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J Infect. 2013 Nov;67(5):439-47. doi: 10.1016/j.jinf.2013.07.020. Epub 2013 Jul 16.

Replacement of healthcare-associated MRSA by community-associated MRSA in Queensland: confirmation by genotyping.

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Pathology Queensland Central Laboratory, Herston, Queensland 4029, Australia; Griffith University School of Medicine, Southport, Queensland 4215, Australia. Electronic address:



To describe the changing prevalence of healthcare- and community-associated MRSA.


Susceptibility phenotypes of MRSA were observed from 2000 to 2012 using routine susceptibility data. Phenotypic definitions of major clones were validated by genotyping isolates from a nested period prevalence survey in 2011.


The predominant healthcare-associated (AUS-2/3 like) MRSA phenotype decreased from 42 to 14 isolates per million occasions of service in outpatients (P < 0.0001) and from 650 to 75 isolates per million accrued patient days in inpatients (P 0.0005), while the respective rates of the healthcare-related EMRSA-15 like phenotype increased from 1 to 19 in outpatients (P < 0.0001) and from 11 to 83 in inpatients (P < 0.0001) and those of the community-associated MRSA phenotype increased from 17 to 296 in outpatients (P < 0.0001) and from 71 to 486 in inpatients (P < 0.0001). When compared with single nucleotide polymorphism genotyping the AUS-2/3 like phenotype had a sensitivity and positive predictive value (PPV) for CC239 of 1 and 0.791 respectively, while the EMRSA-15 like phenotype had a sensitivity and PPV for CC22 of 0.903 and 0.774. PVL-positive CA-MRSA, predominantly ST93 and CC30, accounted for 60.8% of MRSA, while PVL-negative CA-MRSA, mainly CC5 and CC1, accounted for 21.4%.


The initially dominant healthcare-associated MRSA clone has been progressively replaced, mainly by four community-associated lineages.


Australia; Community-associated; Epidemiology; Genotyping; Healthcare-associated; MRSA; Staphylococcus aureus

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