title: 'Feral' and 'wild'-type methicillin-resistant Staphylococcus aureus in the United Kingdom.
abstract: Circulation of methicillin-resistant Staphylococcus aureus (MRSA) outside hospitals could alter the impact of hospital-based control strategies. We investigated two groups of cases (each matched to controls with MRSA): 61 'community cases' not in acute hospital in the year before MRSA isolation; and 21 cases with ciprofloxacin-sensitive (CipS) MRSA. Multi-locus sequence typing, spa-typing and Panton-Valentine leukocidin gene testing were performed and demographics obtained. Additional questionnaires were completed by community case GPs. Community cases comprised 6% of Oxfordshire MRSA. Three community cases had received no regular healthcare or antibiotics: one was infected with CipS. Ninety-one percent of community cases had healthcare-associated sequence type (ST)22/36; CipS MRSA cases had heterogeneous STs but many had recent healthcare exposure. A substantial minority of UK MRSA transmission may occur outside hospitals. Hospital strains are becoming 'feral' or persisting in long-term carriers in the community with regular healthcare contacts; those with recent healthcare exposure may nevertheless acquire non-hospital epidemic MRSA strains in the community.
authors.affiliation: Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK. ruth.miller@ndm.ox.ac.uk
authors.forename: R
authors.initials: R
authors.lastname: Miller
authors.forename: A S
authors.initials: AS
authors.lastname: Walker
authors.forename: K
authors.initials: K
authors.lastname: Knox
authors.forename: D
authors.initials: D
authors.lastname: Wyllie
authors.forename: J
authors.initials: J
authors.lastname: Paul
authors.forename: E
authors.initials: E
authors.lastname: Haworth
authors.forename: D
authors.initials: D
authors.lastname: Mant
authors.forename: T
authors.initials: T
authors.lastname: Peto
authors.forename: D W
authors.initials: DW
authors.lastname: Crook
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D001427:Bacterial Toxins / Q000235:genetics; D015373:Bacterial Typing Techniques; D002939:Ciprofloxacin / Q000494:pharmacology; D017714:Community-Acquired Infections / Q000453:epidemiology* / Q000382:microbiology*; D016172:DNA Fingerprinting; D004269:DNA, Bacterial / Q000737:chemistry / Q000235:genetics; D005098:Exotoxins / Q000235:genetics; D005260:Female; D006801:Humans; D007956:Leukocidins / Q000235:genetics; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification* / Q000235:genetics / Q000302:isolation & purification*; D008875:Middle Aged; D017720:Molecular Epidemiology; D017422:Sequence Analysis, DNA; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D006113:United Kingdom / Q000453:epidemiology; D037521:Virulence Factors / Q000235:genetics; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D004269:DNA, Bacterial; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D037521:Virulence Factors; D002939:Ciprofloxacin