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1 September 2005

Volume 192, Number 5
The Journal of Infectious Diseases 2005;192:811–818
© 2005 by the Infectious Diseases Society of America. All rights reserved.
0022-1899/2005/19205-0012$15.00
DOI: 10.1086/432072
MAJOR ARTICLE

Population Dynamics of Nasal Strains of Methicillin‐Resistant Staphylococcus aureus—and Their Relation to Community‐Associated Disease Activity

Erica S. Pan,1,a,b

Binh An Diep,1,4,a

Edwin D. Charlebois,3

Colette Auerswald,2

Heather A. Carleton,1

George F. Sensabaugh,4 and

Françoise Perdreau‐Remington1

1Departments of Medicine and Pediatrics, Division of Infectious Diseases, 2Department of Pediatrics, Division of Adolescent Medicine, and 3AIDS Research Institute, University of California, San Francisco, and 4Program in Infectious Diseases and Immunity, School of Public Health, University of California, Berkeley

Background.Nasal carriage of methicillin‐resistant Staphylococcus aureus (MRSA) plays a key role in the epidemiology and pathogenesis of disease. The purpose of this study was to determine the characteristics and dynamics of nasal strains of MRSA, as well as their relation to community‐associated disease activity.

Methods.This study is a cross‐sectional survey and molecular epidemiologic analysis of nasal colonization by S. aureus in homeless and runaway youths, an underserved population at high risk for staphylococcal disease.

Results.Of the 308 study participants, 27.6% carried S. aureus, and 6.2% carried MRSA. Subgroups of individuals with increased MRSA carriage rates were also at highest risk for community‐associated MRSA infection; these subgroups included individuals with either HIV infection or AIDS, injection drug users, patients with abscesses, and those recently hospitalized. Multilocus sequence typing and pulsed‐field gel electrophoresis identified 2 genotypes—ST59:P (USA1000) and ST8:S (USA300)—that accounted for 84.2% (16/19) of the MRSA isolates carried. The genotypes were distinct from nosocomial genotypes endemic in the hospital, although they originated from individuals with prior exposure to health care.

Conclusions.Comparison of MRSA strains from asymptomatic carriers versus concurrently collected community‐associated clinical strains from patients treated at local health‐care facilities allowed for the identification of 3 population dynamics of nasal strains of MRSA: (1) endemic clones—for example, ST8:C and ST59:P—sustained asymptomatic carriage and infection over prolonged periods; (2) an epidemic clone, ST8:S, demonstrated enhanced capacity for rapid transmission and widespread infections; and (3) an outbreak clone, ST30:Z (USA1100), was highly infectious but exhibited poor asymptomatic transmission.

Received 19 January 2005; accepted 25 March 2005; electronically published 2 August 2005.

Reprints or correspondence: Dr. Françoise Perdreau‐Remington, Dept. of Medicine, University of California, San Francisco, Division of Infectious Diseases, San Francisco General Hospital, 1001 Potrero Ave., UCSF 1372, Bldg. 100, Room 301, San Francisco, CA 94110 ().

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  • Presented in part: 41st annual meeting of the Infectious Disease Society of America, San Diego, October 2003 (poster 255); International Staphylococci and Staphylococcal Infections meeting, Charleston, SC, October 2004 (oral presentation).

    Potential conflicts of interest: F.P.‐R. is a consultant for Pfizer Inc.

    Financial support: Pfizer Corporation (unrestricted grant); University of California, San Francisco, Traineeship in AIDS Prevention Studies (grant T32 MH‐19105 to E.S.P.); University of California, Berkeley, Eugene Cota‐Robles Predoctoral Fellowship and a Genetics Training Grant (to B.A.D.).

  • E.S.P. and B.A.D. contributed equally to this research.

  • Present affiliation: San Francisco Department of Public Health, San Francisco, California.

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