Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford OX3 9DU, UK.
Epidemiol Infect. 2010 May;138(5):655-65. doi: 10.1017/S0950268809991294. Epub 2009 Dec 14.
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.
耐甲氧西林金黄色葡萄球菌（MRSA）在医院外的传播可能会改变基于医院的控制策略的影响。我们调查了两组病例（每组均与 MRSA 分离前一年内未在急性医院的对照病例相匹配）：61 例“社区病例”，在 MRSA 分离前一年未在急性医院就诊；21 例对环丙沙星敏感（CipS）的 MRSA 病例。进行了多位点序列分型、spa 分型和潘顿-瓦伦丁白细胞毒素基因检测，并获得了人口统计学数据。社区病例的全科医生还完成了额外的调查问卷。社区病例占牛津郡 MRSA 的 6%。有 3 例社区病例未接受过常规医疗保健或抗生素治疗：其中 1 例感染了 CipS。91%的社区病例具有与医疗保健相关的序列型 22/36；CipS-MRSA 病例具有异质性 ST，但许多病例有近期医疗保健接触史。在英国，相当一部分 MRSA 传播可能发生在医院之外。医院菌株正在变得“野生”或在有定期医疗保健接触的社区中长期存在于长期携带者中；那些有近期医疗保健接触史的人，尽管如此，可能在社区中获得非医院流行的 MRSA 菌株。
