated methicillin-resistant Staphylococcus aureus isolates causing healthcare-associated infections. Emerg Infect Dis 2007; 13:236.
  82. Davis SL, Perri MB, Donabedian SM, et al. Epidemiology and outcomes of community-associated methicillin-resistant Staphylococcus aureus infection. J Clin Microbiol 2007; 45:1705.
  83. David MZ, Glikman D, Crawford SE, et al. What is community-associated methicillin-resistant Staphylococcus aureus? J Infect Dis 2008; 197:1235.
  84. Popovich KJ, Snitkin ES, Hota B, et al. Genomic and Epidemiological Evidence for Community Origins of Hospital-Onset Methicillin-Resistant Staphylococcus aureus Bloodstream Infections. J Infect Dis 2017.
  85. Huang SS, Platt R. Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization. Clin Infect Dis 2003; 36:281.
  86. Otter JA, French GL. Nosocomial transmission of community-associated methicillin-resistant Staphylococcus aureus: an emerging threat. Lancet Infect Dis 2006; 6:753.
  87. Popovich KJ, Weinstein RA, Hota B. Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains? Clin Infect Dis 2008; 46:787.
  88. Jernigan JA, Hatfield KM, Wolford H, et al. Multidrug-Resistant Bacterial Infections in U.S. Hospitalized Patients, 2012-2017. N Engl J Med 2020; 382:1309.
  89. Evans ME, Simbartl LA, Kralovic SM, et al. Healthcare-associated infections in Veterans Affairs acute-care and long-term healthcare facilities during the coronavirus disease 2019 (COVID-19) pandemic. Infect Control Hosp Epidemiol 2023; 44:420.
  90. Klein EY, Mojica N, Jiang W, et al. Trends in Methicillin-Resistant Staphylococcus aureus Hospitalizations in the United States, 2010-2014. Clin Infect Dis 2017; 65:1921.
  91. Kanjilal S, Sater MRA, Thayer M, et al. Trends in Antibiotic Susceptibility in Staphylococcus aureus in Boston, Massachusetts, from 2000 to 2014. J Clin Microbiol 2018; 56.
  92. Sader HS, Mendes RE, Streit JM, Flamm RK. Antimicrobial Susceptibility Trends among Staphylococcus aureus Isolates from U.S. Hospitals: Results from 7 Years of the Ceftaroline (AWARE) Surveillance Program, 2010 to 2016. Antimicrob Agents Chemother 2017; 61.
  93. Mertz D, Frei R, Periat N, et al. Exclusive Staphylococcus aureus throat carriage: at-risk populations. Arch Intern Med 2009; 169:172.
  94. Jarvis WR, Jarvis AA, Chinn RY. National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010. Am J Infect Control 2012; 40:194.
  95. Gorwitz RJ, Kruszon-Moran D, McAllister SK, et al. Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004. J Infect Dis 2008; 197:1226.
  96. Bisaga A, Paquette K, Sabatini L, Lovell EO. A prevalence study of methicillin-resistant Staphylococcus aureus colonization in emergency department health care workers. Ann Emerg Med 2008; 52:525.
  97. Suffoletto BP, Cannon EH, Ilkhanipour K, Yealy DM. Prevalence of Staphylococcus aureus nasal colonization in emergency department personnel. Ann Emerg Med 2008; 52:529.
  98. Lucet JC, Paoletti X, Demontpion C, et al. Carriage of methicillin-resistant Staphylococcus aureus in home care settings: prevalence, duration, and transmission to household members. Arch Intern Med 2009; 169:1372.
  99. Cluzet VC, Gerber JS, Nachamkin I, et al. Duration of Colonization and Determinants of Earlier Clearance of Colonization With Methicillin-Resistant Staphylococcus aureus. Clin Infect Dis 2015; 60:1489.
  100. Shenoy ES, Paras ML, Noubary F, et al. Natural history of colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE): a systematic review. BMC Infect Dis 2014; 14:177.
  101. Marschall J, Mühlemann K. Duration of methicillin-resistant Staphylococcus aureus carriage, according to risk factors for acquisition. Infect Control Hosp Epidemiol 2006; 27:1206.
  102. Rogers C, Sharma A, Rimland D, et al. Duration of colonization with methicillin-resistant Staphylococcus aureus in an acute care facility: a study to assess epidemiologic features. Am J Infect Control 2014; 42:249.
  103. MacDougall C, Powell JP, Johnson CK, et al. Hospital and community fluoroquinolone use and resistance in Staphylococcus aureus and Escherichia coli in 17 US hospitals. Clin Infect Dis 2005; 41:435.
  104. Hill DA, Herford T, Parratt D. Antibiotic usage and methicillin-resistant Staphylococcus aureus: an analysis of causality. J Antimicrob Chemother 1998; 42:676.
  105. Asensio A, Guerrero A, Quereda C, et al. Colonization and infection with methicillin-resistant Staphylococcus aureus: associated factors and eradication. Infect Control Hosp Epidemiol 1996; 17:20.
  106. Schneider-Lindner V, Delaney JA, Dial S, et al. Antimicrobial drugs and community-acquired methicillin-resistant Staphylococcus aureus, United Kingdom. Emerg Infect Dis 2007; 13:994.
  107. Couderc C, Jolivet S, Thiébaut AC, et al. Fluoroquinolone use is a risk factor for methicillin-resistant Staphylococcus aureus acquisition in long-term care facilities: a nested case-case-control study. Clin Infect Dis 2014; 59:206.
  108. Hidron AI, Kourbatova EV, Halvosa JS, et al. Risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital: emergence of community-associated MRSA nasal carriage. Clin Infect Dis 2005; 41:159.
  109. Mathews WC, Caperna JC, Barber RE, et al. Incidence of and risk factors for clinically significant methicillin-resistant Staphylococcus aureus infection in a cohort of HIV-infected adults. J Acquir Immune Defic Syndr 2005; 40:155.
  110. Szumowski JD, Wener KM, Gold HS, et al. Methicillin-resistant Staphylococcus aureus colonization, behavioral risk factors, and skin and soft-tissue infection at an ambulatory clinic serving a large population of HIV-infected men who have sex with men. Clin Infect Dis 2009; 49:118.
  111. Popovich KJ, Smith KY, Khawcharoenporn T, et al. Community-associated methicillin-resistant Staphylococcus aureus colonization in high-risk groups of HIV-infected patients. Clin Infect Dis 2012; 54:1296.
  112. Popovich KJ, Hota B, Aroutcheva A, et al. Community-associated methicillin-resistant Staphylococcus aureus colonization burden in HIV-infected patients. Clin Infect Dis 2013; 56:1067.
  113. Zervou FN, Zacharioudakis IM, Ziakas PD, et al. Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus colonization in HIV infection: a meta-analysis. Clin Infect Dis 2014; 59:1302.
  114. Centers for Disease Control and Prevention (CDC). Invasive methicillin-resistant Staphylococcus aureus infections among dialysis patients--United States, 2005. MMWR Morb Mortal Wkly Rep 2007; 56:197.
  115. Nguyen DB, Lessa FC, Belflower R, et al. Invasive methicillin-resistant Staphylococcus aureus infections among patients on chronic dialysis in the United States, 2005-2011. Clin Infect Dis 2013; 57:1393.
  116. Spindel SJ, Strausbaugh LJ, Jacobson C. Infections caused by Staphylococcus aureus in a Veterans' Affairs nursing home care unit: a 5-year experience. Infect Control Hosp Epidemiol 1995; 16:217.
  117. Knox J, Sullivan SB, Urena J, et al. Association of Environmental Contamination in the Home With the Risk for Recurrent Community-Associated, Methicillin-Resistant Staphylococcus aureus Infection. JAMA Intern Med 2016; 176:807.
  118. Ferradas C, Cotter C, Shahbazian JH, et al. Risk factors for antimicrobial resistance among Staphylococcus isolated from pets living with a patient diagnosed with methicillin-resistant Staphylococcus aureus infection. Zoonoses Public Health 2022; 69:550.
  119. Sieber RN, Skov RL, Nielsen J, et al. Drivers and Dynamics of Methicillin-Resistant Livestock-Associated Staphylococcus aureus CC398 in Pigs and Humans in Denmark. mBio 2018; 9.
  120. Uhlemann AC, Dordel J, Knox JR, et al. Molecular tracing of the emergence, diversification, and transmission of S. aureus sequence type 8 in a New York community. Proc Natl Acad Sci U S A 2014; 111:6738.
  121. Price JR, Golubchik T, Cole K, et al. Whole-genome sequencing shows that patient-to-patient transmission rarely accounts for acquisition of Staphylococcus aureus in an intensive care unit. Clin Infect Dis 2014; 58:609.
  122. Popovich KJ, Snitkin E, Green SJ, et al. Genomic Epidemiology of USA300 Methicillin-Resistant Staphylococcus aureus in an Urban Community. Clin Infect Dis 2016; 62:37.
  123. Tosas Auguet O, Stabler RA, Betley J, et al. Frequent Undetected Ward-Based Methicillin-Resistant Staphylococcus aureus Transmission Linked to Patient Sharing Between Hospitals. Clin Infect Dis 2018; 66:840.
  124. Coll F, Harrison EM, Toleman MS, et al. Longitudinal genomic surveillance of MRSA in the UK reveals transmission patterns in hospitals and the community. Sci Transl Med 2017; 9.
  125. Popovich KJ, Green SJ, Okamoto K, et al. MRSA Transmission in Intensive Care Units: Genomic Analysis of Patients, Their Environments, and Healthcare Workers. Clin Infect Dis 2021; 72:1879.
  126. Talbot BM, Jacko NF, Petit RA, et al. Unsuspected Clonal Spread of Methicillin-Resistant Staphylococcus aureus Causing Bloodstream Infections in Hospitalized Adults Detected Using Whole Genome Sequencing. Clin Infect Dis 2022; 75:2104.
  127. Kuehnert MJ, Kruszon-Moran D, Hill HA, et al. Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002. J Infect Dis 2006; 193:172.
  128. Kenner J, O'Connor T, Piantanida N, et al. Rates of carriage of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in an outpatient population. Infect Control Hosp Epidemiol 2003; 24:439.
  129. Reboli AC, John JF Jr, Platt CG, Cantey JR. Methicillin-resistant Staphylococcus aureus outbreak at a Veterans' Affairs Medical Center: importance of carriage of the organism by hospital personnel. Infect Control Hosp Epidemiol 1990; 11:291.
  130. Nelson RE, Evans ME, Simbartl L, et al. Methicillin-resistant Staphylococcus aureus Colonization and Pre- and Post-hospital Discharge Infection Risk. Clin Infect Dis 2019; 68:545.
  131. Coello R, Jiménez J, García M, et al. Prospective study of infection, colonization and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 990 patients. Eur J Clin Microbiol Infect Dis 1994; 13:74.
  132. Sanford MD, Widmer AF, Bale MJ, et al. Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus. Clin Infect Dis 1994; 19:1123.
  133. Reagan DR, Doebbeling BN, Pfaller MA, et al. Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment. Ann Intern Med 1991; 114:101.
  134. Boyce JM, Havill NL, Maria B. Frequency and possible infection control implications of gastrointestinal colonization with methicillin-resistant Staphylococcus aureus. J Clin Microbiol 2005; 43:5992.
  135. Boyce JM, Opal SM, Potter-Bynoe G, Medeiros AA. Spread of methicillin-resistant Staphylococcus aureus in a hospital after exposure to a health care worker with chronic sinusitis. Clin Infect Dis 1993; 17:496.
  136. Sherertz RJ, Reagan DR, Hampton KD, et al. A cloud adult: the Staphylococcus aureus-virus interaction revisited. Ann Intern Med 1996; 124:539.
  137. Cook HA, Furuya EY, Larson E, et al. Heterosexual transmission of community-associated methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2007; 44:410.
  138. Chen KT, Huard RC, Della-Latta P, Saiman L. Prevalence of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in pregnant women. Obstet Gynecol 2006; 108:482.
  139. Rohr U, Wilhelm M, Muhr G, Gatermann S. Qualitative and (semi)quantitative characterization of nasal and skin methicillin-resistant Staphylococcus aureus carriage of hospitalized patients. Int J Hyg Environ Health 2004; 207:51.
  140. Bhalla A, Aron DC, Donskey CJ. Staphylococcus aureus intestinal colonization is associated with increased frequency of S. aureus on skin of hospitalized patients. BMC Infect Dis 2007; 7:105.
  141. Cookson B, Peters B, Webster M, et al. Staff carriage of epidemic methicillin-resistant Staphylococcus aureus. J Clin Microbiol 1989; 27:1471.
  142. Scanvic A, Denic L, Gaillon S, et al. Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage. Clin Infect Dis 2001; 32:1393.
  143. Ellis MW, Hospenthal DR, Dooley DP, et al. Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers. Clin Infect Dis 2004; 39:971.
  144. Robicsek A, Beaumont JL, Peterson LR. Duration of colonization with methicillin-resistant Staphylococcus aureus. Clin Infect Dis 2009; 48:910.
  145. Boyce JM, Potter-Bynoe G, Chenevert C, King T. Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications. Infect Control Hosp Epidemiol 1997; 18:622.
  146. Smith MA, Mathewson JJ, Ulert IA, et al. Contaminated stethoscopes revisited. Arch Intern Med 1996; 156:82.
  147. Guinto CH, Bottone EJ, Raffalli JT, et al. Evaluation of dedicated stethoscopes as a potential source of nosocomial pathogens. Am J Infect Control 2002; 30:499.
  148. Boyce JM, Havill NL, Otter JA, Adams NM. Widespread environmental contamination associated with patients with diarrhea and methicillin-resistant Staphylococcus aureus colonization of the gastrointestinal tract. Infect Control Hosp Epidemiol 2007; 28:1142.
Topic 3157 Version 54.0

References

1 : Methicillin-resistant staphylococci.

2 : Growing clinical significance of methcillin-resistant Staphylococcus aureus.

3 : Evidence for a clonal origin of methicillin resistance in Staphylococcus aureus.

4 : The evolution of methicillin resistance in Staphylococcus aureus: similarity of genetic backgrounds in historically early methicillin-susceptible and -resistant isolates and contemporary epidemic clones.

5 : The evolutionary history of methicillin-resistant Staphylococcus aureus (MRSA).

6 : Novel type V staphylococcal cassette chromosome mec driven by a novel cassette chromosome recombinase, ccrC.

7 : The evolution of pandemic clones of methicillin-resistant Staphylococcus aureus: identification of two ancestral genetic backgrounds and the associated mec elements.

8 : Dissemination among staphylococci of DNA sequences associated with methicillin resistance.

9 : Invasive methicillin-resistant Staphylococcus aureus infections in the United States.

10 : Nosocomial bloodstream infections in US hospitals: analysis of 24,179 cases from a prospective nationwide surveillance study.

11 : Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: microbiology, epidemiology, and preventive measures.

12 : Changes in the epidemiology of methicillin-resistant Staphylococcus aureus in intensive care units in US hospitals, 1992-2003.

13 : Comparison of mortality associated with methicillin-resistant and methicillin-susceptible Staphylococcus aureus bacteremia: a meta-analysis.

14 : Severe surgical site infection in community hospitals: epidemiology, key procedures, and the changing prevalence of methicillin-resistant Staphylococcus aureus.

15 : NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007.

16 : Comparison of community- and health care-associated methicillin-resistant Staphylococcus aureus infection.

17 : Pulsed-field gel electrophoresis typing of oxacillin-resistant Staphylococcus aureus isolates from the United States: establishing a national database.

18 : National Nosocomial Infections Surveillance (NNIS) System Report, data summary from January 1992 through June 2004, issued October 2004.

19 : Laboratory-based surveillance of current antimicrobial resistance patterns and trends among Staphylococcus aureus: 2005 status in the United States.

20 : Vital Signs: Epidemiology and Recent Trends in Methicillin-Resistant and in Methicillin-Susceptible Staphylococcus aureus Bloodstream Infections - United States.

21 : Vital Signs: Trends in Staphylococcus aureus Infections in Veterans Affairs Medical Centers - United States, 2005-2017.

22 : Antimicrobial susceptibility of gram-positive bacteria isolated from European medical centres: results of the Daptomycin Surveillance Programme (2002-2004).

23 : Methicillin-resistant Staphylococcus aureus in Europe.

24 : Epidemiology of staphylococcal resistance.

25 : Methicillin-resistant Staphylococcus aureus disease in three communities.

26 : Epidemiology of nosocomial infections caused by methicillin-resistant Staphylococcus aureus.

27 : Methicillin-resistant Staphylococcus aureus. Detection, epidemiology, and control measures.

28 : Methicillin-resistant Staphylococcus aureus (MRSA) nares colonization at hospital admission and its effect on subsequent MRSA infection.

29 : Risk Factors for Invasive Methicillin-Resistant Staphylococcus aureus Infection After Recent Discharge From an Acute-Care Hospitalization, 2011-2013.

30 : Outcome and attributable mortality in critically Ill patients with bacteremia involving methicillin-susceptible and methicillin-resistant Staphylococcus aureus.

31 : The impact of methicillin resistance in Staphylococcus aureus bacteremia on patient outcomes: mortality, length of stay, and hospital charges.

32 : Costs and outcomes among hemodialysis-dependent patients with methicillin-resistant or methicillin-susceptible Staphylococcus aureus bacteremia.

33 : Nosocomial methicillin-resistant and methicillin-susceptible Staphylococcus aureus primary bacteremia: at what costs?

34 : Risk of death from methicillin-resistant Staphylococcus aureus bacteraemia: a meta-analysis.

35 : Emergence of multidrug-resistant, community-associated, methicillin-resistant Staphylococcus aureus clone USA300 in men who have sex with men.

36 : Complete genome sequence of USA300, an epidemic clone of community-acquired meticillin-resistant Staphylococcus aureus.

37 : Genome and virulence determinants of high virulence community-acquired MRSA.

38 : Roles of 34 virulence genes in the evolution of hospital- and community-associated strains of methicillin-resistant Staphylococcus aureus.

39 : Novel type of staphylococcal cassette chromosome mec identified in community-acquired methicillin-resistant Staphylococcus aureus strains.

40 : Characterization of a strain of community-associated methicillin-resistant Staphylococcus aureus widely disseminated in the United States.

41 : Emergence of community-acquired methicillin-resistant Staphylococcus aureus USA 300 clone as the predominant cause of skin and soft-tissue infections.

42 : Methicillin-resistant Staphylococcus aureus. Epidemiologic observations during a community-acquired outbreak.

43 : Methicillin-resistant S. aureus infections among patients in the emergency department.

44 : National trends in ambulatory visits and antibiotic prescribing for skin and soft-tissue infections.

45 : Staphylococcus aureus colonization among household contacts of patients with skin infections: risk factors, strain discordance, and complex ecology.

46 : Concurrent epidemics of skin and soft tissue infection and bloodstream infection due to community-associated methicillin-resistant Staphylococcus aureus.

47 : Community-acquired methicillin-resistant Staphylococcus aureus in a rural American Indian community.

48 : Methicillin-resistant Staphylococcus aureus-associated hospitalizations among the American Indian and Alaska native population.

49 : A clone of methicillin-resistant Staphylococcus aureus among professional football players.

50 : Recurring methicillin-resistant Staphylococcus aureus infections in a football team.

51 : A high-morbidity outbreak of methicillin-resistant Staphylococcus aureus among players on a college football team, facilitated by cosmetic body shaving and turf burns.

52 : Methicillin-resistant staphylococcus aureus infections among competitive sports participants--Colorado, Indiana, Pennsylvania, and Los Angeles County, 2000-2003.

53 : Community-acquired methicillin-resistant Staphylococcus aureus in children with no identified predisposing risk.

54 : Methicillin-resistant Staphylococcus aureus in two child care centers.

55 : Risk factors for community-associated methicillin-resistant Staphylococcus aureus infections in an outbreak of disease among military trainees in San Diego, California, in 2002.

56 : Meticillin-resistant Staphylococcus aureus among US prisoners and military personnel: review and recommendations for future studies.

57 : From the Centers for Disease Control and Prevention. Public health dispatch: outbreaks of community-associated methicillin-resistant Staphylococcus aureus skin infections--Los Angeles County, California, 2002-2003.

58 : Methicillin-resistant Staphylococcus aureus skin or soft tissue infections in a state prison--Mississippi, 2000.

59 : Outbreak in Alberta of community-acquired (USA300) methicillin-resistant Staphylococcus aureus in people with a history of drug use, homelessness or incarceration.

60 : Staphylococcus aureus colonization and infection in New York State prisons.

61 : Infectious disease outbreaks in competitive sports: a review of the literature.

62 : Colonization With Methicillin-resistant Staphylococcus aureus and Risk for Infection Among Asymptomatic Athletes: A Systematic Review and Metaanalysis.

63 : Methicillin-resistant Staphylococcus aureus skin infections among tattoo recipients--Ohio, Kentucky, and Vermont, 2004-2005.

64 : Epidemiological and biological determinants of Staphylococcus aureus clinical infection in New York State maximum security prisons.

65 : Invasive Methicillin-Resistant Staphylococcus aureus Infections Among Persons Who Inject Drugs - Six Sites, 2005-2016.

66 : Methicillin-resistant staphylococci in companion animals.

67 : Methicillin-resistant Staphylococcus aureus in a family and its pet cat.

68 : Methicillin-resistant Staphylococcus aureus skin infections from an elephant calf--San Diego, California, 2008.

69 : Swine Farming Is a Risk Factor for Infection With and High Prevalence of Carriage of Multidrug-Resistant Staphylococcus aureus.

70 : Emergence of Livestock-Associated Methicillin-Resistant Staphylococcus aureus Bloodstream Infections in Denmark.

71 : Clinical and epidemiologic characteristics cannot distinguish community-associated methicillin-resistant Staphylococcus aureus infection from methicillin-susceptible S. aureus infection: a prospective investigation.

72 : Necrotizing pneumonia and septic shock: suspecting CA-MRSA in patients presenting to Canadian emergency departments.

73 : Methicillin-resistant Staphylococcus aureus as a cause of community-acquired pneumonia.

74 : Factors predicting mortality in necrotizing community-acquired pneumonia caused by Staphylococcus aureus containing Panton-Valentine leukocidin.

75 : Severe community-onset pneumonia in healthy adults caused by methicillin-resistant Staphylococcus aureus carrying the Panton-Valentine leukocidin genes.

76 : Severe methicillin-resistant Staphylococcus aureus community-acquired pneumonia associated with influenza--Louisiana and Georgia, December 2006-January 2007.

77 : Comparison of both clinical features and mortality risk associated with bacteremia due to community-acquired methicillin-resistant Staphylococcus aureus and methicillin-susceptible S. aureus.

78 : Antimicrobial resistance: it's not just for hospitals.

79 : Spread of methicillin-resistant Staphylococcus aureus (MRSA) among household contacts of individuals with nosocomially acquired MRSA.

80 : Emergence of community-associated methicillin-resistant Staphylococcus aureus USA300 genotype as a major cause of health care-associated blood stream infections.

81 : Community-associated methicillin-resistant Staphylococcus aureus isolates causing healthcare-associated infections.

82 : Epidemiology and outcomes of community-associated methicillin-resistant Staphylococcus aureus infection.

83 : What is community-associated methicillin-resistant Staphylococcus aureus?

84 : Genomic and Epidemiological Evidence for Community Origins of Hospital-Onset Methicillin-Resistant Staphylococcus aureus Bloodstream Infections.

85 : Risk of methicillin-resistant Staphylococcus aureus infection after previous infection or colonization.

86 : Nosocomial transmission of community-associated methicillin-resistant Staphylococcus aureus: an emerging threat.

87 : Are community-associated methicillin-resistant Staphylococcus aureus (MRSA) strains replacing traditional nosocomial MRSA strains?

88 : Multidrug-Resistant Bacterial Infections in U.S. Hospitalized Patients, 2012-2017.

89 : Healthcare-associated infections in Veterans Affairs acute-care and long-term healthcare facilities during the coronavirus disease 2019 (COVID-19) pandemic.

90 : Trends in Methicillin-Resistant Staphylococcus aureus Hospitalizations in the United States, 2010-2014.

91 : Trends in Antibiotic Susceptibility in Staphylococcus aureus in Boston, Massachusetts, from 2000 to 2014.

92 : Antimicrobial Susceptibility Trends among Staphylococcus aureus Isolates from U.S. Hospitals: Results from 7 Years of the Ceftaroline (AWARE) Surveillance Program, 2010 to 2016.

93 : Exclusive Staphylococcus aureus throat carriage: at-risk populations.

94 : National prevalence of methicillin-resistant Staphylococcus aureus in inpatients at United States health care facilities, 2010.

95 : Changes in the prevalence of nasal colonization with Staphylococcus aureus in the United States, 2001-2004.

96 : A prevalence study of methicillin-resistant Staphylococcus aureus colonization in emergency department health care workers.

97 : Prevalence of Staphylococcus aureus nasal colonization in emergency department personnel.

98 : Carriage of methicillin-resistant Staphylococcus aureus in home care settings: prevalence, duration, and transmission to household members.

99 : Duration of Colonization and Determinants of Earlier Clearance of Colonization With Methicillin-Resistant Staphylococcus aureus.

100 : Natural history of colonization with methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE): a systematic review.

101 : Duration of methicillin-resistant Staphylococcus aureus carriage, according to risk factors for acquisition.

102 : Duration of colonization with methicillin-resistant Staphylococcus aureus in an acute care facility: a study to assess epidemiologic features.

103 : Hospital and community fluoroquinolone use and resistance in Staphylococcus aureus and Escherichia coli in 17 US hospitals.

104 : Antibiotic usage and methicillin-resistant Staphylococcus aureus: an analysis of causality.

105 : Colonization and infection with methicillin-resistant Staphylococcus aureus: associated factors and eradication.

106 : Antimicrobial drugs and community-acquired methicillin-resistant Staphylococcus aureus, United Kingdom.

107 : Fluoroquinolone use is a risk factor for methicillin-resistant Staphylococcus aureus acquisition in long-term care facilities: a nested case-case-control study.

108 : Risk factors for colonization with methicillin-resistant Staphylococcus aureus (MRSA) in patients admitted to an urban hospital: emergence of community-associated MRSA nasal carriage.

109 : Incidence of and risk factors for clinically significant methicillin-resistant Staphylococcus aureus infection in a cohort of HIV-infected adults.

110 : Methicillin-resistant Staphylococcus aureus colonization, behavioral risk factors, and skin and soft-tissue infection at an ambulatory clinic serving a large population of HIV-infected men who have sex with men.

111 : Community-associated methicillin-resistant Staphylococcus aureus colonization in high-risk groups of HIV-infected patients.

112 : Community-associated methicillin-resistant Staphylococcus aureus colonization burden in HIV-infected patients.

113 : Prevalence of and risk factors for methicillin-resistant Staphylococcus aureus colonization in HIV infection: a meta-analysis.

114 : Invasive methicillin-resistant Staphylococcus aureus infections among dialysis patients--United States, 2005.

115 : Invasive methicillin-resistant Staphylococcus aureus infections among patients on chronic dialysis in the United States, 2005-2011.

116 : Infections caused by Staphylococcus aureus in a Veterans' Affairs nursing home care unit: a 5-year experience.

117 : Association of Environmental Contamination in the Home With the Risk for Recurrent Community-Associated, Methicillin-Resistant Staphylococcus aureus Infection.

118 : Risk factors for antimicrobial resistance among Staphylococcus isolated from pets living with a patient diagnosed with methicillin-resistant Staphylococcus aureus infection.

119 : Drivers and Dynamics of Methicillin-Resistant Livestock-Associated Staphylococcus aureus CC398 in Pigs and Humans in Denmark.

120 : Molecular tracing of the emergence, diversification, and transmission of S. aureus sequence type 8 in a New York community.

121 : Whole-genome sequencing shows that patient-to-patient transmission rarely accounts for acquisition of Staphylococcus aureus in an intensive care unit.

122 : Genomic Epidemiology of USA300 Methicillin-Resistant Staphylococcus aureus in an Urban Community.

123 : Frequent Undetected Ward-Based Methicillin-Resistant Staphylococcus aureus Transmission Linked to Patient Sharing Between Hospitals.

124 : Longitudinal genomic surveillance of MRSA in the UK reveals transmission patterns in hospitals and the community.

125 : MRSA Transmission in Intensive Care Units: Genomic Analysis of Patients, Their Environments, and Healthcare Workers.

126 : Unsuspected Clonal Spread of Methicillin-Resistant Staphylococcus aureus Causing Bloodstream Infections in Hospitalized Adults Detected Using Whole Genome Sequencing.

127 : Prevalence of Staphylococcus aureus nasal colonization in the United States, 2001-2002.

128 : Rates of carriage of methicillin-resistant and methicillin-susceptible Staphylococcus aureus in an outpatient population.

129 : Methicillin-resistant Staphylococcus aureus outbreak at a Veterans' Affairs Medical Center: importance of carriage of the organism by hospital personnel.

130 : Methicillin-resistant Staphylococcus aureus Colonization and Pre- and Post-hospital Discharge Infection Risk.

131 : Prospective study of infection, colonization and carriage of methicillin-resistant Staphylococcus aureus in an outbreak affecting 990 patients.

132 : Efficient detection and long-term persistence of the carriage of methicillin-resistant Staphylococcus aureus.

133 : Elimination of coincident Staphylococcus aureus nasal and hand carriage with intranasal application of mupirocin calcium ointment.

134 : Frequency and possible infection control implications of gastrointestinal colonization with methicillin-resistant Staphylococcus aureus.

135 : Spread of methicillin-resistant Staphylococcus aureus in a hospital after exposure to a health care worker with chronic sinusitis.

136 : A cloud adult: the Staphylococcus aureus-virus interaction revisited.

137 : Heterosexual transmission of community-associated methicillin-resistant Staphylococcus aureus.

138 : Prevalence of methicillin-sensitive and methicillin-resistant Staphylococcus aureus in pregnant women.

139 : Qualitative and (semi)quantitative characterization of nasal and skin methicillin-resistant Staphylococcus aureus carriage of hospitalized patients.

140 : Staphylococcus aureus intestinal colonization is associated with increased frequency of S. aureus on skin of hospitalized patients.

141 : Staff carriage of epidemic methicillin-resistant Staphylococcus aureus.

142 : Duration of colonization by methicillin-resistant Staphylococcus aureus after hospital discharge and risk factors for prolonged carriage.

143 : Natural history of community-acquired methicillin-resistant Staphylococcus aureus colonization and infection in soldiers.

144 : Duration of colonization with methicillin-resistant Staphylococcus aureus.

145 : Environmental contamination due to methicillin-resistant Staphylococcus aureus: possible infection control implications.

146 : Contaminated stethoscopes revisited.

147 : Evaluation of dedicated stethoscopes as a potential source of nosocomial pathogens.

148 : Widespread environmental contamination associated with patients with diarrhea and methicillin-resistant Staphylococcus aureus colonization of the gastrointestinal tract.

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