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Background: Community-acquired methicillin-resistant Staphylococcus aureus(CA-MRSA), a novel strain of MRSA, has recently emerged and rapidly spread inthe community. Invasion into the hospital setting with replacement of thehospital-acquired MRSA (HA-MRSA) has also been documented. Co-colonization withboth CA-MRSA and HA-MRSA would have important clinical implications givendifferences in antimicrobial susceptibility profiles and the potential forexchange of genetic information.  Methods: A deterministic mathematical model was developed to characterize thetransmission dynamics of HA-MRSA and CA-MRSA in the hospital setting and toquantify the emergence of co-colonization with both strains.  Results: The model analysis shows that the state of co-colonization becomesendemic over time and that there is no competitive exclusion of either strain.Increasing the length of stay or rate of hospital entry among patientscolonized with CA-MRSA leads to a rapid increase in the co-colonized state.Compared to MRSA decolonization strategy, improving hand hygiene compliance hasthe greatest impact on decreasing the prevalence of HA-MRSA, CA-MRSA and theco-colonized state.  Conclusions: The model predicts that with the expanding community reservoirof CA-MRSA, the majority of hospitalized patients will become colonized withboth CA-MRSA and HA-MRSA.

Rapid emergence of co-colonization with community-acquired and  hospital-acquired methicillin-resistant Staphylococcus aureus strains in the  hospital setting