Methicillin-ResistantStaphylococcal aureusEvolution in Australia Over 35 Years JOHN D. TURNIDGE and JAN M. BELL

Abstract

Australia has a long association methicillin-resistant Staphylococcus aureus (MRSA). Its unique geographic and demographic features have led to the emergence and spread of three types of MRSA over 35 years. Classical multiresistant hospital-acquired MRSA were first noted in Australia in 1965. By the end of the 1970s, strains of this type of MRSA were well established in the complex tertiary care hospitals in the capital cities on the eastern seaboard of mainland Australia. Characterized by resistance to /3-lactams, erythromycin, tetracycline, gentamicin, and trimethoprim-sulfamethoxazole, these strains have persisted and diversified genetically and have acquired a variety of new resistances. They have proven pathogenicity and are a prominent cause of hospital infection in the endemic institutions. More recently they have become endemic in some central state tertiary care hospitals. Community-acquired strains of MRSA first appeared in the north of Western Australia in the mid-1980s. Strains have subsequently appeared in the south of the state and in the two adjacent central states, and are more frequently isolated from Aboriginal patients. Although harboring few or no additional resistances apart from resistance to )3-lactams initially, these strains are also accumulating additional resistances. A different variety of community-acquired MRSA has recently been noted in eastern Australia. It has a similar antibiogram to the western strains, but an entirely different epidemiology, resembling that currently being experienced in parts of New Zealand, and associated with patients of south Pacific island origin. GEOGRAPHIC AND DEMOGRAPHIC FACTORSAustralia is a physically large industrialized country (7.7 million km2) with a small population (about 19,000,000). Despite the international image as a community with a strong rural focus, 86% of the population live in major urban centers, 54% live in eight national, state, and territory capital cities, and about 85% live within 50 km of the coast. As a consequence, very large urban centers are separated by great distances compared to interurban distances in Western Europe and the United States (Fig. 1). Of all developed countries, only Canada has similar demographic properties. These properties have had a significant impact on the prevalence and spread of MRSA through different centers.Ethnicity has also played a role in the spread of community-

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Teicoplanin as an Effective Alternative to Vancomycin for Treatment of MRSA Infection in Chinese Population: A Meta-analysis of Randomized Controlled Trials

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