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1 June 2008

Volume 46, Number 11
Clinical Infectious Diseases 2008;46:1637–1646
© 2008 by the Infectious Diseases Society of America. All rights reserved.
1058-4838/2008/4611-0001$15.00
DOI: 10.1086/587893
MAJOR ARTICLE

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

Catherine Liu,1,2,a

Christopher J. Graber,1,2,a,b

Michael Karr,1,2

Binh An Diep,1,2

Li Basuino,1,2

Brian S. Schwartz,1,2

Mark C. Enright,9

Simon J. O’Hanlon,9

Jonathon C. Thomas,9

Francoise Perdreau‐Remington,1,2

Shelley Gordon,3

Helen Gunthorpe,4

Richard Jacobs,1,5

Peter Jensen,1,6

Gifford Leoung,7

James S. Rumack,8 and

Henry F. Chambers1,2

1University of California, San Francisco, 2San Francisco General Hospital, 3California Pacific Medical Center, 4St. Mary’s Medical Center, 5Moffit‐Long Hospital, 6Department of Veterans Affairs Medical Center, and 7St. Francis Memorial Hospital, San Francisco, and 8Seton Medical Center, Daly City, California; and 9Department of Infectious Disease Epidemiology, Imperial College, London, United Kingdom

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 ( ) and hospital‐onset ( ) 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.

Received 16 November 2007; accepted 14 January 2008; electronically published 23 April 2008.

Reprints or correspondence: Dr. Catherine Liu, Div. of Infectious Diseases, University of California, San Francisco, 513 Parnassus Ave., S‐380, Box 0654, San Francisco, CA 94143 ().

Cited by

Jeffrey S. Gerber, Susan E. Coffin, Sarah A. Smathers, and Theoklis E. Zaoutis. (2009) Trends in the Incidence of Methicillin‐Resistant Staphylococcus aureus Infection in Children’s Hospitals in the United States. Clinical Infectious Diseases 49:1, 65-71
Online publication date: 1-Jul-2009.
Abstract-Full Text-PDF Version (277 kB)
M. Ender, S. Burger, A. Sokoli, R. Zbinden, B. Berger-Bächi, R. Heusser, M. M. Senn, N. McCallum. (2009) Variability of SCCmec in the Zurich area. European Journal of Clinical Microbiology & Infectious Diseases 28:6, 647-653
Online publication date: 1-Jul-2009.
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M. D. Bartels, K. Kristoffersen, K. Boye, H. Westh. (2009) Rise and subsequent decline of community-associated methicillin resistant Staphylococcus aureus ST30-IVc in Copenhagen, Denmark through an effective search and destroy policy. Clinical Microbiology and Infection
Online publication date: 1-Jun-2009.
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GEORGE Y. LIU. (2009) Molecular Pathogenesis of Staphylococcus aureus Infection. Pediatric Research 65:Supplement, 71R-77R
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H. M. Lode. (2009) Clinical impact of antibiotic-resistant Gram-positive pathogens. Clinical Microbiology and Infection 15:3, 212-217
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Timothy C. Jenkins, MD; Bruce D. McCollister, MD; Rohini Sharma, MD; Kim K. McFann, PhD; Nancy E. Madinger, MD; Michelle Barron, MD; Mary Bessesen, MD; Connie S. Price, MD; William J. Burman, MD. (2009) Epidemiology of Healthcare‐Associated Bloodstream Infection Caused by USA300 Strains of Methicillin‐Resistant Staphylococcus aureus in 3 Affiliated Hospitals •. Infection Control and Hospital Epidemiology 30:3, 233-241
Online publication date: 1-Mar-2009.
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Mukesh Patel. (2009) Community-Associated Meticillin-Resistant Staphylococcus aureus Infections. Drugs 69:6, 693-716
Online publication date: 1-Feb-2009.
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Helen W. Boucher, George H. Talbot, John S. Bradley, John E. Edwards, Jr, David Gilbert, Louis B. Rice, Michael Scheld, Brad Spellberg, and John Bartlett. (2009) Bad Bugs, No Drugs: No ESKAPE! An Update from the Infectious Diseases Society of America. Clinical Infectious Diseases 48:1, 1-12
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Sheldon L. Kaplan. (2008) COMMENTARY: PREVENTION OF RECURRENT STAPHYLOCOCCAL INFECTIONS. The Pediatric Infectious Disease Journal 27:10, 935-937
Online publication date: 1-Nov-2008.
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  • C.L. and C.J.G. contributed equally to this article.

  • Present affiliation: Infectious Diseases Section, VA Greater Los Angeles Healthcare System, Los Angeles, California.

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