Combating MRSA; combining and increasing our understanding on colonisation, transmission and reservoirs will lead to control of infections by MRSA

医院和社区中MRSA克隆流行病学动态的潜在原因争论激烈，不同的解释可能存在争议。大多数研究要么集中在MRSA传播和持续能力的遗传基础上，如PVL、SCCmec IV型等的存在，要么集中在流行病学特征上，如风险群体、抗生素使用的选择或卫生保健中心的预防措施。新菌株传入后，抗生素或消毒剂的使用是重要的推动力，预防应重点放在这一点上。当选定的菌株由于其遗传特征而更容易传播时，应制定针对预防这些特定菌株传播的措施。然而，驱动力的组合将经常出现。简而言之，这项研究将为MRSA的成功和失败提供更多的见解，并与数学模型一起，将针对具体和现实的工具来防止进一步的传播和疾病。这既包括住院病人，也包括其他健康个体，如USA300大规模不受控制的流行病。MACOTRA将结合理解MRSA流行病学的方法，将添加宿主因素，从而旨在解释MRSA在其兴起，维持或消失中的流行病学行为。我们认为，只有结合所有这些方面，我们才能了解流行病学，从而设计出最佳和有针对性的预防措施。

The underlying reasons for the epidemiological dynamics of MRSA clones in the hospital and the community are debated intensely and different explanations can be controversial. Most studies focus either on the genetic basis of the ability of MRSA to spread and be sustained, like the presence of PVL, SCCmec type IV etc. or on the epidemiological features, like risk groups, selection due to antibiotic use, or prevention measures in health care centres. After introduction of new strains, antibiotic or disinfectant use is an important driving force, prevention should be focused on that point. When selected strains are more able to spread due to their genetic profile, measures should be developed targeted on prevention of transmission of these particular strains. However, a combination of driving forces will be often present. In short, this study will create more insight into the success and failure of MRSA, and together with the mathematical model, will target specific and realistic tools to prevent further spreading and thus disease. This accounts both for hospitalized patients and in otherwise healthy individuals, as present in the large uncontrolled epidemic by USA300. MACOTRA will join approaches on understanding the epidemiology of MRSA together, will add the host-factor and herewith aims to explain the epidemiological behaviour of MRSA in its rise, maintenance or disappearance. We believe that only by combining all these aspects, we can understand the epidemiology and thus design optimal and focused prevention measures.