A model for surveillance of methicillin-resistant Staphylococcus aureus.

It is well recognized that methicillin-resistant Staphylococcus aureus (MRSA) has become a community pathogen. Several key differences between community-associated and hospital-associated MRSA strains exist, including distinct methicillin resistance genes and genetic backgrounds and differing susceptibility to antibiotics. Recent studies have demonstrated that typical hospital and community strains easily move between hospital and community environments. Despite evidence of MRSA's expanding reach in the community, the best methods for population-level detection and containment have not been established. In an effort to determine effective methods for monitoring the spread of MRSA, we reviewed the literature on hospital-associated and community-associated MRSA (CA-MRSA) in the community and proposed a model for enhanced surveillance. By linking epidemiologic and molecular techniques within a surveillance system that coordinates activities in the community and health-care setting, scientists and public health officials can begin to measure the true extent of CA-MRSA in communities and hospitals.