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In Reply: Dr Bloom's points are well taken. Intrafamilial spread of methicillin-susceptible S aureus has been well documented.¹ However, because of the relative novelty of problems with community-associated MRSA (CA-MRSA), similar intrafamilial spread of these organisms has been less clearly defined, although it is very likely that this is a significant and growing problem.²

Recent studies of nasal carriage of CA-MRSA document surprisingly low rates of carriage despite widespread dissemination of these organisms in the community. This has suggested that spread from colonized persons may be less of a factor for CA-MRSA than for hospital-associated strains of MRSA. This may be changing, however; a striking increase in nasal carriage of MRSA among injection drug users has recently been documented.³ The possibility of spread of these organisms to humans from family pets⁴ and other animals is being examined as well.⁵ Finally, the role of antibiotic exposure as a selective factor for . . . [Full Text of this Article]

Robert C. Moellering Jr, MD
rmoeller@bidmc.harvard.edu
Department of Medicine
Beth Israel Deaconess Medical Center
Boston, Massachusetts

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