Abstract
There is a need for a regional assessment of the frequency and diversity of MRSA to determine major circulating clones and the extent to which community and healthcare MRSA reservoirs have mixed. We conducted a prospective cohort study of inpatients in Orange County, California, systematically collecting clinical MRSA isolates from 30 hospitals, to assess MRSA diversity and distribution. All isolates were characterized by spa typing, with selective PFGE and MLST to relate spa types with major MRSA clones. We collected 2,246 MRSA isolates from hospital inpatients. This translated to 91/10,000 inpatients with MRSA and an Orange County population estimate of MRSA inpatient clinical cultures of 86/100,000 people. spa type genetic diversity was heterogeneous between hospitals, and relatively high overall (72%). USA300 (t008/ST8), USA100 (t002/ST5) and a previously reported USA100 variant (t242/ST5) were the dominant clones across all Orange County hospitals, representing 83% of isolates. Fifteen hospitals isolated more t008 (USA300) isolates than t002/242 (USA100) isolates, and 12 hospitals isolated more t242 isolates than t002 isolates. The majority of isolates were imported into hospitals. Community-based infection control strategies may still be helpful in stemming the influx of traditionally community-associated strains, particularly USA300, into the healthcare setting.
Highlights
Methicillin-resistant Staphylococcus aureus (MRSA) is a major global cause of morbidity and mortality, imposing serious economic costs on patients and hospitals [1,2,3]
Annual population incidence of clinical inpatient MRSA isolates in Orange County was estimated at 86/100,000 people, with inpatient risk estimated at 91/10,000 admissions
Annual population incidence of clinical inpatient MRSA isolates in Orange County that were community-onset was estimated at 60/100,000 people (62/10,000 admissions); incidence of those that were hospital-onset was estimated at 25/100,000 people (26/10,000 admissions)
Summary
Methicillin-resistant Staphylococcus aureus (MRSA) is a major global cause of morbidity and mortality, imposing serious economic costs on patients and hospitals [1,2,3]. HA-MRSA has long been the primary cause of MRSA infections, but community-associated MRSA (CA-MRSA), which often causes infections among healthy children and young adults with no exposure to the healthcare setting, has become increasingly prevalent across the globe, in the US [7,8,9,10]. CA-MRSA has caused outbreaks in the hospital setting since 2003, often in pediatrics and obstetrics where HA-MRSA prevalence is low and community influx of patients without prior healthcare exposure is common [13]. Some reports suggest traditionally CA-MRSA may be replacing traditionally HA-MRSA in hospitals [15,16,17,18]
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