This article reviews recent findings on the global epidemiology of healthcare-acquired/associated (HA), community-acquired/associated (CA) and livestock-associated (LA) meticillin-resistant Staphylococcus aureus (MRSA) and aims to reach a consensus regarding the harmonisation of typing methods for MRSA. MRSA rates continue to increase rapidly in many regions and there is a dynamic spread of strains across the globe. HA-MRSA is currently endemic in hospitals in most regions. CA-MRSA clones have been spreading rapidly in the community and also infiltrating healthcare in many regions worldwide. To date, LA-MRSA is only prevalent in certain high-risk groups of workers in direct contact with live animals. CA-MRSA and LA-MRSA have become a challenge for countries that have so far maintained low rates of MRSA. These evolutionary changes have resulted in MRSA continuing to be a major threat to public health. Continuous efforts to understand the changing epidemiology of S. aureus infection in humans and animals are therefore necessary, not only for appropriate antimicrobial treatment and effective infection control but also to monitor the evolution of the species. The group made several consensus decisions with regard to harmonisation of typing methods. A stratified, three-level organisation of testing laboratories was proposed: local; regional; and national. The functions of, and testing methodology used by, each laboratory were defined. The group consensus was to recommend spa and staphylococcal cassette chromosome mec (SCCmec) typing as the preferred methods. Both are informative in defining particular strain characteristics and utilise standardised nomenclatures, making them applicable globally. Effective communication between each of the different levels and between national centres was viewed as being crucial to inform and monitor the molecular epidemiology of MRSA at national and international levels.
Bibliographical noteFunding Information:
Funding: This review would not have been possible without the support of the International Society of Chemotherapy (ISC) and without unrestricted educational grants from Astellas Pharma Europe Ltd. , Cepheid Europe s.a. , Becton Dickinson Diagnostics , Novartis Pharma AG and Pfizer , which were used to finance the meeting and to pay for writing support. JAL has received funding from the European Union FP7 and The Wellcome Trust . AWF has received funding from EU and EU/Interreg .
Competing interests: DRC has received unrestricted educational grants from Astellas Pharma Europe Ltd. , Cepheid Europe s.a. , Becton Dickinson Diagnostics , Novartis Pharma AG and Pfizer . HW is a member of speakers boards for Becton Dickinson Diagnostics, Gen-Probe, Cepheid and Roche. All other authors declare no competing interests.
Copyright 2018 Elsevier B.V., All rights reserved.