Methicillin-resistant Staphylococcus aureus control in the 21st century: beyond the acute care hospital

To describe new trends in the epidemiology of methicillin-resistant Staphylococcus aureus in the community, among animals and in long-term care settings and to discuss potential infection control implications.

Healthcare-associated methicillin-resistant S. aureus rates have decreased in several European countries. Community-associated methicillin-resistant S. aureus is spreading quickly in many parts of the world; however, its prevalence and molecular epidemiology varies considerably from continent to continent. Only few intervention studies have been published examining preventive strategies to control community-associated methicillin-resistant S. aureus transmission in the community. Although current North-American guidelines neither recommend contact tracing nor systematic decontamination with topical regimens, anecdotal evidence from several European countries suggests that these strategies could be useful in containing community-associated methicillin-resistant S. aureus. The spread of community-associated methicillin-resistant S. aureus in the healthcare setting is an emerging problem that needs early recognition and aggressive control measures, as proposed in several recent outbreak reports. Whether the increasing animal methicillin-resistant S. aureus reservoir also poses a threat to human health needs further investigation.

The spectrum of methicillin-resistant S. aureus epidemiology is extending into new populations. The impact on healthcare of this worrisome development has been documented in several studies. Implications for long-term methicillin-resistant S. aureus control strategies are yet unclear and need further study.