Crespo‑Piazuelo and Lawlor Ir Vet J (2021) 74:21 https://doi.org/10.1186/s13620‑021‑00200‑7 REVIEW Open Access Livestock‑associated methicillin‑resistant Staphylococcus aureus (LA‑MRSA) prevalence in humans in close contact with animals and measures to reduce on‑farm colonisation Daniel Crespo‑Piazuelo and Peadar G. Lawlor* Abstract Since the 1940s, Staphylococcus aureus has adapted to the use of diferent antimicrobials to treat infections. Although S. aureus can act as a commensal bacterium, some strains are facultative pathogens and acquiring them can be fatal. In particular, treating infections caused by S. aureus with acquired antimicrobial resistance is problematic, as their treatment is more difcult. Some of these S. aureus variants are methicillin‑resistant S. aureus (MRSA) with prevalence across the globe in health‑care facilities, community settings and on livestock farms. Apart from humans, MRSA can colonise other animal species, and because of this, resistance to new antimicrobials can appear and jump between species. Livestock and companion animals are particularly important in this regard considering the relatively high usage of antimicrobials in these species. There is a risk to humans who come into direct contact with animals acquir‑ ing MRSA but there is also the risk of animals acquiring MRSA from colonised humans. In this review, we summarise studies conducted worldwide to characterise the prevalence of MRSA in veterinarians, farmers and other personnel who come into close contact with animals. Finally, alternative treatment, preventive measures and on‑farm strategies to reduce MRSA introduction to a farm and carriage within a herd are discussed. Keywords: LA‑MRSA, Animal production, Prevention, Antimicrobial resistance, Animal contact Introduction without impacting the health of the host. Depending on Staphylococcus aureus is a Gram-positive catalase-posi- the persistence of carriage, hosts can be persistent car- tive bacterium which is commonly found on the skin and riers, intermittent carriers, or non-carriers at all, if the mucosa of humans and animals [1–3]. Te anterior nares bacterium rarely colonises the host, and when it does, of humans are one of the most frequently colonised sites the colonisation is transient and does no last longer than and about 30% of the human population is colonised with about two weeks [6]. However, nasal swabs from persis- S. aureus [3, 4]. Although S. aureus is usually classifed tent carriers usually yield the same MRSA strains over as a commensal bacterium, it is a facultative pathogen, time, and because of the facultative pathogenicity of S. which can potentially cause several diseases from mild aureus, persistent carriers are at a higher risk of develop- skin lesions to severe and potentially fatal infections [5]. ing an infection [6]. As a commensal bacterium, S. aureus colonises its host Within a few years of the introduction of penicillin in the 1940s, the frst cases of penicillin-resistant S. aureus were reported [7]. Resistance was obtained through *Correspondence: [email protected] Teagasc, Pig Development Department, Animal & Grassland Research & the acquisition of plasmids that contained the ß-lacta- Innovation Centre, Moorepark, Fermoy, Co. Cork P61 C996, Ireland mase gene (blaZ), which produce an enzyme capable of © The Author(s) 2021. 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The Creative Commons Public Domain Dedication waiver (http:// creat iveco mmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. Crespo‑Piazuelo and Lawlor Ir Vet J (2021) 74:21 Page 2 of 12 breaking down the β-lactam ring of penicillin and other assigned to the same ST, while strains with closely related antibiotics [8–10]. Te β-lactam ring of penicillin causes STs may belong to the same clonal complex (CC) lineage bacterial lysis by binding to penicillin-binding proteins (e.g., CC398). Another most commonly used method is (PBP), which are needed for cross-linking the peptidogly- spa typing, based on sequencing the variable X region can chains of the cell wall [11]. of the S. aureus surface protein A (spa) gene and assign- Methicillin, a new antibiotic with resistance to ing the strains to a spa type based on the diferent pol- β-lactamase was developed two decades later, in 1960, ymorphisms found (e.g., t011). Te last method that and in less than two years, the frst methicillin-resistant has received most attention is SCCmec typing, which S. aureus (MRSA) appeared [12, 13]. Tis new resist- sequences and classifes the strains based on the difer- ance was driven by the acquisition of the mecA gene, ences in mobile genetic elements (MGE) including the which encodes the penicillin-binding protein 2a (PBP2a), aforementioned mecA gene (e.g., SCCmec IV). Despite a slightly diferent PBP that possesses low afnity for the eforts in classifying the diferent MRSA strains β-lactam antibiotics [14]. found, the epidemiology of MRSA colonisation is chang- Later on, in the 1980s and 1990s, MRSA strains spread ing. Strains of CA-MRSA can share genes between both across the world carrying multidrug resistant traits and LA- and HA- MRSA [23], and some clones are present in being one of the most important agents of nosocomial more than one classifcation group, blurring the distinc- infection [5]. Tese MRSA strains were called hospital- tion between strains [24–26]. acquired MRSA (HA-MRSA), as they were commonly LA-MRSA strains can be transmitted between diferent found in hospitals and health care facilities. animal species and to humans who come in close contact In parallel with the spread of HA-MRSA, control with colonised animals, such as veterinarians and farm measures were applied in hospital settings to prevent workers. However, colonised humans can also transmit nosocomial transmission of MRSA [15]. Tese preven- LA-MRSA to other humans and between animal settings. tive measures reduced HA-MRSA prevalence in several In this review, we have summarised studies conducted countries. However, infections caused by new MRSA worldwide to assess the prevalence of MRSA in person- strains started to increase in communities outside the nel who come into close contact with animals. We also hospital setting in the 1990s [16, 17]. Tese strains discuss preventive measures to avoid MRSA introduction which could spread rapidly among groups of healthy onto a farm, alternative treatments and on-farm strate- individuals were called community-acquired MRSA gies to reduce or eradicate MRSA carriage within a herd. (CA-MRSA) [18]. In 2004, a new MRSA strain was found colonising the MRSA transmission between humans, animal production daughter of a pig farmer in the Netherlands [19]. Both and companion animals parents and a pig on the family farm carried the same MRSA can be transmitted from vertebrate animals strain, which was characterized by the presence of the to humans. Likewise, humans also act as a reservoir mecA gene. Tis strain was diferent from those usually for the transmission of S. aureus to vertebrate ani- found in HA-MRSA and CA-MRSA, as it was impossible mals. Infections that can be present in both humans to classify it using the standard method of pulsed-feld and animals and transmitted in both directions, such gel electrophoresis (PFGE) with restriction endonucle- as S. aureus infections, are defned as “amphixenoses” ase SmaI. Although other studies previously reported a [27]. Te frst reported incident of MRSA colonisa- linkage between animal and human MRSA colonisation, tion in livestock happened in Belgium in the early this was the frst study to demonstrate the transmission 1970s, afecting the milk of cows with bovine mastitis of MRSA between animals and humans. Later on, sev- [28]. Despite most of the isolates having been similar eral other studies reported this in other countries. Te to common bovine strains, a human-to-animal trans- term livestock-associated MRSA (LA-MRSA) was used mission of a new MRSA strain acquired by the farmer to refer to this third group of MRSA strains which were seems more likely due to the observed antimicrobial considered a reservoir in livestock animals [20]. characteristics. Since then, MRSA colonisation has Tere are several methods for screening and typ- been reported in dogs, cats, horses, cattle, pigs, rabbits ing MRSA strains: spa sequence typing; multilocus and poultry [29–32]. It has even been described in wild sequence typing (MLST); staphylococcal cassette chro- birds such as magpies and vultures [33]. Te frst ani- mosome mec (SCCmec) typing; PFGE; and multilo- mal-to-human transmission of S. aureus was reported cus variable-number tandem repeat (VNTR) analysis in dairy sheep [34]. Shortly after, the frst case of MRSA (MLVA) (reviewed in [21, 22]). Based on MLST, strains transmission from animal to human, including human- are assigned to a sequence type (ST) after sequencing to-human transmission of the same strain was reported seven endogenous genes. Identical strains by MLST are [19]. Other interspecies transmission have been Crespo‑Piazuelo and Lawlor Ir Vet J (2021) 74:21 Page 3 of 12 described in household pets, which can be colonised is applied to crop felds are also at a higher risk of being with the same strains as their owners [35].