You are on page 1of 14

Methicillin

Resistant
Staphylococcus
aureus
MRSA
Last Updated: February 2011

An additional version of
this factsheet, with citations
is available at
http://www.cfsph.iastate.edu/
Factsheets/pdfs/mrsacitations.pdf

Importance
Staphylococcus aureus is an opportunistic pathogen often carried
asymptomatically on the human body. Methicillin-resistant S. aureus (MRSA) strains
have acquired a gene that makes them resistant to all beta-lactam antibiotics.
Hospital-associated strains of this organism are serious nosocomial pathogens that
have become resistant to most common antibiotics, and treatment can be
challenging. Community-associated MRSA strains occur in people who have not
been hospitalized or recently had invasive procedures. They first appeared in highrisk populations (e.g., intravenous drug users, people with chronic illnesses), but are
now found even in healthy children. Until recently, community-associated strains
were susceptible to many antibiotics other than beta-lactams; however, resistance
seems to be increasing, and multiple antibiotic resistant strains have started to
emerge. Human-adapted MRSA can be transmitted to animals in close contact,
which can sometimes act as carriers and re-infect people.
Animal-adapted MRSA strains also exist. The pig-associated lineage MRSA
CC398 is a particular concern. This lineage, which apparently emerged between 2003
and 2005, has spread widely among swine in some locations. Colonization with
CC398 has also been reported in other species, including veal calves and poultry.
Asymptomatic carriage is common among people who work with colonized swine or
other livestock, and these organisms can cause opportunistic infections. Other MRSA
strains can also affect animals. Outbreaks in horses suggest that MRSA might be an
emerging problem in this species. Dogs and cats seem to be infected infrequently, and
mainly by human-adapted strains; however, carriage rates can be higher during
outbreaks in veterinary hospitals and other facilities. While colonization of pets is
often transient, it might contribute to maintaining MRSA within a household or
facility.

Etiology
Staphylococcus aureus is a Gram positive, coagulase positive coccus in the family
Staphylococcaceae. Methicillin-resistant S. aureus strains have acquired the mecA
gene, which is carried on a large mobile genetic element called the staphylococcal
chromosomal cassette mec (SCCmec). This gene codes for a penicillin binding
protein, PBP2a, which interferes with the effects of beta lactam antibiotics (e.g.
penicillins and cephalosporins) on cell walls. It confers virtually complete resistance
to all beta-lactam antibiotics including the semi-synthetic penicillins.
Acquisition of mecA seems to have occurred independently in a number of S.
aureus strains. Some clonal lineages of S. aureus have a tendency to colonize specific
species, and may be adapted to either humans or animals. Other lineages (“extended
host spectrum genotypes”) are less host-specific, and can infect a wide variety of
species. Some MRSA strains, called epidemic strains, are more prevalent and tend to
spread within or between hospitals and countries. Other “sporadic” strains are isolated
less frequently and do not usually spread widely. There are also MRSA strains that
produce various exotoxins (e.g., toxic shock syndrome toxin 1, exfoliative toxins A or
B, and enterotoxins) associated with specific syndromes, such as toxic shock
syndrome. Community-associated MRSA strains that express a toxin called PantonValentine leucocidin (PVL) have been linked to skin and soft tissue infections and
severe necrotizing pneumonia. It is possible that PVL are associated with increased
virulence in general, although this remains to be proven.
Phenotypic methicillin resistance and/or the mecA gene has been reported
occasionally in various animal-adapted Staphylococcus species. Some of these
organisms can cause zoonotic infections or colonize people asymptomatically. There
are also concerns that they may transfer mecA to human-adapted staphylococci.
Naming conventions for S. aureus strains
There are at least three different genetic techniques currently used for the
classification of S. aureus strains, including pulsed-field gel electrophoresis (PFGE),
multilocus sequence typing (MLST), and DNA sequencing of the X region of the
protein A gene (spa typing). Additional methods were used in the past. Consequently,
© 2014

page 1 of 14

Geographic Distribution MRSA can be found worldwide. Equine MRSA isolates also appear to vary with the location. There is evidence that these organisms can be Last Updated: February 2011 © 2014 transferred to animals. Examples of strain names are USA100. pigeons and psittacine birds) and turtles. but community-associated MRSA may colonize sites other than the nares. based on PFGE typing.. although bovineassociated strains have been suggested and CC398 has been identified. cats. How long such colonization persists. MRSA ST8 SCCmecIV]) belong to older human lineages that were common in the past. CMRSA1 or EMRSA1. or ST9 in parts of Asia). In case reports. Animals Asymptomatic colonization with MRSA. aureus of that genetic type. Pigs seem to be true reservoir hosts for MRSA CC398. which contain genetically related ST types. Cats and dogs seem to be colonized only sporadically. S. Other strains may be common among pigs in some areas (e.g. CC398 does not seem to be particularly host specific. rodents. or livestock-associated MRSA (LA-MRSA). or “t” followed by a number (e. and strains given a single name in one system are sometimes separated into more than one strain in another system. Most people who develop symptomatic infections with hospital-associated MRSA carry the organism in the nares. depending on the test used for typing. Carrier animals may serve as reservoirs for disease in themselves. Both methicillin-sensitive and methicillin-resistant strains can be found as normal commensals on the skin (especially the axillae and perineum). the nasopharynx and anterior nares of some of the population. has been reported in animals. CC8. aureus (and presumably MRSA) can be transmitted from the mother to her infant during delivery.Methicillin Resistant Staphylococcus aureus a single S. and CC398 may be uncommon or absent in these regions. by MLST. and carriage may be transient or persistent. Although names such as ST9 or CC398 are used for both methicillinresistant and methicillin-susceptible S.. and carriage is often transient.g. Hong Kong and Malaysia. MRSA are also grouped. CC22. page 2 of 14 . and for captive dolphins and walruses at a marine park. MRSA can also be disseminated on fomites (including food that has been contaminated by human carriers) and in aerosols. with colonized or infected people. ST followed by a number (e. humans seemed to be the source of the organism for an elephant calf with skin disease. People can also be infected or colonized with MRSA clonal complexes maintained in animals. t011) in spa typing. Most infections in these species are thought to be acquired from people. a bat. CC30 and CC45. and clinical cases often occur in patients who are not colonized.. into clonal complexes (e. rabbits. However. which differ between geographic regions. and most likely re-transmitted from this source to humans. aureus isolate can have more than one valid name. Humans remain infectious as long as the carrier state persists or the clinical lesions remain active. a recent outbreak in a hospital in the Netherlands suggests that more extensive person-to-person transmission can be seen under some conditions. and may be spreading in horse populations. as well as rats living on pig farms. The organisms can colonize more than one site. many MRSA strains that cause mastitis seem to be of human origin. but have been superceded by other strains. Infection or colonization has been observed in people after as little as 4 hours of close contact with a sick. which is also called “non-typeable MRSA” (NT-MRSA) because most isolates cannot be typed by PFGE (although they can be typed by other methods). the isolates referred to in this factsheet are all MRSA unless otherwise noted. such as CC398. is still uncertain. Transmission Humans In humans. MRSA are usually transmitted by direct contact. a captive elephant. and additional community-associated strains. in the absence of continued contact with the animal.g. Poultry infected with either CC398 or ST9 have been found in Europe. dogs. The most common strains in dogs and cats are those found in humans. CC398 is the predominant MRSA among pigs in Europe. Species Affected Colonization or infection with MRSA has been reported in many species including domesticated ruminants. but it has also been recognized in North America and Singapore. although the prevalence varies between regions. MRSA colonized foal. MRSA strains in horses are varied and their origin is largely unknown.g. Naming conventions are complex. Equine-adapted strains may exist. ST398) based on MLST typing. and it has been detected in other species including horses. or to less common groups. poultry and dogs.. pigs. CMRSA2 [EMRSA3] in Canada. People can also transmit CC398 to animals such as dogs. aureus is an opportunistic pathogen. Many of the common strains in this species (e. mainly by human hospital-associated or community-associated strains. captive marine mammals. Person-to-person spread of the pig-adapted MRSA strain CC398 seems to be infrequent and limited. aureus can occur any time after birth. including both nasal and rectal carriage. CMRSA5 [USA500. and to occur mainly within families or in hospitals and institutions. S. cattle.g. often via the hands. Colonization with S. birds (including poultry. CC398). and they may transmit MRSA to other animals or people. horses. There is little information about MRSA in exotic animals. In cattle.. They include a the common hospital-associated clones CC5. ST9 appears to be the prevalent MRSA strain among pigs in China. Zoonotic potential A number of MRSA strains predominantly colonize people and circulate in human populations.

This organism can also be destroyed by moist heat (121°C for a minimum of 15 minutes) or dry heat (160-170°C for at least 1 hour). colonies are usually beta-hemolytic. the product of mecA. S. postoperative wound infections. Disinfection S. Both Bordetella bronchiseptica and MRSA were isolated from the nasal and oropharyngeal tract of puppies after an outbreak of fatal respiratory disease. omphalophlebitis. alcohols. such as tracing outbreaks. and possibly even in air. In abattoirs that slaughter CC398 carrier pigs. MRSA clones or strains can be identified with molecular tests such as PFGE. One study reported that nasal swabs detected most colonized pigs. Biochemical tests such as the coagulase test are used to differentiate it from other staphylococci. MRSA can also occur in raw milk and cheese. quaternary ammonium compounds. The presence of the mecA gene defines MRSA. but only limited locations were still contaminated by the next morning. which may be found singly. A latex agglutination test can detect PBP2a. mastitis (including gangrenous mastitis) and urinary tract infections. as well as selective plates for MRSA. glutaraldehyde. Diagnostic Tests Infection with MRSA. On pig farms. If S. and less than 7 days on floors under laboratory conditions. Infections in Animals Incubation Period The incubation period varies with the syndrome. Post Mortem Lesions Click to view images The post-mortem lesions of MRSA infections are those seen with any purulent bacterial infection. bacteremia. aureus can also be identified with the API Staph Ident system. and tests to detect this gene. dermatitis including severe pyoderma. aureus is not ordinarily invasive when eaten. Phenotypic antibiotic susceptibility tests (e. metritis. phenolics. In a few case reports. including colonization. family pets seem to have acted as one reservoir for the bacteria. 17 hours in sunlight. MLST. The frequency with which this occurs is still poorly understood. such as CC398. fistulas. MRSA could be detected in a number of areas by the end of the day. Enrichment media. aureus is susceptible to various disinfectants including sodium hypochlorite. are available. The transmission of human-adapted MRSA lineages between animals is poorly understood. although the entire colony carries the resistance genes. and decolonization of humans was unsuccessful when carriage in these animals was not addressed. S. exudative dermatitis in pigs. which can cause a wide variety of suppurative infections. but some animals carried MRSA in both locations. S. formaldehyde. septic arthritis. Nasal and rectal sampling should both be done whenever possible. In addition. genetic testing or antibiotic susceptibility testing can identify methicillin resistant strains. are readily transmitted within the host species to which they are adapted. aureus. Both animal-associated and human-associated MRSA strains have been found in meat. aureus grows on a number of media. but have some drawbacks compared to detecting mecA or PBP2a. osteomyelitis. such as PCR. spa typing and other assays. iodophors. and vary with the organ system or tissue involved. One study conducted at a canine rescue facility suggested that these strains might not be transmitted readily between healthy dogs. This is usually done mainly for epidemiological purposes. aureus is isolated from an infection.. otitis. On microscopic examination. and a few carrier pigs (all weanlings) could only be found using rectal swabs. disk diffusion or MIC determination) can also be used to identify MRSA. Environmental sources and food products S. sinusitis.g. and in many species including dogs and cats.Methicillin Resistant Staphylococcus aureus Some MRSA strains. page 3 of 14 . and a combination of iodine and alcohol. isolates that do not carry mecA (and thus. and intravenous catheter or surgical implant infections. A combination of methods may be needed to identify a strain. S. in short chains or in irregular clusters. and these organisms are mainly of concern in contributing to carriage or infection by direct contact. non-spore forming coccus. rhinitis. the best sampling site to detect carriers is uncertain. aureus are reported to remain viable for 46 hours on glass. some susceptibility tests can overestimate methicillin resistance. On blood agar. MRSA can colonize more than one site. Methicillin-susceptible and resistant subpopulations can coexist in vitro. MRSA Last Updated: February 2011 © 2014 has also been found in other conditions including pneumonia. Environmental contamination with MRSA has been reported in some veterinary practices. in pairs. only a small number of bacteria may express resistance in culture. except under rare and unusual circumstances. the role of MRSA in the outbreak was uncertain. such as dust. are the gold standard for identification. The expression of resistance in phenotypic tests can also vary with growth conditions such as temperature. can be diagnosed by culture and identification of the organism. these organisms have been found in various samples. are not MRSA) can appear to be phenotypically resistant to methicillin. The presence of suture material or orthopedic implants seems to be linked to persistent infections in dogs and cats. Animals can be colonized for prolonged periods without developing clinical signs. MRSA has been specifically isolated from various skin and wound infections including abscesses. aurues is a Gram positive. even at times when MRSA patients were not detected. Clinical Signs Infection with MRSA results in the same syndromes as S. SCCmec typing.

they may the drugs of last resort. The efficacy of decolonization with antimicrobials is uncertain. regardless of susceptibility testing results.g. and many are also resistant to trimethoprim. Morbidity and Mortality Outbreaks or clusters of clinical cases have been reported occasionally among horses at veterinary hospitals. Certain antimicrobials. cephalosporins. particularly in horses. Some MRSA can appear sensitive to clindamycin during routine sensitivity testing. topical treatments and other measures have been used successfully to treat clinical cases. MRSA-infected wounds should be covered whenever possible. Although colonized people can transmit MRSA to animals. Animals treated with topical therapy alone must be monitored closely for signs of localized progression or systemic spread. Animals that have been in contact with either MRSA cases or infected/ colonized staff should be tested. all MRSA strains are considered to be resistant to penicillins. Topical treatment with mupirocin or other drugs to eliminate nasal carriage has been considered impractical in pets. and some studies suggest that MRSA may be an emerging pathogen in this species. also appear to be increasing. however.. together with antibiotics in two horses that remained longterm carriers. Dogs. intravenous catheterization and surgery. may decrease the risk of MRSA introduction to a farm by human visitors. An alternative is to screen targeted populations. e. surgical implants were also removed. and decolonization of human personnel. Avoiding routine antimicrobial use in food animals might reduce selection pressures. On farms. The best method to eliminate MRSA carriage in animals in poorly understood. It is not recommended for routine use in pets. In addition to hand hygiene. and may vary with the species. but may be considered in individual cases to control transmission. . including dedicated clothing and showering in. Researchers have recommended that veterinary hospitals initiate surveillance programs for MRSA. and re-infection is prevented. and environmental disinfection. clindamycin-susceptible MRSA isolates from dogs and cats in Canada. Whether MRSA in manure poses a risk when used as fertilizer. are critically important for treating human illnesses caused by MRSA. In some cases. and fusidic acid and chlorhexidine. inducible clindamycin resistance was very common among erythromycin-resistant. screening and segregation of animal carriers. These animals should be isolated. and lower the prevalence of these organisms in livestock. Meticulous wound management without antimicrobials was successful in one dog. lower mortality in superficial infections and higher case fatality rates in septicemia and other serious invasive page 4 of 14 . Local treatment with antiseptic compounds such as chlorhexidine or povidone iodine may be helpful in some types of infections. Successful treatments used in three colonized dogs were oral doxycycline and rifampin. non-healing or nosocomial infections. Recent publications should be consulted for the current list of critically important drugs. In some cases. and the effectiveness of measures such as composting or heat treatment. and should be avoided if at all possible. The mortality rate is expected to vary with the syndrome. Reports of infections in companion animals. Kenneling a colonized pet. MRSA may sometimes be introduced when buying new stock. Because CC398 has been detected in rats living on pig farms. and spread during livestock movements. However.g. e. Screening at admission allows isolation of carriers. preferably in isolation. but carry a gene that allows them to become resistant during treatment. are unknown. Antibiotic therapy should be based on susceptibility testing. risk factors include repeated courses of antibiotics. and animals belonging to healthcare workers or known MRSA-positive households. MRSA was eliminated with infection control measures. they are controversial for treating MRSA-infected animals.Methicillin Resistant Staphylococcus aureus Treatment Antibiotics. found among horses especially in Canada. the establishment of barrier precautions to prevent transmission to other animals. The use of these drugs in animals may place selection pressure on isolates that can infect humans. infection control measures (with particular attention to invasive devices such as intravenous catheters and urinary catheters). cats and some other animals have been known to spontaneously eliminate MRSA when the environment is regularly cleaned and disinfected. USA500). Thus. rifampin and ciprofloxacin. rats should be considered in control programs. barrier precautions should be used when there is a risk of contact with body fluids or when an animal has a recognized MRSA infection.. Susceptibility to fluoroquinolones and resistance to tetracycline seems to be typical of the epidemic MRSA strain CMRSA5 (CC8 lineage. Most CC398 MRSA are resistant to tetracyclines. when an animal remains a persistent carrier or infection control measures are impossible. In one study. such as animals with nonantibiotic responsive. such as vancomycin and tigecycline. On two colonized horse farms. hospitalizations. Biosecurity measures. screening all animals can be costly and may not be practical in some practices. one study suggests that there may be only a small risk of transmission from colonized surgical personnel if infection control protocols are followed. In addition to MRSA carriage or contact with carriers. and prompt recognition of opportunistic infections caused by these Last Updated: February 2011 © 2014 organisms. Prevention Veterinary hospitals should establish guidelines to minimize cross-contamination by MRSA and other methicillin-resistant staphylococci. or reduce transmission between units. mainly as postoperative complications and wound infections. might be considered in some situations. cephems and other ß-lactam antibiotics.

Studies from North America. One Canadian study reported that infections were clustered. endocarditis.5% to 11% were found on presentation at equine clinics and veterinary hospitals. necrotizing fasciitis. because the preformed toxin is eaten in food and the organism is not present in the body. Other toxinexpressing MRSA strains (exfoliative toxins A or B) can cause staphylococcal scalded skin syndrome. aureus. In Belgium. destructive otomastoiditis. CC398 has mainly been found in superficial skin and soft tissue infections. and in 4-7% of the cattle on infected farms. and up to 81% of the farms in some countries may be affected. In Iowa and Illinois. meningitis and septicemia. aureus. with apparently lower ST9 colonization rates in surveys from Malaysia. Infections in Humans Incubation Period The incubation period for S. page 5 of 14 . Some studies found that colonization in pigs varies with their age. although it was reported in a severely immunocompromised patient who had received antacids. or unaffected. aureus is very unusual. Elevated rates of MRSA carriage have been reported in some animal facilities such as veterinary clinics or kennels.Methicillin Resistant Staphylococcus aureus diseases. especially in Japan. as well as antibiotics to which the (methicillin-sensitive) strain was resistant. Another Belgian study detected MRSA in 20% to 100% of broiler chickens but not in laying hens. Human community-acquired-MRSA strains are mainly associated with superficial skin or soft tissue disease. Overall MRSA carriage may also be low among healthy horses in the community. and severe invasive infection with multiorgan failure. Invasive disease after ingesting S. pneumonia. but its prevalence and importance are still poorly understood. but some case reports have described aggressive wound infection. study found that up to 4% were colonized. It may be involved in various skin and soft tissue infections. the quarter-level prevalence of MRSA in milk was reported to be less than 0. sporadically colonized. In South Korea. in CC5). CC398 was isolated from healthy poultry on 13% of the farms sampled. 92% of dogs with infections mainly affecting the skin and ears were discharged. and colonization seems to be transient in many animals. a study found that 25% of swine. MRSA strains that produce enterotoxins while growing in food can cause acute staphylococcal gastroenteritis (food poisoning). where MRSA is common among people. In susceptible patients. endocarditis. Hong Kong and Brazil reported carriage rates of 0-2% among healthy dogs and cats in the community. aureus infections in humans is highly variable. Hospital-acquired MRSA strains are major causes of nosocomial infections associated with indwelling medical devices and surgical sites. with 13% or 5% of the horses colonized on two farms. Prevalence of MRSA carriage in animals Colonization with MRSA seems to be uncommon in healthy dogs and cats not linked to a source of MRSA. Clinical Signs MRSA is an opportunist.5%. antibiotic resistance is generally irrelevant in this condition.S. although one U. necrotizing pneumonia and other conditions. In Canada. a disease characterized by widespread blistering and loss of the outer layers of the epidermis. MRSA strains that carry the exotoxin TSST-1 have been found in cases of toxic shock syndrome. 84% of horses with MRSA infections at 6 veterinary hospitals in Canada survived to discharge. 0% to 24% of each broiler group entering abattoirs carried MRSA. however. nosocomial bacteremia. One study also found MRSA (mainly CC398) in 88% of the veal calf rearing units and 28% of the veal calves tested in the Netherlands. At several veterinary referral hospitals. and no MRSA detected on eight other farms. and 45% of farms were colonized with MRSA.g. In Belgium. 11% of tested swine carried MRSA. and can cause the same types of infections. sinusitis. as well as invasive conditions such as pneumonia. Some North American and European surveys reported that MRSA was isolated from 0% to less than 2% of horses surveyed. The colonization status can differ for each animal in a multi-pet household or institution. septic arthritis. All of these isolates were CC398. and 23% of their flocks of origin were colonized. However. Zoonotic MRSA can presumably cause the same types of infections as human-associated MRSA strains. assisted living facility) where humans are MRSA carriers. clinical cases may become apparent 4 to 10 days after exposure. mainly CC398 but also CMRSA2 (US100. while others detected no significant difference. Information on livestockassociated MRSA strains in other parts of the world is limited. individual animals may be persistent carriers. The reported prevalence ranges from approximately 1% to 40% in different countries. opportunistic infections can also occur after an indefinite period of asymptomatic carriage. osteomyelitis. Colonization with CC398 is very common among pigs in some parts of Europe. In another study. Approximately 11% of pigs on Chinese farms and 16% of pigs from Hong Kong markets were colonized with MRSA ST9. like other S. EMRSA3. Last Updated: February 2011 © 2014 MRSA has also been detected in poultry in several countries. with no significant differences in the survival rate compared to methicillin-sensitive S. In a household or institution (e.. Europe. but of a spa type not usually detected in other livestock. Carriage rates varying from less than 0. MRSA was detected on almost 10% of farms with mastitis problems. In the Netherlands. The mortality rate was 20% in an outbreak of exudative dermatitis caused by CC398 in young pigs. although they have also caused sepsis. especially during outbreaks.

and in some cases. the case fatality rate differs with the syndrome. and antibiotic use is restricted. environmental cleaning and other infection control measures are expected to reduce the risk of acquiring MRSA from infected or colonized animals. page 6 of 14 . close contact with other people (or susceptible animals) should be avoided. including people who work with pigs or veal calves. although severe infections can occur. High risk patients. Decolonization of humans can be controversial. Agents used to treat serious infections caused by multiple drug resistant MRSA strains include vancomycin linezolid. and vancomycin-resistant strains have been reported. but only some people are persistently colonized. Infections caused by community-acquired MRSA are also becoming more common. The best procedure to follow when a resident animal becomes colonized in a healthcare facility is still uncertain. MRSA carriage is also elevated in farm and abattoir workers who handle live swine.). and resistance to drugs. Antibiotics must be selected based on susceptibility testing. equine and small animal veterinarians). In Belgium. barrier precautions when handling animals with illnesses caused by MRSA. are isolated until the screening test demonstrates that they are MRSA-free. and screening of patients on admission. veal calves or poultry infected with CC398. Treatment may also require adjunct measures such as the removal of catheters. as in animals. Reported colonization rates among staff at veterinary hospitals and referral clinics in Europe and North America vary from 0% to 10%. Germany and Belgium. In one recent outbreak. can occur. particularly hand washing.. dry bandages. as well as the age and health of the patient. Infection control measures. carriage in pets may need to be considered. Skin infections are sometimes treated by management techniques that do not require systemic antibiotics (e. MRSA carriage Carriage rates for human MRSA strains in the general population range from less than 1% to 5%. Decolonization is not always successful. Some evidence suggests that CC398 might be less virulent in people than traditional human-adapted strains. (Staphylococcal food poisoning is diagnosed by examination of the food for the organisms and/or toxins.g. while 42% of patients colonized with other isolates were affected. skin infections occurred in 0. can affect the type of treatment chosen. mupirocin and fusidic acid) and systemic antimicrobials have been used in people. options presented to the facility included removing the animal until it cleared the bacterium. tigecycline. reported colonization with CC398 can be as high as 86% in some populations. due to occupational exposure. People who work with pigs carrying CC398 often become recolonized from this source. Community-acquired MRSA strains have often been resistant only to ß-lactam agents. including the elderly and people with open wounds. and with continued monitoring (culture) and the encouragement of good hand hygiene among human contacts. Some studies have suggested that human colonization with animal-adapted MRSA strains might be transient. and may be recommended in some situations or groups of patients. macrolides and azalides. such as the inability to adequately cover a MRSA-infected wound. incision and drainage for abscesses). and have occasionally been reported to be as high as 27%. aureus infections in humans are diagnosed by culture and identification of the organism. approximately 13% of the patients who carried CC398 had symptomatic infections.Methicillin Resistant Staphylococcus aureus Diagnostic Tests S.g. compared to universal infection control procedures alone. Resistance has been reported to some of these antibiotics. Prevention Hand washing. avoidance of direct contact with nasal secretions and wounds. It can be difficult to find an effective choice for hospital-acquired MRSA. Treatment Factors such as the location.. The Netherlands and Scandinavian counties have greatly reduced the incidence of hospital-associated human MRSA by screening and decolonization of hospital staff. In one hospital in the Netherlands. A variety of agents. Human healthcare workers are expected to be at an increased risk for colonization. MRSA outbreaks are Last Updated: February 2011 © 2014 investigated aggressively. In the Netherlands. with or without antibiotic treatment. or pigs infected with ST9. Morbidity and Mortality Hospital-associated MRSA is one of the most prevalent nosocomial pathogens worldwide. In particular. Other family members may need to be decolonized concurrently. A number of studies have also reported elevated MRSA carriage among veterinary personnel (including livestock. vancomycin resistance seems to be increasing. or allowing it to remain. quinupristin/dalfopristin and daptomycin. Most infections occur in high risk patients. Opinions in other countries remain divided on the benefits of screening on admission. Mortality also depends on success in finding an effective antibiotic for the strain. multiple antibiotic resistant strains have started to emerge.8%. even in people with no known link to a MRSA case. including mupirocin. As with many bacterial infections. Outpatients with MRSA skin lesions should keep them covered with clean. which are often resistant to most common antibiotics. but not others. including various combinations of intranasal agents (e. are also important in preventing MRSA transmission from humans. In some circumstances. resistance to other antibiotics may be increasing. where 38% of humans who lived on swine farms were colonized with CC398. However. severity and progression of the infection. the organism may be reintroduced by carriage in other parts of the body.

merckmanuals.shtml The Merck Manual http://www.1-44. page 7 of 14 .com/Resources/MRSA.gov/hai/ CDC. Girolami R. Characterisation of methicillin-resistant Staphylococcus aureus isolates from dogs and their owners. Siu KH. Morley PS.122(1-2):185-9. 10-13. O’Neill T.121(3-4):307-15.net/ Spa-MLST Mapping [database] http://spaserver2.ca/lab-bio/res/psds-ftss/indexeng.gov/hicpac/mdro/mdro_toc. Razonable RR. Kopec R. 2009. Hasman H. Willams NJ. Strategies for Clinical Management of MRSA in the Community http://www. Merialdi G. Miller LG. Rankin SC.mlst.petpartners.129(3-4):410-7. 2007. Shrestha NK. Baptiste KE.87:3–9. Methicillinresistant staphylococci in companion animals.bsava. Weese JS. Franco A.de/mlst. Emerg Infect Dis. Vet Microbiol. Spain.html The Merck Veterinary Manual http://www.merckmanuals. Pathogen Safety Data Sheets http://www. Lefebvre SL. Pittet D.htm British Small Animal Veterinary Association.22(4):336-43. http://www. Retrospective multicentre study of methicillinresistant Staphylococcus aureus infections in 115 horses. Boyce JM. Gilbert SM.com/professional/index.51 Suppl 2:S183-97.16(1):157-9. Hasman H. Welsh RD. Diagn Microbiol Infect Dis. Guidelines for Hand Hygiene in Health-Care Settings.com/vet/index. Abbott Y. Clin Microbiol Infect. Rankin SC. Occurrence. Moodley A. Bottone EJ. Recommendations of the Healthcare Infection Control Practices Advisory Committee and the HICPAC/SHEA/APIC/IDSA Hand Hygiene Task Force. 1984. Methicillin-resistant Staphylococcus aureus-associated dermatitis in a Congo African grey parrot (Psittacus erithacus erithacus). Lab Invest. 2002/ 51(RR16). Holbrook TC. Morris DO. 2010.html References Aarestrup FM. Vet Microbiol. Lorenzetti R. Tisch DJ. Stamm JM. Chapnick EK. Hart CA. 2007. E Aspiroz C. 2005. Rossney AS. Baptiste KE.Doc?id=659 Public Health Agency of Canada. Last Updated: February 2011 © 2014 Anderson ME. editors. Jensen VF. Equine Vet J. 2010.11(6):808-13. Quale J. Vet Microbiol. Battisti A. Isolation of methicillin-resistant Staphylococcus aureus from a non-healing abscess in a cat. Markey BK. Schneierson’s atlas of diagnostic microbiology.cdc. Evaluation of prevalence and risk factors for methicillin-resistant Staphylococcus aureus colonization in veterinary personnel attending an international equine veterinary conference. antimicrobial resistance and clonality of methicillin. 2008. Management of MultidrugResistant Organisms in Healthcare Settings http://www. Guideline for Hand Hygiene in Health-Care Settings. Community-acquired methicillinresistant Staphylococcus aureus: the role of Panton–Valentine leukocidin.and erythromycin-resistant staphylococci in the nasal cavity of domestic animals. Feltrin F. Taylor DR. Healthcare-associated Infections (HAI) http://www. Williams K.html CDC. Vet Rec.157(13):388-9. Isolation rates of meticillin-resistant Staphylococcus aureus in dogs.phac-aspc. Procop GW.68(1):28-33. Tuohy MJ. Corkill JE.gc. Vet Rec. Iurescia M. Bagcigil FA.166(15):451-5. LeDell KH. Anderson ME. Morb. Wattret A. Leonard FC. Coughlin E. Skin lesion caused by ST398 and ST1 MRSA.org/Document. 2005. Wilson D. Dawson S. Eramo A. Torres SM.cdc. Lasarte JJ. Ghitan M.gov/mrsa/pdf/MRSA-StrategiesExpMtgSummary-2006.pdf Guidelines for Animal-Assisted Interventions in Health Care Facilities http://www. Emerg Infect Dis. Zini M. Bender JB. Progression to bacteremia in critical care patients colonized with methicillin-resistant Staphylococcus aureus expressing Panton-Valentine leukocidin. Blaine KP. Lozano C. Boost MV. Community-associated methicillin-resistant Staphylococcus aureus in hospital nursery and maternity units. 2007.cdc. Aceto H. Hall GS. Aarestrup FM. Vindel A. Decreased susceptibility to zinc chloride is associated with methicillin resistant Staphylococcus aureus CC398 in Danish swine.Methicillin Resistant Staphylococcus aureus Internet Resources Association for Professionals in Infection Control and Epidemiology. Clin Infect Dis. Daum R. Yost R. Boyle-Vavra S. Caron JP.cdc.gov/mrsa/index.php Multi Locus Sequence Typing [database] http://www. 2008. Cavaco L. Anderson ME.htm CDC. Weese JS. Boucher H. Lefebvre SL. Staphylococcus. Serious infections caused by methicillin-resistant Staphylococcus aureus. Bratu S.html CDC. Heterogeneity among methicillin-resistant Staphylococcus aureus from Italian pig finishing holdings. Emerg Infect Dis. Olsen KE. Guardabassi L.142(3-4):455-7.org/MRSA. Moore B. MRSA http://www. Landman D. 2007. p.142(34):361-6. Vet Microbiol.cdc. Leggett B. Guidelines for the Control of MRSA http://goapic. Zarazaga M. 2005. 2010.13(7):731-3. Mortal Wkly Rep. Briscoe JA. Clegg PD.11(12):1942-4. species distribution. Vet Microbiol. 2010. Weese JS. Torres C. O'Donoghue MM. Abbott Park IL: Abbott Laboratories. 2010. J Avian Med Surg. Evaluation of a real-time polymerase chain reaction assay for rapid identification of methicillinresistant Staphylococcus aureus directly from nasal swabs in horses.gov/mmwr/preview/mmwrhtml/rr5116a 1. Hendrick MJ. cats and horses in Ireland. Rosenthal KL.41(4):401-5.aspx Centers for Disease Control and Prevention (CDC) http://www. 9th ed.ridom. 2010.

2007.300(23):109-17. Witte W. Pomba MC. Vandenesch F.J Antimicrob Chemother. Characterization of methicillin-resistant Staphylococcus aureus ST398 from cases of bovine mastitis. Torren-Edo J. Scientific Advisory Group on Antimicrobials (SAGAM). Nübel U. * Accessed 17 Apr 2006. Walther B. Laboratory detection of: vancomycin-intermediate/resistant Staphylococcus aureus (VISA/VRSA) [online]. and ST398 in a veterinary hospital. Enoch DA. Stanek C. Complicated communityacquired soft tissue infection by MRSA from porcine origin. Centers for Disease Control and Prevention [CDC]. Vet Microbiol. 2006.Can Vet J.Methicillinresistant Staphylococcus aureus in resident animals of a longterm care facility. Stanek C. Towner KJ.gov/ncidod/dhqp/ar_visavrsa_labFAQ. PLoS One. 2010. Petré D. Epidemic methicillin-resistant Staphylococcus aureus. Kipp F. Greko C. 2009. Willems G. Dispas M.55(12):329-32. Catry B. Centers for Disease Control and Prevention [CDC]. Weese JS. Int J Med Microbiol.19:598-605. Inducible clindamycinresistance in methicillin-resistant Staphylococcus aureus and methicillin-resistant Staphylococcus pseudintermedius isolates from dogs and cats. 2008. Enright MC. Strommenger B.* Accessed 17 Apr 2006. 1975.cdc. Diller R. Centers for Disease Control and Prevention [CDC]. Busscher JF. CDC. Ran L. Staphylococcus aureus colonization in healthy horses in Atlantic Canada. Li J. Witte W. 1972. Cui S.44(3):847-53. Bender JB. 2005 June. 2006. Guo Y.19:23-27. Strommenger B. Phillips I. The prevalence of methicillin-resistant staphylococci in healthy horses in the Netherlands. Euro Surveill. 2005. Pyörälä S. Forey F. Witte W. Available at: http://www. Fameree L. Struelens MJ. Burton S. Durand G. Witte W. Burstiner LC. Strommenger B. Edwards DI. Methicillinresistant Staphylococcus aureus ST398 in swine farm personnel. 2008. Available at: http://www. Sonntag AK. Chi CY. Clin Infect Dis. Methicillinresistant Staphylococcus aureus skin infections from an elephant calf--San Diego. Cuny C.Methicillin Resistant Staphylococcus aureus Brown DF. Edgeworth JD. Hawkey PM. Bes M. Healthcareassociated methicillin resistant Staphylococcus aureus (HAMRSA).Vet Surg. Zoonoses Public Health. Mellmann A.65(4):619-25. Evidence for cost reduction based on pre-admission MRSA screening in general surgery. Accessed 17 Apr 2006. 1988. Pathak S. Lina G.15(7):1098-101. Centers for Disease Control and Prevention [CDC]. Emerg Infect Dis. 2009 Aug 27. Weese JS.58(8):194-8. Available at: http://www.21 Suppl C:57-65.html.14(4):307-10. 2009 6. Centers for Disease Control and Prevention (CDC). MMWR Morb Mortal Wkly Rep. Wang SM. 2005. Ma Y.36(6):590-2. Faires MC. Catry B. van Duijkeren E. Hu C. Van Damme LR. Faires M. Olsen KE. Epidemiology of methicillin-resistant Staphylococcus aureus in dairy herds.49(8):797-9. Microb Drug Resist. Int J Hyg Environ Health. Layer F.139(3-4):419-20. Kozytska S.56:1000-18. Zentbl Vetmed. Devriese LA. Munoz-Madero C. Nasal colonization of humans with methicillin-resistant Staphylococcus aureus (MRSA) CC398 with and without exposure to pigs.113(1-2):131-6. 2010. Methicillin-resistant Staphylococcus aureus colonization in personnel attending a veterinary surgery conference.11(1). Gard S. Kearns AM. Weese JS.gov/ncidod/dhqp/ar_mrsa. CDC. Isolation and characterization of methicillin-resistant Staphylococcus aureus from swine and workers in China. Methicillin-resistant Staphylococcus aureus in dogs and cats: an emerging problem? J Small Anim Pract. Ohlsen K. Sloet van OldruitenborghOosterbaan MM. Slater JD. Cuny C.64(4):680-3. Declercq P. Kikuchi K. 2006. Layer F.138(5):626-44. Communityassociated MRSA information for clinicians [online]. Threlfall EJ. Butaye P. Ungemach F. Reihe B. Karas JA. Törneke K. Friedrich A. MRSA carriage in a pet therapy dog.42(2):181-5. Belgium. J Antimicrob Chemother.gov/ncidod/dhqp/ar_mrsa_ca_clinicians. Jin S. Schwarz S.4(8):e6800.56(Pt 5):614-9. Cuny C. Ridgway GL.html. Ehricht R. Morrison D. Nathaus R. Farrington M. Kadlec K. Lindsay JA. 2010. Duquette RA. Liassine N. J Clin Microbiol. McClure JT.cdc.cdc. Lin HC. Emergence of methicillin-resistant Staphylococcus aureus (MRSA) in different animal species. Vet Microbiol. Strommenger B. 2009. Epidemiol Infect. 2008.57(3):220-6. 2006. A clinical and microbiological comparison of Staphylococcus aureus toxic shock and scalded skin syndromes in children. Kuemmerle J. Emergence of MRSA infections in horses in a veterinary hospital: strain characterisation and comparison with MRSA from humans. Scott C. Moreno MA. Infection. Aucoin D. 2010. Sanders P. Ruzauskas M. Reflection paper on MRSA in food-producing and companion animals: epidemiology and control options for human and animal health. J Hosp Infect. Suetens C. MMWR Morb Mortal Wkly Rep. 2010. ST254. J Med Microbiol. Cockfield JD. Guidelines for the laboratory diagnosis and susceptibility testing of methicillin-resistant Staphylococcus aureus (MRSA). Van Duijkeren E. Denis O. Wenger A. J Antimicrob Chemother. Gordts B. CDC. Willey B. Devriese LA. Liu CC. Cookson BD. Boxrud D. Rapid determination of hospital-acquired meticillin-resistant Staphylococcus aureus lineages. Communityassociated methicillin-resistant Staphylococcus aureus infection among healthy newborns--Chicago and Los Angeles County. © 2014 page 8 of 14 . 2006. Altmann D. Methicillin (cloxacillin)resistant Staphylococcus aureus strains isolated from bovine mastitis cases.45(12):591-7. 2004. Nuttall TJ. Cuny C. Monecke S.and community-acquired infections in France. Detection of new methicillin-resistant Staphylococcus aureus clones containing the toxic shock syndrome toxin 1 gene responsible for hospital. 2005 Feb. Fessler A. Grevener K. 2009. Senninger N. 2008.211(1-2):205-12. Hommez J. Gordts B. Clusters of infections in horses with MRSA ST1. Voss A. 2004. Emery MM. Li F. J Antimicrob Chemother. Last Updated: February 2011 Coughlan K. 2005 Feb. Ramboer I. Hallin M. Etienne J.60:186e8. Wieler L. Wren MW.html. California. Friedrich AW. Res Vet Sci.39(2):150-7. Meugnier H. Reid-Smith R. 2008.

Whittem T. Kruth SA. Faires MC.43(5):2384-90. Hebert C. Vila J. Skov RL. van Duijkeren E. Livestock-associated methicillinresistant Staphylococcus aureus sequence type 398 in humans. Ito Y. Guardabassi L. Appl Environ Microbiol. Ruiz J. Powers JH. Robicsek A. Yanagisawa C. Sakagami A. Harper AL. Genetic variation among Staphylococcus aureus strains from bovine milk and their relevance to methicillin-resistant isolates from humans. Tyler S. Surynicz K. Tater KC. Isolation of Staphylococcus schleiferi from dogs with pyoderma. Moodley A.Methicillin-resistant staphylococcal colonization in dogs entering a veterinary teaching hospital. Hanselman BA. Mulvey MR. Kearns AM. McGuane S. 2008. Morita E. and participants in the CDC . Jernigan JA. JAMA. Am J Vet Res. Rousseau J. Golding GR. Zweifel C. Eguchi M. in livestock. 2005. Morris DO. Weese JS. Wagenaar JA.15(12):2071-2. Simor AE. Rankin SC. Suzuki Y.23(4):340-5. Accessed 2 Feb 2010. Occurrence and molecular characteristics of methicillin-resistant Staphylococcus aureus and methicillinresistant Staphylococcus pseudintermedius in an academic veterinary hospital. Methicillin-resistant Staphylococcus aureus in marine mammals. Albizu I. Weese JS. Fankhauser C. Koller S. Male MJ. 2009. Van Domselaar G. 2009. van Nes A.48(6):2130-9. Sequence type 398 meticillin-resistant Staphylococcus aureus infection and colonisation in dogs.gov/ncidod/dhqp/ar_mrsa_ca. Heederik D. Vet Rec. Giezendanner N.299(10):1149-57. Katsuda K. Cookson BD. Gortel K. 2008. pii: 19542. J Infect Chemother. Hata E. Uchida I. Wilkes RP. Funabashi Yoh M. Mulvey MR. 2010. van Duijkeren E.html. Renzi G. population based survey of Staphylococcus aureus colonization.235(5):540-3. Vernaz N. Vet Dermatol. Golding GR. Vet Microbiol. Decolonization therapy in infection control. Sax H. Shimokubo N. 2001. Hanson BM. 2002. Hanselman BA. 2006. Graveland H. 1999. Spreitzer DJ. Emerg Infect Dis. 2008. Evaluation of isolation procedures and chromogenic agar media for the detection of MRSA in nasal swabs from pigs and veal calves. J Clin Microbiol. Scand J Infect Dis. Frank LA. Ganner M. Mulvey MR. Weisiger RM. Euro Surveill. Proc Natl Acad Sci U S A.126(1-3):277-81. 2010. 2010.15(2):101-4. Heesterbeek H. Bemis DA. Weese JS. and association with clinical disease. Smith TC. Strategies for clinical management of MRSA in the community: Summary of an experts’ meeting convened by the Centers for Disease Control and Prevention. 2010.16(4):587-94. Simor A. Screening for skin carriage of methicillin-resistant coagulasepositive staphylococci and Staphylococcus schleiferi in dogs with healthy and inflamed skin. Methicillin resistant Staphylococcus aureus ST398 in veal calf farming: human MRSA carriage related with animal antimicrobial usage and farm hygiene. Nakajima C. Low DE.12(12):1933-8. 2010. 2010. Shimazaki M. J Am Vet Med Assoc.S. J Agromedicine.15(12):1998-2000. Christenson J. Heederik D.23(3):268-72. Methicillin-resistant Staphylococcus aureus colonization in veterinary personnel. Toda K. Sturdevant DE. Pitt TL.76(15):5165-74.16(1):69-75. Campbell KL. Griffeth GC. 2006. Mevius D. Leedom Larson KR. Shofer FS. 2003.19(3):142-9. Hanaki H. 2008. Bryden L. Ho J. Wong A. 2009. Lin SX. Campbell JL. Pearl DL. An investigation of methicillinresistant Staphylococcus aureus colonization in people and pets in the same household with an infected person or infected pet.convened Experts’ Meeting on Management of MRSA in the Community. © 2014 page 9 of 14 .222(4):451-4. Novel lineage of methicillin-resistant Staphylococcus aureus. Graham PL. Gravel D.42(4):318-20. Oosting-van Schothorst I. An overview of livestockassociated MRSA in agriculture.cdc. Kania SA. Can J Infect Dis Med Microbiol. Donham KJ. Tater KC. Musser JM. Harbarth S. Kadosawa T.98(15):8821-6. Ann Intern Med. Vergara Y. Lawn K.60(12):1526-30. Methicillin-resistant and -susceptible Staphylococcus aureus infections in dogs. Mergl J. Traverse M. Kruth S. A U. Floras A. Ferguson DD. Muramatsu Y. J Am Vet Med Assoc. Canada. Weese JS. Stephan R. Bandiera-Clerc C.Vet Microbiol. Schaeffer DJ. Kobayashi H. 2010. Ishihara K. Prevalence and characteristics of meticillin-resistant Staphylococcus aureus in humans in contact with farm animals. Ueno H. Tanaka K. Gorwitz RJ.15(16). Mackie SM.PLoS One. McDonald RR. 2010. Available at http://www. Methicillin resistance among staphylococci isolated from dogs. characterization. Holmes A. 2004. Gomez-Lus R Antibiotic resistance and epidemiological typing of Staphylococcus aureus strains from ovine and rabbit mastitis. Goni P. 2010 Jun 8. Hong Kong. Veyhl J. Emerg Infect Dis.144:318-25. Wylie J.8(3):256-61. Abraham JL. 2009. Huber H.166(26):826-7. Fitzgerald JR.5(6):e10990. Nakamura T. Last Updated: February 2011 Graveland H. 2006. Hartmeyer GN. Larson EL. Kakoma I. Willey BM. Staphylococcus aureus isolates carrying Panton-Valentine leucocidin genes in England and Wales: frequency. Pigassociated methicillin-resistant Staphylococcus aureus: family transmission and severe pneumonia in a newborn.139(12):121-5. Int J Antimicrob Agents. Weese JS. Levett PN. Wagenaar JA. Emerg Infect Dis. Staphylococcal scalded-skin syndrome in an adult due to methicillin-resistant Staphylococcus aureus. Curr Opin Infect Dis. Schoormans A. Faires MC. Tamura Y. Gehring E. Pittet D. Emerg Infect Dis.19(4): 273–81. J Clin Microbiol. McGeer A.Methicillin Resistant Staphylococcus aureus Faires MC. 2010. Golding GR. Graham MR. Slavic D. Switzerland. and in food of animal origin. Gill SR. Emerg Infect Dis. Gervaz P. Boost M. Broekhuizen-Stins M. Universal screening for methicillin-resistant Staphylococcus aureus at hospital admission and nosocomial infection in surgical patients. O'Donoghue M. Schrenzel J. Jernigan DB. A preliminary guideline for the assignment of methicillin-resistant Staphylococcus aureus to a Canadian pulsed-field gel electrophoresis epidemic type using spa typing. Hnilica KA. Gahrn-Hansen B. 2009. Weese JS. Evolutionary genomics of Staphylococcus aureus: insights into the origin of methicillin-resistant strains and the toxic shock syndrome epidemic. Kolmos HJ.

34(9):2072-7. 1995. 2006. 1990. Appl Environ Microbiol. Jones TF. Lim JY. Somogyi P. Eo SK. Townes JM. Kim YH. Kadlec K. J Clin Microbiol. Prevalence of Staphylococcus aureus and methicillin-resistant Staphylococcus aureus carriage in three populations. Vergara A. Mankertz J. Emerg Infect Dis.51(4):451-64. 2004. Bulens S. Heck M. 2007. Low levels of meticillin-resistant Staphylococcus aureus in pigs in Malaysia. Hall M.and genotypes of methicillin-resistant Staphylococcus aureus ST398 from diseased swine. Community-associated methicillin-resistant Staphylococcus aureus in outpatients.164(20):626-7. Methicillin-resistant Staphylococcus aureus toxic shock syndrome. Am J Med Sci. Evaluation of the methicillinresistant Staphylococcus aureus (MRSA)-Screen latex agglutination test for detection of MRSA of animal origin. Aarestrup FM.304(6):641-8.141(1-2):178-81. Park YH. Methicillin resistant Staphylococcus aureus colonization in pigs and pig farmers. Somogyi P. Lefebvre SL. Egyed Z.128(3-4) :298-303. Lynfield R. Park H. Antimicrobial susceptibility of environmental Staphylococcus aureus strains isolated from a pigeon slaughterhouse in Italy. 2005. Mu Y. O’Mahony R. Kaldhone P. Keseru J. Diversity of antimicrobial resistance pheno. Fridkin SK. Acta Vet Hung.117(24):304-12. Klein E.158(5):155-9. Lilenbaum W. Denmark. 2009. Kerr S. Juhász-Kaszanyitzky E. Wagenaar JA. Leonard FC. J Vet Med Sci. Staphylococci isolated from animals and food with phenotypically reduced susceptibility to betalactamase-resistant beta-lactam antibiotics.24(1):132-9. Zakaria Z. 2005. Janosi S. Kitai S.Vet Microbiol. Foley SL. Mangalat D. J Antimicrob Chemother. Tragas G. 2010. Laxminarayan R. Ianieri A. Kellum ME. Bruining H. Sørum M. United States. Jeong JM. 2010. Okamoto R. Kitagawa H. Schaffner W. Park KT. Lee Y. Emerg Infect Dis. Skov RL. Lee JH. Kallen AJ.69(11):6489-94. Kottler S. Emerg Infect Dis. Methicillin-resistant Staphylococcus aureus isolated from a veterinary surgeon and five dogs in one practice. A survey of methicillin-resistant Staphylococcus aureus affecting patients in England and Wales. 2008. food and different animal species according to data of the Hungarian resistance monitoring system in 2001. Lloyd DH. Lett Appl Microbiol. Mackintosh CA. Losito P. 2003. Kaszanyitzky EJ. et al. Deplano A. Characterization of methicillin-resistant Staphylococcus aureus isolated from retail raw chicken meat in Japan.15(12):1925-30. Kim S.42(6):2780-2. Khanna T. Weese JS.8(1):82-4. van Leeuwen W. 2002. Moore FM. J Clin Microbiol. 2004. Kempker R. Azeredo MA Prevalence and antimicrobial susceptibility of staphylococci isolated from the skin surface of clinically normal cats. Khalid KA. Vet Rec. Lloyd DH. Acta Vet Hung. Monecke S. Friendship R. Dán A. Moon JS. Vet Rec.16(1):11-5. 2010. Toung OP. Jánosi S. Soares-Magalhaes R.338(5):425-7.Methicillin Resistant Staphylococcus aureus Jamart S. Novicki T. Reese C. Selchau M. Schwarz S. Janosi S. Gershman K. Kaspar H. Active Bacterial Core surveillance (ABCs) MRSA Investigators of the Emerging Infections Program. 2009. Pigs as source of methicillin-resistant Staphylococcus aureus CC398 infections in humans. 1999-2006. 2005. Muscariello T. Youn HY. Weese JS.14(9):1383-9.84(11):1802-7. Antibiotic resistance of staphylococci from humans. Marples RR. Methicillin-resistant Staphylococcus aureus in food products: cause for concern or case for complacency? Clin Microbiol Infect.11(4):636-7. Lewis HC. Nakano C. Food-initiated outbreak of methicillin-resistant Staphylococcus aureus analyzed by pheno.J Vet Intern Med. Middleton JR. Bae W. Chae JS. De Bels D. Fritsche TR. Shukla SK. van Leeuwen N. Denis O. Smith DL. Szabo I. 2005-2008. Ehricht R. Bell M. Yagi M. 2010 Sep 2. Gal Z. An outbreak of community-acquired foodborne illness caused by methicillin-resistant Staphylococcus aureus. van Duijkeren E. Barker E. Quinn PJ. Nunes EL. Saitoh Y.138(5):595-605. J Hosp Infect. Markey BK. Last Updated: February 2011 © 2014 Kluytmans J. Abbott Y. Kawano J. Lin Y. Choi SS. Reingold A. Kongphet-Tran T. Eaton M. Schaffner W. Health care-associated invasive MRSA infections. 2009. Perry J. Patel PR. Herwaldt L. Emerg Infect Dis. 2006. Markey BK. 2008. Rost J. J Hosp Infect. Dewey C.Companion animals: a reservoir for methicillin-resistant Staphylococcus aureus in the community? Epidemiol Infect. Saito T. Rossney A. Messer S. 2003. J Clin Microbiol. Kim SH. McOrist S. Isolation of methicillin-resistant coagulase-negative staphylococci from chickens. Pantrangi M. Harrison LH. Lack of transmission of methicillin-resistant Staphylococcus aureus (MRSA) between apparently healthy dogs in a rescue kennel. 2008. Contamination of pet therapy dogs with MRSA and Clostridium difficile. Hollis R. Dumyati G. Agost G.and genotyping. Loeffler A.33(5):1121-8. Kawano J. Kim JM. Kislow J. [Epub ahead of print] Loeffler A. Emerg Infect Dis. Hong SK. Meticillin-resistant Staphylococcus aureus in animals: a review. Beware of the pet dog: a case of Staphylococcus intermedius infection. 2010. Semjen G. Egyed Z. Clin Med Res. Characteristics of methicillin resistant Staphylococcus aureus isolated from chicken meat and hospitalized dogs in Korea and their epidemiological relatedness. Kerr GE. van der Graaf-van Bloois L. Steinacker U. Methicillin (oxacillin)-resistant Staphylococcus aureus strains isolated from major food animals and their potential transmission to humans.64(6):1156-64. Lindsay JA. Cohn LA.175(1):27-36.16(1):35-48. Shimizu A. Weese JS. Uji T. Vet J. 1998. Goessens W. Porter SS. JAMA.27(4):224-8. Veres Z. 2009. Poult Sci. Kwon NH. Devriendt J. Shimizu A. Evidence of multiple virulence subtypes in nosocomial and community-associated MRSA genotypes in companion animals from the upper midwestern and northeastern United States. Kaszanyitzky EJ. Mølbak K. Sato E. 2009. MRSA transmission between cows and humans. Ray SM. Lee JH. Vet Microbiol.72:268e283 Leonard FC. Park YH. Stemper ME.13(4):630-2. Pfeiffer DU. Petit S. Vet Microbiol. Kim JY. Kluytmans JA.52(1):7-17. 1996. page 10 of 14 . 2010.67(1):107-10. Vandergheynst A. Jung WK.

Case study: an MRSA intervention at Evanston Northwestern Healthcare. Chen TP. 2006.138(5):743-55. O'Mahony R. J Antimicrob Chemother. van Belkum A. Chaberny IF. Voss A. Gerlach GF.15(3):452-3. Owen MR. Mulders MN. 2010. Meticillin-resistant Staphylococcus aureus in a veterinary orthopaedic referral hospital: staff nasal colonisation and incidence of clinical cases. Methicillin-resistant Staphylococcus aureus (MRSA) in foods of animal origin product in Italy. Murphy CP. Haenen AP. 2007. Siu LK. Pollock PJ. Loução F.Scand J Work Environ Health. Manian FA. Normanno G. Markey BK. McLean CL. Epidemiol Infect. Thomson RB Jr. Tomasz A.65(11): 2479-81. Coe RJ.33(12):732-8. Moodley A. Virgilio S. J Clin Microbiol 2005. Nienhoff U.43(6):2916-9.49(4):170-7. Peng CF. Hacek DM. Couto N.ca/msds-ftss/msds143e. [Epub ahead of print] Lozano C. Kaul KL. page 11 of 14 . Prevalence of livestock-associated MRSA in broiler flocks and risk factors for slaughterhouse personnel in The Netherlands. Otter JA. Risk factors and molecular analysis of community methicillinresistant Staphylococcus aureus carriage. 2010 Dec 15:1-7. Abbott Y. 2008. Kinyon JM. Struelens M. Van De Giessen AW. Malik S. Celano GV. Pomba C. Paule SM. Zarazaga M. French GL. Perreten V. Rossney AS. Parisi A. Prevalence of ST9 methicillin-resistant Staphylococcus aureus among pigs and pig handlers in Malaysia. Aspiroz C.45(9):2993-8. 2010. Bosch T. 2009.45(12):609-12. J Antimicrob Chemother. Methicillin-resistant Staphylococcus aureus: an emerging problem in horses? J Am Vet Med Assoc. Hacek DM. Barton MD. High risk for nasal carriage of methicillinresistant Staphylococcus aureus among Danish veterinary practitioners.Can Vet J. Baptista FM. Quaglia NC. Office of Laboratory Security. Fanning S. Haesebrouck F. Lloyd DH. Persoons D. Hartmann F.10(4):227-39. 2007. 2010. Rad EG. Hermans K. Kadlec K. Stegger M. Torres C. Dam-Deisz WD. Vet Microbiol. Leonard N.98(19):10886-91. Luby CD. Skov RL.52(10):3817-9. Oaks JL. Huijsdens XW. Molecular epidemiology of communityassociated meticillin-resistant Staphylococcus aureus in Europe. Torres C. Maddox CW. 2005.152(4):176-82. Baptiste KE. 2009. Weese JS. Vesseur PC. Gerber V. Lipinska U. Robicsek A. Panchaud Y.html. methicillin-resistant Staphylococcus aureus (MRSA) in a pet dog associated with MRSA infection in household contacts. Hermans K. Kufner B. 2003. Ness MG. Leonard FC. Escherichia coli and selected veterinary and zoonotic pathogens isolated from environmental sites in companion animal veterinary hospitals in southern Ontario. Performance of the BD GeneOhm methicillin-resistant Staphylococcus aureus test before and during high-volume clinical use. Neela V. Public Health Agency of Canada. spa typing of methicillin-resistant Staphylococcus aureus isolated from domestic animals and veterinary staff in the UK and Ireland.Schweiz Arch Tierheilkd. Moodley A. Int J Food Microbiol.64(6):1325-6. Hassard L.44(2):413-6. Loeffler A. Partial nucleotide sequencing of the mecA genes of Staphylococcus aureus isolates from cats and dogs. Peng H. Stegger M. [Epub ahead of print] Moodley A. Van Hoorebeke S. J Clin Microbiol. Fales WH. Comp Immunol Microbiol Infect Dis. Management of MRSA septic arthritis in a dog using a gentamicin-impregnated collagen sponge. Haesebrouck F.Methicillin Resistant Staphylococcus aureus Lozano C.64(3):660-2. Bacterial infections in horses: a retrospective study at the University Equine Clinic of Bern. 2007. Lasarte JJ. Deplano A. Accessed 16 Apr 2006. Antimicrob Agents Chemother. J Small Anim Pract. 2008. Verspohl J. Available at: http://www.223(10):1399-400. Graat EA. Wu CC. 5 Million Lives Campaign. Pinho MG. Dynamic of nasal colonization by methicillinresistant Staphylococcus aureus ST398 and ST1 after mupirocin treatment in a family in close contact with pigs. 2008.phac-aspc. Schwarz S. 2009. J Clin Microbiol. Prescott JF. Truchon K. Transmission of methicillinresistant Staphylococcus aureus strains between humans and dogs: two case reports. de Kruif A. 2006. Guardabassi L.34(2):151-7. Peterson LR. Denis O. An acquired and a native penicillin-binding protein cooperate in building the cell wall of drug-resistant staphylococci. Mohd Zafrul A.36(2):e26-8. Nielsen SS. Last Updated: February 2011 © 2014 Nemati M. McEwen SA. Epidemiol Infect. Geenen PL. Chin LC. Ma L. Reid-Smith RJ. Moores AP. Greco G. Guardabassi L. 2010. Detection of methicillin-resistant Staphylococcus aureus ST398 in food samples of animal origin in Spain. Rossano A. Asymptomatic nasal carriage of mupirocin-resistant. Ruiz-Larrea F. Hengeveld PD.117(2):219-22.109(34):285-96. Butaye P. Office of Laboratory Security. Skov R. Zarazaga M. Methicillin-resistant Staphylococcus aureus (MRSA) isolated from animals and veterinary personnel in Ireland. Bagcigil AF. 2010 Jul 19.47(12):4138-40. Hasman H. Clin Infect Dis. Bellacicco AL. Boerlin P. de Lencastre H. Liew YK. Pasmans F. Mariana NS.J Antimicrob Chemother. Abbott Y. Lu PL. Surveillance of Staphylococcus aureus in veterinary teaching hospitals. Janecko N. Welsh RD. López M.gc. J Small Anim Pract. Quinn PJ. Methicillin-resistant Staphylococcus aureus CC398 isolates with indistinguishable ApaI restriction patterns in colonized and infected pigs and humans. Guardabassi L. Poldervaart ES. Dewulf J. Emerg Infect Dis.J Antimicrob Chemother. Lancet Infect Dis. O’Rourke K. Nolte I. Nightingale EC. Dambrosio A. Williams NJ. Jt Comm J Qual Patient Saf. J Clin Microbiol. Corrente M.58(6):1118-23. 2005. Devriese LA. J Clin Microbiol. 2010.43(1):132-9. Simon D. Antimicrobial resistance of old and recent Staphylococcus aureus isolates from poultry: first detection of livestockassociated methicillin-resistant strain ST398. Mevius D. Gómez-Sanz E. La Salandra G. Methicillin-resistant Staphylococcus aureus in poultry. Latronico F. Material Safety Data Sheet: Staphylococcus aureus [online]. Middleton JR. 2001 March. Sanchez S. Experimental colonization of pigs with methicillin-resistant Staphylococcus aureus (MRSA): insights into the colonization and transmission of livestock-associated MRSA.51(9):963-72. 2004. Robicsek A. Peterson LR. Chiang YH. 2003. 2009. Gómez-Sanz E. 2001. Proc Natl Acad Sci U S A.

Alberta. 2010. Fields B. Kaul KL. Takahashi N. Hammerl JA. Molecular phylogenetic evidence for noninvasive zoonotic transmission of Staphylococcus intermedius from a canine pet to a human. Kikuchi K. Juranek D. methicillin-resistant Staphylococcus aureus in a newborn nursery: report of an outbreak and laboratory investigations. Fetsch A. Spa-MLST Mapping 104. Bräunig J. Pascual A.12:29-34. van Leeuwen WB. Chicago IL. Allardice G. Universal screening for meticillinresistant Staphylococcus aureus: interim results from the NHS Scotland pathfinder project. Sergio DM. Francis BJ. Guerra B. Gálvez J. Ashford D.Ann Intern Med. Thomson RB Jr. J Clin Microbiol.50(11):1177-80.74(1):35-41. Kakutani O. Infect Control Hosp Epidemiol. Smith TC.37(5):1459-63. Milanesi B. Pantosti A. 2009. Shimizu A. Weese JS. Goering RV. Lestari ES. 1992. 2000. 2008. J Clin Microbiol. Quoraishi AH. Roberts S. Besser R. Kadlec K. Thomson R. Methicillin-resistant Staphylococcus aureus isolates from companion animals. Yamamoto C. Methicillin-resistant Staphylococcus aureus (MRSA) in three dairy herds in southwest Germany. O’Shea K. Van Belkum A. Accessed 12 Jan 2011. Vet Microbiol. Pastink M. van Wamel W.148(6):409-18. J Med Microbiol. Methicillin-resistant and susceptible Staphylococcus aureus sequence type 398 in pigs and humans. J Health Popul Nutr. Pedroni P. Kloos WE. Schroeter A. Reid-Smith R. Hacek DM. Center for Food Safety and Applied Nutrition. Vet Med Sci. Vet Rec. Roberts L. 54(12):5413-7. Tenhagen BA. Saxena S. Velasco C. Jones RN.4(1):e4258. 1988. Panton valentine leukocidin (PVL) toxin positive MRSA strains isolated from companion animals. Horst-Kreft D. Whitney C. Hiramatsu K. Zanetti L. Peeters JK. Available at: http://www. 1997. PLoS One. Crossinfection between animals and man: possible feline transmission of Staphylococcus aureus infection in humans? J Hosp Infect. Hadi U. Paule SM.154(10):310.Rich M. Lorenzo M. Foodborne pathogenic microorganisms and natural toxins handbook. Williams C. Wong S.56(Pt 8):1107-9. 2010. Hsu LY. Duerink DO. Gould IM. Richardson JF. swine and swine workers. Antimicrob Agents Chemother. Carpenter J. Prevalence of MRSA types in slaughter pigs in different German abattoirs. del Toro MD. Rau J.cfsan. Tenover FC. Available at: http://www. American Society for Healthcare Engineering/American Hospital Association. Ridom GmbH Ridom. Spohr M.38(4):1628-31. Rodríguez-Baño J. McNeil MM.105(3-4):313-4. Antonini B. Strommenger B. Can Vet J. Verbrugh HA. Kowall J. Goessens WH. Reilly JS. Toom NL. van Duijkeren E. Kamata S. Appel B.ridom.31(8):786-95. Guerra B. García L. Benson CE. Recommendations from CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC). Huijsdens XW. J Hosp Infect.Investigation of meticillin-resistant Staphylococcus aureus in pigs used for research. Stührenberg B. Zoonoses Public Health. Youvan DC. Campbell J. J Clin Microbiol. Stewart S. Friedrich A. Methicillinresistant Staphylococcus aureus (MRSA) strain ST398 is present in midwestern U. 2010 Jul 11. Melles DC.108(1-2):145-8. Methicillin-resistant Staphylococcus aureus and Staphylococcus pseudintermedius detected in the BfT-GermVet monitoring programme 2004-2006 in Germany. Donlan R. Schleuter G. Vet Microbiol.59:935-937. Nasal carriage of methicillin-resistant and methicillin-sensitive strains of Staphylococcus sciuri in the Indonesian population.S. Chow PK . FDA. Sehulster LM.64(3):441-6. 2008. King P. Robicsek A.de/mlst. Muniain MA. Methicillin-resistant Staphylococcus aureus strain USA300: origin and epidemiology.Methicillin Resistant Staphylococcus aureus Rankin S. Rothenburger J.fda. 2004. Dutch Working Party on Surveillance and Research of MRSA-SOM. Seguin JC. Diekema DJ. 2008.165(20):589-93. Verbrugh HA. Christie P. Talwar V. Available at: http://spaserver2. Kämpe U. Masterton R. Hertwig S. Kroeger JS. 2009. Accessed 15 Apr 2006. Marples RR. Lupión C. Emerg Infect Dis. Walker RD. Methicillin-resistant Staphylococcus aureus outbreak in a veterinary teaching hospital: potential human-to-animal transmission. Methicillin-resistant Staphylococcus pseudintermedius in a veterinary teaching hospital. George CG. Signorini L. Guidelines for environmental infection control in health-care facilities. Carosi G. Snijders SV. J. Moritz ED. 2005. van Belkum A. Hammerl JA. J Antimicrob Chemother. Pan A. Everett CL. on behalf of the "Antimicrobial Resistance in Indonesia. Caron JP. Scott GM. Arduino MJ. Prevalence of methicillin resistant Staphylococcus aureus colonization among healthcare workers and healthy community residents. Millán AB. page 12 of 14 . Italy.shtml. Spalburg E.cdc. Sasaki T. Prevalence of methicillin-resistant Staphylococcus aureus colonization in horses in Saskatchewan.20(3):279-80. Malone-Lee J. Kamada M. Matteelli A. Methicillin-resistant staphylococci isolated from animals. J Hosp Infect.14(3):479-83. Ridgway GL. Prevalence. Stellini R.gov/hicpac/pdf/guidelines/eic_in_HCF_03. Chinn RYW. and British Columbia. 2010. Fluit AC. Käsbohrer A. 2005.gov/~mow/intro. Capuano AW. 2009. Herwaldt LA. Kearns A. Ramírez E. de Neeling AJ. Harper AL. López-Cerero L. Maloney D. Tanaka Y.pdf Last Updated: February 2011 © 2014 Soavi L.16(2):109-21. Koh TH. Klittich G. Beaumont JL. Stephen C.45(4):1118-25. Universal surveillance for methicillin-resistant Staphylococcus aureus in 3 affiliated hospitals. Betalactamase-negative. Rich M. Bastura V. Gow SP. Mathur M. J Antimicrob Chemother. Das S. Manning ST. Goh AL. Tenhagen BA. 1990. Staphylococcus aureus. Hollis RJ. Vet Rec. Pfaller MA. Severin JA. Tinkler GP. Kuntaman K. Anzai T. Genetic analysis of equine methicillin-resistant Staphylococcus aureus by pulsed-field gel electrophoresis. Smith A. 2002. 2007. 1999. 2009.html. Tokateloff N. Cleveland J. Kawano J. 2004.16(2):346-8. Ogden BE. and Prevention" (AMRIN) study group. 2010. Schwarz S. Male MJ. [Epub ahead of print] Tanner MA. Long-term control of endemic hospital-wide methicillin-resistant Staphylococcus aureus (MRSA): the impact of targeted active surveillance for MRSA in patients and healthcare workers. Goyal R. Roberts L. Emerg Infect Dis. Fetsch A. Methicillin-resistant Staphylococcus aureus ST398. Peterson LR.61(2):282-5. United States Food and Drug Administration. 2007.

Vengust M. Hanssen AM. Comparative molecular analysis substantiates zoonotic potential of equine methicillin-resistant Staphylococcus aureus. 2010. Merz LR.43(12):6209-11. Liao RS. Wolfhagen MJ. Wulf MW. J Vet Intern Med. Methicillin-resistant Staphylococcus aureus in horses and horse personnel. Soba A. Mulders MN. Loeffen F. Van den Broek MJ. Am J Infect Control.127(12):171-8.28:13(9). Vitale CB. Methicillin-resistant Staphylococcus aureus in horses at a veterinary teaching hospital: frequency. Dhooge I. Last Updated: February 2011 © 2014 Wagenaar JA.119(1):137-40.13(12):1834-9. Lipinska U. 2009. Wulf M. Christensen E. Bosch T. Willey BM. Van den Eede A. Archambault M. Wannet WJ. Hermans K. Bosch T. 2010. van de Giessen AW. Van Keulen PH. 2008. Vet Rec. Deplano A. McGeer A. J Clin Microbiol. 2005. Prevalence of livestock-associated MRSA in communities with high pig-densities in The Netherlands. 2005. Emerg Infect Dis. Willey BM. 2007.36(2):78-85. Van Cleef BA. Jovanovic M. Kluytmans JA. van Duijkeren E.91(2-4):270-3.167(5):183-4. Gumley N. Epidemiol Infect. Increase in a Dutch hospital of methicillin-resistant Staphylococcus aureus related to animal farming. Anderson ME.139(3-4):405-9. Weese JS. van Cleef BA. Rousseau J. Occurrence of methicillinresistant Staphylococcus aureus in rats living on pig farms. Broens EM. Van Duijkeren E. 2005. Methicillin-resistant Staphylococcus aureus in people living and working in pig farms.Prev Vet Med. Clin Infect Dis. Peregrine A. Wleklinski CG. Markestein A. Guidelines for animal-assisted interventions in health care facilities. Emerg Infect Dis. van Santen-Verheuvel MG.115(1-3):148-55. Heck ME. Methicillinresistant Staphylococcus aureus in pig farming. An outbreak of methicillin-resistant Staphylococcus aureus skin infections resulting from horse to human transmission in a veterinary hospital. Robinson J. Rousseau J. 2006. Benoit M. Kohn B.42(12):5578-81. Said-Salim B. Low DE. Bakker J. Fetsch A. Kreiswirth BN. Attempted eradication of methicillinresistant Staphylococcus aureus colonisation in horses on two farms. Laryngoscope. page 13 of 14 . Buiting AG. Castrodale L. Epidemiol Infect. Mevius DJ. Card ML. Vet Microbiol.J Clin Microbiol. Methicillinresistant staphylococcal colonization in clinically normal dogs and horses in the community. Tiemersma E. Aureden K. 2004. Vanderhaeghen W. McGeer A. methicillin-resistant Staphylococcus aureus strain between humans and a dog. Innis B. Wannet WJ Transmission of a Panton-Valentine leucocidin-positive. Lagasse N. 2006. Lefebvre SL. MRSA in pigs in Serbia. Wolfhagen MJ. Emerg Infect Dis. Writing Panel of Working Group. Willey BM.37(6):510-4. 2009. Mirilovic M. 2009. Suspected transmission of methicillin-resistant Staphylococcus aureus between domestic pets and humans in veterinary clinics and in the household. Destructive otomastoiditis by MRSA from porcine origin. Haenen A.10(12):2235-7. Van Hoecke H. Low DE. van Loo I. 2008. Box AT.138(5):756-63. Van Benthem BH. Reusken CB. Walther B. Broens EM. June 2007. 2000-2002.46(2):261-3. Klaassen C. Vet Microbiol. 2004. Mulders MN. Low DE. Haesebrouck F. 2008.Methicillin-resistant Staphylococcus aureus (MRSA) in food production animals. Reid-Smith RJ. Haesebrouck F. PLoS One. Martens A. Detection of methicillin-resistant Staphylococcus aureus directly from nasal swab specimens by a real-time PCR assay.Methicillin Resistant Staphylococcus aureus Van Cleef BA. Methicillin-resistant Staphylococcus aureus (MRSA) isolated from small and exotic animals at a university hospital during routine microbiological examinations. Warren DK. Voss A. Huijsdens X. Human-to-dog transmission of methicillin-resistant Staphylococcus aureus. 2010. Kluytmans JA. Huijsdens XW. Hearn P. Teodorovic V. Weese JS.138(5):606-25. Low DE. High occurrence of methicillin-resistant Staphylococcus aureus ST398 in equine nasal samples. van Duijkeren E. Walther B. Broens EM. Wieler LH.5(2):e9385. 2009. Vet Microbiol. Avery BP. 2008. Weese JS. Yue H. High prevalence of nasal MRSA carriage in slaughterhouse workers in contact with live pigs in The Netherlands. Epidemiol Infect. Prescott JF. Gross TL. Velebit B. Weese JS.114(1-2):160-4. Emerg Infect Dis. Struelens M. Verkade EJ. Ruscher C. Kreiswirth BN. Voss A. Huijsdens XW. van de SandeBruinsma N. Van Rijen MM. De Leenheer E.Vet Microbiol. Lübke-Becker A. Voss A. Struelens M. Denis O. 2010. Emerg Infect Dis. Eveland M. Slickers P. Euro Surveill. Weese JS. Brunnberg L. Züchner L. 2005:11.Vet Microbiol. Kreiswirth BN. Bialachowski A. 2006. Kluytmans JA.43(6):602-6. Wulf MW. Caldwell F. First outbreak of methicillin resistant Staphylococcus aureus ST398 in a Dutch Hospital. Methicillin-resistant Staphylococcus aureus in cat and owner.20(1):182-6.12(12):1998-2000. Butaye P. Heck ME. Klaassen C. de Neeling A. Archambault M.51(3):338-42. Van der Wolf PJ. Unexpected sequence types in livestock associated methicillin-resistant Staphylococcus aureus (MRSA): MRSA ST9 and a single locus variant of ST9 in pig farming in China. 2006. Weese JS. Weese JS. Van De Giessen AW. Weese JS. Hermans K. Verschraegen G. Van den Broek IV. Kluytmans JA. van Pelt W. Voss A. van der Linden FT.1965–6. 2009. Lübke-Becker A. J Clin Microbiol. Tiemersma EW. characterization. Rousseau J. Detection and quantification of methicillin-resistant Staphylococcus aureus (MRSA) clones in retail meat products. Kluytmans J. Dunne WM Jr. Friedrich AW. and association with clinical disease. 2009.47(3):704-10. Huijsdens XW. Monecke S. Broekhuizen-Stins M. Gasthuys F. Willey BM. McGeer A. Ehricht R. Beaujean D. Equine Vet J. Voss A.133(12):138-44. Van de Giessen AW. Verduin CM. 2010.11(3):430-5. 2006. Piette A. McGeer A. Wieler LH. Lett Appl Microbiol. Dick H. Huijsdens X.Lett Appl Microbiol. Friedrich AW. Likhoshvay Y. Hengeveld PD. Golab GC. Pritchard J.137(5):700-8. Weese JS. Fluit AC. Van Horne L. Rousseau J. Emergence of methicillin-resistant Staphylococcus aureus of animal origin in humans.

Voss A. Kluytmans J. *Link defunct as of 2011 Last Updated: February 2011 © 2014 page 14 of 14 . Klaassen CH. Sørum M. 2008. Leenders AC.Methicillin Resistant Staphylococcus aureus Wulf MW. van Nes A. Emerg Infect Dis. MRSA carriage in healthcare personnel in contact with farm animals. Tiemersma E.Clin Microbiol Infect. Imagawa T. Melchers WJ. 2008. Hosp Infect.70(2):186-90. van Nes A. Jansen MW. the Netherlands. Voss A. de Vries J.14(1):29-34. Voss A. 1996. Mitsuda T. Wulf MW. Berkhout J. Klaassen C. Bogaers D. Isken M. Eikelenboom-Boskamp A. Melchers W. Methicillin-resistant Staphylococcus aureus in veterinary doctors and students.70(2):206-10. 2006. Skov R. Arai K. Ruijters E. [A case of staphylococcal scalded skin syndrome caused by exfoliative toxin-B producing MRSA] Kansenshogaku Zasshi. Katakura S. Yokota S. Haverkate D.12(12):1939-41. Prevalence of methicillin-resistant Staphylococcus aureus among veterinarians: an inter-national study. Wulf M.