title: Methicillin-resistant Staphylococcus aureus in the Australian community: an evolving epidemic.
abstract: OBJECTIVE
  To describe antimicrobial resistance and molecular epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) isolated in community settings in Australia.
  
  
  METHODS
  Survey of S. aureus isolates collected prospectively Australia-wide between July 2004 and February 2005; results were compared with those of similar surveys conducted in 2000 and 2002.
  
  
  METHODS
  Up to 100 consecutive, unique clinical isolates of S. aureus from outpatient settings were collected at each of 22 teaching hospital and five private laboratories from cities in all Australian states and territories. They were characterised by antimicrobial susceptibilities (by agar dilution methods), coagulase gene typing, pulsed-field gel electrophoresis, multilocus sequence typing, SCCmec typing and polymerase chain reaction tests for Panton-Valentine leukocidin (PVL) gene.
  
  
  RESULTS
  2652 S. aureus isolates were collected, of which 395 (14.9%) were MRSA. The number of community-associated MRSA (CA-MRSA) isolates rose from 4.7% (118/2498) of S. aureus isolates in 2000 to 7.3% (194/2652) in 2004 (P = 0.001). Of the three major CA-MRSA strains, WA-1 constituted 45/257 (18%) of MRSA in 2000 and 64/395 (16%) in 2004 (P = 0.89), while the Queensland (QLD) strain increased from 13/257 (5%) to 58/395 (15%) (P = 0.0004), and the south-west Pacific (SWP) strain decreased from 33/257 (13%) to 26/395 (7%) (P = 0.01). PVL genes were detected in 90/195 (46%) of CA-MRSA strains, including 5/64 (8%) of WA-1, 56/58 (97%) of QLD, and 25/26 (96%) of SWP strains. Among health care-associated MRSA strains, all AUS-2 and AUS-3 isolates were multidrug-resistant, and UK EMRSA-15 isolates were resistant to ciprofloxacin and erythromycin (50%) or to ciprofloxacin alone (44%). Almost all (98%) of CA-MRSA strains were non-multiresistant.
  
  
  CONCLUSIONS
  Community-onset MRSA continues to spread throughout Australia. The hypervirulence determinant PVL is often found in two of the most common CA-MRSA strains. The rapid changes in prevalence emphasise the importance of ongoing surveillance.
authors.affiliation: Microbiology Department, Queensland Health Pathology Service, Brisbane, QLD, Australia. Graeme_Nimmo@health.qld.gov.au
authors.forename: Graeme R
authors.initials: GR
authors.lastname: Nimmo
authors.forename: Geoffrey W
authors.initials: GW
authors.lastname: Coombs
authors.forename: Julie C
authors.initials: JC
authors.lastname: Pearson
authors.forename: Francis G
authors.initials: FG
authors.lastname: O'Brien
authors.forename: Keryn J
authors.initials: KJ
authors.lastname: Christiansen
authors.forename: John D
authors.initials: JD
authors.lastname: Turnidge
authors.forename: Iain B
authors.initials: IB
authors.lastname: Gosbell
authors.forename: Peter
authors.initials: P
authors.lastname: Collignon
authors.forename: Mary-Louise
authors.initials: ML
authors.lastname: McLaws
mesh_terms: D001315:Australia / Q000453:epidemiology; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D003428:Cross Infection / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks / Q000706:statistics & numerical data*; D005843:Geography; D006306:Health Surveys; D006801:Humans; D016106:Methicillin Resistance / Q000235:genetics; D010641:Phenotype; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification*