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			<p class="Type-of-Article">&nbsp;</p>
			<p class="Type-of-Article"><span class="CharOverride-1">Review Article</span></p>
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			<p class="title- ParaOverride-1">Methicillin Resistant <span class="CharOverride-2">Staphylococcus aureus </span>(MRSA): A Review</p>
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			<p class="Normal ParaOverride-1" lang="en-US"><span class="Authors" lang="en-GB">Hafsat Ali Grema</span><span class="Authors CharOverride-3" lang="en-GB">1</span><span class="Authors" lang="en-GB">, Yaqub Ahmed Geidam</span><span class="Authors CharOverride-3" lang="en-GB">1</span><span class="Authors" lang="en-GB">, Galadima Bala Gadzama</span><span class="Authors CharOverride-3" lang="en-GB">2</span><span class="Authors" lang="en-GB">, James Agbo Ameh</span><span class="Authors CharOverride-3" lang="en-GB">3</span><span class="Authors" lang="en-GB">, Abubakar Suleiman</span><span class="Authors CharOverride-3" lang="en-GB">4</span></p>
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			<p class="Normal ParaOverride-1" lang="en-US"><span class="Authors-Affiliations CharOverride-4">1</span><span class="Authors-Affiliations">Department of Veterinary Medicine, Faculty of Veterinary Medicine; </span><span class="Authors-Affiliations CharOverride-4">2</span><span class="Authors-Affiliations">Department of Microbiology, College of Medical Sciences, University of Maiduguri Teaching Hospital; </span><span class="Authors-Affiliations CharOverride-4">3</span><span class="Authors-Affiliations">Department of Veterinary Microbiology, Faculty of Veterinary Medicine; University of Maiduguri, P. M. B 1069, Maiduguri, Borno State, Nigeria; </span><span class="Authors-Affiliations CharOverride-4">4</span><span class="Authors-Affiliations">Department of Veterinary Microbiology, Ahmadu Bello University, Zaria, Nigeria.</span></p>
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			<p class="Abstract ParaOverride-1">&nbsp;</p>
		  <p class="Abstract ParaOverride-1"><span class="CharOverride-5">Abstract</span> |<span class="Abstract"> </span><span class="Abstract CharOverride-6" lang="en-US">Staphylococcus aureus</span><span class="Abstract" lang="en-US"> (</span><span class="Abstract CharOverride-6" lang="en-US">S. aureus</span><span class="Abstract" lang="en-US">) is a&#160;gram positive&#160;organism that serves as an opportunistic pathogen and frequent colonizer of the epithelium causing severe diseases in human and animals. The widespread use of antibiotics both in human and Veterinary medicine resulted in the emergence of resistant strains of </span><span class="Abstract CharOverride-6" lang="en-US">S. aureus</span><span class="Abstract" lang="en-US">. Methicillin-resistant </span><span class="Abstract CharOverride-6" lang="en-US">Staphylococcus aureus</span><span class="Abstract" lang="en-US"> (MRSA) is a common bacterial pathogen responsible for a variety of infections. Resistance to methicillin is determined by the mecA gene, which encodes the low-affinity penicillin-binding protein&#160;PBP 2. Lately, new methicillin resistance gene, mecC has been discovered from humans, animals and food products. MRSA infection was first considered hospital-associated (HA-MRSA) and community-associated MRSA (CA-MRSA) infections. However, another group emerged known as livestock-associated MRSA (LA-MRSA). The isolation of MRSA from different species, food products and the environment raised concern on the role of animals particularly livestock and wildlife in the epidemiology of MRSA. The spatial distribution of MRSA indicates interspecies transmission and colonization of different populations. This review summarizes the current knowledge, transmission pattern and the epidemiology of MRSA from hospitals, communities, animals and their products.</span></p>
			<p class="Abstract ParaOverride-1">&nbsp;</p>
			<p class="Abstract ParaOverride-1"><span class="Abstract CharOverride-5">Keywords </span><span class="Abstract">| HA-MRSA, CA-MRSA, LA-MRSA, Epidemiology, Transmission</span></p>
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			<p class="Editor----Citation"><span class="CharOverride-8">Editor</span> | Kuldeep Dhama, Indian Veterinary Research Institute, Uttar Pradesh, India.</p>
			
            <p class="Editor----Citation"><span class="CharOverride-5">Received</span> | December 01, 2014; 
 <span class="CharOverride-5">Revised</span> | December 16, 2014; <span class="CharOverride-5">Accepted</span> | December 18, 2014; <span class="CharOverride-5">Published</span> | January 02, 2015&#9;&#9;</p>
			<p class="Editor----Citation"><span class="CharOverride-5">*Correspondence</span> | Hafsat Ali Grema, University of Maiduguri, Maiduguri, Borno State, Nigeria<span class="Editor---Citation">; </span><span class="Editor---Citation CharOverride-5">Email: </span>gremahafsa@yahoo.com</p>
			
          <p class="Editor----Citation"><span class="Editor---Citation CharOverride-5">Citation</span> | Grema HA, Geidam YA, Gadzama GB, Ameh JA, Suleiman A (2015). Methicillin resistant Staphyloccus aureus (MRSA): a review. Adv. Anim. Vet. Sci. 3(2): 79-98.  </p>
		<p class="Editor----Citation"><span class="CharOverride-8">DOI</span><span class="CharOverride-9"> | </span><a href="http://dx.doi.org/10.14737/journal.aavs/2015/3.2.79.98"><span class="Hyperlink">http://dx.doi.org/10.14737/journal.aavs/2015/3.2.79.98</span></a></p>
			<p class="Editor----Citation"><span class="Editor---Citation CharOverride-5" lang="en-US">ISSN (Online)</span> | 2307-8316; <span class="Editor---Citation CharOverride-5" lang="en-US">ISSN (Print)  | </span>2309-3331</p>
            
		  <p class="Editor----Citation"><span class="CharOverride-8">Copyright </span>© 2015 Grema et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.</p>
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			<p class="Heading-1--Introduction----">&nbsp;</p>
		  <p class="Heading-1--Introduction----">Introduction</p>
			<p class="Caps-on-First-Para ParaOverride-1">&nbsp;</p>
		  <p class="Caps-on-First-Para ParaOverride-1"><span class="_idGenDropcap-1">S</span><span class="CharOverride-6">taphylococcus </span><span class="CharOverride-11">aureus</span> is a bacterium of significant importance because of its ability to cause a wide range of diseases and capacity to adapt to diverse environmental forms (<a href="#Lowy-FD--1998-."><span class="Hyperlink">Lowy, 1998</span></a>; <a href="#Waldvogel-FA--2000-."><span class="Hyperlink">Waldvogel, 2000</span></a>). The organism colonises skin, skin glands and mucous membrane, causing infections both in human and animals such as rashes, inflammations of bones and the meninges as well as septicaemia (<a href="#klilu-E--Zunita-Z--Hassan-L--Chen-HC--2010-."><span class="Hyperlink">Aklilu et al., 2010</span></a>). In addition, <span class="CharOverride-6">S. aureus</span> causes inflammation of the mammary gland in bovine and the lower part of the foot in poultry (<a href="#Quinn-PJ--Carter-ME--Markey-BK--Carter-GR--2000-."><span class="Hyperlink">Quinn et al., 2000</span></a>). Penicillin and its derivatives, including methicillin have been used for the treatments of infections caused by <span class="CharOverride-6">S. aureus</span> (<a href="#Rayner-C--Munckhof-WJ--2005-."><span class="Hyperlink">Rayner and Munckhof, 2005</span></a>). However, certain strains of <span class="CharOverride-6">S. aureus</span> developed resistance known as methicillin resistant <span class="CharOverride-11">Staphylococcus aureus</span> (MRSA). At present, less than 90% of <span class="CharOverride-6">S. aureus</span> strains are resistant to most penicillin derivatives (<a href="#Freeman-Cook-L--Freeman-Cook-K--2006-."><span class="Hyperlink">Freeman-Cook and Freeman-Cook, 2006</span></a>) and ordinary antimicrobial agents like drugs from the family of aminoglycosides, macrolides, chloramphenicols, tetracyclines and fluoroquinolones (<a href="#Lee-JH--2003-"><span class="Hyperlink">Lee, 2003</span></a>). </p>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1">A gene known as <span class="CharOverride-6">mec</span>A gene is responsible for the resistance to methicillin which codes for penicillin-binding protein PBP 2A (<a href="#Wielders--C.-L.-C.-A.-C.-Fluit--S.-Brisse--J.-Verhoef--and-F.-J.-Schmitz--2002-."><span class="Hyperlink">Wielders et al., 2002</span></a>). Lately, a new methicillin resistance mechanism gene,&#160;<span class="CharOverride-6">mec</span>C was described in&#160;<span class="CharOverride-6">S. aureus</span> (<a href="#Porrero-CM---Mentaberre-G--S-nchez-S--Fern-ndez-Llario-P--G-mez-Barrero-2012"><span class="Hyperlink">Porrero et al., 2014</span></a>). <a href="#Garc-a--lvarez-L--Holden-MT--Lindsay-H--Webb-CR--Brown-DF--Curran-MD-2011-.-Me"><span class="Hyperlink">García-Álvarez et al. (2011)</span></a>, <a href="#Paterson-GK--Larsen-AR--Robb-A--Edwards-GE--Pennycott-TW--Foster-G--2012-."><span class="Hyperlink">Paterson et al. (2012)</span></a>, <a href="#Walther-B--Wieler-LH--Vincze-S--Antao-EM--Brandenburg-A--Stamm-I--2012-."><span class="Hyperlink">Walther&#160;et al. (2012)</span></a> and <a href="#Paterson-GK--Harrison-EM--Holmes-MA--2014a-."><span class="Hyperlink">Paterson et al. (2014)</span></a> reported MRSA isolates carrying&#160;<span class="CharOverride-6">mec</span>C gene from humans and animals. <a href="#Harrison-EM--Paterson-GK--Holden-MTG--Morgan-FJE--Larsen-AR--et-al.--2013-."><span class="Hyperlink">Harrison et al. (2013)</span></a> suggested the public health hazard of <span class="CharOverride-6">mecC</span>-positive MRSA isolates as it has been isolated in human case and their livestock.</p>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1">Until recently, MRSA was associated with prior exposure to health care facility, and as such, was considered a nosocomial pathogen (<a href="#Tiemersma-EW--Bronzwaer-S--Lyytikainen-O--Degener-JE---2004"><span class="Hyperlink">Tiemersma et al., 2004</span></a>). A number of publications on MRSA infections in populations lacking traditional risk factors (<a href="#Herold-BC--Immergluck-LC--Maranan-MC--Lauderdale-DS--Gaskin-RE--Boyle--Vavra-S--Leitch-CD--Daum-RS--"><span class="Hyperlink">Herold et al., 1998</span></a>) have been reported. This raised concern for infections originating from the community and veterinary species (<a href="#Cohn-LA--Middleton-JR--2010-."><span class="Hyperlink">Cohn and Middleton, 2010</span></a>). Reports of MRSA isolation in domestic animals seems to be rising in number (<a href="#Devriese-LA--Hommez-J--1975-."><span class="Hyperlink">Devriese and Hommez, 1975</span></a>; <a href="#Hartmann-FA--Trostle-SS--Klohnen-AA--1997-."><span class="Hyperlink">Hartmann et al., 1997</span></a>; <a href="#Tomlin-J--Pead-MJ--Lloyd-D-H--Howell-S--Hartmann-F--Jackson-HA--Muir-P--1999-."><span class="Hyperlink">Tomlin et al</span><span class="Hyperlink CharOverride-6">.</span><span class="Hyperlink">, 1999</span></a>; <a href="#Lee-JH--2003-"><span class="Hyperlink">Lee, 2003</span></a>; <a href="#Goni-P--Vergara-Y--Ruiz-J--Albizu-I--Vila-J--Gomez-Lus-R--2004-."><span class="Hyperlink">Goni et al., 2004</span></a>; <a href="#Rich-M--Roberts-L--2004-"><span class="Hyperlink">Rich and Roberts, 2004</span></a>). The epidemiology of MRSA isolates from human and animal sources showed that for certain strains, a cross-infection might have happened (<a href="#Seguin-JC--Walker-RD--Caron-JP--Kloos-WE--George-CG--Hollis-RJ--Pfaller-MA--1999"><span class="Hyperlink">Seguin et al., 1999</span></a>; <a href="#Strommenger-B--Kettlitz-C--Weniger-T--Harmsen-D--Friedrich-AW--Witte-W--2006"><span class="Hyperlink">Strommenger et al., 2006</span></a>; <a href="#Weese-JS--Caldwell-F--Willey-BM--Kreiswirth-BN--McGeer-A--Rousseau-J--et-al.--2006-."><span class="Hyperlink">Weese et al., 2006</span></a>). Studies conducted by <a href="#Ferreira-JP--Anderson-KL--Correa-MT--Lyman-R--Ruffin-F--et-al.--2011-."><span class="Hyperlink">Feirrera et al. (2011)</span></a> and <a href="#Verkade-E--Kluytmans-J.--2014-."><span class="Hyperlink">Verkade and Kluytman</span><span class="Hyperlink CharOverride-6"> </span><span class="Hyperlink">(2014)</span></a> suggested that animals can be a potential source of MRSA infection to humans.</p>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1">Therefore knowledge on the epidemiology of MRSA will underpin effective prevention and control strategies, including the rational use of antibiotics. This review article wishes to highlight the epidemiology and possible source of MRSA transmission in hospitals, community and livestock settings.</p>
			<p class="Heading-1--Introduction----">&nbsp;</p>
		  <p class="Heading-1--Introduction----">Historical Background of MRSA</p>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1">Alexander Fleming conducted a research and reported the bactericidal effects of a fungal contaminant that produced penicillin against <span class="CharOverride-6">S. aureus </span>growing on culture plates (<a href="#Fleming-A--1929-.-On-the-antiba"><span class="Hyperlink">Fleming, 1929</span></a>). A mass production of the drug from vats of cornsteep liquid growing on the mold was preceded due to the high mortalities during World War II (<a href="#Neushul-P--1993-.-S"><span class="Hyperlink">Neushul, 1993</span></a>). Subsequently, there was a dramatic drop in death rates from bacterial pneumonia and meningitis in World War II compared to World War I. This led to the development of penicillin as the first major driver in selecting for resistant <span class="CharOverride-6">S. aureus</span>. In 1940, an active <span class="CharOverride-12">β</span>- lactam ring enzyme was described in <span class="CharOverride-6">Escherichia coli </span>that are capable of hydrolyzing the penicillin. This enzyme was later named “penicillinase” (<a href="#Abraham-EP--Chain-E--1940-."><span class="Hyperlink">Abraham and Chain, 1940</span></a>) while in 1944; penicillinase production was also discovered in <span class="CharOverride-6">S. aureus </span>(<a href="#Kirby-WMM--1944-.-Ext"><span class="Hyperlink">Kirby, 1944</span></a>). In 1948, it was observed that over 50% of staphylococcal isolates recovered from patients in a United Kingdom hospital were resistant to penicillin (<a href="#Barber-M--Rozwadowska-Dowzenko-M--1948-."><span class="Hyperlink">Barber and Rozwadowska-Dowzenko, 1948</span></a>). Since then to date, 90 to 95% of <span class="CharOverride-6">S. aureus </span>strains worldwide are penicillin resistant, with the plasmid encoded penicillinase readily transferable via transduction or conjugation. A penicillinase-resistant penicillin known as methicillin was introduced in 1959 to combat penicillin-resistant <span class="CharOverride-6">S. aureus</span>, but within a year, late Professor Patricia Jevons reported the first human <span class="CharOverride-6">S. aureus</span> strain to be methicillin resistant in UK hospital (<a href="#Kim-JY--2009-"><span class="Hyperlink">Kim, 2009</span></a>).&#160;In 1962, an epidemic occurred at a hospital called Queen Mary’s Children’s Hospital, Carshalton. These strains became widespread in hospitals and into communities by the 1960’s (<a href="#Spink-WW--1978-.-Infec"><span class="Hyperlink">Spink, 1978</span></a>). In 1968, United States recorded the first outbreak of MRSA (<a href="#Palavecino-E--2004-."><span class="Hyperlink">Palavecino, 2004</span></a>) while in the 1970s, <span class="CharOverride-6">S. aureus</span> strains have become resistant to most penicillinase-stable penicillins.<span class="CharOverride-5">&#160;</span>It was first assumed to be a disease of human origin until when MRSA was first isolated in 1972 in a mastitic cow (<a href="#Devriese-LA--Van-Damme-LR--Fameree-L--1972-."><span class="Hyperlink">Deveriese et al., 1972</span></a>).  Thereafter, reports of MRSA infection became established in domestic and wild animals (<a href="#Rich-M--Roberts-L--2004-"><span class="Hyperlink">Rich and Roberts, 2004</span></a>; <a href="#Wardyn-SE--Kauffman-LK--Smith-TC--2012-"><span class="Hyperlink">Wardyn et al., 2012</span></a>).</p>
			<p class="Heading-1--Introduction----">&nbsp;</p>
		  <p class="Heading-1--Introduction----">Epidemiology of MRSA&#160;</p>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1">Epidemiological typing of MRSA strains resulted in the recognition of different lineages that are zoonotic, humanosis and/or host specific. Seventeen epidemic strains of human MRSA have been described in the United Kingdom (<a href="#Aucken-HM--Ganner-M--Murchan-S--Cookson-B--Johnson-AP--2002-."><span class="Hyperlink">Aucken et al., 2002</span></a>) but the most dorminant are EMRSA-15 and EMRSA-16 (<a href="#Hardy-KJ--Hawkey-PM--Gao-F--Oppenheim-BA--2004-."><span class="Hyperlink">Hardy et al., 2004.</span></a>). The EMRSA-16 clone represents major cause of human MRSA infections in Europe and America (<span class="Hyperlink">Holden et al., 2004</span>). In Africa, epidemiological data on the predominant clones responsible for most epidemics is poorly documented. According to <span class="Hyperlink">Breurec et al. (2011)</span>, the most predominant clones of African origin are ST88-IV, ST5-IV and ST239-III which are CA-MRSA. ST88-IV is a clone identified both in hospitals and community infections. The European lineage (EMRSA-16) has been described to originate from sub-saharan Africa (<a href="#Stegger-M--Wirth-T--Andersen-PS--Skov-RL--De-Grassi-A--Sim-es-2014"><span class="Hyperlink">Stegger et al., 2014</span></a>) and has been reported in hospital and community acquired infections in Algeria (<a href="#Abdulqader-SMA--Shittu-A--Nicol-PM--Kaba-W--2014-."><span class="Hyperlink">Abdulqader et al., 2014</span></a>). Other lineages of human origin include CC1, CC5, CC8, CC22, CC30 and CC45 while MRSA lineage predominant in pigs and other food animals is CC398 (<a href="#Witte-W--Strommenger-B--Stanek-C--Cuny-C--2007-."><span class="Hyperlink">Witte et al</span><span class="Hyperlink CharOverride-6">.</span><span class="Hyperlink">, 2007</span></a>; <a href="#Fe-ler-AT--Richard-GM--Olde-R--Rothkamp-A-2012"><span class="Hyperlink">Feßler et al., 2012</span></a>). Interspecies transmission of the strain CC398 (ST398) is a potential hazard and can be facilitated by frequent contact, environmental contamination and individual’s immunity (<a href="#Declercq-P--Petr--D--Gordts-B--Voss-A--2008-."><span class="Hyperlink">Declercq et al</span><span class="Hyperlink CharOverride-6">.</span><span class="Hyperlink">, 2008</span></a>). Three major settings were recognized according to host specification, reservoir and source of transmission (<a href="#Millar-BC--Loughrey-A--Elborn-JS--Moore-JE--2007-."><span class="Hyperlink">Millar et al., 2007</span></a>). </p>
			<p class="Heading-2--History-in-MM-">&nbsp;</p>
		  <p class="Heading-2--History-in-MM-">Healthcare-Associated MRSA (HA-MRSA)</p>
			<p class="Body-Text ParaOverride-1">MRSA isolates from hospital settings has been gradually increasing in the United States and other parts of the world (Summary of MRSA prevalence from different countries across the world is presented in (<a href="#Table-1"><span class="Hyperlink">Table 1</span></a>). However, reports in 2011 surveillance programme in USA suggest the recent decline in MRSA infections specific to hospital settings (<a href="#Raymund-D--Yi-M--Belflower-R--Aragon-D--Dumyati-G--Harris2013"><span class="Hyperlink">Raymund et al., 2013</span></a>). Depending on the study area and sample size, high rate of MRSA rates (&gt;50%) have been reportd in USA, Asia and Malta, intermediate rate (25-50%) reported in Africa, China and Europe while in some part of Europe, the prevalence rate is relatively lower than 50% (<a href="#Mej-a-C--Zurita-J--Guzm-n-Blanco-M.--2010-."><span class="Hyperlink">Mejìa </span><span class="Hyperlink">et al., 2010</span></a>). <a href="#Stefani-S--Chung-DR--Lindsay-JA--Friedrich-AW--Kearns-AM--Westh-H--MacKenzie-FM--2012"><span class="Hyperlink">Stafeni et al. (2012)</span></a> compiled the prevalence rates of HA-MRSA in some European countries like France, Ireland and UK and reported decline in hospital cases. While in Asia particularly South Korea (77.6%), Vietnam (74.1%), Taiwan (65%) and Hong Kong (56.8%) reports on HA-MRSA infections is still high. The major lineage responsible to the hospital spread of MRSA between these continents is CC8 (ST239) (<span class="Hyperlink">Harris et al., 2010</span>). For MRSA acquired in hospitals, colonisation do increases the chance for infection (<a href="#Safdar-N--Bradley-EA--2008-.-T"><span class="Hyperlink">Safdar and Bradley, 2008</span></a>). Anterior nare is the usual site for MRSA colonization, although other anatomical sites such as hands, perineal region, skin wounds, throat, genitourinary tract and the digestive tract may also be colonized (<a href="#Sanford-MD--Widmer-AF--Bale-MJ--Jones-RN--Wenzel-RP--1994-."><span class="Hyperlink">Sanford et al., 1994</span></a>).&#160;High chance of hospital colonization may be from contact with MRSA colonized patient or contaminated objects. Respiratory infection is a predisposing factor for dessimination of MRSA through aerosols (<a href="#Kucers-A--Bennett-NMcK--1987-."><span class="Hyperlink">Kucers and Bennett, 1987</span></a>) which can cause serious infections and complications. Generally, HA-MRSA results in dermatitis, septicemias, heart and lung diseases which are mostly seen in immunocompromised people. Risk factors include hospitalization, surgery, dialysis and previous history of MRSA infection (<a href="#Umaru-GA--Kabiru-J--Adamu-NB--Umar-YA--2011-"><span class="Hyperlink">Umaru et al., 2011</span></a>). </p>
			<p class="Heading-2--History-in-MM-">&nbsp;</p>
		  <p class="Heading-2--History-in-MM-">Community-Associated MRSA (CA-MRSA) </p>
			<p class="Body-Text ParaOverride-1">MRSA strains acquired in the community were first reported in the late 1990s in patients with no history of exposure to healthcare settings (<a href="#Umaru-GA--Kabiru-J--Adamu-NB--Umar-YA--2011-"><span class="Hyperlink">Umaru et al., 2011</span></a>). The most common lineage in this case was USA300 (CC8-ST8) in the USA. These strains are mostly responsible to skin and soft tissue infections. In comparism, the most dorminant lineage causing infection in Europe is CC80 (ST80). However the strain USA300 has also been reported in Europe (<a href="#Tietz-A--Frei-R--Widmer-AF--2005-."><span class="Hyperlink">Tietz et al., 2005</span></a>). Transboundary transmission of MRSA strain is reported between countries like North America and Middle East, Asia and South America (<a href="#Stefani-S--Chung-DR--Lindsay-JA--Friedrich-AW--Kearns-AM--Westh-H--MacKenzie-FM--2012"><span class="Hyperlink">Stefani et al., 2012</span></a>). The spread of CA-MRSA has extended to healthcare centres in USA and France (<a href="#Donnio-PY--Preney-L--Gautier-Lerestif-AL--Avril-JL--Lafforgue-N.--2004-."><span class="Hyperlink">Donnio et al., 2004</span></a>). Outbreaks of CA-MRSA is mostly seen from populations such as sports teams (<a href="#Collins-CJ--O-Connell-B--2012-"><span class="Hyperlink">Collins and O</span><span class="Hyperlink CharOverride-12">ꞌ</span><span class="Hyperlink">connell, 2012</span></a>), prisons (<a href="#Palavecino-E--2004-."><span class="Hyperlink">Palavecino, 2004</span></a>), day care centers (<a href="#Simmonds-KA--Dover-DC--Louie-M--Keays-G--2008-."><span class="Hyperlink">Simmonds </span><span class="Hyperlink">et al., 2008</span></a>), military quarters (Marchese et al., 2000) homeless people (<a href="#Yano-M--Doki-Y--Inoue-M--Tsujinaka-T--Shiozaki-H--Monden-M--2000-."><span class="Hyperlink">Yano et al., 2000</span></a>), and intravenous drug users (<a href="#Torres-Tortosa-M--de-Cueto-M--Vergara-A--Sanchez-Porto-A--Perez-1994"><span class="Hyperlink">Torres-Tortosa et al., 1994</span></a>). Risk factors include international travel (<a href="#Mikael-S---rtqvist----Ringberg-H--Larsson-L--Olsson-Liljequist-B--H-ggman-S--Kalin-M--Ekdahl-K--2010"><span class="Hyperlink">Mikael et al., 2010</span></a>), overcrowding, compromised skin, poor hygiene and sharing of items such as towels, sporting equipment and unsterilized first aid instruments (<span class="Hyperlink">Kazakova et al., 2005</span>).&#160; </p>
			<p class="Heading-2--History-in-MM-">&nbsp;</p>
		  <p class="Heading-2--History-in-MM-">Livestock-Associated MRSA (LA-MRSA) </p>
			<p class="Body-Text">The scope of MRSA infection is not limited to human medicine only but also in Veterinary Medicine (<a href="#Lee-JH--2003-"><span class="Hyperlink">Lee, 2003</span></a>; <a href="#Baptiste-KE--Williams-K--Willams-NJ--Wattret---A"><span class="Hyperlink">Baptise et al. 2005</span></a>; <a href="#Voss-A--Loeffen-F--Bakker-J--Klaassen-C--Wulf-M--2005-."><span class="Hyperlink">Voss et al., 2005</span></a>; <a href="#Khanna-T--Friendship-R--Dewey-C--Weese-JS--2008-."><span class="Hyperlink">Khanna et al., 2008</span></a>; <a href="#Smith-TC--Male-MJ--Harper-AL--Kroeger-JS--Tinkler-GP--Moritz-ED--Capuano-AW--Herwaldt-LA--Diekema-DJ"><span class="Hyperlink">Smith </span><span class="Hyperlink">et al., 2008</span></a>). MRSA was first considered a human infection until when it was isolated in a dairy cow with mastitis (<a href="#Devriese-LA--Van-Damme-LR--Fameree-L--1972-."><span class="Hyperlink">Devriese et al, 1972</span></a>) and in pigs (<a href="#Stefani-S--Chung-DR--Lindsay-JA--Friedrich-AW--Kearns-AM--Westh-H--MacKenzie-FM--2012"><span class="Hyperlink">Stefani et al., 2012</span></a>). The most pre<span class="Body-Text ParaOverride-1">dominant lineage in livestock is CC398 which has been reported in Europe, USA and Asia (<span class="Hyperlink">Monecke et al., 2011</span>). However, the prevalence of LA-MRSA CC398 in these countries is still very low (<a href="#Stefani-S--Chung-DR--Lindsay-JA--Friedrich-AW--Kearns-AM--Westh-H--MacKenzie-FM--2012"><span class="Hyperlink">Stefani et al., 2012</span></a>). But in countries like Denmark, Netherland and Belgium, the report of MRSA CC398 in livestock is high (<span class="Hyperlink">Köck et al., 2009a</span>; <span class="Hyperlink">Köck et al., 2009b</span>). Epidemiological studies in UK indicate the spread of LA-MRSA into hospitals particularly in individuals with frequent animal contact (<a href="#Paterson-GK--Larsen-AR--Robb-A--Edwards-GE--Pennycott-TW--Foster-G--2012-."><span class="Hyperlink">Paterson et al., 2012</span></a>). Recently, there is evidence of MRSA transmission between human-to-animals and animals-to-humans (<a href="#Umaru-GA--Kabiru-J--Adamu-NB--Umar-YA--2011-"><span class="Hyperlink">Umaru et al., 2011</span></a>). <a href="#Voss-A--Loeffen-F--Bakker-J--Klaassen-C--Wulf-M--2005-."><span class="Hyperlink">Voss et al. (2005)</span></a> reported 23% of pig farmers colonized MRSA from a pig farm in the Netherlands with while <a href="#van-Rijen-MM--Van-Keulen-PH--Kluytmans-JA--2008-."><span class="Hyperlink">VanRijen et al., 2008</span></a> found 32% of farm workers colonized with MRSA. </span></p>
			<p class="Figure--and-Table-Heading"><span class="CharOverride-5"><a id="Table-1"></a><a id="Table-1--Prevalence-of-MRSA-carriage-in-some-countries-across-the-world"></a>Table 1:</span> Prevalence of MRSA carriage in some countries across the world</p>
			<table width="728" class="Table-Style-1" id="table-1">
				<colgroup>
					<col class="_idGenTableRowColumn-1" />
					<col class="_idGenTableRowColumn-2" />
					<col class="_idGenTableRowColumn-3" />
					<col class="_idGenTableRowColumn-4" />
					<col class="_idGenTableRowColumn-5" />
					<col class="_idGenTableRowColumn-6" />
				</colgroup>
				<tbody>
					<tr class="_idGenTableRowColumn-7">
						<td>
							<p class="Basic-Paragraph">Country</p>
						</td>
						<td>
							<p class="Basic-Paragraph">Sample size</p>
						</td>
						<td>
							<p class="Basic-Paragraph">Prevalence %</p>
						</td>
						<td>
							<p class="Basic-Paragraph">Source</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">References</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph">Argentina</p>
						</td>
						<td>
							<p class="Basic-Paragraph">591</p>
						</td>
						<td>
							<p class="Basic-Paragraph">16</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Egea et al., 2014</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Bangladesh</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">49</p>
						</td>
						<td>
							<p class="Basic-Paragraph">53.1</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital specimens</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Afroz et al., 2008</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Bolivia</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">585</p>
						</td>
						<td>
							<p class="Basic-Paragraph">0.5</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">community</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Batoloni et al 2013</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-7">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Cameroon</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">295</p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">34.6</span></p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph">Hospital staff/patients</p>
						</td>
						<td>
							<p class="Basic-Paragraph">Gonsu et al., 2013</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Chile</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">246</p>
						</td>
						<td>
							<p class="Basic-Paragraph">80</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Guzman-Blanco, 2009</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Columbia</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">538</p>
						</td>
						<td>
							<p class="Basic-Paragraph">92.4,65.1,43.6</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital record</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Jiménez&#160; et al., 2012</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-10">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Congo</span></p>
						</td>
						<td />
						<td>
							<p class="Basic-Paragraph">60</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">patients</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Iyamba et al., 2014</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Costa Rica</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">674</p>
						</td>
						<td>
							<p class="Basic-Paragraph">58</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Guzman-Blanco, 2009</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Cuba</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">80</p>
						</td>
						<td>
							<p class="Basic-Paragraph">6</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Guzman-Blanco, 2009</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Equator</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">1363</p>
						</td>
						<td>
							<p class="Basic-Paragraph">25</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Guzman-Blanco, 2009</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Ethiopia</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">118</p>
						</td>
						<td>
							<p class="Basic-Paragraph">44.1</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Shibabaw et al., 2013</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Guatemala</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">1483</p>
						</td>
						<td>
							<p class="Basic-Paragraph">64</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Guzman-Blanco, 2009</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hongkong</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">NK</p>
						</td>
						<td>
							<p class="Basic-Paragraph">75</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">NK</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Diekema et al., 2000</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hounduras</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">393</p>
						</td>
						<td>
							<p class="Basic-Paragraph">12</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Guzman-Blanco, 2009</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Indonesia</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">1502</p>
						</td>
						<td>
							<p class="Basic-Paragraph">4.3</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Santosaningsih et al., 2014</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Japan</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">90</p>
						</td>
						<td>
							<p class="Basic-Paragraph">44.4</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Environmental surfaces</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Asoh et al., 2005</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Kenya</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">950</p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">7.0</span></p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph">Hospital</p>
						</td>
						<td>
							<p class="Basic-Paragraph">Aiken et al., 2014</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Malaysia</span></p>
						</td>
						<td />
						<td>
							<p class="Basic-Paragraph">26</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Norazah, 2008</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Mexico</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">497</p>
						</td>
						<td>
							<p class="Basic-Paragraph">52</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Guzman-Blanco, 2009</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Nepal</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">750</p>
						</td>
						<td>
							<p class="Basic-Paragraph">26.14</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Kumari et al., 2008</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Netherland</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">9859</p>
						</td>
						<td>
							<p class="Basic-Paragraph">0.03</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Wertheim et al., 2004</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Nicaragua</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">296</p>
						</td>
						<td>
							<p class="Basic-Paragraph">20</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Guzman-Blanco, 2009</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Nigeria</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">208</p>
						</td>
						<td>
							<p class="Basic-Paragraph">19.2</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Olowe et al., 2013</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">North India</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">6743</p>
						</td>
						<td>
							<p class="Basic-Paragraph">46</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Arora et al., 2010</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Paraguay</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">980</p>
						</td>
						<td>
							<p class="Basic-Paragraph">44</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Guzman-Blanco, 2009</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Peru</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">1431</p>
						</td>
						<td>
							<p class="Basic-Paragraph">80</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Guzman-Blanco, 2009</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Singapore</span></p>
						</td>
						<td />
						<td>
							<p class="Basic-Paragraph">35</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Hsu et al., 2007</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Sudan</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">426</p>
						</td>
						<td>
							<p class="Basic-Paragraph">69.4</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Elimam et al., 2014</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-11">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Thailand</span></p>
						</td>
						<td />
						<td>
							<p class="Basic-Paragraph">41.5</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Hospital</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">Trakulsomboom and Thamlikitkul, 2008</p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-12">Uganda</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph">188</p>
						</td>
						<td>
							<p class="Basic-Paragraph">31.5</p>
						</td>
						<td>
							<p class="Basic-Paragraph">Hospital</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Ojulong et al., 2008</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph">Uraguay</p>
						</td>
						<td>
							<p class="Basic-Paragraph">2114</p>
						</td>
						<td>
							<p class="Basic-Paragraph">59</p>
						</td>
						<td>
							<p class="Basic-Paragraph">Hospital</p>
						</td>
						<td colspan="2">
							<p class="Basic-Paragraph"><span class="CharOverride-12">Guzman-Blanco, 2009</span></p>
						</td>
					</tr>
				</tbody>
			</table>
			<p class="Figure--and-Table-Heading">NK: Not known			</p>
			<p class="Figure--and-Table-Heading"><span class="CharOverride-5"><a id="Table-2"></a><a id="Table-2--Prevalence-of-MRSA-infection-and-carriage-rates-in-different-animal"></a>Table 2:</span> Prevalence of MRSA infection and carriage rates in different animals</p>
			<p class="Normal" lang="en-US"><span class="Title"><a id="x.34450"></a></span></p>
		  <table id="table-2" class="Table-Style-1">
				<colgroup>
					<col class="_idGenTableRowColumn-12" />
					<col class="_idGenTableRowColumn-13" />
					<col class="_idGenTableRowColumn-14" />
					<col class="_idGenTableRowColumn-15" />
					<col class="_idGenTableRowColumn-16" />
					<col class="_idGenTableRowColumn-17" />
					<col class="_idGenTableRowColumn-18" />
					<col class="_idGenTableRowColumn-19" />
				</colgroup>
				<tbody>
					<tr class="_idGenTableRowColumn-20">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-17">Year</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-17">Country</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-17">Species</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-17">Sample</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-17">Prevalence (%)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-17">Detection Methods</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-17">MRSA Characterization</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-17">References</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-21">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">2010/2012</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Germany</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Dogs, cats, horses</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Wound specimen</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">62.7,46.4, 41.3</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-19">Spa</span><span class="CharOverride-18">, MLST</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">CC22, CC5, CC398</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Vincze</span><span class="CharOverride-19"> </span><span class="CharOverride-18">et al., 2014</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-20">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">2003/2004</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Germany</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Cats</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Clincal </span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">10</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">BA/ChromAgar</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">ST22/SCCmecIV</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Walther et al., 2008</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-22">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">2007</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Belgium</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Horses</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Clinical</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">10.9</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Phenotypic, PCR</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">ST398, t011&amp; t1451</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Van den Eede et al., 2009</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-20">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">2007/2008</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Netherland</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Calves</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18"> Nasal sample</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">88,28 </span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Phenotypic and PCR</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">ST398</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Graveland et al., 2010</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-22">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">2010</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Germany</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Pigs</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Healthy swabs</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">52</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">PCR, MLST</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">CC398</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Alt et al., 2011</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-20">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">2006/2008</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Czech Republic</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Goat Farm</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Goats milk</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">1.1</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">PCR</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">SCC</span><span class="CharOverride-19">mec</span><span class="CharOverride-18"> IV, spa type t064</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Stastkova et al., 2009</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-22">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">2009/2011</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Belgium</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Cows/ Broilers</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Nasal, cloaca</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">5.0,5.0</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">PCR, MLST</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">CC599, CC130, CC398</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Vandendriessche et al., 2013</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-20">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">2years </span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Malaysia Egypt</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Tilapia Tilapia</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Brain, eyes,kidney swabs</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">50</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">MSA/PCR</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">NK</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Atyah et al., 2010, Soliman et al., 2014</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-22">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">2009</span></p>
						</td>
						<td />
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Elephant</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Clinical</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">100</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">PFGE</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">USA300</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Leggiadro, 2009</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-20">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">2006</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Canada</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Dolphin, Walrus</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Necropsy</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Nasal swab</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">33.3, 16.7</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">PFGE</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">USA100</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Faires et al., 2009</span></p>
						</td>
					</tr>
				</tbody>
			</table>
			<p class="Figure--and-Table-Heading">BA: Blood Agar; MSA: Mannitol salt agar; PCR: Polymerase Chain Reaction, NK: Not Known; PFGE: Pulse Field Gel Electrophoresis</p>
			<p class="Figure--and-Table-Heading">&nbsp;</p>
			<p class="Figure--and-Table-Heading"><a id="Table-3-"></a><span class="CharOverride-5">Table 3: </span>Prevalence of MRSA isolates from major food/meat product</p>
			<table width="727" height="280" class="Table-Style-1" id="table-3">
				<colgroup>
					<col class="_idGenTableRowColumn-23" />
					<col class="_idGenTableRowColumn-24" />
					<col class="_idGenTableRowColumn-3" />
					<col class="_idGenTableRowColumn-3" />
					<col class="_idGenTableRowColumn-25" />
				</colgroup>
				<tbody>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-17">Food Product</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-17">Samples collected</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-17">Prevalence (%)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-17">Source</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-17">References</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Beef</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">395</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">42 (10.6)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Farm</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">De Boer et al., 2009</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Milk</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">894</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">265 (29.6)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Farm</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Lee, 2003</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Pork</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">395</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">26 (6.6)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Retail</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">O&apos;Brien et al., 2012</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Chicken</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">25</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">11 (44.0)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Retailer</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Karmi, 2013</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Turkey</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">116</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">41 (35.3)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Retail Trade</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">De Boer et al., 2009</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Guinea fowl</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">118</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">4 (3.4)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Retail Trade</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">De Boer et al., 2009</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Lamb/mutton</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">324</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">20 (6.2)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Retail Trade</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">De Boer et al., 2009</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Tilapia Fish</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">559</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">198 (50)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Fish pond</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Atyah et al., 2010</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-8">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Game birds</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">178</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">4 (2.2)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Retail Trade</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">De Boer et al., 2009</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-9">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Veal</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">119</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">20 (16.8)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Retail</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-18">Anonymous, 2007</span></p>
						</td>
					</tr>
				</tbody>
			</table>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1">Likewise, <a href="#Stein-RA--2009-"><span class="Hyperlink">Stein (2009)</span></a> conducted a study among pig farmers in North America and found colonization rates of 20%. These results backup other findings that revealed the chances of animals becoming reservoirs of human MRSA infections regardless of location (<a href="#Feingold-BJ--Silbergeld-EK--Curriero-FC--van-Cleef-BA--Heck-ME--Kluytmans-JA--2012-."><span class="Hyperlink">Feingold et al 2012</span></a>). In addition, human-to-human transmission can occur following one’s exposure to colonized or infected animals due to isolation of<span class="CharOverride-22"> </span>MRSA strains from people with no animal contact<span class="CharOverride-22"> (</span><span class="Hyperlink">Huijsdens et al., 2006</span><span class="CharOverride-22">).</span> High risk groups are the veterinary clinic personnel and the animals care givers (<span class="Hyperlink">O’Mahony et al., 2005</span>; <a href="#Moodley-A--Nightingale-EC--Stegger-M--Nielsen-SS--Skov-RL--Guardabassi-L--2008-.-H"><span class="Hyperlink">Moodley et al., 2005</span></a>; <a href="#Wulf-M--van-Nes-A--Eikelenboom-Boskamp-A--de-Vries-J--Melchers-W--Klaassen-C-et-al.--2006-"><span class="Hyperlink">Wulf et al., 2006</span></a><span class="CharOverride-22">;</span> <a href="#Hanselman-BA--Kruth-SA--Rousseau-J--Low-DE--Willey-BM--McGeer-A--et-al.--2006-."><span class="Hyperlink">Hanselman et al., 2006</span></a>). </p>
			<p class="Heading-2--History-in-MM-">&nbsp;</p>
			<p class="Heading-2--History-in-MM-">MRSA in companion Animals</p>
			<p class="Body-Text ParaOverride-1">Animals such as dogs, cats and horses have become an important part of most families particularly in developed countries like USA and UK (<span class="Hyperlink">chomel and sun 2011</span>). Therefore, there are high chances of human colonization or infection with MRSA from these animals (<a href="#Mustapha-M--Bukar-Kolo-YM--Geidam-YA-and-Gulani-IA.--2014"><span class="Hyperlink">Mustapha et al., 2014</span></a>). In the UK, 1.5% of MRSA were recovered from samples of infected companion animals (<a href="#Rich-M--Roberts-L--2004-"><span class="Hyperlink">Rich and Robert</span></a><span class="Hyperlink">s, 2004</span>) and dogs are more infected/colonized with MRSA in comparism to cats (<a href="#Morgan-M--2008-."><span class="Hyperlink">Morgan</span></a><span class="Hyperlink">, 2008</span>). Skin and soft tissue infections are the main form of disease manifestation. MRSA strains isolated in most UK hospitals are identified as EMRSA-15 (ST22) and EMRSA-16 (ST36) (<a href="#llington-MJ--Hope-R--Livermore-DM--Kearns-2010"><span class="Hyperlink">Ellington et al., 2010</span></a>) while the strains isolated in USA pets are the USA100 (ST5) which has been documented in HA-MRSA infections in humans (<a href="#McDougal-LK--Steward-CD--Killgore-GE--Chaitram-JM--McAllister-SK--Tenover-FC--2003-."><span class="Hyperlink">McDougal et al.</span></a><span class="Hyperlink">, 2003</span>). In addition, a study in UK recovered MRSA clone (ST398) in dogs and horses that were characteristic of livestock animals (<a href="#Loeffler-A--Boag-AK--Sung-J--Lindsay-JA--Guardabassi-L--Dalsgaard-A--Smith-H--Stevens-KB--Lloyd-DH--"><span class="Hyperlink">Loeffler et al., 2009</span></a>).</p>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1">Reports of MRSA colonization in horses with a percentage rate of 0 to 11% has been published (<a href="#Loeffler-A--Boag-AK--Sung-J--Lindsay-JA--Guardabassi-L--Dalsgaard-A--Smith-H--Stevens-KB--Lloyd-DH--"><span class="Hyperlink">Loeffler et al., 2011</span></a>). Most cases and outbreak of MRSA infections were reported in large stables and post-operative complications (<a href="#Weese-JS--Archambault-M--Willey-BM--Dic--2005"><span class="Hyperlink">Weese et al., 2005</span></a>; <a href="#Morgan-M--2008-."><span class="Hyperlink">Morgan, 2008</span></a>). In horses, MRSA lineages isolated were distinct from the strains isolated in humans (<a href="#Loeffler-A--Lloyd-DH--2010-.-C"><span class="Hyperlink">Loeffler and Lloyd, 2010</span></a>).</p>
			<p class="Heading-2--History-in-MM-">&nbsp;</p>
			<p class="Heading-2--History-in-MM-">MRSA in Wildlife</p>
			<p class="Body-Text ParaOverride-1">Although the role of wildlife as reservoir for MRSA colonisation and/or infection has not yet been established, there are several studies that revealed the isolation of MRSA in many captive wildlife animals (<a href="#Loncaric--I--K-bber-Heiss-A--Posautz-A--Stalder-GL--Hoffmann-D--Rosengarten-R--Walzer-C--2014-."><span class="Hyperlink">Loncaric et al., 2014</span></a>). A study by <a href="#Wardyn-SE--Kauffman-LK--Smith-TC--2012-"><span class="Hyperlink">Wardyn et al. (2012)</span></a> revealed the isolation of MRSA from cottontail rabbit and a lesser yellow migratory shore bird. Other studies include isolation of MRSA from Wild rat, (<a href="#Himsworth-CG--Miller-RR--Montoya-V--Hoang-L--Romney-MG--Al-Rawahi-GN--Kerr-T--Jardine-CM--Patrick-DM"><span class="Hyperlink">Himsworth et al., 2014</span></a>), wood mice (<a href="#G-mez-P--Gonz-lez-Barrio-D--Benito-D--et-al.--2014-."><span class="Hyperlink">Gómez et al</span><span class="Hyperlink">., 2014</span></a>) red deer, Iberian ibex, vulture, wild boar (<a href="#Porrero-CM---Mentaberre-G--S-nchez-S--Fern-ndez-Llario-P--G-mez-Barrero-2012"><span class="Hyperlink">Porrero et al., 201</span></a><span class="Hyperlink">2</span>). In some of the studies, the homologue of mecA gene known as mecC strain (ST398 and ST1) were isolated and suspected to be of livestock and human origin (<a href="#Porrero-CM---Mentaberre-G--S-nchez-S--Fern-ndez-Llario-P--G-mez-Barrero-2012"><span class="Hyperlink">Porrero et al., 201</span></a><span class="Hyperlink">2</span>). Although the <span class="CharOverride-6">mec</span>C homologue is currently uncommon in human infections globally, it has been identified recently in human and animal infections in the UK, Denmark and Ireland (<a href="#Paterson-GK--Morgan-FJE--Harrison-EM--Peacock-SJ--Parkhill-J--Zadoks-RN--Holmes-MA--2014b"><span class="Hyperlink">Paterson et al., 2014b</span></a>). The most common animal lineage that causes disease in wild life is CC130 and ST425 (<a href="#Paterson-GK--Harrison-EM--Holmes-MA--2014a-."><span class="Hyperlink">Paterson et al., 2014a</span></a>). </p>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1">As the menance of MRSA colonization is extending into the wild life, control of the disease in human and domesticated animals will become a new challenge. This is due to the fact that wild animals can serve as source of animal and human colonization (particularly park rangers and zoo keepers) as well as contamination of the environment (<a href="#Guidance-on-Management-of-Zoonoses-in-zoos--Managing-Zoonotic-Risk-in-Zoos-and-Wildlife-Parks--2011-"><span class="Hyperlink">Guideline for management of zoonoses, 2011</span></a>; <a href="#Chethan-Kumar-HB--Lokesha-KM--Madhavaprasad-...-2013"><span class="Hyperlink">Chethan Kumar et al., 2013</span></a>). Summary of MRSA prevalence in animals (both wild and domesticated) is presented in <a href="#Table-2-"><span class="Hyperlink">Table 2</span></a> according to some reports published.</p>
			<p class="Heading-2--History-in-MM-">&nbsp;</p>
			<p class="Heading-2--History-in-MM-">MRSA in abattoirs, food processing units and animal products</p>
			<p class="Body-Text ParaOverride-1">The environment of abattoirs and food production units are contaminated with MRSA (<a href="#EFSA--2007-.-R"><span class="Hyperlink">EFSA, 2009</span></a>). The sources of contamination can either be the animals moving into the abattoir for slaughter or the workers involved in processing the end product (<a href="#Gilbert-MJ--Bos-ME--Duim-B--Urlings-BA--Heres-L--Wagenaar-JA--Heederik-DJ--2012-."><span class="Hyperlink">Gilbert et al., 2012</span></a>). Contaminated skin, feces, infected organs and water used in processing are the vital sources of contamination in abattoirs and food processing units (<a href="#Soonthornchaikul-N--Garelick-H--Jones-H--Jacobs-J--Ball-D--Choudhury-M--2006-"><span class="Hyperlink">Soonthornchaikul et al., 2006</span></a>). Some studies suggest that <span class="CharOverride-6">S. aureus </span>from food handlers can be part of normal body flora that subsequently contaminates carcasses. <a href="#Broens-EM--Graat-EA--Van-der-Wolf...-2011"><span class="Hyperlink">Broens et al. (2011)</span></a> conducted a study and found 12 out of 117 pigs tested MRSA positive in a slaughterhouse after being tested negative during and after transportation.</p>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1">Animal food products such as meat, meat products and milk may become contaminated with MRSA through slaughter or milking of colonized/ infected animal, thus, contaminating the product and environment. MRSA strains have been discovered from foods such as bovine milk and cheese, pork and beef as well as raw chicken meat (<a href="#Kwon-NH--Kun-TP--Woo-KJ--Hwa-YY--Yeonhee-L--So-HK--Wonki-B--Ji-YL--Ji-YK--Jun-MK--Soon-KH--Yong-HP--"><span class="Hyperlink">Kwon et al., 2006</span></a>; <a href="#Normanno-G--Corrente-M--La-Salandra-G--Dambrosio-A--Quaglia-NC--Parisi-A--Greco-G--Bellacicco-AL--Vi"><span class="Hyperlink">Normanno et al., 2007</span></a>; <a href="#van-Loo-I--Huisdens--Tiemersma-E--de-Neeling-A--van-de-Sande-Bruinsma-N--Bearijlan-D--Voss--Kluytman"><span class="Hyperlink">Van Loo et al., 2007</span></a>; <a href="#O-Brien-AM--Hanson-BM--Farina-SA--Wu-JY--Simmering-JE--Brett-MF--Kurlick-ME--Wallinga-DB--Smith-TC."><span class="Hyperlink">O’Brien et al., 2012</span></a>). The strains of MRSA isolated in most food samples include ST398, ST125 and ST217 (<a href="#Faccioli-Martins-YP-and-de-Souza-da-Cunha-MR--2012-."><span class="Hyperlink">Faccioli-Martins and de Souza da Cunha, 2012</span></a>) while the recent mecC homologue of mecA gene has been isolated in bovine milk in England (<a href="#Paterson-GK--Morgan-FJE--Harrison-EM--Peacock-SJ--Parkhill-J--Zadoks-RN--Holmes-MA--2014b"><span class="Hyperlink">Paterson et al., 2014b</span></a>). The presence of these strains on food products could suggest possible human or animal contamination. An important link in food borne infections connecting humans and food producing animals is the meat and milk or their products (<a href="#Mayrhofer-S--Paulsen-P--Smulders-FJM--Hilbert-F--2004-."><span class="Hyperlink">Mayrhofer et al., 2004</span></a>). Although food products may serve as vehicle for MRSA transmission, consumption of such meat carry only small risk as <span class="CharOverride-6">S. aureus</span> found on meat surfaces and can be killed by high temperature. However, there is high risk of transmission from live animal or raw meat to people working directly with animals or their products. <span lang="en-US">The prevalence of MRSA isolation from food/meat products is presented in </span><a href="#Table-3-"><span class="Hyperlink" lang="en-US">table 3</span></a><span lang="en-US">.</span></p>
			<p class="Heading-2--History-in-MM-">&nbsp;</p>
			<p class="Heading-2--History-in-MM-">MRSA Transmission in hospital settings</p>
			<p class="Body-Text ParaOverride-1">For hospital infection, the hands and nostrils of colonized individuals are the major sources of MRSA transmission. MRSA is released into the hospital environment either through aerosol, skin cells or stools of infected patient (<a href="#Klotz-M--Zimmermann-S--Opper-S--Heeg-K--Mutters-R--2005-."><span class="Hyperlink">Klotz et al</span><span class="Hyperlink CharOverride-6">.</span><span class="Hyperlink">, 2005</span></a>). Areas contaminated in the hospital include medical instrument, beddings, clothing, furnitures, toiletries and the atmosphere (<a href="#Dancer-SJ--2008-."><span class="Hyperlink">Dancer, 2008</span></a>). <a href="#Gehanno-J--Louvel-A--Nouvellon-M--Caillard-JF--Pestel-Caron-M--2009-.-Ae"><span class="Hyperlink">Gehanno et al</span><span class="Hyperlink CharOverride-6">.</span><span class="Hyperlink"> (2009)</span></a> found similar strain of MRSA in patients of a hospital and the room atmosphere. While <a href="#Loeffler-A--Boag-AK--Sung-J--Lindsay-JA--Guardabassi-L--Dalsgaard-A--Smith-H--Stevens-KB--Lloyd-DH--"><span class="Hyperlink">Loeffler et al</span><span class="Hyperlink CharOverride-6">.</span><span class="Hyperlink"> (2005)</span></a> and <a href="#Weese-JS--Caldwell-F--Willey-BM--Kreiswirth-BN--McGeer-A--Rousseau-J--et-al.--2006-."><span class="Hyperlink">Weese et al</span><span class="Hyperlink CharOverride-6">.</span><span class="Hyperlink"> (2004)</span></a> reported MRSA in environmental samples collected from small animal veterinary hospital and equine veterinary hospital, respectively. Although, hospital cleaning reduces MRSA contamination of the environment, in some cases it does not eliminate it. </p>
			<p class="Heading-2--History-in-MM-">&nbsp;</p>
			<p class="Heading-2--History-in-MM-">MRSA in the Community</p>
			<p class="Body-Text ParaOverride-1">Some studies investigated environmental contamination of MRSA outside hospital settings (<a href="#EFSA--2007-.-R"><span class="Hyperlink">EFSA, 200</span></a><span class="Hyperlink">7</span>). Reports include continous colonization of a medical staff which was related to contamination of home environment (<a href="#Allen-KD--Anson-JJ--Parsons-LA--Frost-NG--1997-."><span class="Hyperlink">Allen et al</span><span class="Hyperlink CharOverride-6">.</span><span class="Hyperlink">, 1997</span></a>; <a href="#de-Boer-HEL--van-Elzelingen-Dekker-2006"><span class="Hyperlink">de Boer et al</span><span class="Hyperlink CharOverride-6">.</span><span class="Hyperlink">, 2006</span></a>). Again, contamination of animal housing revealed the possibility of human and animal colonization. <a href="#Van-den-Broek-IV--van-Cleef-BA--Haenen-A--Broens-EM--van-der-Wolf-P-2008"><span class="Hyperlink">Van Den Broek et al</span><span class="Hyperlink CharOverride-6">.</span><span class="Hyperlink"> (2008)</span></a> isolated MRSA from pig house dust and humans working in MRSA positive pig farms. </p>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1">Airborne MRSA in livestock settings are mostly seen in dust particles that are derived from the animals. MRSA was isolated in dust from infected herds which may be subsequently inhaled by workers in the farm (<a href="#EFSA--2007-.-R"><span class="Hyperlink">EFSA, 2007</span></a>; <a href="#Schulz-J--Friese-A--Klees-S--Tenhagen-BA--Fetsch-A--R-sler-U--Hartung-J--2012-."><span class="Hyperlink">Schulz </span><span class="Hyperlink">et al., 2012</span></a>). Transmission of disease through water may occur in aquatic animals such as fish. Transmission from fish to humans could be through injury from cleaning aquarium with bare hands (<a href="#Alinovi-A--Vecchini-F--Bassissi-P--1993-."><span class="Hyperlink">Alinovi et al., 1993</span></a>) and exposure to fish tank water (<a href="#Kern-W--Vanek-E--Jungbluth-H--1989-."><span class="Hyperlink">Kern et al., 1989</span></a>).</p>
			<p class="Heading-2--History-in-MM-">&nbsp;</p>
			<p class="Heading-2--History-in-MM-">MRSA Detection in Humans and Animals</p>
			<p class="Body-Text ParaOverride-1">In an effort to control MRSA in major settings (hospital, community, animals) colonized and infected humans, animals and environmental surfaces must be identified. The menance of MRSA colonization and infection has extended from human, companion and food animals into wildlife animals. The screening of human carriers in hospitals and communities is necessary for the successful diagnosis and control of MRSA. In addition, companion animals with skin and soft tissue infections should be screened for MRSA. Sites for screening of MRSA colonized animals include nose, skin, perineum and rectal or cloacal swabs (<a href="#e-Neeling-AJ--van-den-Broek-MJ--Spalburg--..-2007"><span class="Hyperlink">de Neeling et al</span><span class="Hyperlink CharOverride-6">.,</span><span class="Hyperlink"> 2007</span></a>; <a href="#Khanna-T--Friendship-R--Dewey-C--Weese-JS--2008-."><span class="Hyperlink">Khanna et al</span><span class="Hyperlink CharOverride-6">.,</span><span class="Hyperlink"> 2008</span></a>) and nostril for humans (<a href="#Peacock--SJ--de-Silva-I--Lowy-FD--2001-.-Wh"><span class="Hyperlink">Peacock et al</span><span class="Hyperlink CharOverride-6">.,</span><span class="Hyperlink"> 2001</span></a>). Nasal screening alone identifies 80% of carriers, and addition of sampling from throat, may increase this to 92% (<a href="#Grundmann-H--Aires-de-Sousa-M--Boyce-J--Tiemersma-E--2006-."><span class="Hyperlink">Grundmann et al</span><span class="Hyperlink CharOverride-6">.,</span><span class="Hyperlink"> 2006</span></a>). For environmental samples, swabs are taken from dust samples (<a href="#EFSA--2007-.-R"><span class="Hyperlink">EFSA, 2007</span></a>; <a href="#Broens-EM--Graat-EA--van-der-Wolf-PJ--van-der-Broek-IV-..2008"><span class="Hyperlink">Broens et al</span><span class="Hyperlink CharOverride-6">.,</span><span class="Hyperlink"> 2008</span></a>), tables, containers, feed material or feces and bedding material (<a href="#Lee-JH--2003-"><span class="Hyperlink">Lee, 2003</span></a>). Other samples like milk and meat from animals and cloacal swab from poultry should be cultured for detection of MRSA.</p>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1">Various methods are applied for the detection of MRSA through phenotypic and genotypic characterization of samples from infected sites such as skin lesions, abscesses or blood. Both has advantages and disadvantages such as speed, reliability and acessibility. Phenotypic methods involves standard microbiological technique of <span class="CharOverride-6">S. aureus</span> detection which include Gram staining, colonial morphorlogy, catalase and coagulase tests, pigment production and anaerobic growth (<a href="#Karthy-ES--Ranjitha-P--MohankUmaru-A--2009-."><span class="Hyperlink">Karthy et al</span><span class="Hyperlink CharOverride-6">.</span><span class="Hyperlink">, 2009</span></a>). Additional methods include Minimum Inhibitory Concentrations, methods that detect <span class="CharOverride-6">mec</span>A gene or PBP2<span class="CharOverride-24">0</span> protein and media containing oxacillin (<a href="#Louie-L--Majury-A--Goodfekllow-J--Louie-M--Simor-AE--2001-."><span class="Hyperlink">Louie et al</span><span class="Hyperlink CharOverride-6">.,</span><span class="Hyperlink"> 2001</span></a>). Selective enrichment media have been developed to achieve isolation and identification of MRSA in a single step, thus by-passing the conventional procedures (<a href="#Stoakes-L--Reyes-R--Daniel-J--Lennox-G--John-M-A--Lannigan-R--Hussain-Z--2006-."><span class="Hyperlink">Stoakes et al</span><span class="Hyperlink CharOverride-6">.,</span><span class="Hyperlink"> 2006</span></a>). Ideal enrichment media contains indicators, inhibitory agents and antibiotics usually oxacillin or cefoxitin. Examples are Oxacillin Resistant Screening Agar Base (ORSAB) which result in intense blue colonies<span class="CharOverride-6"> </span>(<a href="#Becker-A--Forster-DH--Kniehl-E--2002-.-O"><span class="Hyperlink">Becker et al</span><span class="Hyperlink CharOverride-6">.,</span><span class="Hyperlink"> 2002</span></a>), CHROM agar which give rise to a rose to mauve color and MRSA ID which forms distinctive green colonies.</p>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
		  <p class="Body-Text ParaOverride-1">In addition to culture media, antimicrobial susceptibility tests (AST) such as agar disc diffusion technique or minimum inhibitory concentration are used in diagnostic laboratories to isolate MRSA (<a href="#klilu-E--Zunita-Z--Hassan-L--Chen-HC--2010-."><span class="Hyperlink">Aklilu et al., 2010</span></a>). Detection of the <span class="CharOverride-6">mec</span>A gene is considered as the reference method for determining methicillin resistance (<a href="#Chambers-HF--1997-."><span class="Hyperlink">Chambers, 1997</span></a>). Resistance of <span class="CharOverride-6">S. aureus</span> to oxacillin and/or cefoxitin provides a clue for MRSA suspicion (<a href="#Van-Enk-R-A--Thompson-K-D--1992-."><span class="Hyperlink">van Enk and Thompson, 1992</span></a>). Oxacillin and cefoxitin test are the preferred method for testing <span class="CharOverride-6">mec</span>A resistant gene of <span class="CharOverride-6">S. aureus</span> (<a href="#CLSI--2006-.-P"><span class="Hyperlink">CLSI, 2006</span></a>). In order to report isolates as resistant or susceptible should be based on the result obtained on the cefoxitin test. Cefoxitin disc diffusion is the most sensitive methods for detecting MRSA isolates showing negative and positive predictive values of 100% and 98%, respectively (<a href="#Valesco-D--del-Mar-Tomas-M--Cartelle-M--Beceiro-A--Perez-A--Molina-F--Moure-R--Villanueva-R--Bou-G"><span class="Hyperlink">Valesco et al</span><span class="Hyperlink CharOverride-6">.,</span><span class="Hyperlink"> 2005</span></a>). </p>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
			<p class="Body-Text ParaOverride-1">A more advanced technique usually accompanies the phenotypic methods in order to enhance specificity and time. Molecular methods such as PCR are used to detect <span class="CharOverride-6">S. aureus </span>specific DNA sequences encoding for protein synthesis and the <span class="CharOverride-6">mec</span> genes. Other molecular typing methods include pulsed-field gel electrophoresis (PGFE) and multilocus sequence typing (MLST), Staphylococcal Protein A Gene (spa) locus typing and Staphylococcal Cassette Chromosme (SCC<span class="CharOverride-6">mec</span>) typing. The strength and weaknesses of the above genotypic methods are presented in <a href="#Table-4"><span class="Hyperlink">table 4</span></a>.</p>
			<p class="Heading-1--Introduction----">&nbsp;</p>
		  <p class="Heading-1--Introduction----">Treatment and Control of MRSA</p>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
			<p class="Body-Text ParaOverride-1">The indiscriminate exposure of humans and animals to antibiotics created problem through acquisition and dessimination of MRSA which limit the choice of treatment. Most antibiotics used for treatment of MRSA infection has been reported to have developed resistance (<a href="#Ayliffe-G--1997-."><span class="Hyperlink">Ayliffe, 1997</span></a>). In order to manage the risk of antibiotic resistance in humans and animals, decolonization of carriers and monitoring of resistant strains through susceptibility test will surely help. The use of antibiotic to treat infection should depend on the result of antimicrobial susceptibility testing, although most strains appear ineffective during treatment even when sensitive in routine susceptibility test. Antibiotics such as trimethoprim-sulphamethoxazole, clindamycin and doxycycline are reported to be effective in the treatment of CA-MRSA infection (<a href="#Ernst-J--2012-."><span class="Hyperlink">Ernst, 2012</span></a>). Newer drugs such as oritavancin, telavancin omadacycline, tedizolid and dalbavancin have a promising impact on the treatment of MRSA. Other existing agents such as fosfomycin and fusidic acid are under investigation for potential used in the treatment of MRSA infection (<a href="#Burke-ST-and-Warren-ER--2014-."><span class="Hyperlink">Burke and Warren, 2014</span></a>). </p>
		  <p class="Body-Text ParaOverride-1">&nbsp;</p>
			<p class="Figure--and-Table-Heading ParaOverride-1"><span class="CharOverride-5"><a id="Table-4"></a>Table 4:</span> Summary of the comparative strength and weaknesses of current genotypic methods used for MRSA typing </p>
			<table id="table-4" class="Table-Style-1">
				<colgroup>
					<col class="_idGenTableRowColumn-26" />
					<col class="_idGenTableRowColumn-6" />
					<col class="_idGenTableRowColumn-27" />
					<col class="_idGenTableRowColumn-6" />
					<col class="_idGenTableRowColumn-24" />
				</colgroup>
				<tbody>
					<tr class="_idGenTableRowColumn-28">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-25">Methods</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-25">Principle</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-25">Strengths</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-25">Weaknesses</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-25">References</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-29">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Pulsed-field gel electrophoresis (PFGE)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-27">S. aureus</span><span class="CharOverride-26"> DNA fragments are move down the gel, creating unique band patterns that are then compared with those of other isolates to identify related strains</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">High discriminatory power</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Technically demanding</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Slow</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Limited inter laboratory portability</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Multiple nomenclature</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Tenover et al., 1995</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-30">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Multilocus sequence typing</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">(MLST)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Uses sequence analysis of ~500-bp internal fragments of seven housekeeping genes: </span><span class="CharOverride-27">arcC</span><span class="CharOverride-26">, </span><span class="CharOverride-27">aroE</span><span class="CharOverride-26">, </span><span class="CharOverride-27">glpF</span><span class="CharOverride-26">, </span><span class="CharOverride-27">gmk</span><span class="CharOverride-26">, </span><span class="CharOverride-27">pta</span><span class="CharOverride-26">, </span><span class="CharOverride-27">tpi</span><span class="CharOverride-26">, and </span><span class="CharOverride-27">yqiL</span><span class="CharOverride-26">. The DNAsequences are compared to those of previously identified alleles at each locus on the MLST online database</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Phylogenic structure of core genome</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Inter laboratory portability</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Standard nomenclature</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Limited discriminatory power</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Low throughput</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Expensive</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Enright et al., 2000</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-29">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-27">S. aureus</span><span class="CharOverride-26"> protein A (spa)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Typing of a single locus zone in the polymorphic region X of </span><span class="CharOverride-27">S. aureus</span><span class="CharOverride-26"> A which involves duplication and mutation in the variable repeats of 24bp</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Rapid</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">High throughput</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Inter laboratory portability</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Standard nomenclature</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Attribution of MLSTS STs by BURP algorithm</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Moderate discriminatory power</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Misclassification of particular STs due to recombination/homoplasy</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Szabó  (2014)</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-31">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">SCC</span><span class="CharOverride-27">mec</span><span class="CharOverride-26"> typing</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Used to define the 7 major </span><span class="CharOverride-27">mec</span><span class="CharOverride-26"> and ccr gene of 7 major SCC</span><span class="CharOverride-27">mec</span><span class="CharOverride-26"> types and subtypes ranging from 20 to 67kb</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">High discriminatory power</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">No universally used assay</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">No nomenclature used but a combination of SCC</span><span class="CharOverride-27">mec </span><span class="CharOverride-26">typing and MLST has been proposed</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Chongtrakool et al., 2006</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-32">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Rep- PCR typing</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Polymorphism in chromosomal inter-repeat element spacers</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Rapid</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">High throughput</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Limited discriminatory power</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">No validated interpretation criteria</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">No standard nomenclature</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Struelens</span><span class="CharOverride-27"> </span><span class="CharOverride-26">et al., 2009</span></p>
						</td>
					</tr>
					<tr class="_idGenTableRowColumn-31">
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Multilocus VNTR analysis (MLVA)</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Polymorphism in number of chromosomal VNTR elements</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Rapid</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">High throughput</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Limited discriminatory power</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">No validated interpretation criteria</span></p>
							<p class="Basic-Paragraph"><span class="CharOverride-26">No standard nomenclature</span></p>
						</td>
						<td>
							<p class="Basic-Paragraph"><span class="CharOverride-26">Struelens et al., 2009</span></p>
						</td>
					</tr>
				</tbody>
			</table>
			<p class="Body-Text ParaOverride-1">As the MRSA epidemic becomes life threatening and beyond antibiotic therapy, development of vaccine to combat the disease became important (<a href="#Cimolai-N--2006-."><span class="Hyperlink">Cimolai, 2006</span></a>). The first attempt to develop <span class="CharOverride-6">S. aureus</span> vaccine was by the use of Streptococcus pneumonia and hemophilus influenza vaccine model. The formula was called Staphvax developed by biopharmaceuticals in 1990s though unsuccessful (<a href="#McKenna-M--2014-."><span class="Hyperlink">Mckenna, 201</span></a><span class="Hyperlink">4</span>). Continous attempts were made by different institutions like University of Chicago and the Absynth biologics which uses clotting factors to produce abscess and membrane protein, respectively (<a href="#Cheng-AG--McAdow-M--Kim-HK--Bae-T--Missiakas-DM--et-al.--2010-."><span class="Hyperlink">Cheng et al., 2010</span></a>). However, trial on mice did not produce the desired result of abscess development and antibody production (<a href="#Hu-CJ--Fang-RH--Luk-BT--Zhang-L--2013-.-Nanoparticle-d"><span class="Hyperlink">Hu et al., 2013</span></a>). Recently, <a href="#Russel-CD--2012-."><span class="Hyperlink">Russell (2012)</span></a> suggested the role of polyvalent pneumococcal vaccine to develop vaccine for staphylococcal infections. Therefore based on published data, researches are still been conducted on MRSA vaccine development but no established vaccine is available. In the absence of preventive measures such as vaccination, basic control options that will reduce MRSA colonisation or infection in humans and animals are necessary.</p>
			<p class="Body-Text ParaOverride-1">Basic hygiene, good husbandry and biosecurity measures on farms, abattoirs and food processing units have a tendency to reduce the spread of MRSA in animal population. Individuals with frequent animal contact should be educated on the risk of MRSA transmission in animals or their environment. In hospitals, hygienic measures particularly hand washing before and after contact with contaminated surfaces and the avoidance of close contact with discharges from nose, mouth and wounds of infected human and animals will surely reduce the chances of transmission. Decolonization of MRSA positive carriers’ either through the use of antibiotic therapy (chlorhexidene or murocidin) or culling of affected animals or product will reduce the spread in the environment. Medical practitioners should be encouraged to choose antibiotic based on susceptibility test and to wear protective equipment during surgery and handling of patients to reduce contamination and spread. </p>
			<p class="Heading-1--Introduction----">&nbsp;</p>
		  <p class="Heading-1--Introduction----">Conclusion</p>
			<p class="Body-Text ParaOverride-1">&nbsp;</p>
			<p class="Body-Text ParaOverride-1">In conclusion, the prevalence of MRSA isolation from hospitals, community, animals and their products has increased in different geographical locations. The continous vigilance of MRSA through monitoring of newer strains, their characteristic, host specificity and transmission routes in each of the settings (HA-MRSA, CA-MRSA, LA-MRSA) will help in effective control of MRSA. MRSA is no longer infection acquired in the hospital alone, but rather in communities through contact with domesticated and wild animals as well as food products and the environment. Therefore, there is need for effective control of MRSA in all the settings and the avoidance of indiscriminate use of antibiotics to prevent further selection of resistance by microorganisms.</p>
			<p class="Heading-1--Introduction----">&nbsp;</p>
			<p class="Heading-1--Introduction----">References</p>
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