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Abstract
Efforts to control spread of community-associated methicillin-resistant Staphylococcus
aureus (CA-MRSA) are often based on eradication of colonization. However, the role
of nasal and non-nasal colonization in the pathogenesis of these infections remains
poorly understood. Patients with acute S. aureus skin and soft tissue infection (SSTI)
were prospectively enrolled. Each subject's nasal, axillary, inguinal and rectal areas
were swabbed for S. aureus and epidemiological risk factors were surveyed. Among the
117 patients enrolled, there were 99 patients who had an SSTI and for whom data could
be analysed. Sixty-five patients had a CA-MRSA SSTI. Among these patients, MRSA colonization
in the nares, axilla, inguinal area and rectum was 25, 6, 11 and 13%, respectively,
and 37% overall were MRSA colonized. Most (96%) MRSA colonization was detected using
nose and inguinal screening alone. Non-nasal colonization was 25% among CA-MRSA patients,
but only 6% among patients with CA-methicillin-susceptible S. aureus (MSSA) or healthcare-associated
MRSA or MSSA. These findings suggest that colonization patterns in CA-MRSA infection
are distinct from those in non-CA-MRSA S. aureus infections. The relatively high prevalence
of non-nasal colonization may play a key role in CA-MRSA transmission and acquisition
of infection.