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

Am J Med. 2006 Nov;119(11):943-51. doi: 10.1016/j.amjmed.2006.01.004.


Purpose: The study's purpose was to elucidate the evolutionary, microbiologic, and clinical characteristics of methicillin-resistant Staphylococcus aureus (MRSA) infections.

Methods: MRSA 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.

Results: Over 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.

Conclusions: Community-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.

Publication types

  • Research Support, U.S. Gov't, Non-P.H.S.

MeSH terms

  • Adult
  • Anti-Bacterial Agents / therapeutic use
  • California / epidemiology
  • Clindamycin / therapeutic use
  • Community-Acquired Infections / epidemiology
  • Community-Acquired Infections / microbiology
  • Cross Infection / drug therapy
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology*
  • Drug Resistance, Bacterial
  • Female
  • Humans
  • Incidence
  • Male
  • Methicillin Resistance*
  • Staphylococcal Infections / diagnosis
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / epidemiology*
  • Staphylococcus aureus / drug effects*
  • Staphylococcus aureus / genetics


  • Anti-Bacterial Agents
  • Clindamycin