In the past few years, California jails have seen a large jump in methicillin resistant Staphylococcus aureus (MRSA). According to a study published in the November 15 issue of Clinical Infectious Diseases, now available online, not only are the rates of MRSA increasing, but newer, drug-resistant strains are appearing at an increasingly fast pace outside the hospital environment.

MRSA is typically spread by direct physical contact and indirect contact through objects such as towels, sheets, clothes, and sports equipment. Jails tend to be high-risk areas for MRSA due to the close living conditions and high turnover rates. In contrast to prisons where inmates serve longer sentences, jails are locally maintained facilities where the average sentence is one year or less. This population flux increases the chances of MRSA being commuted into the jail or out to the community.

This study, the first longitudinal study of MRSA in a jail setting, investigates the changing epidemiology of the bacteria over six years. The authors found that while there were six major S. aureus clonal groups present in their strain collection, two dominated: ST30:Z and ST8:S. Author Dr. Francoise Perdreau-Remington of the University of California, San Francisco notes, "The 1999 [ST30: Z] clone had only been previously described in Australia and New Zealand." The strain settled in California in 1996 and became the predominant clone until 2000, but was overtaken by ST8:S in 2001.

Doctors first identified the ST8:S clone in a sample collected from an outpatient in 2000. It appeared in the inpatient ward nine months later, and in that short time gained further multi-drug resistance. Perdreau-Remington states, "When we first saw the ST8:S clone in that one patient, it was 'only' erythromycin and methicillin resistant. Now it has acquired resistance to quinolones and, in some cases, to tetracycline."

The expansion in resistance is troubling, and Perdreau-Remington an
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Contact: Diana Olson
dolson@idsociety.org
703-299-0201
Infectious Diseases Society of America
20-Oct-2003

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