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

医院和社区对MRSA克隆的流行病学动态的潜在原因进行了激烈的辩论，不同的解释可能存在争议。大多数研究要么侧重于MRSA传播和持续能力的遗传基础，如PVL、SCCmec IV型等的存在，要么侧重于流行病学特征，如风险群体、因使用抗生素而进行的选择，或卫生保健中心的预防措施。新菌株引入后，抗生素或消毒剂的使用是重要的驱动力，预防应重点关注这一点。当选定的菌株由于其基因特征而更能传播时，应制定有针对性的措施，以防止这些特定菌株的传播。然而，各种驱动力的组合往往会出现。简而言之，这项研究将对MRSA的成功和失败产生更多的洞察，并与数学模型一起，针对特定和现实的工具，以防止进一步传播，从而防止疾病。这既包括住院的患者，也包括其他健康的个人，就像USA300出现的大规模不受控制的疫情一样。MACOTRA将加入了解MRSA流行病学的方法，将增加宿主因素，并据此旨在解释MRSA在其兴起、维持或消失过程中的流行病学行为。我们认为，只有将所有这些方面结合起来，我们才能了解流行病学，从而制定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.