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Methicillin-resistant Staphylococcus aureus - Wikipedia

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class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Intravenous_drug_users"> <div class="vector-toc-text"> <span class="vector-toc-numb">2.6</span> <span>Intravenous drug users</span> </div> </a> <ul id="toc-Intravenous_drug_users-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Mechanism" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Mechanism"> <div class="vector-toc-text"> <span class="vector-toc-numb">3</span> <span>Mechanism</span> </div> </a> <button aria-controls="toc-Mechanism-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Mechanism subsection</span> </button> <ul id="toc-Mechanism-sublist" class="vector-toc-list"> <li id="toc-SCCmec" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#SCCmec"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.1</span> <span>SCC<i>mec</i></span> </div> </a> <ul id="toc-SCCmec-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-mecA" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#mecA"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.2</span> <span><i>mecA</i></span> </div> </a> <ul id="toc-mecA-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Arginine_catabolic_mobile_element" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Arginine_catabolic_mobile_element"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.3</span> <span>Arginine catabolic mobile element</span> </div> </a> <ul id="toc-Arginine_catabolic_mobile_element-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Strains" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Strains"> <div class="vector-toc-text"> <span class="vector-toc-numb">3.4</span> <span>Strains</span> </div> </a> <ul id="toc-Strains-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Diagnosis" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Diagnosis"> <div class="vector-toc-text"> <span class="vector-toc-numb">4</span> <span>Diagnosis</span> </div> </a> <button aria-controls="toc-Diagnosis-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Diagnosis subsection</span> </button> <ul id="toc-Diagnosis-sublist" class="vector-toc-list"> <li id="toc-Microbiology" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Microbiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">4.1</span> <span>Microbiology</span> </div> </a> <ul id="toc-Microbiology-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Prevention" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Prevention"> <div class="vector-toc-text"> <span class="vector-toc-numb">5</span> <span>Prevention</span> </div> </a> <button aria-controls="toc-Prevention-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Prevention subsection</span> </button> <ul id="toc-Prevention-sublist" class="vector-toc-list"> <li id="toc-Screening" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Screening"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.1</span> <span>Screening</span> </div> </a> <ul id="toc-Screening-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Handwashing" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Handwashing"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.2</span> <span>Handwashing</span> </div> </a> <ul id="toc-Handwashing-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Isolation" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Isolation"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.3</span> <span>Isolation</span> </div> </a> <ul id="toc-Isolation-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Restricting_antibiotic_use" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Restricting_antibiotic_use"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.4</span> <span>Restricting antibiotic use</span> </div> </a> <ul id="toc-Restricting_antibiotic_use-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Public_health_considerations" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Public_health_considerations"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.5</span> <span>Public health considerations</span> </div> </a> <ul id="toc-Public_health_considerations-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Decolonization" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Decolonization"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.6</span> <span>Decolonization</span> </div> </a> <ul id="toc-Decolonization-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Community_settings" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Community_settings"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.7</span> <span>Community settings</span> </div> </a> <ul id="toc-Community_settings-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Agriculture" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Agriculture"> <div class="vector-toc-text"> <span class="vector-toc-numb">5.8</span> <span>Agriculture</span> </div> </a> <ul id="toc-Agriculture-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Treatment" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Treatment"> <div class="vector-toc-text"> <span class="vector-toc-numb">6</span> <span>Treatment</span> </div> </a> <button aria-controls="toc-Treatment-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Treatment subsection</span> </button> <ul id="toc-Treatment-sublist" class="vector-toc-list"> <li id="toc-Antibiotics" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Antibiotics"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.1</span> <span>Antibiotics</span> </div> </a> <ul id="toc-Antibiotics-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Skin_and_soft-tissue_infections" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Skin_and_soft-tissue_infections"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.2</span> <span>Skin and soft-tissue infections</span> </div> </a> <ul id="toc-Skin_and_soft-tissue_infections-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Children_2" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Children_2"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.3</span> <span>Children</span> </div> </a> <ul id="toc-Children_2-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Endocarditis_and_bacteremia" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Endocarditis_and_bacteremia"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.4</span> <span>Endocarditis and bacteremia</span> </div> </a> <ul id="toc-Endocarditis_and_bacteremia-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Respiratory_infections" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Respiratory_infections"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.5</span> <span>Respiratory infections</span> </div> </a> <ul id="toc-Respiratory_infections-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Bone_and_joint_infections" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Bone_and_joint_infections"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.6</span> <span>Bone and joint infections</span> </div> </a> <ul id="toc-Bone_and_joint_infections-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Infected_implants" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Infected_implants"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.7</span> <span>Infected implants</span> </div> </a> <ul id="toc-Infected_implants-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Central_nervous_system" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Central_nervous_system"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.8</span> <span>Central nervous system</span> </div> </a> <ul id="toc-Central_nervous_system-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Other_infections" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#Other_infections"> <div class="vector-toc-text"> <span class="vector-toc-numb">6.9</span> <span>Other infections</span> </div> </a> <ul id="toc-Other_infections-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-Epidemiology" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Epidemiology"> <div class="vector-toc-text"> <span class="vector-toc-numb">7</span> <span>Epidemiology</span> </div> </a> <button aria-controls="toc-Epidemiology-sublist" class="cdx-button cdx-button--weight-quiet cdx-button--icon-only vector-toc-toggle"> <span class="vector-icon mw-ui-icon-wikimedia-expand"></span> <span>Toggle Epidemiology subsection</span> </button> <ul id="toc-Epidemiology-sublist" class="vector-toc-list"> <li id="toc-HA-MRSA_(healthcare_associated)" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#HA-MRSA_(healthcare_associated)"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.1</span> <span>HA-MRSA (healthcare associated)</span> </div> </a> <ul id="toc-HA-MRSA_(healthcare_associated)-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-CA-MRSA_(community_associated)" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#CA-MRSA_(community_associated)"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.2</span> <span>CA-MRSA (community associated)</span> </div> </a> <ul id="toc-CA-MRSA_(community_associated)-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-LA-MRSA_(livestock_associated)" class="vector-toc-list-item vector-toc-level-2"> <a class="vector-toc-link" href="#LA-MRSA_(livestock_associated)"> <div class="vector-toc-text"> <span class="vector-toc-numb">7.3</span> <span>LA-MRSA (livestock associated)</span> </div> </a> <ul id="toc-LA-MRSA_(livestock_associated)-sublist" class="vector-toc-list"> </ul> </li> </ul> </li> <li id="toc-History" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#History"> <div class="vector-toc-text"> <span class="vector-toc-numb">8</span> <span>History</span> </div> </a> <ul id="toc-History-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-In_the_media" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#In_the_media"> <div class="vector-toc-text"> <span class="vector-toc-numb">9</span> <span>In the media</span> </div> </a> <ul id="toc-In_the_media-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Research" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Research"> <div class="vector-toc-text"> <span class="vector-toc-numb">10</span> <span>Research</span> </div> </a> <ul id="toc-Research-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-See_also" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#See_also"> <div class="vector-toc-text"> <span class="vector-toc-numb">11</span> <span>See also</span> </div> </a> <ul id="toc-See_also-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-References" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#References"> <div class="vector-toc-text"> <span class="vector-toc-numb">12</span> <span>References</span> </div> </a> <ul id="toc-References-sublist" class="vector-toc-list"> </ul> </li> <li id="toc-Further_reading" class="vector-toc-list-item vector-toc-level-1"> <a class="vector-toc-link" href="#Further_reading"> <div class="vector-toc-text"> <span class="vector-toc-numb">13</span> <span>Further reading</span> </div> </a> <ul id="toc-Further_reading-sublist" class="vector-toc-list"> </ul> </li> </ul> </div> </div> </nav> </div> </div> <div class="mw-content-container"> <main id="content" class="mw-body"> <header class="mw-body-header vector-page-titlebar"> <nav aria-label="Contents" class="vector-toc-landmark"> <div id="vector-page-titlebar-toc" class="vector-dropdown vector-page-titlebar-toc vector-button-flush-left" title="Table of Contents" > <input type="checkbox" id="vector-page-titlebar-toc-checkbox" role="button" aria-haspopup="true" data-event-name="ui.dropdown-vector-page-titlebar-toc" class="vector-dropdown-checkbox " aria-label="Toggle the table of contents" > <label id="vector-page-titlebar-toc-label" for="vector-page-titlebar-toc-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--icon-only " aria-hidden="true" ><span class="vector-icon mw-ui-icon-listBullet 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Available in 39 languages" > <label id="p-lang-btn-label" for="p-lang-btn-checkbox" class="vector-dropdown-label cdx-button cdx-button--fake-button cdx-button--fake-button--enabled cdx-button--weight-quiet cdx-button--action-progressive mw-portlet-lang-heading-39" aria-hidden="true" ><span class="vector-icon mw-ui-icon-language-progressive mw-ui-icon-wikimedia-language-progressive"></span> <span class="vector-dropdown-label-text">39 languages</span> </label> <div class="vector-dropdown-content"> <div class="vector-menu-content"> <ul class="vector-menu-content-list"> <li class="interlanguage-link interwiki-ar mw-list-item"><a href="https://ar.wikipedia.org/wiki/%D9%85%D9%83%D9%88%D8%B1%D8%A7%D8%AA_%D8%B9%D9%86%D9%82%D9%88%D8%AF%D9%8A%D8%A9_%D8%B0%D9%87%D8%A8%D9%8A%D8%A9_%D9%85%D9%82%D8%A7%D9%88%D9%85%D8%A9_%D9%84%D9%84%D9%85%D9%8A%D8%AB%D9%8A%D8%B3%D9%8A%D9%84%D9%8A%D9%86" title="مكورات عنقودية ذهبية مقاومة للميثيسيلين – Arabic" lang="ar" hreflang="ar" data-title="مكورات عنقودية ذهبية مقاومة للميثيسيلين" data-language-autonym="العربية" data-language-local-name="Arabic" class="interlanguage-link-target"><span>العربية</span></a></li><li class="interlanguage-link interwiki-bg mw-list-item"><a href="https://bg.wikipedia.org/wiki/%D0%9C%D0%B5%D1%82%D0%B8%D1%86%D0%B8%D0%BB%D0%B8%D0%BD-%D1%80%D0%B5%D0%B7%D0%B8%D1%81%D1%82%D0%B5%D0%BD%D1%82%D0%B5%D0%BD_%D1%81%D1%82%D0%B0%D1%84%D0%B8%D0%BB%D0%BE%D0%BA%D0%BE%D0%BA" title="Метицилин-резистентен стафилокок – Bulgarian" lang="bg" hreflang="bg" data-title="Метицилин-резистентен стафилокок" data-language-autonym="Български" data-language-local-name="Bulgarian" class="interlanguage-link-target"><span>Български</span></a></li><li class="interlanguage-link interwiki-ca mw-list-item"><a href="https://ca.wikipedia.org/wiki/Staphylococcus_aureus_resistent_a_la_meticil%C2%B7lina" title="Staphylococcus aureus resistent a la meticil·lina – Catalan" lang="ca" hreflang="ca" data-title="Staphylococcus aureus resistent a la meticil·lina" data-language-autonym="Català" data-language-local-name="Catalan" class="interlanguage-link-target"><span>Català</span></a></li><li class="interlanguage-link interwiki-cs mw-list-item"><a href="https://cs.wikipedia.org/wiki/Meticilin-rezistentn%C3%AD_zlat%C3%BD_stafylokok" title="Meticilin-rezistentní zlatý stafylokok – Czech" lang="cs" hreflang="cs" data-title="Meticilin-rezistentní zlatý stafylokok" data-language-autonym="Čeština" data-language-local-name="Czech" class="interlanguage-link-target"><span>Čeština</span></a></li><li class="interlanguage-link interwiki-cy mw-list-item"><a href="https://cy.wikipedia.org/wiki/Staphylococcus_aureus_ymwrthiol_i_fethisilin" title="Staphylococcus aureus ymwrthiol i fethisilin – Welsh" lang="cy" hreflang="cy" data-title="Staphylococcus aureus ymwrthiol i fethisilin" data-language-autonym="Cymraeg" data-language-local-name="Welsh" class="interlanguage-link-target"><span>Cymraeg</span></a></li><li class="interlanguage-link interwiki-da mw-list-item"><a href="https://da.wikipedia.org/wiki/MRSA" title="MRSA – Danish" lang="da" hreflang="da" data-title="MRSA" data-language-autonym="Dansk" data-language-local-name="Danish" class="interlanguage-link-target"><span>Dansk</span></a></li><li class="interlanguage-link interwiki-et mw-list-item"><a href="https://et.wikipedia.org/wiki/Metitsilliinile_resistentne_Staphylococcus_aureus" title="Metitsilliinile resistentne Staphylococcus aureus – Estonian" lang="et" hreflang="et" data-title="Metitsilliinile resistentne Staphylococcus aureus" data-language-autonym="Eesti" data-language-local-name="Estonian" class="interlanguage-link-target"><span>Eesti</span></a></li><li class="interlanguage-link interwiki-es mw-list-item"><a href="https://es.wikipedia.org/wiki/Staphylococcus_aureus_resistente_a_la_meticilina" title="Staphylococcus aureus resistente a la meticilina – Spanish" lang="es" hreflang="es" data-title="Staphylococcus aureus resistente a la meticilina" data-language-autonym="Español" data-language-local-name="Spanish" class="interlanguage-link-target"><span>Español</span></a></li><li class="interlanguage-link interwiki-fa mw-list-item"><a href="https://fa.wikipedia.org/wiki/%D8%A7%D8%B3%D8%AA%D8%A7%D9%81%DB%8C%D9%84%D9%88%DA%A9%D9%88%DA%A9%D9%88%D8%B3_%D8%A7%D9%88%D8%B1%D8%A6%D9%88%D8%B3_%D9%85%D9%82%D8%A7%D9%88%D9%85_%D8%A8%D9%87_%D9%85%D8%AA%DB%8C%E2%80%8C%D8%B3%DB%8C%D9%84%DB%8C%D9%86" title="استافیلوکوکوس اورئوس مقاوم به متی‌سیلین – Persian" lang="fa" hreflang="fa" data-title="استافیلوکوکوس اورئوس مقاوم به متی‌سیلین" data-language-autonym="فارسی" data-language-local-name="Persian" class="interlanguage-link-target"><span>فارسی</span></a></li><li class="interlanguage-link interwiki-fr mw-list-item"><a href="https://fr.wikipedia.org/wiki/Staphylococcus_aureus_r%C3%A9sistant_%C3%A0_la_m%C3%A9ticilline" title="Staphylococcus aureus résistant à la méticilline – French" lang="fr" hreflang="fr" data-title="Staphylococcus aureus résistant à la méticilline" data-language-autonym="Français" data-language-local-name="French" class="interlanguage-link-target"><span>Français</span></a></li><li class="interlanguage-link interwiki-ga mw-list-item"><a href="https://ga.wikipedia.org/wiki/Staphylococcus_aureus_frithsheasmhach_in_aghaidh_meiticilline" title="Staphylococcus aureus frithsheasmhach in aghaidh meiticilline – Irish" lang="ga" hreflang="ga" data-title="Staphylococcus aureus frithsheasmhach in aghaidh meiticilline" data-language-autonym="Gaeilge" data-language-local-name="Irish" class="interlanguage-link-target"><span>Gaeilge</span></a></li><li class="interlanguage-link interwiki-gl mw-list-item"><a href="https://gl.wikipedia.org/wiki/SARM" title="SARM – Galician" lang="gl" hreflang="gl" data-title="SARM" data-language-autonym="Galego" data-language-local-name="Galician" class="interlanguage-link-target"><span>Galego</span></a></li><li class="interlanguage-link interwiki-ko mw-list-item"><a href="https://ko.wikipedia.org/wiki/%EB%A9%94%ED%8B%B0%EC%8B%A4%EB%A6%B0_%EB%82%B4%EC%84%B1_%ED%99%A9%EC%83%89%ED%8F%AC%EB%8F%84%EC%83%81%EA%B5%AC%EA%B7%A0" title="메티실린 내성 황색포도상구균 – Korean" lang="ko" hreflang="ko" data-title="메티실린 내성 황색포도상구균" data-language-autonym="한국어" data-language-local-name="Korean" class="interlanguage-link-target"><span>한국어</span></a></li><li class="interlanguage-link interwiki-hr mw-list-item"><a href="https://hr.wikipedia.org/wiki/MRSA" title="MRSA – Croatian" lang="hr" hreflang="hr" data-title="MRSA" data-language-autonym="Hrvatski" data-language-local-name="Croatian" class="interlanguage-link-target"><span>Hrvatski</span></a></li><li class="interlanguage-link interwiki-id mw-list-item"><a href="https://id.wikipedia.org/wiki/Staphylococcus_aureus_resisten-metisilin" title="Staphylococcus aureus resisten-metisilin – Indonesian" lang="id" hreflang="id" data-title="Staphylococcus aureus resisten-metisilin" data-language-autonym="Bahasa Indonesia" data-language-local-name="Indonesian" class="interlanguage-link-target"><span>Bahasa Indonesia</span></a></li><li class="interlanguage-link interwiki-is mw-list-item"><a href="https://is.wikipedia.org/wiki/M%C3%93SA" title="MÓSA – Icelandic" lang="is" hreflang="is" data-title="MÓSA" data-language-autonym="Íslenska" data-language-local-name="Icelandic" class="interlanguage-link-target"><span>Íslenska</span></a></li><li class="interlanguage-link interwiki-it mw-list-item"><a href="https://it.wikipedia.org/wiki/Staphylococcus_aureus_resistente_alla_meticillina" title="Staphylococcus aureus resistente alla meticillina – Italian" lang="it" hreflang="it" data-title="Staphylococcus aureus resistente alla meticillina" data-language-autonym="Italiano" data-language-local-name="Italian" class="interlanguage-link-target"><span>Italiano</span></a></li><li class="interlanguage-link interwiki-he mw-list-item"><a href="https://he.wikipedia.org/wiki/MRSA" title="MRSA – Hebrew" lang="he" hreflang="he" data-title="MRSA" data-language-autonym="עברית" data-language-local-name="Hebrew" class="interlanguage-link-target"><span>עברית</span></a></li><li class="interlanguage-link interwiki-ku mw-list-item"><a href="https://ku.wikipedia.org/wiki/Bergir%C3%AE_dij%C3%AE_ent%C3%AEbayot%C3%AEk" title="Bergirî dijî entîbayotîk – Kurdish" lang="ku" hreflang="ku" data-title="Bergirî dijî entîbayotîk" data-language-autonym="Kurdî" data-language-local-name="Kurdish" class="interlanguage-link-target"><span>Kurdî</span></a></li><li class="interlanguage-link interwiki-la mw-list-item"><a href="https://la.wikipedia.org/wiki/Staphylococcus_aureus_methicillino_resistens" title="Staphylococcus aureus methicillino resistens – Latin" lang="la" hreflang="la" data-title="Staphylococcus aureus methicillino resistens" data-language-autonym="Latina" data-language-local-name="Latin" class="interlanguage-link-target"><span>Latina</span></a></li><li class="interlanguage-link interwiki-mk mw-list-item"><a href="https://mk.wikipedia.org/wiki/%D0%9C%D0%A0%D0%A1%D0%90" title="МРСА – Macedonian" lang="mk" hreflang="mk" data-title="МРСА" data-language-autonym="Македонски" data-language-local-name="Macedonian" class="interlanguage-link-target"><span>Македонски</span></a></li><li class="interlanguage-link interwiki-ms mw-list-item"><a href="https://ms.wikipedia.org/wiki/Staphylococcus_aureus_tahan_metisilin" title="Staphylococcus aureus tahan metisilin – Malay" lang="ms" hreflang="ms" data-title="Staphylococcus aureus tahan metisilin" data-language-autonym="Bahasa Melayu" data-language-local-name="Malay" class="interlanguage-link-target"><span>Bahasa Melayu</span></a></li><li class="interlanguage-link interwiki-nl mw-list-item"><a href="https://nl.wikipedia.org/wiki/Meticilline-resistente_Staphylococcus_aureus" title="Meticilline-resistente Staphylococcus aureus – Dutch" lang="nl" hreflang="nl" data-title="Meticilline-resistente Staphylococcus aureus" data-language-autonym="Nederlands" data-language-local-name="Dutch" class="interlanguage-link-target"><span>Nederlands</span></a></li><li class="interlanguage-link interwiki-ja mw-list-item"><a href="https://ja.wikipedia.org/wiki/%E3%83%A1%E3%83%81%E3%82%B7%E3%83%AA%E3%83%B3%E8%80%90%E6%80%A7%E9%BB%84%E8%89%B2%E3%83%96%E3%83%89%E3%82%A6%E7%90%83%E8%8F%8C" title="メチシリン耐性黄色ブドウ球菌 – Japanese" lang="ja" hreflang="ja" data-title="メチシリン耐性黄色ブドウ球菌" data-language-autonym="日本語" data-language-local-name="Japanese" class="interlanguage-link-target"><span>日本語</span></a></li><li class="interlanguage-link interwiki-no mw-list-item"><a href="https://no.wikipedia.org/wiki/Meticillinresistente_Staphylococcus_aureus" title="Meticillinresistente Staphylococcus aureus – Norwegian Bokmål" lang="nb" hreflang="nb" data-title="Meticillinresistente Staphylococcus aureus" data-language-autonym="Norsk bokmål" data-language-local-name="Norwegian Bokmål" class="interlanguage-link-target"><span>Norsk bokmål</span></a></li><li class="interlanguage-link interwiki-nn mw-list-item"><a href="https://nn.wikipedia.org/wiki/Methicillin-resistente_gule_stafylokokkar" title="Methicillin-resistente gule stafylokokkar – Norwegian Nynorsk" lang="nn" hreflang="nn" data-title="Methicillin-resistente gule stafylokokkar" data-language-autonym="Norsk nynorsk" data-language-local-name="Norwegian Nynorsk" class="interlanguage-link-target"><span>Norsk nynorsk</span></a></li><li class="interlanguage-link interwiki-pl mw-list-item"><a href="https://pl.wikipedia.org/wiki/MRSA" title="MRSA – Polish" lang="pl" hreflang="pl" data-title="MRSA" data-language-autonym="Polski" data-language-local-name="Polish" class="interlanguage-link-target"><span>Polski</span></a></li><li class="interlanguage-link interwiki-pt mw-list-item"><a href="https://pt.wikipedia.org/wiki/Staphylococcus_aureus_resistente_%C3%A0_meticilina" title="Staphylococcus aureus resistente à meticilina – Portuguese" lang="pt" hreflang="pt" data-title="Staphylococcus aureus resistente à meticilina" data-language-autonym="Português" data-language-local-name="Portuguese" class="interlanguage-link-target"><span>Português</span></a></li><li class="interlanguage-link interwiki-ro mw-list-item"><a href="https://ro.wikipedia.org/wiki/Stafilococ_auriu_meticilino-rezistent" title="Stafilococ auriu meticilino-rezistent – Romanian" lang="ro" hreflang="ro" data-title="Stafilococ auriu meticilino-rezistent" data-language-autonym="Română" data-language-local-name="Romanian" class="interlanguage-link-target"><span>Română</span></a></li><li class="interlanguage-link interwiki-ru mw-list-item"><a href="https://ru.wikipedia.org/wiki/%D0%9C%D0%B5%D1%82%D0%B8%D1%86%D0%B8%D0%BB%D0%BB%D0%B8%D0%BD%D1%80%D0%B5%D0%B7%D0%B8%D1%81%D1%82%D0%B5%D0%BD%D1%82%D0%BD%D1%8B%D0%B9_%D0%B7%D0%BE%D0%BB%D0%BE%D1%82%D0%B8%D1%81%D1%82%D1%8B%D0%B9_%D1%81%D1%82%D0%B0%D1%84%D0%B8%D0%BB%D0%BE%D0%BA%D0%BE%D0%BA%D0%BA" title="Метициллинрезистентный золотистый стафилококк – Russian" lang="ru" hreflang="ru" data-title="Метициллинрезистентный золотистый стафилококк" data-language-autonym="Русский" data-language-local-name="Russian" class="interlanguage-link-target"><span>Русский</span></a></li><li class="interlanguage-link interwiki-simple mw-list-item"><a href="https://simple.wikipedia.org/wiki/MRSA" title="MRSA – Simple English" lang="en-simple" hreflang="en-simple" data-title="MRSA" data-language-autonym="Simple English" data-language-local-name="Simple English" class="interlanguage-link-target"><span>Simple English</span></a></li><li class="interlanguage-link interwiki-sl mw-list-item"><a href="https://sl.wikipedia.org/wiki/Proti_meticilinu_odporni_Staphylococcus_aureus" title="Proti meticilinu odporni Staphylococcus aureus – Slovenian" lang="sl" hreflang="sl" data-title="Proti meticilinu odporni Staphylococcus aureus" data-language-autonym="Slovenščina" data-language-local-name="Slovenian" class="interlanguage-link-target"><span>Slovenščina</span></a></li><li class="interlanguage-link interwiki-sr mw-list-item"><a href="https://sr.wikipedia.org/wiki/%D0%9C%D0%B5%D1%82%D0%B8%D1%86%D0%B8%D0%BB%D0%B8%D0%BD_%D1%80%D0%B5%D0%B7%D0%B8%D1%81%D1%82%D0%B5%D0%BD%D1%82%D0%BD%D0%B8_%D1%81%D1%82%D0%B0%D1%84%D0%B8%D0%BB%D0%BE%D0%BA%D0%BE%D0%BA%D1%83%D1%81_%D0%B0%D1%83%D1%80%D0%B5%D1%83%D1%81" title="Метицилин резистентни стафилококус ауреус – Serbian" lang="sr" hreflang="sr" data-title="Метицилин резистентни стафилококус ауреус" data-language-autonym="Српски / srpski" data-language-local-name="Serbian" class="interlanguage-link-target"><span>Српски / srpski</span></a></li><li class="interlanguage-link interwiki-sh mw-list-item"><a href="https://sh.wikipedia.org/wiki/Meticilin_rezistentni_stafilokokus_aureus" title="Meticilin rezistentni stafilokokus aureus – Serbo-Croatian" lang="sh" hreflang="sh" data-title="Meticilin rezistentni stafilokokus aureus" data-language-autonym="Srpskohrvatski / српскохрватски" data-language-local-name="Serbo-Croatian" class="interlanguage-link-target"><span>Srpskohrvatski / српскохрватски</span></a></li><li class="interlanguage-link interwiki-fi mw-list-item"><a href="https://fi.wikipedia.org/wiki/MRSA" title="MRSA – Finnish" lang="fi" hreflang="fi" data-title="MRSA" data-language-autonym="Suomi" data-language-local-name="Finnish" class="interlanguage-link-target"><span>Suomi</span></a></li><li class="interlanguage-link interwiki-sv mw-list-item"><a href="https://sv.wikipedia.org/wiki/MRSA" title="MRSA – Swedish" lang="sv" hreflang="sv" data-title="MRSA" data-language-autonym="Svenska" data-language-local-name="Swedish" class="interlanguage-link-target"><span>Svenska</span></a></li><li class="interlanguage-link interwiki-tl mw-list-item"><a href="https://tl.wikipedia.org/wiki/MRSA" title="MRSA – Tagalog" lang="tl" hreflang="tl" data-title="MRSA" data-language-autonym="Tagalog" data-language-local-name="Tagalog" class="interlanguage-link-target"><span>Tagalog</span></a></li><li class="interlanguage-link interwiki-th mw-list-item"><a href="https://th.wikipedia.org/wiki/Staphylococcus_aureus_%E0%B8%8A%E0%B8%99%E0%B8%B4%E0%B8%94%E0%B8%95%E0%B9%89%E0%B8%B2%E0%B8%99%E0%B8%97%E0%B8%B2%E0%B8%99%E0%B8%95%E0%B9%88%E0%B8%AD%E0%B9%80%E0%B8%A1%E0%B8%98%E0%B8%B4%E0%B8%8B%E0%B8%B4%E0%B8%A5%E0%B8%A5%E0%B8%B4%E0%B8%99" title="Staphylococcus aureus ชนิดต้านทานต่อเมธิซิลลิน – Thai" lang="th" hreflang="th" data-title="Staphylococcus aureus ชนิดต้านทานต่อเมธิซิลลิน" data-language-autonym="ไทย" data-language-local-name="Thai" class="interlanguage-link-target"><span>ไทย</span></a></li><li class="interlanguage-link interwiki-zh mw-list-item"><a href="https://zh.wikipedia.org/wiki/%E8%80%90%E7%94%B2%E6%B0%A7%E8%A5%BF%E6%9E%97%E9%87%91%E9%BB%84%E8%89%B2%E8%91%A1%E8%90%84%E7%90%83%E8%8F%8C" title="耐甲氧西林金黄色葡萄球菌 – Chinese" lang="zh" hreflang="zh" data-title="耐甲氧西林金黄色葡萄球菌" data-language-autonym="中文" data-language-local-name="Chinese" 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searchaux" style="display:none">Bacterium responsible for difficult-to-treat infections in humans</div> <style data-mw-deduplicate="TemplateStyles:r1236090951">.mw-parser-output .hatnote{font-style:italic}.mw-parser-output div.hatnote{padding-left:1.6em;margin-bottom:0.5em}.mw-parser-output .hatnote i{font-style:normal}.mw-parser-output .hatnote+link+.hatnote{margin-top:-0.5em}@media print{body.ns-0 .mw-parser-output .hatnote{display:none!important}}</style><div role="note" class="hatnote navigation-not-searchable">"MRSA" redirects here. For other uses, see <a href="/wiki/MRSA_(disambiguation)" class="mw-disambig" title="MRSA (disambiguation)">MRSA (disambiguation)</a>.</div> <p class="mw-empty-elt"> </p> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Human_neutrophil_ingesting_MRSA.jpg" class="mw-file-description"><img alt="Colorized scanning electron micrograph of a human neutrophil ingesting MRSA" src="//upload.wikimedia.org/wikipedia/commons/thumb/0/01/Human_neutrophil_ingesting_MRSA.jpg/220px-Human_neutrophil_ingesting_MRSA.jpg" decoding="async" width="220" height="291" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/0/01/Human_neutrophil_ingesting_MRSA.jpg/330px-Human_neutrophil_ingesting_MRSA.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/0/01/Human_neutrophil_ingesting_MRSA.jpg/440px-Human_neutrophil_ingesting_MRSA.jpg 2x" data-file-width="1894" data-file-height="2501" /></a><figcaption>Colorized <a href="/wiki/Scanning_electron_micrograph" class="mw-redirect" title="Scanning electron micrograph">scanning electron micrograph</a> of a human <a href="/wiki/Neutrophil_granulocyte" class="mw-redirect" title="Neutrophil granulocyte">neutrophil</a> ingesting MRSA</figcaption></figure> <p><b>Methicillin-resistant <i>Staphylococcus aureus</i></b> (<b>MRSA</b>) is a group of <a href="/wiki/Gram-positive_bacteria" title="Gram-positive bacteria">gram-positive bacteria</a> that are genetically distinct from other <a href="/wiki/Strain_(biology)" title="Strain (biology)">strains</a> of <i><a href="/wiki/Staphylococcus_aureus" title="Staphylococcus aureus">Staphylococcus aureus</a></i>. MRSA is responsible for several difficult-to-treat <a href="/wiki/Infection" title="Infection">infections</a> in humans. It caused more than 100,000 deaths worldwide attributable to <a href="/wiki/Antimicrobial_resistance" title="Antimicrobial resistance">antimicrobial resistance</a> in 2019. </p><p>MRSA is any strain of <i>S. aureus</i> that has developed (through <a href="/wiki/Evolution#Natural_selection" title="Evolution">natural selection</a>) or acquired (through <a href="/wiki/Horizontal_gene_transfer" title="Horizontal gene transfer">horizontal gene transfer</a>) a <a href="/wiki/Multiple_drug_resistance" title="Multiple drug resistance">multiple drug resistance</a> to <a href="/wiki/Beta-lactam_antibiotics" class="mw-redirect" title="Beta-lactam antibiotics">beta-lactam antibiotics</a>. Beta-lactam (β-lactam) antibiotics are a <a href="/wiki/Broad-spectrum_antibiotic" title="Broad-spectrum antibiotic">broad-spectrum group</a> that include some <a href="/wiki/Penam" title="Penam">penams</a> (<a href="/wiki/Penicillin" title="Penicillin">penicillin</a> derivatives such as <a href="/wiki/Methicillin" title="Methicillin">methicillin</a> and <a href="/wiki/Oxacillin" title="Oxacillin">oxacillin</a>) and <a href="/wiki/Cephem" title="Cephem">cephems</a> such as the <a href="/wiki/Cephalosporin" title="Cephalosporin">cephalosporins</a>.<sup id="cite_ref-CochraneSurg2013_1-0" class="reference"><a href="#cite_note-CochraneSurg2013-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> Strains unable to resist these antibiotics are classified as methicillin-susceptible <i>S. aureus</i>, or MSSA. </p><p>MRSA infection is common in hospitals, prisons, and nursing homes, where people with open <a href="/wiki/Wound" title="Wound">wounds</a>, invasive devices such as <a href="/wiki/Catheter" title="Catheter">catheters</a>, and weakened <a href="/wiki/Immune_system" title="Immune system">immune systems</a> are at greater risk of <a href="/wiki/Hospital-acquired_infection" title="Hospital-acquired infection">healthcare-associated infection</a>. MRSA began as a hospital-acquired infection but has become community-acquired, as well as livestock-acquired. The terms HA-MRSA (healthcare-associated or hospital-acquired MRSA), CA-MRSA (community-associated MRSA), and LA-MRSA (livestock-associated MRSA) reflect this.<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">&#91;<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="This claim needs references to reliable sources. (August 2022)">citation needed</span></a></i>&#93;</sup> </p> <meta property="mw:PageProp/toc" /> <div class="mw-heading mw-heading2"><h2 id="Signs_and_symptoms">Signs and symptoms</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=1" title="Edit section: Signs and symptoms"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Mrsa2.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/f/fb/Mrsa2.jpg/220px-Mrsa2.jpg" decoding="async" width="220" height="176" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/f/fb/Mrsa2.jpg 1.5x" data-file-width="237" data-file-height="190" /></a><figcaption>Although usually carried without symptoms, MRSA often presents as small red pustular skin infections</figcaption></figure> <p>In humans, <i>Staphylococcus aureus</i> is part of the normal <a href="/wiki/Microbiota" title="Microbiota">microbiota</a> present in the upper respiratory tract,<sup id="cite_ref-URTmicribiome2016rev_2-0" class="reference"><a href="#cite_note-URTmicribiome2016rev-2"><span class="cite-bracket">&#91;</span>2<span class="cite-bracket">&#93;</span></a></sup> and on skin and in the gut mucosa.<sup id="cite_ref-3" class="reference"><a href="#cite_note-3"><span class="cite-bracket">&#91;</span>3<span class="cite-bracket">&#93;</span></a></sup> However, along with similar bacterial species that can colonize and act symbiotically, they can cause disease if they begin to take over the tissues they have colonized or invade other tissues; the resultant infection has been called a "pathobiont".<sup id="cite_ref-URTmicribiome2016rev_2-1" class="reference"><a href="#cite_note-URTmicribiome2016rev-2"><span class="cite-bracket">&#91;</span>2<span class="cite-bracket">&#93;</span></a></sup> </p><p>After 72 hours, MRSA can take hold in human tissues and eventually become resistant to treatment. The initial presentation of MRSA is small red bumps that resemble pimples, spider bites, or boils; they may be accompanied by fever and, occasionally, rashes. Within a few days, the bumps become larger and more painful; they eventually open into deep, pus-filled boils. About 75 percent of CA-MRSA infections are localized to skin and soft tissue and usually can be treated effectively.<sup id="cite_ref-IDSA2011_4-0" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Risk_factors">Risk factors</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=2" title="Edit section: Risk factors"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>A select few of the populations at risk include: </p> <ul><li>People with indwelling implants, prostheses, drains, and catheters<sup id="cite_ref-CochraneSurg2013_1-1" class="reference"><a href="#cite_note-CochraneSurg2013-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-Sga2016_5-0" class="reference"><a href="#cite_note-Sga2016-5"><span class="cite-bracket">&#91;</span>5<span class="cite-bracket">&#93;</span></a></sup></li> <li>People who are frequently in crowded places, especially with shared equipment and skin-to-skin contact<sup id="cite_ref-riskfactors_6-0" class="reference"><a href="#cite_note-riskfactors-6"><span class="cite-bracket">&#91;</span>6<span class="cite-bracket">&#93;</span></a></sup></li> <li>People with weak immune systems (<a href="/wiki/HIV" title="HIV">HIV</a>/<a href="/wiki/AIDS" class="mw-redirect" title="AIDS">AIDS</a>, <a href="/wiki/Lupus" title="Lupus">lupus</a>, or <a href="/wiki/Cancer" title="Cancer">cancer</a> patients; <a href="/wiki/Organ_transplantation" title="Organ transplantation">transplant</a> recipients; severe <a href="/wiki/Asthma" title="Asthma">asthmatics</a>; primary immune deficiencies , etc.)</li> <li><a href="/wiki/Diabetes" title="Diabetes">Diabetics</a><sup id="cite_ref-CochraneSurg2013_1-2" class="reference"><a href="#cite_note-CochraneSurg2013-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-7" class="reference"><a href="#cite_note-7"><span class="cite-bracket">&#91;</span>7<span class="cite-bracket">&#93;</span></a></sup></li> <li><a href="/wiki/Intravenous_drug" class="mw-redirect" title="Intravenous drug">Intravenous drug</a> users<sup id="cite_ref-8" class="reference"><a href="#cite_note-8"><span class="cite-bracket">&#91;</span>8<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-9" class="reference"><a href="#cite_note-9"><span class="cite-bracket">&#91;</span>9<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-10" class="reference"><a href="#cite_note-10"><span class="cite-bracket">&#91;</span>10<span class="cite-bracket">&#93;</span></a></sup></li> <li>Regular contact with someone who has injected drugs in the past year<sup id="cite_ref-Loewen_512–520_11-0" class="reference"><a href="#cite_note-Loewen_512–520-11"><span class="cite-bracket">&#91;</span>11<span class="cite-bracket">&#93;</span></a></sup></li> <li>Users of <a href="/wiki/Quinolone_antibiotic" title="Quinolone antibiotic">quinolone antibiotics</a><sup id="cite_ref-Sga2016_5-1" class="reference"><a href="#cite_note-Sga2016-5"><span class="cite-bracket">&#91;</span>5<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-tacconelli2008_12-0" class="reference"><a href="#cite_note-tacconelli2008-12"><span class="cite-bracket">&#91;</span>12<span class="cite-bracket">&#93;</span></a></sup></li> <li>Elderly people<sup id="cite_ref-Sga2016_5-2" class="reference"><a href="#cite_note-Sga2016-5"><span class="cite-bracket">&#91;</span>5<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-Dumyati2017_13-0" class="reference"><a href="#cite_note-Dumyati2017-13"><span class="cite-bracket">&#91;</span>13<span class="cite-bracket">&#93;</span></a></sup></li> <li>School children sharing sports and other equipment</li> <li>College students living in dormitories<sup id="cite_ref-riskfactors_6-1" class="reference"><a href="#cite_note-riskfactors-6"><span class="cite-bracket">&#91;</span>6<span class="cite-bracket">&#93;</span></a></sup></li> <li>People staying or working in a health-care facility for an extended period of time<sup id="cite_ref-Sga2016_5-3" class="reference"><a href="#cite_note-Sga2016-5"><span class="cite-bracket">&#91;</span>5<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-riskfactors_6-2" class="reference"><a href="#cite_note-riskfactors-6"><span class="cite-bracket">&#91;</span>6<span class="cite-bracket">&#93;</span></a></sup></li> <li>People who spend time in coastal waters where MRSA is present, such as some beaches in <a href="/wiki/Florida" title="Florida">Florida</a> and the <a href="/wiki/West_Coast_of_the_United_States" title="West Coast of the United States">West Coast of the United States</a><sup id="cite_ref-florida_14-0" class="reference"><a href="#cite_note-florida-14"><span class="cite-bracket">&#91;</span>14<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-AP1_15-0" class="reference"><a href="#cite_note-AP1-15"><span class="cite-bracket">&#91;</span>15<span class="cite-bracket">&#93;</span></a></sup></li> <li>People who spend time in confined spaces with other people, including occupants of homeless shelters, <a href="/wiki/Prison" title="Prison">prison</a> inmates, and military recruits in <a href="/wiki/Recruit_training" class="mw-redirect" title="Recruit training">basic training</a><sup id="cite_ref-soldiers_16-0" class="reference"><a href="#cite_note-soldiers-16"><span class="cite-bracket">&#91;</span>16<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-The_University_of_Chicago_Medical_Center_17-0" class="reference"><a href="#cite_note-The_University_of_Chicago_Medical_Center-17"><span class="cite-bracket">&#91;</span>17<span class="cite-bracket">&#93;</span></a></sup></li> <li>Veterinarians, livestock handlers, and pet owners<sup id="cite_ref-cmr_18-0" class="reference"><a href="#cite_note-cmr-18"><span class="cite-bracket">&#91;</span>18<span class="cite-bracket">&#93;</span></a></sup></li> <li>People who ingest unpasteurized milk<sup id="cite_ref-Gopal2017_19-0" class="reference"><a href="#cite_note-Gopal2017-19"><span class="cite-bracket">&#91;</span>19<span class="cite-bracket">&#93;</span></a></sup></li> <li>People who are immunocompromised and also colonized<sup id="cite_ref-Ficalora_20-0" class="reference"><a href="#cite_note-Ficalora-20"><span class="cite-bracket">&#91;</span>20<span class="cite-bracket">&#93;</span></a></sup><sup class="reference nowrap"><span title="Page / location: 249">&#58;&#8202;249&#8202;</span></sup></li> <li>People with <a href="/wiki/Chronic_obstructive_pulmonary_disease" title="Chronic obstructive pulmonary disease">chronic obstructive pulmonary disease</a><sup id="cite_ref-Sga2016_5-4" class="reference"><a href="#cite_note-Sga2016-5"><span class="cite-bracket">&#91;</span>5<span class="cite-bracket">&#93;</span></a></sup></li> <li>People who have had thoracic surgery<sup id="cite_ref-Sga2016_5-5" class="reference"><a href="#cite_note-Sga2016-5"><span class="cite-bracket">&#91;</span>5<span class="cite-bracket">&#93;</span></a></sup></li></ul> <p>As many as 22% of people infected with MRSA do not have any discernable risk factors.<sup id="cite_ref-Winn_21-0" class="reference"><a href="#cite_note-Winn-21"><span class="cite-bracket">&#91;</span>21<span class="cite-bracket">&#93;</span></a></sup><sup class="reference nowrap"><span title="Page / location: 637">&#58;&#8202;637&#8202;</span></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Hospitalized_people">Hospitalized people</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=3" title="Edit section: Hospitalized people"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>People who are hospitalized, including the elderly, are often <a href="/wiki/Immunocompromised" class="mw-redirect" title="Immunocompromised">immunocompromised</a> and susceptible to infection of all kinds, including MRSA; an infection by MRSA is called healthcare-associated or hospital-acquired methicillin-resistant <i>S. aureus</i> (HA-MRSA).<sup id="cite_ref-CochraneSurg2013_1-3" class="reference"><a href="#cite_note-CochraneSurg2013-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-Sga2016_5-6" class="reference"><a href="#cite_note-Sga2016-5"><span class="cite-bracket">&#91;</span>5<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-CochraneNonSurg2013_22-0" class="reference"><a href="#cite_note-CochraneNonSurg2013-22"><span class="cite-bracket">&#91;</span>22<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-23" class="reference"><a href="#cite_note-23"><span class="cite-bracket">&#91;</span>23<span class="cite-bracket">&#93;</span></a></sup> Generally, those infected by MRSA stay infected for just under 10 days, if treated by a doctor, although effects may vary from person to person.<sup id="cite_ref-24" class="reference"><a href="#cite_note-24"><span class="cite-bracket">&#91;</span>24<span class="cite-bracket">&#93;</span></a></sup> </p><p>Both surgical and nonsurgical wounds can be infected with HA-MRSA.<sup id="cite_ref-CochraneSurg2013_1-4" class="reference"><a href="#cite_note-CochraneSurg2013-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-Sga2016_5-7" class="reference"><a href="#cite_note-Sga2016-5"><span class="cite-bracket">&#91;</span>5<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-CochraneNonSurg2013_22-1" class="reference"><a href="#cite_note-CochraneNonSurg2013-22"><span class="cite-bracket">&#91;</span>22<span class="cite-bracket">&#93;</span></a></sup> Surgical site infections occur on the skin surface, but can spread to internal organs and blood to cause <a href="/wiki/Sepsis" title="Sepsis">sepsis</a>.<sup id="cite_ref-CochraneSurg2013_1-5" class="reference"><a href="#cite_note-CochraneSurg2013-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> Transmission can occur between healthcare providers and patients because some providers may neglect to perform preventative hand-washing between examinations.<sup id="cite_ref-tacconelli2008_12-1" class="reference"><a href="#cite_note-tacconelli2008-12"><span class="cite-bracket">&#91;</span>12<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-muto2003_25-0" class="reference"><a href="#cite_note-muto2003-25"><span class="cite-bracket">&#91;</span>25<span class="cite-bracket">&#93;</span></a></sup> </p><p>People in <a href="/wiki/Nursing_home" title="Nursing home">nursing homes</a> are at risk for all the reasons above, further complicated by their generally weaker immune systems.<sup id="cite_ref-Dumyati2017_13-1" class="reference"><a href="#cite_note-Dumyati2017-13"><span class="cite-bracket">&#91;</span>13<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-CochraneNursHomeStop2013_26-0" class="reference"><a href="#cite_note-CochraneNursHomeStop2013-26"><span class="cite-bracket">&#91;</span>26<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Prison_inmates_and_military_personnel">Prison inmates and military personnel</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=4" title="Edit section: Prison inmates and military personnel"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Prisons and military barracks<sup id="cite_ref-Gopal2017_19-1" class="reference"><a href="#cite_note-Gopal2017-19"><span class="cite-bracket">&#91;</span>19<span class="cite-bracket">&#93;</span></a></sup> can be crowded and confined, and poor hygiene conditions may proliferate, thus putting inhabitants at increased risk of contracting MRSA.<sup id="cite_ref-cmr_18-1" class="reference"><a href="#cite_note-cmr-18"><span class="cite-bracket">&#91;</span>18<span class="cite-bracket">&#93;</span></a></sup> Cases of MRSA in such populations were first reported in the United States and later in Canada. The earliest reports were made by the <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">Centers for Disease Control and Prevention</a> in US state prisons. In the news media, hundreds of reports of MRSA outbreaks in prisons appeared between 2000 and 2008. For example, in February 2008, the <a href="/wiki/Tulsa_County,_Oklahoma" title="Tulsa County, Oklahoma">Tulsa County</a> jail in <a href="/wiki/Oklahoma" title="Oklahoma">Oklahoma</a> started treating an average of 12 <i>S. aureus</i> cases per month.<sup id="cite_ref-27" class="reference"><a href="#cite_note-27"><span class="cite-bracket">&#91;</span>27<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Animals">Animals</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=5" title="Edit section: Animals"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Antibiotic_use_in_livestock" title="Antibiotic use in livestock">Antibiotic use in livestock</a> increases the risk that MRSA will develop among the livestock and other animals that may reside near them; strains <a href="/wiki/MRSA_ST398" title="MRSA ST398">MRSA ST398</a> and <a href="/wiki/CC398" title="CC398">CC398</a> are transmissible to humans.<sup id="cite_ref-Gopal2017_19-2" class="reference"><a href="#cite_note-Gopal2017-19"><span class="cite-bracket">&#91;</span>19<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-Mehn2014_28-0" class="reference"><a href="#cite_note-Mehn2014-28"><span class="cite-bracket">&#91;</span>28<span class="cite-bracket">&#93;</span></a></sup> Generally, animals are asymptomatic.<sup id="cite_ref-CochraneSurg2013_1-6" class="reference"><a href="#cite_note-CochraneSurg2013-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> </p><p>Domestic pets are susceptible to MRSA infection by transmission from their owners; conversely, MRSA-infected pets can also transmit MRSA to humans.<sup id="cite_ref-29" class="reference"><a href="#cite_note-29"><span class="cite-bracket">&#91;</span>29<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Athletes">Athletes</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=6" title="Edit section: Athletes"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Changing_room" title="Changing room">Locker rooms</a>, <a href="/wiki/Gym" title="Gym">gyms</a>, and related athletic facilities offer potential sites for MRSA contamination and infection.<sup id="cite_ref-30" class="reference"><a href="#cite_note-30"><span class="cite-bracket">&#91;</span>30<span class="cite-bracket">&#93;</span></a></sup> Athletes have been identified as a high-risk group.<sup id="cite_ref-Gopal2017_19-3" class="reference"><a href="#cite_note-Gopal2017-19"><span class="cite-bracket">&#91;</span>19<span class="cite-bracket">&#93;</span></a></sup> A study linked MRSA to the abrasions caused by <a href="/wiki/Artificial_turf" title="Artificial turf">artificial turf</a>.<sup id="cite_ref-31" class="reference"><a href="#cite_note-31"><span class="cite-bracket">&#91;</span>31<span class="cite-bracket">&#93;</span></a></sup> Three studies by the Texas State Department of Health found the infection rate among football players was 16 times the national average. In October 2006, a high-school football player was temporarily paralyzed from MRSA-infected turf burns. His infection returned in January 2007 and required three surgeries to remove infected tissue, and three weeks of hospital stay.<sup id="cite_ref-epstein1_32-0" class="reference"><a href="#cite_note-epstein1-32"><span class="cite-bracket">&#91;</span>32<span class="cite-bracket">&#93;</span></a></sup> </p><p>In 2013, <a href="/wiki/Lawrence_Tynes" title="Lawrence Tynes">Lawrence Tynes</a>, <a href="/wiki/Carl_Nicks_(American_football)" title="Carl Nicks (American football)">Carl Nicks</a>, and <a href="/wiki/Johnthan_Banks" title="Johnthan Banks">Johnthan Banks</a> of the <a href="/wiki/Tampa_Bay_Buccaneers" title="Tampa Bay Buccaneers">Tampa Bay Buccaneers</a> were diagnosed with MRSA. Tynes and Nicks apparently did not contract the infection from each other, but whether Banks contracted it from either individual is unknown.<sup id="cite_ref-33" class="reference"><a href="#cite_note-33"><span class="cite-bracket">&#91;</span>33<span class="cite-bracket">&#93;</span></a></sup> In 2015, <a href="/wiki/Los_Angeles_Dodgers" title="Los Angeles Dodgers">Los Angeles Dodgers</a> infielder <a href="/wiki/Justin_Turner" title="Justin Turner">Justin Turner</a> was infected while the team visited the <a href="/wiki/New_York_Mets" title="New York Mets">New York Mets</a>.<sup id="cite_ref-34" class="reference"><a href="#cite_note-34"><span class="cite-bracket">&#91;</span>34<span class="cite-bracket">&#93;</span></a></sup> In October 2015, <a href="/wiki/New_York_Giants" title="New York Giants">New York Giants</a> tight end <a href="/wiki/Daniel_Fells" title="Daniel Fells">Daniel Fells</a> was hospitalized with a serious MRSA infection.<sup id="cite_ref-35" class="reference"><a href="#cite_note-35"><span class="cite-bracket">&#91;</span>35<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Children">Children</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=7" title="Edit section: Children"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>MRSA is becoming a critical problem in children;<sup id="cite_ref-36" class="reference"><a href="#cite_note-36"><span class="cite-bracket">&#91;</span>36<span class="cite-bracket">&#93;</span></a></sup> studies found 4.6% of patients in U.S. health-care facilities, (presumably) including hospital nurseries,<sup id="cite_ref-37" class="reference"><a href="#cite_note-37"><span class="cite-bracket">&#91;</span>37<span class="cite-bracket">&#93;</span></a></sup> were infected or colonized with MRSA.<sup id="cite_ref-APIC_38-0" class="reference"><a href="#cite_note-APIC-38"><span class="cite-bracket">&#91;</span>38<span class="cite-bracket">&#93;</span></a></sup> Children and adults who come in contact with day-care centers,<sup id="cite_ref-Gopal2017_19-4" class="reference"><a href="#cite_note-Gopal2017-19"><span class="cite-bracket">&#91;</span>19<span class="cite-bracket">&#93;</span></a></sup> playgrounds, locker rooms, camps, dormitories, classrooms and other school settings, and gyms and workout facilities are at higher risk of contracting MRSA. Parents should be especially cautious of children who participate in activities where sports equipment is shared, such as football helmets and uniforms.<sup id="cite_ref-39" class="reference"><a href="#cite_note-39"><span class="cite-bracket">&#91;</span>39<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Intravenous_drug_users">Intravenous drug users</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=8" title="Edit section: Intravenous drug users"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Needle-required drugs have caused an increase of MRSA,<sup id="cite_ref-40" class="reference"><a href="#cite_note-40"><span class="cite-bracket">&#91;</span>40<span class="cite-bracket">&#93;</span></a></sup> with injection drug use (IDU) making up 24.1% (1,839 individuals) of Tennessee Hospital's Discharge System. The unsanitary methods of injection causes an access point for the MRSA to enter the blood stream and begin infecting the host. Furthermore, with MRSA's high contagion rate,<sup id="cite_ref-Loewen_512–520_11-1" class="reference"><a href="#cite_note-Loewen_512–520-11"><span class="cite-bracket">&#91;</span>11<span class="cite-bracket">&#93;</span></a></sup> a common risk factor is individuals who are in constant contact with someone who has injected drugs in the past year. </p> <div class="mw-heading mw-heading2"><h2 id="Mechanism">Mechanism</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=9" title="Edit section: Mechanism"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Antimicrobial_resistance" title="Antimicrobial resistance">Antimicrobial resistance</a> is genetically based; resistance is mediated by the acquisition of extrachromosomal genetic elements containing genes that confer resistance to certain antibiotics. Examples of such elements include <a href="/wiki/Plasmid" title="Plasmid">plasmids</a>, <a href="/wiki/Transposable_element" title="Transposable element">transposable genetic elements</a>, and <a href="/wiki/Genomic_islands" class="mw-redirect" title="Genomic islands">genomic islands</a>, which can be transferred between bacteria through <a href="/wiki/Horizontal_gene_transfer" title="Horizontal gene transfer">horizontal gene transfer</a>.<sup id="cite_ref-jenson1_41-0" class="reference"><a href="#cite_note-jenson1-41"><span class="cite-bracket">&#91;</span>41<span class="cite-bracket">&#93;</span></a></sup> A defining characteristic of MRSA is its ability to thrive in the presence of <a href="/wiki/Penicillin" title="Penicillin">penicillin</a>-like antibiotics, which normally prevent bacterial growth by inhibiting synthesis of <a href="/wiki/Cell_wall" title="Cell wall">cell wall</a> material. This is due to a resistance gene, <i>mecA</i>, which stops β-lactam antibiotics from inactivating the enzymes (transpeptidases) critical for cell wall synthesis.<sup id="cite_ref-42" class="reference"><a href="#cite_note-42"><span class="cite-bracket">&#91;</span>42<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="SCCmec">SCC<i>mec</i></h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=10" title="Edit section: SCCmec"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Staphylococcal <a href="/wiki/Gene_cassette" title="Gene cassette">cassette chromosome</a> <i>mec</i> (<a href="/wiki/SCCmec" title="SCCmec">SCC<i>mec</i></a>) is a genomic island of unknown origin containing the antibiotic resistance gene <i>mecA</i>.<sup id="cite_ref-lowy1_43-0" class="reference"><a href="#cite_note-lowy1-43"><span class="cite-bracket">&#91;</span>43<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-monaco1_44-0" class="reference"><a href="#cite_note-monaco1-44"><span class="cite-bracket">&#91;</span>44<span class="cite-bracket">&#93;</span></a></sup> SCC<i>mec</i> contains additional genes beyond <i>mecA</i>, including the <a href="/wiki/Cytolysin" title="Cytolysin">cytolysin</a> gene <i>psm-mec</i>, which may suppress virulence in HA-acquired MRSA strains.<sup id="cite_ref-45" class="reference"><a href="#cite_note-45"><span class="cite-bracket">&#91;</span>45<span class="cite-bracket">&#93;</span></a></sup> In addition, this locus encodes strain-dependent gene regulatory RNAs known as <i>psm-mec</i>RNA.<sup id="cite_ref-46" class="reference"><a href="#cite_note-46"><span class="cite-bracket">&#91;</span>46<span class="cite-bracket">&#93;</span></a></sup> SCC<i>mec</i> also contains <i>ccrA</i> and <i>ccrB</i>; both genes encode recombinases that mediate the site-specific integration and excision of the SCC<i>mec</i> element from the <i>S. aureus</i> chromosome.<sup id="cite_ref-lowy1_43-1" class="reference"><a href="#cite_note-lowy1-43"><span class="cite-bracket">&#91;</span>43<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-monaco1_44-1" class="reference"><a href="#cite_note-monaco1-44"><span class="cite-bracket">&#91;</span>44<span class="cite-bracket">&#93;</span></a></sup> Currently, six unique SCC<i>mec</i> types ranging in size from 21 to 67 kb have been identified;<sup id="cite_ref-lowy1_43-2" class="reference"><a href="#cite_note-lowy1-43"><span class="cite-bracket">&#91;</span>43<span class="cite-bracket">&#93;</span></a></sup> they are designated types I–VI and are distinguished by variation in <i>mec</i> and <i>ccr</i> gene complexes.<sup id="cite_ref-jenson1_41-1" class="reference"><a href="#cite_note-jenson1-41"><span class="cite-bracket">&#91;</span>41<span class="cite-bracket">&#93;</span></a></sup> Owing to the size of the SCC<i>mec</i> element and the constraints of horizontal gene transfer, a minimum of five clones are thought to be responsible for the spread of MRSA infections, with clonal complex (CC) 8 most prevalent.<sup id="cite_ref-lowy1_43-3" class="reference"><a href="#cite_note-lowy1-43"><span class="cite-bracket">&#91;</span>43<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-47" class="reference"><a href="#cite_note-47"><span class="cite-bracket">&#91;</span>47<span class="cite-bracket">&#93;</span></a></sup> SCC<i>mec</i> is thought to have originated in the closely related <i><a href="/wiki/Staphylococcus_sciuri" class="mw-redirect" title="Staphylococcus sciuri">Staphylococcus sciuri</a></i> species and transferred horizontally to <i>S. aureus.</i><sup id="cite_ref-48" class="reference"><a href="#cite_note-48"><span class="cite-bracket">&#91;</span>48<span class="cite-bracket">&#93;</span></a></sup> </p><p>Different SCC<i>mec</i> genotypes confer different microbiological characteristics, such as different antimicrobial resistance rates.<sup id="cite_ref-kuo1_49-0" class="reference"><a href="#cite_note-kuo1-49"><span class="cite-bracket">&#91;</span>49<span class="cite-bracket">&#93;</span></a></sup> Different genotypes are also associated with different types of infections. Types I–III SCC<i>mec</i> are large elements that typically contain additional resistance genes and are characteristically isolated from HA-MRSA strains.<sup id="cite_ref-monaco1_44-2" class="reference"><a href="#cite_note-monaco1-44"><span class="cite-bracket">&#91;</span>44<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-kuo1_49-1" class="reference"><a href="#cite_note-kuo1-49"><span class="cite-bracket">&#91;</span>49<span class="cite-bracket">&#93;</span></a></sup> Conversely, CA-MRSA is associated with types IV and V, which are smaller and lack resistance genes other than <i>mecA</i>.<sup id="cite_ref-monaco1_44-3" class="reference"><a href="#cite_note-monaco1-44"><span class="cite-bracket">&#91;</span>44<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-kuo1_49-2" class="reference"><a href="#cite_note-kuo1-49"><span class="cite-bracket">&#91;</span>49<span class="cite-bracket">&#93;</span></a></sup> </p><p>These distinctions were thoroughly investigated by Collins et al. in 2001, and can be explained by the fitness differences associated with carriage of a large or small SCC<i>mec</i> plasmid. Carriage of large plasmids, such as SCC<i>mec</i>I–III, is costly to the bacteria, resulting in a compensatory decrease in <a href="/wiki/Virulence" title="Virulence">virulence</a> expression.<sup id="cite_ref-:0_50-0" class="reference"><a href="#cite_note-:0-50"><span class="cite-bracket">&#91;</span>50<span class="cite-bracket">&#93;</span></a></sup> MRSA is able to thrive in hospital settings with increased antibiotic resistance but decreased virulence – HA-MRSA targets immunocompromised, hospitalized hosts, thus a decrease in virulence is not maladaptive.<sup id="cite_ref-:0_50-1" class="reference"><a href="#cite_note-:0-50"><span class="cite-bracket">&#91;</span>50<span class="cite-bracket">&#93;</span></a></sup> In contrast, CA-MRSA tends to carry lower-fitness cost SCC<i>mec</i> elements to offset the increased virulence and toxicity expression required to infect healthy hosts.<sup id="cite_ref-:0_50-2" class="reference"><a href="#cite_note-:0-50"><span class="cite-bracket">&#91;</span>50<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="mecA"><i>mecA</i></h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=11" title="Edit section: mecA"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/MecA_(gene)" class="mw-redirect" title="MecA (gene)"><i>mecA</i></a> is a <a href="/wiki/Biomarker" title="Biomarker">biomarker</a> gene responsible for resistance to methicillin and other β-lactam antibiotics. After acquisition of <i>mecA</i>, the gene must be integrated and localized in the <i>S. aureus</i> chromosome.<sup id="cite_ref-lowy1_43-4" class="reference"><a href="#cite_note-lowy1-43"><span class="cite-bracket">&#91;</span>43<span class="cite-bracket">&#93;</span></a></sup> <i>mecA</i> encodes penicillin-binding protein 2a (PBP2a), which differs from other penicillin-binding proteins as its active site does not bind methicillin or other β-lactam antibiotics.<sup id="cite_ref-lowy1_43-5" class="reference"><a href="#cite_note-lowy1-43"><span class="cite-bracket">&#91;</span>43<span class="cite-bracket">&#93;</span></a></sup> As such, PBP2a can continue to catalyze the transpeptidation reaction required for <a href="/wiki/Peptidoglycan" title="Peptidoglycan">peptidoglycan</a> cross-linking, enabling cell wall synthesis even in the presence of antibiotics. As a consequence of the inability of PBP2a to interact with β-lactam moieties, acquisition of <i>mecA</i> confers resistance to all β-lactam antibiotics in addition to methicillin.<sup id="cite_ref-lowy1_43-6" class="reference"><a href="#cite_note-lowy1-43"><span class="cite-bracket">&#91;</span>43<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-51" class="reference"><a href="#cite_note-51"><span class="cite-bracket">&#91;</span>51<span class="cite-bracket">&#93;</span></a></sup> </p><p><i>mecA</i> is under the control of two <a href="/wiki/Regulatory_genes" class="mw-redirect" title="Regulatory genes">regulatory genes</a>, <i>mecI</i> and <i>mecR1</i>. MecI is usually bound to the <i>mecA</i> promoter and functions as a <a href="/wiki/Repressor" title="Repressor">repressor</a>.<sup id="cite_ref-jenson1_41-2" class="reference"><a href="#cite_note-jenson1-41"><span class="cite-bracket">&#91;</span>41<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-monaco1_44-4" class="reference"><a href="#cite_note-monaco1-44"><span class="cite-bracket">&#91;</span>44<span class="cite-bracket">&#93;</span></a></sup> In the presence of a β-lactam antibiotic, MecR1 initiates a <a href="/wiki/Signal_transduction_cascade" class="mw-redirect" title="Signal transduction cascade">signal transduction cascade</a> that leads to transcriptional activation of <i>mecA</i>.<sup id="cite_ref-jenson1_41-3" class="reference"><a href="#cite_note-jenson1-41"><span class="cite-bracket">&#91;</span>41<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-monaco1_44-5" class="reference"><a href="#cite_note-monaco1-44"><span class="cite-bracket">&#91;</span>44<span class="cite-bracket">&#93;</span></a></sup> This is achieved by MecR1-mediated cleavage of MecI, which alleviates MecI repression.<sup id="cite_ref-jenson1_41-4" class="reference"><a href="#cite_note-jenson1-41"><span class="cite-bracket">&#91;</span>41<span class="cite-bracket">&#93;</span></a></sup> <i>mecA</i> is further controlled by two co-repressors, <i>blaI</i> and <i>blaR1</i>. <i>blaI</i> and <i>blaR1</i> are homologous to <i>mecI</i> and <i>mecR1</i>, respectively, and normally function as regulators of <i>blaZ</i>, which is responsible for penicillin resistance.<sup id="cite_ref-lowy1_43-7" class="reference"><a href="#cite_note-lowy1-43"><span class="cite-bracket">&#91;</span>43<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-berger-bachi_52-0" class="reference"><a href="#cite_note-berger-bachi-52"><span class="cite-bracket">&#91;</span>52<span class="cite-bracket">&#93;</span></a></sup> The DNA sequences bound by <i>mecI</i> and <i>blaI</i> are identical;<sup id="cite_ref-lowy1_43-8" class="reference"><a href="#cite_note-lowy1-43"><span class="cite-bracket">&#91;</span>43<span class="cite-bracket">&#93;</span></a></sup> therefore, <i>blaI</i> can also bind the <i>mecA</i> operator to repress transcription of <i>mecA</i>.<sup id="cite_ref-berger-bachi_52-1" class="reference"><a href="#cite_note-berger-bachi-52"><span class="cite-bracket">&#91;</span>52<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Arginine_catabolic_mobile_element">Arginine catabolic mobile element</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=12" title="Edit section: Arginine catabolic mobile element"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The <a href="/wiki/Arginine_catabolic_mobile_element" title="Arginine catabolic mobile element">arginine catabolic mobile element</a> (ACME) is a virulence factor present in many MRSA strains but not prevalent in MSSA.<sup id="cite_ref-&#80;MID17409207_53-0" class="reference"><a href="#cite_note-PMID17409207-53"><span class="cite-bracket">&#91;</span>53<span class="cite-bracket">&#93;</span></a></sup> SpeG-positive ACME compensates for the <a href="/wiki/Polyamine" title="Polyamine">polyamine</a> hypersensitivity of <i>S. aureus</i> and facilitates stable skin colonization, wound infection, and person-to-person transmission.<sup id="cite_ref-54" class="reference"><a href="#cite_note-54"><span class="cite-bracket">&#91;</span>54<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Strains">Strains</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=13" title="Edit section: Strains"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:MecA_Resistance.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/c/c8/MecA_Resistance.svg/220px-MecA_Resistance.svg.png" decoding="async" width="220" height="92" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/c/c8/MecA_Resistance.svg/330px-MecA_Resistance.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/c/c8/MecA_Resistance.svg/440px-MecA_Resistance.svg.png 2x" data-file-width="1549" data-file-height="647" /></a><figcaption>Diagram depicting antibiotic resistance through alteration of the antibiotic's target site, modeled after MRSA's resistance to penicillin. Beta-lactam antibiotics permanently inactivate <a href="/wiki/Penicillin_binding_protein" class="mw-redirect" title="Penicillin binding protein">PBP enzymes</a>, which are essential for cell wall synthesis and thus for bacterial life, by permanently binding to their active sites. Some forms of MRSA, however, express a different PBP that will not allow the antibiotic into its active site.</figcaption></figure> <p>Acquisition of SCC<i>mec</i> in methicillin-sensitive <i>S. aureus</i> (MSSA) gives rise to a number of genetically different MRSA lineages. These genetic variations within different MRSA strains possibly explain the variability in virulence and associated MRSA infections.<sup id="cite_ref-GordonLowy2008_55-0" class="reference"><a href="#cite_note-GordonLowy2008-55"><span class="cite-bracket">&#91;</span>55<span class="cite-bracket">&#93;</span></a></sup> The first MRSA strain, ST250 MRSA-1, originated from SCC<i>mec</i> and ST250-MSSA integration.<sup id="cite_ref-GordonLowy2008_55-1" class="reference"><a href="#cite_note-GordonLowy2008-55"><span class="cite-bracket">&#91;</span>55<span class="cite-bracket">&#93;</span></a></sup> Historically, major MRSA clones ST2470-MRSA-I, ST239-MRSA-III, ST5-MRSA-II, and ST5-MRSA-IV were responsible for causing hospital-acquired MRSA (HA-MRSA) infections.<sup id="cite_ref-GordonLowy2008_55-2" class="reference"><a href="#cite_note-GordonLowy2008-55"><span class="cite-bracket">&#91;</span>55<span class="cite-bracket">&#93;</span></a></sup> ST239-MRSA-III, known as the Brazilian clone, was highly transmissible compared to others and distributed in Argentina, Czech Republic, and Portugal.<sup id="cite_ref-GordonLowy2008_55-3" class="reference"><a href="#cite_note-GordonLowy2008-55"><span class="cite-bracket">&#91;</span>55<span class="cite-bracket">&#93;</span></a></sup> </p><p>In the UK, the most common strains of MRSA are EMRSA15 and EMRSA16.<sup id="cite_ref-JAntimicrobChemother2001-Johnson_56-0" class="reference"><a href="#cite_note-JAntimicrobChemother2001-Johnson-56"><span class="cite-bracket">&#91;</span>56<span class="cite-bracket">&#93;</span></a></sup> EMRSA16 has been found to be identical to the <a href="/wiki/MLST" class="mw-redirect" title="MLST">ST</a>36:USA200 strain, which circulates in the United States, and to carry the SCC<i>mec</i> type II, <a href="/wiki/Enterotoxin" title="Enterotoxin">enterotoxin</a> A and <a href="/wiki/Toxic_shock_syndrome" title="Toxic shock syndrome">toxic shock syndrome</a> toxin 1 genes.<sup id="cite_ref-diep2006_57-0" class="reference"><a href="#cite_note-diep2006-57"><span class="cite-bracket">&#91;</span>57<span class="cite-bracket">&#93;</span></a></sup> Under the new international typing system, this strain is now called MRSA252. EMRSA 15 is also found to be one of the common MRSA strains in Asia. Other common strains include ST5:USA100 and EMRSA 1.<sup id="cite_ref-StefaniChung2012_58-0" class="reference"><a href="#cite_note-StefaniChung2012-58"><span class="cite-bracket">&#91;</span>58<span class="cite-bracket">&#93;</span></a></sup> These strains are genetic characteristics of HA-MRSA.<sup id="cite_ref-calfee2011_59-0" class="reference"><a href="#cite_note-calfee2011-59"><span class="cite-bracket">&#91;</span>59<span class="cite-bracket">&#93;</span></a></sup> </p><p>Community-acquired MRSA (CA-MRSA) strains emerged in late 1990 to 2000, infecting healthy people who had not been in contact with healthcare facilities.<sup id="cite_ref-calfee2011_59-1" class="reference"><a href="#cite_note-calfee2011-59"><span class="cite-bracket">&#91;</span>59<span class="cite-bracket">&#93;</span></a></sup> Researchers suggest that CA-MRSA did not evolve from HA-MRSA.<sup id="cite_ref-calfee2011_59-2" class="reference"><a href="#cite_note-calfee2011-59"><span class="cite-bracket">&#91;</span>59<span class="cite-bracket">&#93;</span></a></sup> This is further proven by molecular typing of CA-MRSA strains<sup id="cite_ref-daum2007_60-0" class="reference"><a href="#cite_note-daum2007-60"><span class="cite-bracket">&#91;</span>60<span class="cite-bracket">&#93;</span></a></sup> and genome comparison between CA-MRSA and HA-MRSA, which indicate that novel MRSA strains integrated SCC<i>mec</i> into MSSA separately on its own.<sup id="cite_ref-calfee2011_59-3" class="reference"><a href="#cite_note-calfee2011-59"><span class="cite-bracket">&#91;</span>59<span class="cite-bracket">&#93;</span></a></sup> By mid-2000, CA-MRSA was introduced into healthcare systems and distinguishing CA-MRSA from HA-MRSA became a difficult process.<sup id="cite_ref-calfee2011_59-4" class="reference"><a href="#cite_note-calfee2011-59"><span class="cite-bracket">&#91;</span>59<span class="cite-bracket">&#93;</span></a></sup> Community-acquired MRSA is more easily treated and more virulent than hospital-acquired MRSA (HA-MRSA).<sup id="cite_ref-calfee2011_59-5" class="reference"><a href="#cite_note-calfee2011-59"><span class="cite-bracket">&#91;</span>59<span class="cite-bracket">&#93;</span></a></sup> The genetic mechanism for the enhanced virulence in CA-MRSA remains an active area of research. The <a href="/wiki/Panton%E2%80%93Valentine_leukocidin" title="Panton–Valentine leukocidin">Panton–Valentine leukocidin</a> (PVL) genes are of particular interest because they are a unique feature of CA-MRSA.<sup id="cite_ref-GordonLowy2008_55-4" class="reference"><a href="#cite_note-GordonLowy2008-55"><span class="cite-bracket">&#91;</span>55<span class="cite-bracket">&#93;</span></a></sup> </p><p>In the United States, most cases of CA-MRSA are caused by a CC8 strain designated <a href="/wiki/ST8:USA300" title="ST8:USA300">ST8:USA300</a>, which carries SCC<i>mec</i> type IV, <a href="/wiki/Panton%E2%80%93Valentine_leukocidin" title="Panton–Valentine leukocidin">Panton–Valentine leukocidin</a>, <a href="/wiki/Phenol-soluble_modulin" title="Phenol-soluble modulin">PSM-alpha</a> and <a href="/wiki/Enterotoxin" title="Enterotoxin">enterotoxins</a> Q and K,<sup id="cite_ref-diep2006_57-1" class="reference"><a href="#cite_note-diep2006-57"><span class="cite-bracket">&#91;</span>57<span class="cite-bracket">&#93;</span></a></sup> and <a href="/w/index.php?title=ST1:USA400&amp;action=edit&amp;redlink=1" class="new" title="ST1:USA400 (page does not exist)">ST1:USA400</a>.<sup id="cite_ref-61" class="reference"><a href="#cite_note-61"><span class="cite-bracket">&#91;</span>61<span class="cite-bracket">&#93;</span></a></sup> The ST8:USA300 strain results in skin infections, <a href="/wiki/Necrotizing_fasciitis" title="Necrotizing fasciitis">necrotizing fasciitis</a>, and toxic shock syndrome, whereas the ST1:USA400 strain results in necrotizing pneumonia and pulmonary sepsis.<sup id="cite_ref-GordonLowy2008_55-5" class="reference"><a href="#cite_note-GordonLowy2008-55"><span class="cite-bracket">&#91;</span>55<span class="cite-bracket">&#93;</span></a></sup> Other community-acquired strains of MRSA are ST8:USA500 and ST59:USA1000. In many nations of the world, MRSA strains with different genetic background types have come to predominate among CA-MRSA strains; USA300 easily tops the list in the U.S. and is becoming more common in Canada after its first appearance there in 2004. For example, in Australia, ST93 strains are common, while in continental Europe ST80 strains, which carry SCC<i>mec</i> type IV, predominate.<sup id="cite_ref-62" class="reference"><a href="#cite_note-62"><span class="cite-bracket">&#91;</span>62<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-GouldDavid2012_63-0" class="reference"><a href="#cite_note-GouldDavid2012-63"><span class="cite-bracket">&#91;</span>63<span class="cite-bracket">&#93;</span></a></sup> In Taiwan, ST59 strains, some of which are resistant to many non-beta-lactam antibiotics, have arisen as common causes of skin and soft tissue infections in the community. In a remote region of Alaska, unlike most of the continental U.S., USA300 was found only rarely in a study of MRSA strains from outbreaks in 1996 and 2000 as well as in surveillance from 2004 to 2006.<sup id="cite_ref-pmid18976551_64-0" class="reference"><a href="#cite_note-pmid18976551-64"><span class="cite-bracket">&#91;</span>64<span class="cite-bracket">&#93;</span></a></sup> </p><p>A MRSA strain, <a href="/wiki/CC398" title="CC398">CC398</a>, is found in <a href="/wiki/Intensive_animal_farming" title="Intensive animal farming">intensively reared</a> production animals (primarily pigs, but also cattle and poultry), where it can be transmitted to humans as LA-MRSA (livestock-associated MRSA).<sup id="cite_ref-StefaniChung2012_58-1" class="reference"><a href="#cite_note-StefaniChung2012-58"><span class="cite-bracket">&#91;</span>58<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-65" class="reference"><a href="#cite_note-65"><span class="cite-bracket">&#91;</span>65<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-GravelandDuim2011_66-0" class="reference"><a href="#cite_note-GravelandDuim2011-66"><span class="cite-bracket">&#91;</span>66<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Diagnosis">Diagnosis</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=14" title="Edit section: Diagnosis"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:MRSA_on_a_selective_choromogenic_media_plate.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/7/77/MRSA_on_a_selective_choromogenic_media_plate.jpg/220px-MRSA_on_a_selective_choromogenic_media_plate.jpg" decoding="async" width="220" height="246" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/7/77/MRSA_on_a_selective_choromogenic_media_plate.jpg/330px-MRSA_on_a_selective_choromogenic_media_plate.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/7/77/MRSA_on_a_selective_choromogenic_media_plate.jpg/440px-MRSA_on_a_selective_choromogenic_media_plate.jpg 2x" data-file-width="1836" data-file-height="2052" /></a><figcaption>A selective and differential chromogenic medium for the qualitative direct detection of MRSA</figcaption></figure> <figure class="mw-default-size mw-halign-right" typeof="mw:File/Thumb"><a href="/wiki/File:MRSA_on_MHA_media_resistant_to_oxacillin_antibiotic_strip.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/d/d7/MRSA_on_MHA_media_resistant_to_oxacillin_antibiotic_strip.jpg/220px-MRSA_on_MHA_media_resistant_to_oxacillin_antibiotic_strip.jpg" decoding="async" width="220" height="219" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/d/d7/MRSA_on_MHA_media_resistant_to_oxacillin_antibiotic_strip.jpg/330px-MRSA_on_MHA_media_resistant_to_oxacillin_antibiotic_strip.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/d/d7/MRSA_on_MHA_media_resistant_to_oxacillin_antibiotic_strip.jpg/440px-MRSA_on_MHA_media_resistant_to_oxacillin_antibiotic_strip.jpg 2x" data-file-width="1776" data-file-height="1764" /></a><figcaption>MRSA resistance to oxacillin being tested. The top <i>S. aureus</i> isolate is a control that is not resistant to oxacillin; the other three isolates are MRSA-positive.</figcaption></figure> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:Muller_Hinton_agar_with_MRSA.jpg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/6/61/Muller_Hinton_agar_with_MRSA.jpg/220px-Muller_Hinton_agar_with_MRSA.jpg" decoding="async" width="220" height="165" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/6/61/Muller_Hinton_agar_with_MRSA.jpg/330px-Muller_Hinton_agar_with_MRSA.jpg 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/6/61/Muller_Hinton_agar_with_MRSA.jpg/440px-Muller_Hinton_agar_with_MRSA.jpg 2x" data-file-width="2048" data-file-height="1536" /></a><figcaption><a href="/wiki/Mueller%E2%80%93Hinton_agar" title="Mueller–Hinton agar">Mueller–Hinton agar</a> showing MRSA resistant to an oxacillin disk</figcaption></figure> <p>Diagnostic microbiology laboratories and reference laboratories are key for identifying outbreaks of MRSA. Normally, a bacterium must be cultured from blood, urine, <a href="/wiki/Sputum" title="Sputum">sputum</a>, or other body-fluid samples, and in sufficient quantities to perform confirmatory tests early-on. Still, because no quick and easy method exists to diagnose MRSA, initial treatment of the infection is often based upon "strong suspicion" and techniques by the treating physician; these include <a href="/wiki/Quantitative_PCR" class="mw-redirect" title="Quantitative PCR">quantitative PCR</a> procedures, which are employed in clinical laboratories for quickly detecting and identifying MRSA strains.<sup id="cite_ref-FrancoisP_67-0" class="reference"><a href="#cite_note-FrancoisP-67"><span class="cite-bracket">&#91;</span>67<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-Mackay_68-0" class="reference"><a href="#cite_note-Mackay-68"><span class="cite-bracket">&#91;</span>68<span class="cite-bracket">&#93;</span></a></sup> </p><p>Another common laboratory test is a rapid latex <a href="/wiki/Agglutination_(biology)" title="Agglutination (biology)">agglutination</a> test that detects the PBP2a protein. PBP2a is a variant <a href="/wiki/Penicillin-binding_protein" class="mw-redirect" title="Penicillin-binding protein">penicillin-binding protein</a> that imparts the ability of <i>S. aureus</i> to be resistant to oxacillin.<sup id="cite_ref-Hardy_69-0" class="reference"><a href="#cite_note-Hardy-69"><span class="cite-bracket">&#91;</span>69<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Microbiology">Microbiology</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=15" title="Edit section: Microbiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Like all <i>S. aureus</i> (also abbreviated SA at times), methicillin-resistant <i>S. aureus</i> is a gram-positive, spherical (<a href="/wiki/Coccus" class="mw-redirect" title="Coccus">coccus</a>) <a href="/wiki/Bacterium" class="mw-redirect" title="Bacterium">bacterium</a> about 1 <a href="/wiki/Micron" class="mw-redirect" title="Micron">micron</a> in <a href="/wiki/Diameter" title="Diameter">diameter</a>. It does not form <a href="/wiki/Endospore" title="Endospore">spores</a> and it is not <a href="/wiki/Motility" title="Motility">motile</a>. It is frequently found in grape-like clusters or chains.<sup id="cite_ref-Murray_70-0" class="reference"><a href="#cite_note-Murray-70"><span class="cite-bracket">&#91;</span>70<span class="cite-bracket">&#93;</span></a></sup><sup class="reference nowrap"><span title="Page / location: 390">&#58;&#8202;390&#8202;</span></sup> Unlike methicillin-susceptible <i>S. aureus</i> (MSSA), MRSA is slow-growing on a variety of media and has been found to exist in mixed colonies of MSSA. The <i>mecA</i> gene, which confers resistance to a number of antibiotics, is always present in MRSA and usually absent in MSSA; however, in some instances, the <i>mecA</i> gene is present in MSSA but is not <a href="/wiki/Gene_expression" title="Gene expression">expressed</a>. <a href="/wiki/Polymerase_chain_reaction" title="Polymerase chain reaction">Polymerase chain reaction</a> (PCR) testing is the most precise method for identifying MRSA strains. Specialized culture media have been developed to better differentiate between MSSA and MRSA and, in some cases, such media can be used to identify specific strains that are resistant to different antibiotics.<sup id="cite_ref-Murray_70-1" class="reference"><a href="#cite_note-Murray-70"><span class="cite-bracket">&#91;</span>70<span class="cite-bracket">&#93;</span></a></sup><sup class="reference nowrap"><span title="Page / location: 402">&#58;&#8202;402&#8202;</span></sup> </p><p>Other strains of <i>S. aureus</i> have emerged that are resistant to <a href="/wiki/Oxacillin" title="Oxacillin">oxacillin</a>, clindamycin, teicoplanin, and <a href="/wiki/Erythromycin" title="Erythromycin">erythromycin</a>. These resistant strains may or may not possess the <i>mecA</i> gene. <i>S. aureus</i> has also developed resistance to <a href="/wiki/Vancomycin" title="Vancomycin">vancomycin</a> (VRSA). One strain is only partially susceptible to vancomycin and is called vancomycin-intermediate <i>S. aureus</i> (VISA). GISA, a strain of resistant<i> S. aureus</i>, is glycopeptide-intermediate <i>S. aureus</i> and is less suspectible to vancomycin and teicoplanin. Resistance to antibiotics in <i>S. aureus</i> can be quantified by determining the amount of the antibiotic that must be used to inhibit growth. If <i>S. aureus</i> is inhibited at a concentration of vancomycin less than or equal to 4 μg/ml, it is said to be susceptible. If a concentration greater than 32 μg/ml is necessary to inhibit growth, it is said to be resistant.<sup id="cite_ref-Winn_21-1" class="reference"><a href="#cite_note-Winn-21"><span class="cite-bracket">&#91;</span>21<span class="cite-bracket">&#93;</span></a></sup><sup class="reference nowrap"><span title="Page / location: 637">&#58;&#8202;637&#8202;</span></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Prevention">Prevention</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=16" title="Edit section: Prevention"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Screening">Screening</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=17" title="Edit section: Screening"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In health-care settings, isolating those with MRSA from those without the infection is one method to prevent transmission. Rapid culture and sensitivity testing and molecular testing identifies carriers and reduces infection rates.<sup id="cite_ref-71" class="reference"><a href="#cite_note-71"><span class="cite-bracket">&#91;</span>71<span class="cite-bracket">&#93;</span></a></sup> It is especially important to test patients in these settings since 2% of people are <a href="/wiki/Asymptomatic_carrier" title="Asymptomatic carrier">carriers</a> of MRSA, even though in many of these cases the bacteria reside in the nostril and the patient will not present any symptoms.<sup id="cite_ref-72" class="reference"><a href="#cite_note-72"><span class="cite-bracket">&#91;</span>72<span class="cite-bracket">&#93;</span></a></sup> </p><p>MRSA can be identified by swabbing the nostrils and isolating the bacteria found there. Combined with extra sanitary measures for those in contact with infected people, swab screening people admitted to hospitals has been found to be effective in minimizing the spread of MRSA in hospitals in the United States, <a href="/wiki/Denmark" title="Denmark">Denmark</a>, <a href="/wiki/Finland" title="Finland">Finland</a>, and the <a href="/wiki/Netherlands" title="Netherlands">Netherlands</a>.<sup id="cite_ref-73" class="reference"><a href="#cite_note-73"><span class="cite-bracket">&#91;</span>73<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Handwashing">Handwashing</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=18" title="Edit section: Handwashing"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>The <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">Centers for Disease Control and Prevention</a> offers suggestions for preventing the contraction and spread of MRSA infection which are applicable to those in community settings, including incarcerated populations, childcare center employees, and athletes. To prevent the spread of MRSA, the recommendations are to <a href="/wiki/Handwashing" class="mw-redirect" title="Handwashing">wash hands</a> thoroughly and regularly using soap and water or an alcohol-based sanitizer. Additional recommendations are to keep wounds clean and covered, avoid contact with other people's wounds, avoid sharing personal items such as razors or towels, shower after exercising at athletic facilities, and shower before using swimming pools or whirlpools.<sup id="cite_ref-74" class="reference"><a href="#cite_note-74"><span class="cite-bracket">&#91;</span>74<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Isolation">Isolation</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=19" title="Edit section: Isolation"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Excluding <a href="/wiki/Medical_facility" class="mw-redirect" title="Medical facility">medical facilities</a>, current US guidance does not require workers with MRSA infections to be routinely excluded from the general workplace.<sup id="cite_ref-NIOSH_MRSA_75-0" class="reference"><a href="#cite_note-NIOSH_MRSA-75"><span class="cite-bracket">&#91;</span>75<span class="cite-bracket">&#93;</span></a></sup> The <a href="/wiki/National_Institutes_of_Health" title="National Institutes of Health">National Institutes of Health</a> recommend that those with wound drainage that cannot be covered and contained with a clean, dry bandage and those who cannot maintain good hygiene practices be reassigned,<sup id="cite_ref-NIOSH_MRSA_75-1" class="reference"><a href="#cite_note-NIOSH_MRSA-75"><span class="cite-bracket">&#91;</span>75<span class="cite-bracket">&#93;</span></a></sup> and patients with wound drainage should also automatically be put on "<a href="/wiki/Transmission-based_precaution" class="mw-redirect" title="Transmission-based precaution">Contact Precaution</a>," regardless of whether or not they have a known infection.<sup id="cite_ref-cdc.gov_76-0" class="reference"><a href="#cite_note-cdc.gov-76"><span class="cite-bracket">&#91;</span>76<span class="cite-bracket">&#93;</span></a></sup> Workers with active infections are excluded from activities where skin-to-skin contact is likely to occur.<sup id="cite_ref-CDC1998_77-0" class="reference"><a href="#cite_note-CDC1998-77"><span class="cite-bracket">&#91;</span>77<span class="cite-bracket">&#93;</span></a></sup> To prevent the spread of staphylococci or MRSA in the workplace, employers are encouraged to make available adequate facilities that support good hygiene. In addition, surface and equipment sanitizing should conform to <a href="/wiki/Environmental_Protection_Agency" class="mw-redirect" title="Environmental Protection Agency">Environmental Protection Agency</a>-registered disinfectants.<sup id="cite_ref-NIOSH_MRSA_75-2" class="reference"><a href="#cite_note-NIOSH_MRSA-75"><span class="cite-bracket">&#91;</span>75<span class="cite-bracket">&#93;</span></a></sup> In hospital settings, contact isolation can be stopped after one to three cultures come back negative.<sup id="cite_ref-Ban2018_78-0" class="reference"><a href="#cite_note-Ban2018-78"><span class="cite-bracket">&#91;</span>78<span class="cite-bracket">&#93;</span></a></sup> Before the patient is cleared from isolation, it is advised that there is dedicated patient-care or single-use equipment for that particular patient. If this is not possible, the equipment must be properly disinfected before it is used on another patient.<sup id="cite_ref-cdc.gov_76-1" class="reference"><a href="#cite_note-cdc.gov-76"><span class="cite-bracket">&#91;</span>76<span class="cite-bracket">&#93;</span></a></sup> </p><p>To prevent the spread of MRSA in the home, health departments recommend laundering materials that have come into contact with infected persons separately and with a dilute bleach solution; to reduce the bacterial load in one's nose and skin; and to clean and disinfect those things in the house that people regularly touch, such as sinks, tubs, kitchen counters, cell phones, light switches, doorknobs, phones, toilets, and computer keyboards.<sup id="cite_ref-tpchd_79-0" class="reference"><a href="#cite_note-tpchd-79"><span class="cite-bracket">&#91;</span>79<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Restricting_antibiotic_use">Restricting antibiotic use</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=20" title="Edit section: Restricting antibiotic use"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p><a href="/wiki/Glycopeptide_antibiotic" title="Glycopeptide antibiotic">Glycopeptides</a>, <a href="/wiki/Cephalosporin" title="Cephalosporin">cephalosporins</a>, and in particular, <a href="/wiki/Quinolone_antibiotic" title="Quinolone antibiotic">quinolones</a> are associated with an increased risk of colonisation of MRSA. Reducing use of antibiotic classes that promote MRSA colonisation, especially fluoroquinolones, is recommended in current guidelines.<sup id="cite_ref-tacconelli2008_12-2" class="reference"><a href="#cite_note-tacconelli2008-12"><span class="cite-bracket">&#91;</span>12<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-muto2003_25-1" class="reference"><a href="#cite_note-muto2003-25"><span class="cite-bracket">&#91;</span>25<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Public_health_considerations">Public health considerations</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=21" title="Edit section: Public health considerations"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Mathematical models describe one way in which a loss of infection control can occur after measures for screening and isolation seem to be effective for years, as happened in the UK. In the "search and destroy" strategy that was employed by all UK hospitals until the mid-1990s, all hospitalized people with MRSA were immediately isolated, and all staff were screened for MRSA and were prevented from working until they had completed a course of eradication therapy that was proven to work. Loss of control occurs because colonised people are discharged back into the community and then readmitted; when the number of colonised people in the community reaches a certain threshold, the "search and destroy" strategy is overwhelmed.<sup id="cite_ref-80" class="reference"><a href="#cite_note-80"><span class="cite-bracket">&#91;</span>80<span class="cite-bracket">&#93;</span></a></sup> One of the few countries not to have been overwhelmed by MRSA is the Netherlands: an important part of the success of the Dutch strategy may have been to attempt eradication of carriage upon discharge from hospital.<sup id="cite_ref-bootsma2006_81-0" class="reference"><a href="#cite_note-bootsma2006-81"><span class="cite-bracket">&#91;</span>81<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Decolonization">Decolonization</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=22" title="Edit section: Decolonization"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">Main article: <a href="/wiki/Decolonization_(medicine)" title="Decolonization (medicine)">Decolonization (medicine)</a></div> <p>As of 2013, no randomized clinical trials had been conducted to understand how to treat nonsurgical wounds that had been colonized, but not infected, with MRSA,<sup id="cite_ref-CochraneNonSurg2013_22-2" class="reference"><a href="#cite_note-CochraneNonSurg2013-22"><span class="cite-bracket">&#91;</span>22<span class="cite-bracket">&#93;</span></a></sup> and insufficient studies had been conducted to understand how to treat surgical wounds that had been colonized with MRSA.<sup id="cite_ref-CochraneSurg2013_1-7" class="reference"><a href="#cite_note-CochraneSurg2013-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> As of 2013, whether strategies to eradicate MRSA colonization of people in nursing homes reduced infection rates was not known.<sup id="cite_ref-CochraneNursHomeStop2013_26-1" class="reference"><a href="#cite_note-CochraneNursHomeStop2013-26"><span class="cite-bracket">&#91;</span>26<span class="cite-bracket">&#93;</span></a></sup> </p><p>Care should be taken when trying to drain boils, as disruption of surrounding tissue can lead to larger infections, including <a href="/wiki/Sepsis" title="Sepsis">infection of the blood stream</a>.<sup id="cite_ref-NIH_82-0" class="reference"><a href="#cite_note-NIH-82"><span class="cite-bracket">&#91;</span>82<span class="cite-bracket">&#93;</span></a></sup> <a href="/wiki/Mupirocin" title="Mupirocin">Mupirocin</a> 2% ointment can be effective at reducing the size of lesions. A secondary covering of clothing is preferred.<sup id="cite_ref-tpchd_79-1" class="reference"><a href="#cite_note-tpchd-79"><span class="cite-bracket">&#91;</span>79<span class="cite-bracket">&#93;</span></a></sup> As shown in an animal study with diabetic mice, the topical application of a mixture of sugar (70%) and 3% povidone-iodine paste is an effective agent for the treatment of diabetic ulcers with MRSA infection.<sup id="cite_ref-83" class="reference"><a href="#cite_note-83"><span class="cite-bracket">&#91;</span>83<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Community_settings">Community settings</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=23" title="Edit section: Community settings"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1251242444">.mw-parser-output .ambox{border:1px solid #a2a9b1;border-left:10px solid #36c;background-color:#fbfbfb;box-sizing:border-box}.mw-parser-output .ambox+link+.ambox,.mw-parser-output .ambox+link+style+.ambox,.mw-parser-output .ambox+link+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+style+.ambox,.mw-parser-output .ambox+.mw-empty-elt+link+link+.ambox{margin-top:-1px}html body.mediawiki .mw-parser-output .ambox.mbox-small-left{margin:4px 1em 4px 0;overflow:hidden;width:238px;border-collapse:collapse;font-size:88%;line-height:1.25em}.mw-parser-output .ambox-speedy{border-left:10px solid #b32424;background-color:#fee7e6}.mw-parser-output .ambox-delete{border-left:10px solid #b32424}.mw-parser-output .ambox-content{border-left:10px solid #f28500}.mw-parser-output .ambox-style{border-left:10px solid #fc3}.mw-parser-output .ambox-move{border-left:10px solid #9932cc}.mw-parser-output .ambox-protection{border-left:10px solid #a2a9b1}.mw-parser-output .ambox .mbox-text{border:none;padding:0.25em 0.5em;width:100%}.mw-parser-output .ambox .mbox-image{border:none;padding:2px 0 2px 0.5em;text-align:center}.mw-parser-output .ambox .mbox-imageright{border:none;padding:2px 0.5em 2px 0;text-align:center}.mw-parser-output .ambox .mbox-empty-cell{border:none;padding:0;width:1px}.mw-parser-output .ambox .mbox-image-div{width:52px}@media(min-width:720px){.mw-parser-output .ambox{margin:0 10%}}@media print{body.ns-0 .mw-parser-output .ambox{display:none!important}}</style><table class="box-Globalize plainlinks metadata ambox ambox-content ambox-globalize" role="presentation"><tbody><tr><td class="mbox-image"><div class="mbox-image-div"><span typeof="mw:File"><span><img alt="Globe icon." src="//upload.wikimedia.org/wikipedia/commons/thumb/b/bd/Ambox_globe_content.svg/48px-Ambox_globe_content.svg.png" decoding="async" width="48" height="40" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/b/bd/Ambox_globe_content.svg/73px-Ambox_globe_content.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/b/bd/Ambox_globe_content.svg/97px-Ambox_globe_content.svg.png 2x" data-file-width="350" data-file-height="290" /></span></span></div></td><td class="mbox-text"><div class="mbox-text-span">The examples and perspective in this section <b>deal primarily with the United Kingdom and do not represent a <a href="/wiki/Wikipedia:WikiProject_Countering_systemic_bias" title="Wikipedia:WikiProject Countering systemic bias">worldwide view</a> of the subject</b>.<span class="hide-when-compact"> You may <a class="external text" href="https://en.wikipedia.org/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit">improve this section</a>, discuss the issue on the <a href="/wiki/Talk:Methicillin-resistant_Staphylococcus_aureus" title="Talk:Methicillin-resistant Staphylococcus aureus">talk page</a>, or create a new section, as appropriate.</span> <span class="date-container"><i>(<span class="date">August 2020</span>)</i></span><span class="hide-when-compact"><i> (<small><a href="/wiki/Help:Maintenance_template_removal" title="Help:Maintenance template removal">Learn how and when to remove this message</a></small>)</i></span></div></td></tr></tbody></table> <p>Maintaining the necessary cleanliness may be difficult for people if they do not have access to facilities such as public toilets with handwashing facilities. In the United Kingdom, the <a href="/wiki/Workplace_(Health,_Safety_and_Welfare)_Regulations_1992" title="Workplace (Health, Safety and Welfare) Regulations 1992">Workplace (Health, Safety and Welfare) Regulations 1992</a><sup id="cite_ref-84" class="reference"><a href="#cite_note-84"><span class="cite-bracket">&#91;</span>84<span class="cite-bracket">&#93;</span></a></sup> require businesses to provide toilets for their employees, along with washing facilities including soap or other suitable means of cleaning. Guidance on how many toilets to provide and what sort of washing facilities should be provided alongside them is given in the Workplace (Health, Safety and Welfare) Approved Code of Practice and Guidance L24, available from <a rel="nofollow" class="external text" href="https://web.archive.org/web/20150512005700/http://www.hsebooks.co.uk/">Health and Safety Executive Books</a>, but no legal obligations exist on local authorities in the United Kingdom to provide <a href="/wiki/Public_toilet" title="Public toilet">public toilets</a>, and although in 2008, the House of Commons <a href="/wiki/Communities_and_Local_Government_Committee" class="mw-redirect" title="Communities and Local Government Committee">Communities and Local Government Committee</a> called for a duty on local authorities to develop a public toilet strategy,<sup id="cite_ref-85" class="reference"><a href="#cite_note-85"><span class="cite-bracket">&#91;</span>85<span class="cite-bracket">&#93;</span></a></sup> this was rejected by the Government.<sup id="cite_ref-86" class="reference"><a href="#cite_note-86"><span class="cite-bracket">&#91;</span>86<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Agriculture">Agriculture</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=24" title="Edit section: Agriculture"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Antibiotic_use_in_livestock" title="Antibiotic use in livestock">Antibiotic use in livestock</a></div> <p>The <a href="/wiki/World_Health_Organization" title="World Health Organization">World Health Organization</a> advocates regulations on the use of antibiotics in animal feed to prevent the emergence of drug-resistant strains of MRSA.<sup id="cite_ref-Mehn2014_28-1" class="reference"><a href="#cite_note-Mehn2014-28"><span class="cite-bracket">&#91;</span>28<span class="cite-bracket">&#93;</span></a></sup> MRSA is established in animals and birds.<sup id="cite_ref-Gopal2017_19-5" class="reference"><a href="#cite_note-Gopal2017-19"><span class="cite-bracket">&#91;</span>19<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Treatment">Treatment</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=25" title="Edit section: Treatment"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <div class="mw-heading mw-heading3"><h3 id="Antibiotics">Antibiotics</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=26" title="Edit section: Antibiotics"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <link rel="mw-deduplicated-inline-style" href="mw-data:TemplateStyles:r1236090951"><div role="note" class="hatnote navigation-not-searchable">See also: <a href="/wiki/Medications_used_to_treat_MRSA" class="mw-redirect" title="Medications used to treat MRSA">Medications used to treat MRSA</a></div> <p>Treatment of MRSA infection is urgent and delays can be fatal.<sup id="cite_ref-Ficalora_20-1" class="reference"><a href="#cite_note-Ficalora-20"><span class="cite-bracket">&#91;</span>20<span class="cite-bracket">&#93;</span></a></sup><sup class="reference nowrap"><span title="Page / location: 328">&#58;&#8202;328&#8202;</span></sup> The location and history related to the infection determines the treatment. The route of administration of an antibiotic varies. Antibiotics effective against MRSA can be given by IV, oral, or a combination of both, and depend on the specific circumstances and patient characteristics.<sup id="cite_ref-IDSA2011_4-1" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> The use of concurrent treatment with <a href="/wiki/Vancomycin" title="Vancomycin">vancomycin</a> or other <a href="/wiki/Beta-lactam" class="mw-redirect" title="Beta-lactam">beta-lactam</a> agents may have a synergistic effect.<sup id="cite_ref-Winn_21-2" class="reference"><a href="#cite_note-Winn-21"><span class="cite-bracket">&#91;</span>21<span class="cite-bracket">&#93;</span></a></sup><sup class="reference nowrap"><span title="Page / location: 637">&#58;&#8202;637&#8202;</span></sup> </p><p>Both CA-MRSA and HA-MRSA are resistant to traditional anti-staphylococcal <a href="/wiki/Beta-lactam_antibiotic" class="mw-redirect" title="Beta-lactam antibiotic">beta-lactam antibiotics</a>, such as <a href="/wiki/Cephalexin" class="mw-redirect" title="Cephalexin">cephalexin</a>. CA-MRSA has a greater spectrum of antimicrobial susceptibility to <a href="/wiki/Sulfonamide_(medicine)" title="Sulfonamide (medicine)">sulfa drugs</a> (like co-trimoxazole (<a href="/wiki/Trimethoprim/sulfamethoxazole" title="Trimethoprim/sulfamethoxazole">trimethoprim/sulfamethoxazole</a>), <a href="/wiki/Tetracycline_antibiotics" title="Tetracycline antibiotics">tetracyclines</a> (like <a href="/wiki/Doxycycline" title="Doxycycline">doxycycline</a> and <a href="/wiki/Minocycline" title="Minocycline">minocycline</a>) and <a href="/wiki/Clindamycin" title="Clindamycin">clindamycin</a> (for <a href="/wiki/Osteomyelitis" title="Osteomyelitis">osteomyelitis</a>).<sup id="cite_ref-IDSA2011_4-2" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> MRSA can be eradicated with a regimen of <a href="/wiki/Linezolid" title="Linezolid">linezolid</a>,<sup id="cite_ref-GurusamyWilson2013_87-0" class="reference"><a href="#cite_note-GurusamyWilson2013-87"><span class="cite-bracket">&#91;</span>87<span class="cite-bracket">&#93;</span></a></sup> though treatment protocols vary and serum levels of antibiotics vary widely from person to person and may affect outcomes.<sup id="cite_ref-ChooChambers2016_88-0" class="reference"><a href="#cite_note-ChooChambers2016-88"><span class="cite-bracket">&#91;</span>88<span class="cite-bracket">&#93;</span></a></sup> The effective treatment of MRSA with <a href="/wiki/Linezolid" title="Linezolid">linezolid</a> has been successful<sup id="cite_ref-GurusamyWilson2013_87-1" class="reference"><a href="#cite_note-GurusamyWilson2013-87"><span class="cite-bracket">&#91;</span>87<span class="cite-bracket">&#93;</span></a></sup> in 87% of people. Linezolid is more effective in soft tissue infections than vancomycin.<sup id="cite_ref-YueDong2016_89-0" class="reference"><a href="#cite_note-YueDong2016-89"><span class="cite-bracket">&#91;</span>89<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-CochraneSurg2013_1-8" class="reference"><a href="#cite_note-CochraneSurg2013-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> This is compared to eradication of infection in those with MRSA treated with vancomycin. Treatment with vancomycin is successful in approximately 49% of people.<sup id="cite_ref-CochraneSurg2013_1-9" class="reference"><a href="#cite_note-CochraneSurg2013-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> Linezolid belongs to the newer <a href="/wiki/Oxazolidinone" title="Oxazolidinone">oxazolidinone</a> class of antibiotics which has been shown to be effective against both CA-MRSA and HA-MRSA. The <a href="/wiki/Infectious_Disease_Society_of_America" class="mw-redirect" title="Infectious Disease Society of America">Infectious Disease Society of America</a> recommends vancomycin, linezolid, or clindamycin (if susceptible) for treating those with MRSA pneumonia.<sup id="cite_ref-IDSA2011_4-3" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> <a href="/wiki/Ceftaroline" class="mw-redirect" title="Ceftaroline">Ceftaroline</a>, a fifth-generation cephalosporin, is the first beta-lactam antibiotic approved in the US to treat MRSA infections in skin and soft tissue or community-acquired pneumonia.<sup id="cite_ref-90" class="reference"><a href="#cite_note-90"><span class="cite-bracket">&#91;</span>90<span class="cite-bracket">&#93;</span></a></sup> </p><p>Vancomycin and <a href="/wiki/Teicoplanin" title="Teicoplanin">teicoplanin</a> are <a href="/wiki/Glycopeptide_antibiotic" title="Glycopeptide antibiotic">glycopeptide antibiotics</a> used to treat MRSA infections.<sup id="cite_ref-91" class="reference"><a href="#cite_note-91"><span class="cite-bracket">&#91;</span>91<span class="cite-bracket">&#93;</span></a></sup> Teicoplanin is a structural <a href="/wiki/Congener_(chemistry)" title="Congener (chemistry)">congener</a> of vancomycin that has a similar activity spectrum but a longer <a href="/wiki/Biological_half-life" title="Biological half-life">half-life</a>.<sup id="cite_ref-92" class="reference"><a href="#cite_note-92"><span class="cite-bracket">&#91;</span>92<span class="cite-bracket">&#93;</span></a></sup> Because the oral absorption of vancomycin and teicoplanin is very low, these agents can be administered intravenously to control systemic infections.<sup id="cite_ref-93" class="reference"><a href="#cite_note-93"><span class="cite-bracket">&#91;</span>93<span class="cite-bracket">&#93;</span></a></sup> Treatment of MRSA infection with vancomycin can be complicated, due to its inconvenient route of administration. Moreover, the efficacy of vancomycin against MRSA is inferior to that of anti-staphylococcal <a href="/wiki/Beta-lactam_antibiotic" class="mw-redirect" title="Beta-lactam antibiotic">beta-lactam antibiotics</a> against methicillin-susceptible <i>S. aureus</i> (MSSA).<sup id="cite_ref-94" class="reference"><a href="#cite_note-94"><span class="cite-bracket">&#91;</span>94<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-95" class="reference"><a href="#cite_note-95"><span class="cite-bracket">&#91;</span>95<span class="cite-bracket">&#93;</span></a></sup> </p><p>Several newly discovered strains of MRSA show antibiotic resistance even to vancomycin and teicoplanin. Strains with intermediate (4–8&#160;μg/ml) levels of resistance, termed glycopeptide-intermediate <i>S. aureus</i> (GISA) or <a href="/wiki/Vancomycin-resistant_Staphylococcus_aureus#Vancomycin-intermediate_S._aureus_(VISA)" title="Vancomycin-resistant Staphylococcus aureus">vancomycin-intermediate <i>S. aureus</i> (VISA)</a>,<sup id="cite_ref-96" class="reference"><a href="#cite_note-96"><span class="cite-bracket">&#91;</span>96<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-97" class="reference"><a href="#cite_note-97"><span class="cite-bracket">&#91;</span>97<span class="cite-bracket">&#93;</span></a></sup> began appearing in the late 1990s. The first identified case was in Japan in 1996, and strains have since been found in hospitals in England, France, and the US. The first documented strain with complete (&gt;16&#160;μg/ml) resistance to vancomycin, termed <a href="/wiki/Vancomycin-resistant_Staphylococcus_aureus" title="Vancomycin-resistant Staphylococcus aureus">vancomycin-resistant <i>S. aureus</i> (VRSA)</a>, appeared in the United States in 2002.<sup id="cite_ref-98" class="reference"><a href="#cite_note-98"><span class="cite-bracket">&#91;</span>98<span class="cite-bracket">&#93;</span></a></sup> In 2011, a variant of vancomycin was tested that binds to the lactate variation and also binds well to the original target, thus reinstating potent antimicrobial activity.<sup id="cite_ref-99" class="reference"><a href="#cite_note-99"><span class="cite-bracket">&#91;</span>99<span class="cite-bracket">&#93;</span></a></sup> <a href="/wiki/Linezolid" title="Linezolid">Linezolid</a>, <a href="/wiki/Quinupristin/dalfopristin" title="Quinupristin/dalfopristin">quinupristin/dalfopristin</a>, <a href="/wiki/Daptomycin" title="Daptomycin">daptomycin</a>, <a href="/wiki/Ceftaroline" class="mw-redirect" title="Ceftaroline">ceftaroline</a>, and <a href="/wiki/Tigecycline" title="Tigecycline">tigecycline</a> are used to treat more severe infections that do not respond to glycopeptides such as vancomycin.<sup id="cite_ref-100" class="reference"><a href="#cite_note-100"><span class="cite-bracket">&#91;</span>100<span class="cite-bracket">&#93;</span></a></sup> Current guidelines recommend daptomycin for VISA bloodstream infections and endocarditis.<sup id="cite_ref-IDSA2011_4-4" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> </p><p><a href="/wiki/Linezolid" title="Linezolid">Oxazolidinones</a> such as <a href="/wiki/Linezolid" title="Linezolid">linezolid</a> became available in the 1990s and are comparable to vancomycin in effectiveness against MRSA. Linezolid resistance in <i>S. aureus</i> was reported in 2001,<sup id="cite_ref-101" class="reference"><a href="#cite_note-101"><span class="cite-bracket">&#91;</span>101<span class="cite-bracket">&#93;</span></a></sup> but infection rates have been at consistently low levels. In the United Kingdom and Ireland, no linezolid resistance was found in staphylococci collected from&#160;<a href="/wiki/Bacteremia" class="mw-redirect" title="Bacteremia">bacteremia</a>&#160;cases between 2001 and 2006.<sup id="cite_ref-102" class="reference"><a href="#cite_note-102"><span class="cite-bracket">&#91;</span>102<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Skin_and_soft-tissue_infections">Skin and soft-tissue infections</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=27" title="Edit section: Skin and soft-tissue infections"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In skin abscesses, the primary treatment recommended is removal of dead tissue, incision, and drainage. More information is needed to determine the effectiveness of specific antibiotics therapy in surgical site infections (SSIs).<sup id="cite_ref-IDSA2011_4-5" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> Examples of soft-tissue infections from MRSA include ulcers, <a href="/wiki/Impetigo" title="Impetigo">impetigo</a>, abscesses, and SSIs.<sup id="cite_ref-YueDong2016_89-1" class="reference"><a href="#cite_note-YueDong2016-89"><span class="cite-bracket">&#91;</span>89<span class="cite-bracket">&#93;</span></a></sup> In surgical wounds, evidence is weak (high risk of <a href="/wiki/Bias" title="Bias">bias</a>) that <a href="/wiki/Linezolid" title="Linezolid">linezolid</a> may be better than <a href="/wiki/Vancomycin" title="Vancomycin">vancomycin</a> to eradicate MRSA SSIs.<sup id="cite_ref-CochraneSurg2013_1-10" class="reference"><a href="#cite_note-CochraneSurg2013-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> </p><p>MRSA colonization is also found in nonsurgical wounds such as traumatic wounds, <a href="/wiki/Burn" title="Burn">burns</a>, and chronic <a href="/wiki/Ulcer" title="Ulcer">ulcers</a> (i.e.: <a href="/wiki/Diabetic_ulcer" class="mw-redirect" title="Diabetic ulcer">diabetic ulcer</a>, <a href="/wiki/Pressure_ulcer" title="Pressure ulcer">pressure ulcer</a>, <a href="/wiki/Arterial_insufficiency_ulcer" title="Arterial insufficiency ulcer">arterial insufficiency ulcer</a>, <a href="/wiki/Venous_ulcer" title="Venous ulcer">venous ulcer</a>). No conclusive evidence has been found about the best antibiotic regimen to treat MRSA colonization.<sup id="cite_ref-CochraneNonSurg2013_22-3" class="reference"><a href="#cite_note-CochraneNonSurg2013-22"><span class="cite-bracket">&#91;</span>22<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Children_2">Children</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=28" title="Edit section: Children"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In skin infections and secondary infection sites, topical <a href="/wiki/Mupirocin" title="Mupirocin">mupirocin</a> is used successfully. For bacteremia and endocarditis, vancomycin or daptomycin is considered. For children with MRSA-infected bone or joints, treatment is individualized and long-term. Neonates can develop neonatal pustulosis as a result of topical infection with MRSA.<sup id="cite_ref-IDSA2011_4-6" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> Clindamycin is not approved for the treatment of MRSA infection, but it is still used in children for soft-tissue infections.<sup id="cite_ref-IDSA2011_4-7" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Endocarditis_and_bacteremia">Endocarditis and bacteremia</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=29" title="Edit section: Endocarditis and bacteremia"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Evaluation for the replacement of a prosthetic valve is considered. Appropriate antibiotic therapy may be administered for up to six weeks. Four to six weeks of antibiotic treatment is often recommended, and is dependent upon the extent of MRSA infection.<sup id="cite_ref-IDSA2011_4-8" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Respiratory_infections">Respiratory infections</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=30" title="Edit section: Respiratory infections"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>CA-MRSA in hospitalized patients pneumonia treatment begins before culture results. After the susceptibility to antibiotics is performed, the infection may be treated with vancomycin or linezolid for up to 21 days. If the pneumonia is complicated by the accumulation of pus in the pleural cavity surrounding the lungs, drainage may be done along with antibiotic therapy.<sup id="cite_ref-IDSA2011_4-9" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> People with cystic fibrosis may develop respiratory complications related to MRSA infection. The incidence of MRSA in those with cystic fibrosis increased during 2000 to 2015 by five times. Most of these infections were HA-MRSA. MRSA accounts for 26% of lung infections in those with cystic fibrosis.<sup id="cite_ref-MaselliKeyt2017_103-0" class="reference"><a href="#cite_note-MaselliKeyt2017-103"><span class="cite-bracket">&#91;</span>103<span class="cite-bracket">&#93;</span></a></sup> </p><p>There is insufficient evidence to support the use of topical or systematic antibiotics for nasal or extra-nasal MRSA infection.<sup id="cite_ref-104" class="reference"><a href="#cite_note-104"><span class="cite-bracket">&#91;</span>104<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Bone_and_joint_infections">Bone and joint infections</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=31" title="Edit section: Bone and joint infections"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Cleaning the wound of dead tissue and draining abscesses is the first action to treat the MRSA infection. Administration of antibiotics is not standardized and is adapted by a case-by-case basis. Antibiotic therapy can last up to 3 months and sometimes even longer.<sup id="cite_ref-IDSA2011_4-10" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Infected_implants">Infected implants</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=32" title="Edit section: Infected implants"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>MRSA infection can occur associated with implants and joint replacements. Recommendations on treatment are based upon the length of time the implant has been in place. In cases of a recent placement of a surgical implant or artificial joint, the device may be retained while antibiotic therapy continues. If the placement of the device has occurred over 3 weeks ago, the device may be removed. Antibiotic therapy is used in each instance sometimes long-term.<sup id="cite_ref-IDSA2011_4-11" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Central_nervous_system">Central nervous system</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=33" title="Edit section: Central nervous system"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>MRSA can infect the central nervous system and form brain abscess, subdural empyema, and spinal epidural abscess. Excision and drainage can be done along with antibiotic treatment. Septic thrombosis of cavernous or <a href="/wiki/Dural_venous_sinus" class="mw-redirect" title="Dural venous sinus">dural venous sinus</a> can sometimes be a complication.<sup id="cite_ref-IDSA2011_4-12" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="Other_infections">Other infections</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=34" title="Edit section: Other infections"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Treatment is not standardized for other instances of MRSA infection in a wide range of tissues. Treatment varies for MRSA infections related to: subperiosteal abscesses, necrotizing pneumonia, cellulitis, pyomyositis, necrotizing fasciitis, mediastinitis, myocardial, perinephric, hepatic, and splenic abscesses, septic thrombophlebitis, and severe ocular infections, including endophthalmitis.<sup id="cite_ref-IDSA2011_4-13" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> Pets can be reservoirs and pass on MRSA to people. In some cases, the infection can be symptomatic and the pet can develop a MRSA infection. Health departments recommend that the pet be taken to the veterinarian if MRSA infections keep occurring in the people who have contact with the pet.<sup id="cite_ref-tpchd_79-2" class="reference"><a href="#cite_note-tpchd-79"><span class="cite-bracket">&#91;</span>79<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Epidemiology">Epidemiology</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=35" title="Edit section: Epidemiology"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Worldwide, an estimated 2&#160;billion people carry some form of <i>S. aureus</i>; of these, up to 53&#160;million (2.7% of carriers) are thought to carry MRSA.<sup id="cite_ref-105" class="reference"><a href="#cite_note-105"><span class="cite-bracket">&#91;</span>105<span class="cite-bracket">&#93;</span></a></sup> <i>S. aureus</i> was identified as one of the six leading pathogens for deaths associated with resistance in 2019 and 100,000 deaths caused by MRSA were attributable to antimicrobial resistance.<sup id="cite_ref-106" class="reference"><a href="#cite_note-106"><span class="cite-bracket">&#91;</span>106<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="HA-MRSA_(healthcare_associated)"><span id="HA-MRSA_.28healthcare_associated.29"></span>HA-MRSA (healthcare associated)</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=36" title="Edit section: HA-MRSA (healthcare associated)"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In a US cohort study of 1,300 healthy children, 2.4% carried MRSA in their nose.<sup id="cite_ref-auto_107-0" class="reference"><a href="#cite_note-auto-107"><span class="cite-bracket">&#91;</span>107<span class="cite-bracket">&#93;</span></a></sup> Bacterial sepsis occurs with most (75%) of cases of invasive MRSA infection.<sup id="cite_ref-IDSA2011_4-14" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> In 2009, there were an estimated 463,017 hospitalizations due to MRSA, or a rate of 11.74 per 1,000 hospitalizations.<sup id="cite_ref-klein2013_108-0" class="reference"><a href="#cite_note-klein2013-108"><span class="cite-bracket">&#91;</span>108<span class="cite-bracket">&#93;</span></a></sup> Many of these infections are less serious, but the Centers for Disease Control and Prevention (CDC) estimate that there are 80,461 invasive MRSA infections and 11,285 deaths due to MRSA annually.<sup id="cite_ref-109" class="reference"><a href="#cite_note-109"><span class="cite-bracket">&#91;</span>109<span class="cite-bracket">&#93;</span></a></sup> In 2003, the cost for a hospitalization due to MRSA infection was US$92,363; a hospital stay for MSSA was $52,791.<sup id="cite_ref-YueDong2016_89-2" class="reference"><a href="#cite_note-YueDong2016-89"><span class="cite-bracket">&#91;</span>89<span class="cite-bracket">&#93;</span></a></sup> </p><p>Infection after surgery is relatively uncommon, but occurs as much as 33% in specific types of surgeries. Infections of surgical sites range from 1% to 33%. MRSA sepsis that occurs within 30 days following a surgical infection has a 15–38% mortality rate; MRSA sepsis that occurs within one year has a mortality rate of around 55%. There may be increased mortality associated with cardiac surgery. There is a rate of 12.9% in those infected with MRSA while only 3% infected with other organisms. SSIs infected with MRSA had longer hospital stays than those who did not.<sup id="cite_ref-CochraneSurg2013_1-11" class="reference"><a href="#cite_note-CochraneSurg2013-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> </p><p>Globally, MRSA infection rates are dynamic and vary year to year.<sup id="cite_ref-110" class="reference"><a href="#cite_note-110"><span class="cite-bracket">&#91;</span>110<span class="cite-bracket">&#93;</span></a></sup> According to the 2006 SENTRY Antimicrobial Surveillance Program report, the incidence of MRSA bloodstream infections was 35.9% in North America. MRSA blood infections in Latin America was 29%. European incidence was 22.8%. The rate of all MRSA infections in Europe ranged from 50% in Portugal down to 0.8% in Sweden. Overall MRSA infection rates varied in Latin America: Colombia and Venezuela combined had 3%, Mexico had 50%, Chile 38%, Brazil 29%, and Argentina 28%.<sup id="cite_ref-YueDong2016_89-3" class="reference"><a href="#cite_note-YueDong2016-89"><span class="cite-bracket">&#91;</span>89<span class="cite-bracket">&#93;</span></a></sup> </p><p>The <a href="/wiki/Centers_for_Disease_Control_and_Prevention" title="Centers for Disease Control and Prevention">Centers for Disease Control and Prevention</a> (CDC) estimated that about 1.7&#160;million nosocomial infections occurred in the United States in 2002, with 99,000 associated deaths.<sup id="cite_ref-111" class="reference"><a href="#cite_note-111"><span class="cite-bracket">&#91;</span>111<span class="cite-bracket">&#93;</span></a></sup> The estimated incidence is 4.5 nosocomial infections per 100 admissions, with direct costs (at 2004 prices) ranging from $10,500 (£5300, €8000 at 2006 rates) per case (for bloodstream, urinary tract, or respiratory infections in immunocompetent people) to $111,000 (£57,000, €85,000) per case for antibiotic-resistant infections in the bloodstream in people with transplants. With these numbers, conservative estimates of the total direct costs of nosocomial infections are above $17&#160;billion. The reduction of such infections forms an important component of efforts to improve healthcare safety. (BMJ 2007)<sup class="noprint Inline-Template Template-Fact" style="white-space:nowrap;">&#91;<i><a href="/wiki/Wikipedia:Citation_needed" title="Wikipedia:Citation needed"><span title="proper citing (February 2009)">citation needed</span></a></i>&#93;</sup> MRSA alone was associated with 8% of nosocomial infections reported to the CDC National Healthcare Safety Network from January 2006 to October 2007.<sup id="cite_ref-pmid18947320_112-0" class="reference"><a href="#cite_note-pmid18947320-112"><span class="cite-bracket">&#91;</span>112<span class="cite-bracket">&#93;</span></a></sup> </p><p>The <a href="/wiki/British_National_Audit_Office" class="mw-redirect" title="British National Audit Office">British National Audit Office</a> estimated that the incidence of nosocomial infections in Europe ranges from 4% to 10% of all hospital admissions. As of early 2005, the number of deaths in the United Kingdom attributed to MRSA has been estimated by various sources to lie in the area of 3,000 per year.<sup id="cite_ref-113" class="reference"><a href="#cite_note-113"><span class="cite-bracket">&#91;</span>113<span class="cite-bracket">&#93;</span></a></sup> </p><p>In the United States, an estimated 95&#160;million people carry <i>S. aureus</i> in their noses; of these, 2.5&#160;million (2.6% of carriers) carry MRSA.<sup id="cite_ref-114" class="reference"><a href="#cite_note-114"><span class="cite-bracket">&#91;</span>114<span class="cite-bracket">&#93;</span></a></sup> A population review conducted in three U.S. communities showed the annual incidence of CA-MRSA during 2001–2002 to be 18–25.7/100,000; most CA-MRSA isolates were associated with clinically relevant infections, and 23% of people required hospitalization.<sup id="cite_ref-115" class="reference"><a href="#cite_note-115"><span class="cite-bracket">&#91;</span>115<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="CA-MRSA_(community_associated)"><span id="CA-MRSA_.28community_associated.29"></span>CA-MRSA (community associated)</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=37" title="Edit section: CA-MRSA (community associated)"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In a US cohort study of 1,300 healthy children, 2.4% carried MRSA in their noses.<sup id="cite_ref-auto_107-1" class="reference"><a href="#cite_note-auto-107"><span class="cite-bracket">&#91;</span>107<span class="cite-bracket">&#93;</span></a></sup> There are concerns that the presence of MRSA in the environment may allow resistance to be transferred to other bacteria through <a href="/wiki/Bacteriophage" title="Bacteriophage">phages</a> (viruses that infect bacteria). The source of MRSA could come from hospital waste, farm sewage, or other waste water.<sup id="cite_ref-IDSA2011_4-15" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> MRSA is also common in infections of dogs and cats and transmission to humans can occur, since pet owners hug and kiss their pets or let them sleep in their beds.<sup id="cite_ref-Feuer2024_116-0" class="reference"><a href="#cite_note-Feuer2024-116"><span class="cite-bracket">&#91;</span>116<span class="cite-bracket">&#93;</span></a></sup> While sharing of isolates can occur, infections in humans seem to originate from HA-MRSA rather than from pet-acquired CA-MRSA.<sup id="cite_ref-117" class="reference"><a href="#cite_note-117"><span class="cite-bracket">&#91;</span>117<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading3"><h3 id="LA-MRSA_(livestock_associated)"><span id="LA-MRSA_.28livestock_associated.29"></span>LA-MRSA (livestock associated)</h3><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=38" title="Edit section: LA-MRSA (livestock associated)"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>In 2004, MRSA was first isolated on a Dutch pig farm leading to further investigations of livestock associated MRSA (LA-MRSA).<sup id="cite_ref-118" class="reference"><a href="#cite_note-118"><span class="cite-bracket">&#91;</span>118<span class="cite-bracket">&#93;</span></a></sup> Livestock associated MRSA (LA-MRSA) has been observed in Korea, Brazil, Switzerland, Malaysia, India, Great Britain, Denmark, and China.<sup id="cite_ref-Gopal2017_19-6" class="reference"><a href="#cite_note-Gopal2017-19"><span class="cite-bracket">&#91;</span>19<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="History">History</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=39" title="Edit section: History"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <figure class="mw-default-size" typeof="mw:File/Thumb"><a href="/wiki/File:EARS-Net_CAESAR_MRSA_2017-en.svg" class="mw-file-description"><img src="//upload.wikimedia.org/wikipedia/commons/thumb/9/9c/EARS-Net_CAESAR_MRSA_2017-en.svg/220px-EARS-Net_CAESAR_MRSA_2017-en.svg.png" decoding="async" width="220" height="192" class="mw-file-element" srcset="//upload.wikimedia.org/wikipedia/commons/thumb/9/9c/EARS-Net_CAESAR_MRSA_2017-en.svg/330px-EARS-Net_CAESAR_MRSA_2017-en.svg.png 1.5x, //upload.wikimedia.org/wikipedia/commons/thumb/9/9c/EARS-Net_CAESAR_MRSA_2017-en.svg/440px-EARS-Net_CAESAR_MRSA_2017-en.svg.png 2x" data-file-width="533" data-file-height="465" /></a><figcaption>Incidence of MRSA in human blood samples in countries which took part in the study in 2017</figcaption></figure> <p>In 1961, the first known MRSA isolates were reported in a British study, and from 1961 to 1967, infrequent hospital outbreaks occurred in Western Europe and Australia,<sup id="cite_ref-The_University_of_Chicago_Medical_Center_17-1" class="reference"><a href="#cite_note-The_University_of_Chicago_Medical_Center-17"><span class="cite-bracket">&#91;</span>17<span class="cite-bracket">&#93;</span></a></sup> with <a href="/wiki/Methicillin" title="Methicillin">methicillin</a> then being licensed in England to treat resistant infections. Other reports of MRSA began to be described in the 1970s.<sup id="cite_ref-CochraneSurg2013_1-12" class="reference"><a href="#cite_note-CochraneSurg2013-1"><span class="cite-bracket">&#91;</span>1<span class="cite-bracket">&#93;</span></a></sup> Resistance to other antibiotics was documented in some strains of <i>S. aureus</i>. In 1996, vancomycin resistance was reported in Japan.<sup id="cite_ref-Winn_21-3" class="reference"><a href="#cite_note-Winn-21"><span class="cite-bracket">&#91;</span>21<span class="cite-bracket">&#93;</span></a></sup><sup class="reference nowrap"><span title="Page / location: 637">&#58;&#8202;637&#8202;</span></sup> In many countries, outbreaks of MRSA infection were reported to be transmitted between hospitals.<sup id="cite_ref-Murray_70-2" class="reference"><a href="#cite_note-Murray-70"><span class="cite-bracket">&#91;</span>70<span class="cite-bracket">&#93;</span></a></sup><sup class="reference nowrap"><span title="Page / location: 402">&#58;&#8202;402&#8202;</span></sup> The rate had increased to 22% by 1995, and by 1997 the level of hospital <i>S. aureus</i> infections attributable to MRSA had reached 50%. </p><p>The first report of community-associated MRSA (CA-MRSA) occurred in 1981, and in 1982, a large outbreak of CA-MRSA occurred among intravenous drug users in Detroit, Michigan.<sup id="cite_ref-The_University_of_Chicago_Medical_Center_17-2" class="reference"><a href="#cite_note-The_University_of_Chicago_Medical_Center-17"><span class="cite-bracket">&#91;</span>17<span class="cite-bracket">&#93;</span></a></sup> Additional outbreaks of CA-MRSA were reported through the 1980s and 1990s, including outbreaks among Australian Aboriginal populations that had never been exposed to hospitals. In the mid-1990s, scattered reports of CA-MRSA outbreaks among US children were made. While HA-MRSA rates stabilized between 1998 and 2008, CA-MRSA rates continued to rise. A report released by the University of Chicago Children's Hospital comparing two periods (1993–1995 and 1995–1997) found a 25-fold increase in the rate of hospitalizations due to MRSA among children in the United States.<sup id="cite_ref-119" class="reference"><a href="#cite_note-119"><span class="cite-bracket">&#91;</span>119<span class="cite-bracket">&#93;</span></a></sup> In 1999, the University of Chicago reported the first deaths from invasive MRSA among otherwise healthy children in the United States.<sup id="cite_ref-The_University_of_Chicago_Medical_Center_17-3" class="reference"><a href="#cite_note-The_University_of_Chicago_Medical_Center-17"><span class="cite-bracket">&#91;</span>17<span class="cite-bracket">&#93;</span></a></sup> By 2004, the genome for various strains of MRSA were described.<sup id="cite_ref-120" class="reference"><a href="#cite_note-120"><span class="cite-bracket">&#91;</span>120<span class="cite-bracket">&#93;</span></a></sup> </p><p>The observed increased mortality among MRSA-infected people arguably may be the result of the increased underlying <a href="/wiki/Morbidity" class="mw-redirect" title="Morbidity">morbidity</a> of these people. Several studies, however, including one by Blot and colleagues, that have adjusted for underlying disease still found MRSA bacteremia to have a higher attributable mortality than methicillin-susceptible <i>S. aureus</i> (MSSA) bacteremia.<sup id="cite_ref-121" class="reference"><a href="#cite_note-121"><span class="cite-bracket">&#91;</span>121<span class="cite-bracket">&#93;</span></a></sup> </p><p>A population-based study of the incidence of MRSA infections in <a href="/wiki/San_Francisco" title="San Francisco">San Francisco</a> during 2004–05 demonstrated that nearly one in 300 residents had such an infection in the course of a year and that greater than 85% of these infections occurred outside of the healthcare setting.<sup id="cite_ref-122" class="reference"><a href="#cite_note-122"><span class="cite-bracket">&#91;</span>122<span class="cite-bracket">&#93;</span></a></sup> A 2004 study showed that people in the United States with <i>S. aureus</i> infection had, on average, three times the length of hospital stay (14.3 vs. 4.5 days), incurred three times the total cost ($48,824 vs. $14,141), and experienced five times the risk of in-hospital death (11.2% vs 2.3%) than people without this infection.<sup id="cite_ref-123" class="reference"><a href="#cite_note-123"><span class="cite-bracket">&#91;</span>123<span class="cite-bracket">&#93;</span></a></sup> In a meta-analysis of 31 studies, Cosgrove <i>et al.</i>,<sup id="cite_ref-124" class="reference"><a href="#cite_note-124"><span class="cite-bracket">&#91;</span>124<span class="cite-bracket">&#93;</span></a></sup> concluded that MRSA bacteremia is associated with increased mortality as compared with MSSA bacteremia (odds ratio= 1.93; 95% <span class="nowrap">CI = 1.93 ± 0.39</span>).<sup id="cite_ref-125" class="reference"><a href="#cite_note-125"><span class="cite-bracket">&#91;</span>125<span class="cite-bracket">&#93;</span></a></sup> In addition, Wyllie <i>et al.</i> report a death rate of 34% within 30 days among people infected with MRSA, a rate similar to the death rate of 27% seen among MSSA-infected people.<sup id="cite_ref-126" class="reference"><a href="#cite_note-126"><span class="cite-bracket">&#91;</span>126<span class="cite-bracket">&#93;</span></a></sup> </p><p>In the US, the CDC issued guidelines on October 19, 2006, citing the need for additional research, but declined to recommend such screening.<sup id="cite_ref-127" class="reference"><a href="#cite_note-127"><span class="cite-bracket">&#91;</span>127<span class="cite-bracket">&#93;</span></a></sup> According to the CDC, the most recent estimates of the incidence of healthcare-associated infections that are attributable to MRSA in the United States indicate a decline in such infection rates. Incidence of MRSA central line-associated blood-stream infections as reported by hundreds of intensive care units decreased 50–70% from 2001 to 2007.<sup id="cite_ref-mrsa-surveillance_128-0" class="reference"><a href="#cite_note-mrsa-surveillance-128"><span class="cite-bracket">&#91;</span>128<span class="cite-bracket">&#93;</span></a></sup> A separate system tracking all hospital MRSA bloodstream infections found an overall 34% decrease between 2005 and 2008.<sup id="cite_ref-mrsa-surveillance_128-1" class="reference"><a href="#cite_note-mrsa-surveillance-128"><span class="cite-bracket">&#91;</span>128<span class="cite-bracket">&#93;</span></a></sup> In 2010, vancomycin was the drug of choice.<sup id="cite_ref-IDSA2011_4-16" class="reference"><a href="#cite_note-IDSA2011-4"><span class="cite-bracket">&#91;</span>4<span class="cite-bracket">&#93;</span></a></sup> </p><p>Across Europe, based mostly on data from 2013, seven countries (Iceland, Norway, Sweden, the Netherlands, Denmark, Finland, and Estonia, from lowest to highest) had low levels of hospital-acquired MRSA infections compared to the others,<sup id="cite_ref-EHCI2015_129-0" class="reference"><a href="#cite_note-EHCI2015-129"><span class="cite-bracket">&#91;</span>129<span class="cite-bracket">&#93;</span></a></sup><sup class="reference nowrap"><span title="Page / location: 92–93">&#58;&#8202;92–93&#8202;</span></sup> and among countries with higher levels, significant improvements had been made only in Bulgaria, Poland, and the British Isles.<sup id="cite_ref-EHCI2015_129-1" class="reference"><a href="#cite_note-EHCI2015-129"><span class="cite-bracket">&#91;</span>129<span class="cite-bracket">&#93;</span></a></sup><sup class="reference nowrap"><span title="Page / location: 40">&#58;&#8202;40&#8202;</span></sup> </p><p>A 1,000-year-old <a href="/wiki/Collyrium" title="Collyrium">eye salve</a> recipe found in the medieval <i><a href="/wiki/Bald%27s_Leechbook" title="Bald&#39;s Leechbook">Bald's Leechbook</a></i> at the <a href="/wiki/British_Library" title="British Library">British Library</a>, one of the earliest known medical textbooks, was found to have activity against MRSA <i>in vitro</i> and in skin wounds in mice.<sup id="cite_ref-130" class="reference"><a href="#cite_note-130"><span class="cite-bracket">&#91;</span>130<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-131" class="reference"><a href="#cite_note-131"><span class="cite-bracket">&#91;</span>131<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-132" class="reference"><a href="#cite_note-132"><span class="cite-bracket">&#91;</span>132<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="In_the_media">In the media</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=40" title="Edit section: In the media"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>MRSA is frequently a media topic, especially if well-known personalities have announced that they have or have had the infection.<sup id="cite_ref-133" class="reference"><a href="#cite_note-133"><span class="cite-bracket">&#91;</span>133<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-134" class="reference"><a href="#cite_note-134"><span class="cite-bracket">&#91;</span>134<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-135" class="reference"><a href="#cite_note-135"><span class="cite-bracket">&#91;</span>135<span class="cite-bracket">&#93;</span></a></sup> Word of outbreaks of infection appears regularly in newspapers and television news programs. A report on skin and soft-tissue infections in the <a href="/wiki/Cook_County,_Illinois" title="Cook County, Illinois">Cook County</a> jail in <a href="/wiki/Chicago" title="Chicago">Chicago</a> in 2004–05 demonstrated MRSA was the most common cause of these infections among those incarcerated there.<sup id="cite_ref-:2_136-0" class="reference"><a href="#cite_note-:2-136"><span class="cite-bracket">&#91;</span>136<span class="cite-bracket">&#93;</span></a></sup> Lawsuits filed against those who are accused of infecting others with MRSA are also popular stories in the media.<sup id="cite_ref-137" class="reference"><a href="#cite_note-137"><span class="cite-bracket">&#91;</span>137<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-138" class="reference"><a href="#cite_note-138"><span class="cite-bracket">&#91;</span>138<span class="cite-bracket">&#93;</span></a></sup> </p><p>MRSA is the topic of radio programs,<sup id="cite_ref-139" class="reference"><a href="#cite_note-139"><span class="cite-bracket">&#91;</span>139<span class="cite-bracket">&#93;</span></a></sup> television shows,<sup id="cite_ref-140" class="reference"><a href="#cite_note-140"><span class="cite-bracket">&#91;</span>140<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-141" class="reference"><a href="#cite_note-141"><span class="cite-bracket">&#91;</span>141<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-142" class="reference"><a href="#cite_note-142"><span class="cite-bracket">&#91;</span>142<span class="cite-bracket">&#93;</span></a></sup> books,<sup id="cite_ref-143" class="reference"><a href="#cite_note-143"><span class="cite-bracket">&#91;</span>143<span class="cite-bracket">&#93;</span></a></sup> and movies.<sup id="cite_ref-144" class="reference"><a href="#cite_note-144"><span class="cite-bracket">&#91;</span>144<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="Research">Research</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=41" title="Edit section: Research"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <p>Various antibacterial chemical extracts from various species of the sweetgum tree (genus <i><a href="/wiki/Liquidambar" title="Liquidambar">Liquidambar</a></i>) have been investigated for their activity in inhibiting MRSA. Specifically, these are: <a href="/wiki/Cinnamic_acid" title="Cinnamic acid">cinnamic acid</a>, cinnamyl cinnamate, <a href="/wiki/Ethyl_cinnamate" title="Ethyl cinnamate">ethyl cinnamate</a>, <a href="/wiki/Benzyl_cinnamate" title="Benzyl cinnamate">benzyl cinnamate</a>, <a href="/wiki/Styrene" title="Styrene">styrene</a>, <a href="/wiki/Vanillin" title="Vanillin">vanillin</a>, <a href="/wiki/Cinnamyl_alcohol" title="Cinnamyl alcohol">cinnamyl alcohol</a>, 2-phenylpropyl alcohol, and 3-phenylpropyl cinnamate.<sup id="cite_ref-CrandallLingbeck2015_145-0" class="reference"><a href="#cite_note-CrandallLingbeck2015-145"><span class="cite-bracket">&#91;</span>145<span class="cite-bracket">&#93;</span></a></sup> </p><p>The delivery of inhaled antibiotics along with systematic administration to treat MRSA are being developed. This may improve the outcomes of those with <a href="/wiki/Cystic_fibrosis" title="Cystic fibrosis">cystic fibrosis</a> and other respiratory infections.<sup id="cite_ref-MaselliKeyt2017_103-1" class="reference"><a href="#cite_note-MaselliKeyt2017-103"><span class="cite-bracket">&#91;</span>103<span class="cite-bracket">&#93;</span></a></sup> <a href="/wiki/Phage_therapy" title="Phage therapy">Phage therapy</a> has been used for years in MRSA in eastern countries, and studies are ongoing in western countries.<sup id="cite_ref-146" class="reference"><a href="#cite_note-146"><span class="cite-bracket">&#91;</span>146<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-147" class="reference"><a href="#cite_note-147"><span class="cite-bracket">&#91;</span>147<span class="cite-bracket">&#93;</span></a></sup> <a href="/wiki/Host-directed_therapeutics" title="Host-directed therapeutics">Host-directed therapeutics</a>, including host kinase inhibitors, as well as <a href="/wiki/Antimicrobial_peptides" title="Antimicrobial peptides">antimicrobial peptides</a> are under study as adjunctive or alternative treatment for MRSA.<sup id="cite_ref-148" class="reference"><a href="#cite_note-148"><span class="cite-bracket">&#91;</span>148<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-149" class="reference"><a href="#cite_note-149"><span class="cite-bracket">&#91;</span>149<span class="cite-bracket">&#93;</span></a></sup><sup id="cite_ref-150" class="reference"><a href="#cite_note-150"><span class="cite-bracket">&#91;</span>150<span class="cite-bracket">&#93;</span></a></sup> </p><p>A 2015 <a href="/wiki/Cochrane_(organisation)" title="Cochrane (organisation)">Cochrane</a> <a href="/wiki/Systematic_review" title="Systematic review">systematic review</a> aimed to assess the effectiveness of wearing gloves, gowns and masks to help stop the spread of MRSA in hospitals, however no eligible studies were identified for inclusion. The review authors concluded that there is a need for <a href="/wiki/Randomized_controlled_trial" title="Randomized controlled trial">randomized controlled trials</a> to be conducted to help determine if the use of gloves, gowns, and masks reduces the transmission of MRSA in hospitals.<sup id="cite_ref-151" class="reference"><a href="#cite_note-151"><span class="cite-bracket">&#91;</span>151<span class="cite-bracket">&#93;</span></a></sup> </p> <div class="mw-heading mw-heading2"><h2 id="See_also">See also</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=42" title="Edit section: See also"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <ul><li><a href="/wiki/MRSA_ST398" title="MRSA ST398">MRSA ST398</a></li></ul> <div class="mw-heading mw-heading2"><h2 id="References">References</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=43" title="Edit section: References"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1239543626">.mw-parser-output .reflist{margin-bottom:0.5em;list-style-type:decimal}@media screen{.mw-parser-output .reflist{font-size:90%}}.mw-parser-output .reflist .references{font-size:100%;margin-bottom:0;list-style-type:inherit}.mw-parser-output .reflist-columns-2{column-width:30em}.mw-parser-output .reflist-columns-3{column-width:25em}.mw-parser-output .reflist-columns{margin-top:0.3em}.mw-parser-output .reflist-columns ol{margin-top:0}.mw-parser-output .reflist-columns li{page-break-inside:avoid;break-inside:avoid-column}.mw-parser-output .reflist-upper-alpha{list-style-type:upper-alpha}.mw-parser-output .reflist-upper-roman{list-style-type:upper-roman}.mw-parser-output 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href="#cite_ref-CochraneSurg2013_1-8"><sup><i><b>i</b></i></sup></a> <a href="#cite_ref-CochraneSurg2013_1-9"><sup><i><b>j</b></i></sup></a> <a href="#cite_ref-CochraneSurg2013_1-10"><sup><i><b>k</b></i></sup></a> <a href="#cite_ref-CochraneSurg2013_1-11"><sup><i><b>l</b></i></sup></a> <a href="#cite_ref-CochraneSurg2013_1-12"><sup><i><b>m</b></i></sup></a></span> <span class="reference-text"><style data-mw-deduplicate="TemplateStyles:r1238218222">.mw-parser-output cite.citation{font-style:inherit;word-wrap:break-word}.mw-parser-output .citation q{quotes:"\"""\"""'""'"}.mw-parser-output .citation:target{background-color:rgba(0,127,255,0.133)}.mw-parser-output .id-lock-free.id-lock-free a{background:url("//upload.wikimedia.org/wikipedia/commons/6/65/Lock-green.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-limited.id-lock-limited a,.mw-parser-output .id-lock-registration.id-lock-registration a{background:url("//upload.wikimedia.org/wikipedia/commons/d/d6/Lock-gray-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .id-lock-subscription.id-lock-subscription a{background:url("//upload.wikimedia.org/wikipedia/commons/a/aa/Lock-red-alt-2.svg")right 0.1em center/9px no-repeat}.mw-parser-output .cs1-ws-icon a{background:url("//upload.wikimedia.org/wikipedia/commons/4/4c/Wikisource-logo.svg")right 0.1em center/12px no-repeat}body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-free a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-limited a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-registration a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .id-lock-subscription a,body:not(.skin-timeless):not(.skin-minerva) .mw-parser-output .cs1-ws-icon a{background-size:contain;padding:0 1em 0 0}.mw-parser-output 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</ol></div></div> <div class="mw-heading mw-heading2"><h2 id="Further_reading">Further reading</h2><span class="mw-editsection"><span class="mw-editsection-bracket">[</span><a href="/w/index.php?title=Methicillin-resistant_Staphylococcus_aureus&amp;action=edit&amp;section=44" title="Edit section: Further reading"><span>edit</span></a><span class="mw-editsection-bracket">]</span></span></div> <style data-mw-deduplicate="TemplateStyles:r1235681985">.mw-parser-output .side-box{margin:4px 0;box-sizing:border-box;border:1px solid #aaa;font-size:88%;line-height:1.25em;background-color:var(--background-color-interactive-subtle,#f8f9fa);display:flow-root}.mw-parser-output .side-box-abovebelow,.mw-parser-output .side-box-text{padding:0.25em 0.9em}.mw-parser-output .side-box-image{padding:2px 0 2px 0.9em;text-align:center}.mw-parser-output .side-box-imageright{padding:2px 0.9em 2px 0;text-align:center}@media(min-width:500px){.mw-parser-output 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title="commons:Category:Methicillin-resistant Staphylococcus aureus">MRSA</a></span>.</div></div> </div> <ul><li><a rel="nofollow" class="external text" href="https://www.cdc.gov/mrsa/">The Centers for Disease Control and Prevention</a> information, prevention, statistics, at risk groups, causes, educational resources, and environmental factors.</li> <li><a rel="nofollow" class="external text" href="https://www.cdc.gov/niosh/topics/mrsa/">National Institute for Occupational Safety and Health</a> information on the bacteria, exposure in the workplace, and reducing risks of being infected.</li></ul> <div class="navbox-styles"><style data-mw-deduplicate="TemplateStyles:r1129693374">.mw-parser-output .hlist dl,.mw-parser-output .hlist ol,.mw-parser-output .hlist ul{margin:0;padding:0}.mw-parser-output .hlist dd,.mw-parser-output .hlist dt,.mw-parser-output .hlist li{margin:0;display:inline}.mw-parser-output .hlist.inline,.mw-parser-output .hlist.inline dl,.mw-parser-output .hlist.inline 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href="/wiki/Template:Gram-positive_firmicutes_diseases" title="Template:Gram-positive firmicutes diseases"><abbr title="View this template">v</abbr></a></li><li class="nv-talk"><a href="/wiki/Template_talk:Gram-positive_firmicutes_diseases" title="Template talk:Gram-positive firmicutes diseases"><abbr title="Discuss this template">t</abbr></a></li><li class="nv-edit"><a href="/wiki/Special:EditPage/Template:Gram-positive_firmicutes_diseases" title="Special:EditPage/Template:Gram-positive firmicutes diseases"><abbr title="Edit this template">e</abbr></a></li></ul></div><div id="*_Bacillota_(low-G+C)_Infectious_diseases_*_Bacterial_diseases:_G+" style="font-size:114%;margin:0 4em"> <ul><li><a href="/wiki/Bacillota" title="Bacillota">Bacillota</a> (low-<a href="/wiki/GC-content" title="GC-content">G+C</a>) <a href="/wiki/Infection" title="Infection">Infectious diseases</a></li> <li><a href="/wiki/Pathogenic_bacteria" title="Pathogenic bacteria">Bacterial diseases</a>: <a href="/wiki/Gram-positive_bacterial_infection" class="mw-redirect" title="Gram-positive bacterial infection">G+</a></li></ul> </div></th></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Bacilli" title="Bacilli">Bacilli</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Lactobacillales" class="mw-redirect" title="Lactobacillales">Lactobacillales</a><br />(<a href="/wiki/Catalase" title="Catalase">Cat-</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Streptococcus" title="Streptococcus">Streptococcus</a></i></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Alpha-hemolytic_streptococci" class="mw-redirect" title="Alpha-hemolytic streptococci">α</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Optochin" title="Optochin">optochin</a> susceptible</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Streptococcus_pneumoniae" title="Streptococcus pneumoniae">S. pneumoniae</a></i> <ul><li><a href="/wiki/Pneumococcal_infection" title="Pneumococcal infection">Pneumococcal infection</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">optochin resistant</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Viridans_streptococci" title="Viridans streptococci">Viridans streptococci</a>: <i><a href="/wiki/Streptococcus_mitis" title="Streptococcus mitis">S. mitis</a></i></li> <li><i><a href="/wiki/Streptococcus_mutans" title="Streptococcus mutans">S. mutans</a></i></li> <li><i><a href="/wiki/Streptococcus_oralis" title="Streptococcus oralis">S. oralis</a></i></li> <li><i><a href="/wiki/Streptococcus_sanguinis" title="Streptococcus sanguinis">S. sanguinis</a></i></li> <li><i><a href="/wiki/Streptococcus_sobrinus" title="Streptococcus sobrinus">S. sobrinus</a></i></li> <li><a href="/wiki/Streptococcus_anginosus_group" title="Streptococcus anginosus group"><i>S. anginosus</i> group</a></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Beta-hemolytic_streptococci" class="mw-redirect" title="Beta-hemolytic streptococci">β</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Group_A_streptococcal_infection" title="Group A streptococcal infection">A</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bacitracin" title="Bacitracin">bacitracin</a> susceptible: <i><a href="/wiki/Streptococcus_pyogenes" title="Streptococcus pyogenes">S. pyogenes</a></i> <ul><li><a href="/wiki/Group_A_streptococcal_infection" title="Group A streptococcal infection">Group A streptococcal infection</a></li> <li><a href="/wiki/Streptococcal_pharyngitis" title="Streptococcal pharyngitis">Streptococcal pharyngitis</a></li> <li><a href="/wiki/Scarlet_fever" title="Scarlet fever">Scarlet fever</a></li> <li><a href="/wiki/Erysipelas" title="Erysipelas">Erysipelas</a></li> <li><a href="/wiki/Rheumatic_fever" title="Rheumatic fever">Rheumatic fever</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Group_B_streptococcal_infection" title="Group B streptococcal infection">B</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li>bacitracin resistant, <a href="/wiki/CAMP_test" title="CAMP test">CAMP test</a>+: <i><a href="/wiki/Streptococcus_agalactiae" title="Streptococcus agalactiae">S. agalactiae</a></i> <ul><li><a href="/wiki/Group_B_streptococcal_infection" title="Group B streptococcal infection">Group B streptococcal infection</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%">ungrouped</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Streptococcus_iniae" title="Streptococcus iniae">Streptococcus iniae</a></i> <ul><li><a href="/wiki/Cutaneous_Streptococcus_iniae_infection" title="Cutaneous Streptococcus iniae infection">Cutaneous Streptococcus iniae infection</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Hemolysis_(microbiology)#Gamma" title="Hemolysis (microbiology)">γ</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Streptococcus#Group_D_(enterococci)_*variable_in_hemolysis" title="Streptococcus">D</a></li> <li><a href="/wiki/Bile_esculin_agar" title="Bile esculin agar">BEA</a>+: <i><a href="/wiki/Streptococcus_bovis" title="Streptococcus bovis">Streptococcus bovis</a></i></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Enterococcus" title="Enterococcus">Enterococcus</a></i></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><a href="/wiki/Bile_esculin_agar" title="Bile esculin agar">BEA</a>+: <i><a href="/wiki/Enterococcus_faecalis" title="Enterococcus faecalis">Enterococcus faecalis</a></i> <ul><li><a href="/wiki/Urinary_tract_infection" title="Urinary tract infection">Urinary tract infection</a></li></ul></li> <li><i><a href="/wiki/Enterococcus_faecium" title="Enterococcus faecium">Enterococcus faecium</a></i></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Bacillales" title="Bacillales">Bacillales</a><br />(<a href="/wiki/Catalase" title="Catalase">Cat+</a>)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Staphylococcal_infection" title="Staphylococcal infection">Staphylococcus</a></i></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Coagulase" title="Coagulase">Cg+</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Staphylococcus_aureus" title="Staphylococcus aureus">S. aureus</a></i> <ul><li><a href="/wiki/Staphylococcal_scalded_skin_syndrome" title="Staphylococcal scalded skin syndrome">Staphylococcal scalded skin syndrome</a></li> <li><a href="/wiki/Toxic_shock_syndrome" title="Toxic shock syndrome">Toxic shock syndrome</a></li> <li><a class="mw-selflink selflink">MRSA</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Coagulase" title="Coagulase">Cg-</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Novobiocin" title="Novobiocin">novobiocin</a> susceptible</i> <ul><li><i><a href="/wiki/Staphylococcus_epidermidis" title="Staphylococcus epidermidis">S. epidermidis</a></i></li></ul></li> <li><i>novobiocin resistant</i> <ul><li><i><a href="/wiki/Staphylococcus_saprophyticus" title="Staphylococcus saprophyticus">S. saprophyticus</a></i></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Bacillus" title="Bacillus">Bacillus</a></i></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Bacillus_anthracis" title="Bacillus anthracis">Bacillus anthracis</a></i> <ul><li><a href="/wiki/Anthrax" title="Anthrax">Anthrax</a></li></ul></li> <li><i><a href="/wiki/Bacillus_cereus" title="Bacillus cereus">Bacillus cereus</a></i> <ul><li><a href="/wiki/Foodborne_illness" title="Foodborne illness">Food poisoning</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Listeria" title="Listeria">Listeria</a></i></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Listeria_monocytogenes" title="Listeria monocytogenes">Listeria monocytogenes</a></i> <ul><li><a href="/wiki/Listeriosis" title="Listeriosis">Listeriosis</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Clostridia" title="Clostridia">Clostridia</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Clostridium" title="Clostridium">Clostridium</a></i> (<a href="/wiki/Endospore" title="Endospore">spore</a>-forming)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><i>motile:</i></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Clostridium_botulinum" title="Clostridium botulinum">Clostridium botulinum</a></i> <ul><li><a href="/wiki/Botulism" title="Botulism">Botulism</a></li></ul></li> <li><i><a href="/wiki/Clostridium_tetani" title="Clostridium tetani">Clostridium tetani</a></i> <ul><li><a href="/wiki/Tetanus" title="Tetanus">Tetanus</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><i>nonmotile:</i></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Clostridium_perfringens" title="Clostridium perfringens">Clostridium perfringens</a></i> <ul><li><a href="/wiki/Gas_gangrene" title="Gas gangrene">Gas gangrene</a></li> <li><a href="/wiki/Clostridial_necrotizing_enteritis" title="Clostridial necrotizing enteritis">Clostridial necrotizing enteritis</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Clostridioides" title="Clostridioides">Clostridioides</a></i> (<a href="/wiki/Endospore" title="Endospore">spore</a>-forming)</th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Clostridioides_difficile" title="Clostridioides difficile">Clostridioides difficile</a></i> [<i>Clostridium difficile</i>] <ul><li><a href="/wiki/Pseudomembranous_colitis" class="mw-redirect" title="Pseudomembranous colitis">Pseudomembranous colitis</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><i><a href="/wiki/Finegoldia" title="Finegoldia">Finegoldia</a></i> (non-spore forming)</th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Finegoldia" title="Finegoldia">Finegoldia magna</a></i></li></ul> </div></td></tr></tbody></table><div></div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Mollicutes" title="Mollicutes">Mollicutes</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"></div><table class="nowraplinks navbox-subgroup" style="border-spacing:0"><tbody><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Mycoplasmataceae" title="Mycoplasmataceae">Mycoplasmataceae</a></th><td class="navbox-list-with-group navbox-list navbox-even" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Ureaplasma_urealyticum" title="Ureaplasma urealyticum">Ureaplasma urealyticum</a></i> <ul><li><a href="/wiki/Ureaplasma_infection" class="mw-redirect" title="Ureaplasma infection">Ureaplasma infection</a></li></ul></li> <li><i><a href="/wiki/Mycoplasma_genitalium" title="Mycoplasma genitalium">Mycoplasma genitalium</a></i></li> <li><i><a href="/wiki/Mycoplasma_pneumoniae" title="Mycoplasma pneumoniae">Mycoplasma pneumoniae</a></i> <ul><li><a href="/wiki/Mycoplasma_pneumonia" title="Mycoplasma pneumonia">Mycoplasma pneumonia</a></li></ul></li></ul> </div></td></tr><tr><th scope="row" class="navbox-group" style="width:1%"><a href="/wiki/Anaeroplasmatales" class="mw-redirect" title="Anaeroplasmatales">Anaeroplasmatales</a></th><td class="navbox-list-with-group navbox-list navbox-odd" style="width:100%;padding:0"><div style="padding:0 0.25em"> <ul><li><i><a href="/wiki/Erysipelothrix_rhusiopathiae" title="Erysipelothrix rhusiopathiae">Erysipelothrix rhusiopathiae</a></i> <ul><li><a href="/wiki/Erysipeloid" title="Erysipeloid">Erysipeloid</a></li></ul></li></ul> </div></td></tr></tbody></table><div></div></td></tr></tbody></table></div> <div 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