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A Population-Based Study of the Incidence and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus Disease in San Francisco, 2004—2005

Catherine Liu, Christopher J. Graber, Michael Karr, Binh An Diep, Li Basuino, Brian S. Schwartz, Mark C. Enright, Simon J. O'Hanlon, Jonathon C. Thomas, Francoise Perdreau-Remington, Shelley Gordon, Helen Gunthorpe, Richard Jacobs, Peter Jensen, Giffford Leoung, James S. Rumack and Henry F. Chambers
Clinical Infectious Diseases
Vol. 46, No. 11 (Jun. 1, 2008), pp. 1637-1646
Published by: Oxford University Press
Stable URL: http://www.jstor.org/stable/40307468
Page Count: 10
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A Population-Based Study of the Incidence and Molecular Epidemiology of Methicillin-Resistant Staphylococcus aureus Disease in San Francisco, 2004—2005
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Abstract

Background. Methicillin-resistant Staphylococcus aureus (MRSA) infections have become a major public health problem in both the community and hospitals. Few studies have characterized the incidence and clonal composition of disease-causing strains in an entire population. Our objective was to perform a population-based survey of the clinical and molecular epidemiology of MRSA disease in San Francisco, California. Methods. We prospectively collected 3985 MRSA isolates and associated clinical and demographic information over a 12-month period (2004–2005) at 9 San Francisco–area medical centers. A random sample of 801 isolates was selected for molecular analysis. Results. The annual incidence of community-onset MRSA disease among San Francisco residents was 316 cases per 100,000 population, compared with 31 cases per 100,000 population for hospital-onset disease. Persons who were aged 35–44 years, were men, and were black had the highest incidence of community-onset disease. The USA300 MRSA clone accounted for 234 cases of community-onset disease and 15 cases of hospital-onset disease per 100,000 population, constituting an estimated 78.5% and 43.4% of all cases of MRSA disease, respectively. Patients with community-onset USA300 MRSA versus non-USA300 MRSA disease were more likely to be male, be of younger age, and have skin and soft-tissue infections. USA300 strains were generally more susceptible to multiple antibiotics, although decreased susceptibility to tetracycline was observed in both community-onset (P = .008) and hospital-onset (P = .03) USA300 compared to non-USA300 strains. Conclusions. The annual incidence of community-onset MRSA disease in San Francisco is substantial, surpassing that of hospital-onset disease. USA300 is the predominant clone in both the community and hospitals. The dissemination of USA300 from the community into the hospital setting has blurred its distinction as a community-associated pathogen.

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