Methicillin resistance in Staphylococcus aureus: emergence and molecular basis

Methicillin-resistant Staphylococcus aureus (MRSA) is often the severe causal agent in nosocomial infections that are becoming increasingly difficult to cure because of emerging resistance to all current antibiotic classes. Geographic spread of several MRSA clones between countries and continents has been reported and proven by molecular evidence. Several strains have been isolated from patients in the community without established risk factors for MRSA acquisition. Some of them may have origins in the hospital but others appear to be community-acquired strains. Community MRSA strains have several distinguishing characteristics that may enable them to more readily colonize and infect otherwise healthy hosts. Molecular typing approaches have been used with great advantage in studying of the MRSA epidemiology. It appears that a complete characterization of MRSA requires not only identification of the genetic background of the bacteria but also identification of the structural types of Staphylococcal Cassette Chromosome mec element (SCCmec), which carries methicillin resistance determinant mecA. Rapid and precise identification of MRSA is a prerequisite for control of hospital infections. This article reviews recent publications addressing the epidemiology markers of MRSA, specially of community-acquired strains, and the genetic diversity of SCCmec for identifying MRSA. It appears that MRSA will be an increasing important pathogen in the community.