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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.

Original publication

DOI

10.1017/S0950268809991294

Type

Journal article

Journal

Epidemiol Infect

Publication Date

05/2010

Volume

138

Pages

655 - 665

Keywords

Adolescent, Adult, Aged, Aged, 80 and over, Anti-Bacterial Agents, Bacterial Toxins, Bacterial Typing Techniques, Ciprofloxacin, Community-Acquired Infections, DNA Fingerprinting, DNA, Bacterial, Exotoxins, Female, Humans, Leukocidins, Male, Methicillin-Resistant Staphylococcus aureus, Middle Aged, Molecular Epidemiology, Sequence Analysis, DNA, Staphylococcal Infections, United Kingdom, Virulence Factors, Young Adult