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Journal of Clinical Microbiology, July 2006, p. 2423-2427, Vol. 44, No. 7
0095-1137/06/$08.00+0     doi:10.1128/JCM.00254-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.

Comparisons of Community-Associated Methicillin-Resistant Staphylococcus aureus (MRSA) and Hospital-Associated MSRA Infections in Sacramento, California

Hsin Huang, Neil M. Flynn,* Jeff H. King, Caroline Monchaud, Margaret Morita, and Stuart H. Cohen

Department of Infectious Disease, Department of Internal Medicine, University of California, Davis, Medical Center, Sacramento, California 95817

Received 3 February 2006/ Returned for modification 28 March 2006/ Accepted 13 May 2006

Methicillin-resistant Staphylococcus aureus (MRSA) has long been a common pathogen in healthcare facilities, but in the past decade, it has emerged as a problematic pathogen in the community setting as well. A retrospective case series study of patients from whom MRSA was isolated from December 1, 2003, through May 31, 2004, was conducted at the University of California, Davis, Medical Center. Patient data were collected from electronic medical records and traditional chart reviews to determine whether MRSA acquisition was likely to have been in the community or in the hospital. Antimicrobial susceptibility testing and pulsed-field gel electrophoresis (PFGE) were performed for all confirmed isolates. Skin and soft tissue were the most common infection sites for all MRSA patients. Among the 283 MRSA infections, 127 (44.9%) were defined as community-associated (CA)-MRSA. Ninety-six percent of the CA-MRSA isolates were susceptible to clindamycin. Double-disk diffusion tests were performed to examine inducible clindamycin resistance by erythromycin induction on both CA and hospital-associated (HA) clindamycin-susceptible and erythromycin-resistant isolates. Ten percent (17 of 183) were positive. Most CA-MRSA isolates were identified by PFGE as a unique strain, genotype USA300, which was not genetically related to the predominant genotype, USA100, in the HA-MRSA isolates. Injecting drug users accounted for 49% of CA-MRSA infections but only 19% of the HA-MRSA infections (odds ratio, 4.2; 95% confidence interval, 2.4 to 7.4). Our study shows that a single clone of CA-MRSA accounts for the majority of infections. This strain originated in the community and is not related to MRSA strains from healthcare settings. Injecting drug users could be a major reservoir for CA-MRSA transmission.

* Corresponding author. Mailing address: Department of Internal Medicine, University of California, Davis, Medical Center, 4150 V Street, PSSB, G500, Sacramento, CA 95817. Phone: (916) 734-3815. Fax: (916) 734-7766. E-mail: nmflynn{at}ucdavis.edu.

Journal of Clinical Microbiology, July 2006, p. 2423-2427, Vol. 44, No. 7
0095-1137/06/$08.00+0     doi:10.1128/JCM.00254-06
Copyright © 2006, American Society for Microbiology. All Rights Reserved.



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