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In Reply: Dr David and colleagues highlight the difficulty in classifying persons with invasive infections with MRSA in terms of their exposures to established risk factors. We previously reported the frequency of strains of community origin among persons with health care risk factors, and of strains of health care origin among persons without health care risk factors,¹ indicating that microbiologic characteristics are no longer accurate in classifying the source of acquisition of MRSA.

We agree that 1 of these risk factors, history of MRSA colonization or infection, might not reflect exposure to health care because, especially recently, community strains of MRSA are often transmitted in the community setting independent of exposures to hospitals.² Using previous MRSA infection or colonization as the only criterion for classification of a community-onset infection as health care–associated would overestimate this proportion.

However, in our surveillance program, we maintain the ability to ascertain which of the . . . [Full Text of this Article]

R. Monina Klevens, DDS, MPH
rmk2@cdc.gov

Melissa A. Morrison, MPH; Scott K. Fridkin, MD
Centers for Disease Control and Prevention
Atlanta, Georgia

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