Background. The USA300 methicillin resistant Staphylococcus aureus (MRSA) genetic background has rapidly emerged as the predominant cause of community-associated S. aureus infections in the U.S. However, epidemiologic characteristics of S. aureus household transmission are poorly understood.Methods. We performed a cross-sectional study of adults and children with S. aureus skin infections and their household contacts in Los Angeles and Chicago. Subjects were surveyed for S. aureus colonization of the nares, oropharynx, and inguinal region and risk factors for S. aureus disease. All isolates underwent genetic typing.Results. We enrolled 1162 persons (350 index patients and 812 household members). The most common infection isolate characteristic was ST8/SCCmec IV, PVL1 MRSA (USA300) (53%). S. aureus colonized 40% (137/350) of index patients and 50% (405/812) of household contacts. A nares-only survey would have missed 48% of S. aureus and 51% of MRSA colonized persons. Sixty-five percent of households had .1 S. aureus genetic background identified and 26% of MRSA isolates in household contacts were discordant with the index patients' infecting MRSA strain type. Factors independently associated (P , .05) with the index strain type colonizing household contacts were recent skin infection, recent cephalexin use, and USA300 genetic background.Conclusions. In our study population, USA300 MRSA appeared more transmissible among household members compared with other S. aureus genetic backgrounds. Strain distribution was complex; .1 S. aureus genetic background was present in many households. S. aureus decolonization strategies may need to address extra-nasal colonization and the consequences of eradicating S. aureus genetic backgrounds infrequently associated with infection.

In our longitudinal study, patients with a S. aureus skin infection were more likely to suffer a recurrence if household fomites were MRSA contaminated. Interventions to prevent recurrence may be enhanced by decontamination of household fomites.

We found that infecting S. aureus isolates frequently persisted environmentally in households 3 months after skin infection. Presence of pathogenic S. aureus strain type in the environment in a household may represent a persistent reservoir that places household members at risk of future infection.

We found that infecting S. aureus isolates frequently persisted environmentally in households 3 months after skin infection. Presence of pathogenic S. aureus strain type in the environment in a household may represent a persistent reservoir that places household members at risk of future infection.

In the recent past, there has been a dramatic increase in the incidence of methicillin-resistant Staphylococcus aureus (MRSA) infections, especially community-associated methicillin-resistant S. aureus (CA-MRSA) infections. Many media descriptions of MRSA are sensational and focus on its potential for severe disease and contagiousness.Our objective is to describe psychological and social morbidity associated with MRSA infection via a case series of five patients with CA-MRSA infection. We also analyze the resulting stigmatization associated with being diagnosed with MRSA infection.We learned that patients describe a variety of stigmatization related to their diagnosis of MRSA, including being shunned at home and in the workplace. Patients describe being asked by family, colleagues, and clients to take extraordinary measures to prevent MRSA transmission. Consequences of MRSA diagnoses have included erosion or termination of key personal and business relationships.In conclusion, stigmatization resulting from the diagnosis of MRSA can have profound personal and social morbidity. Media and public health awareness of MRSA infection needs to be balanced with information about how MRSA transmission is usually preventable with simple hygienic measures.Over the past decade, the number of methicillin-resistant S. aureus (MRSA) infections has escalated. This increase includes a rise in the incidence of both healthcare-associated MRSA infections and community-associated MRSA (CA-MRSA) infections. 1, 2 CA-MRSA infections affect children and adults and can cause recurrent skin infections.3 MRSA infections have now received global attention in the mainstream media,4 , 5 spurned the emergence of patient-driven support groups, and spawned legislation aimed at decreasing infections. 6 Public consciousnesses of MRSA infections has probably never been higher. However, many media descriptions of MRSA are sensational and focus on its potential for severe disease, contagiousness, and death. 7 With the rise in awareness of MRSA infections, we have witnessed an increased number of MRSA-diagnosed patients who are stigmatized by family, friends and colleagues. Although