Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) at ambient freshwater beaches

Hydrogen peroxide preoxidation as a strategy for enhanced antimicrobial photodynamic action against methicillin-resistant Staphylococcus aureus

Antimicrobial photodynamic treatment (aPDT) is a photooxidative process based on the excitation of a photosensitizer (PS) in the presence of molecular oxygen, under specific wavelengths of light. It is a promising method for advanced treatment of water and wastewater, particularly targeting disinfection challenges, such as antibiotic-resistant bacteria (ARB). Research in improved aPDT has been exploring new PS materials, and additives in general. Hydrogen peroxide (H2O2) a widely applied disinfectant, mostly in the food industry and clinical settings, present environmentally negligible residuals at the usually applied concentrations, making it friendly for the water and wastewater sectors. Here, we explored the effects of preoxidation with H2O2 followed by blue light-mediated (450 nm) aPDT using curcumin (a natural-based PS) against methicillin-resistant Staphylococcus aureus (MRSA). Results of the sequential treatment pointed to a slight hampering in aPDT efficiency at very low H2O2 concentrations, followed by an increasing cooperative effect up to a deleterious point (≥7 log10 inactivation in CFU mL-1), suggesting a synergistic interaction of preoxidation and aPDT. The increased performance in H2O2-pretreated aPDT encourages studies of optimal operational conditions for the assisted technology and describes potentials for using the described strategy to tackle the issue of ARB spread.

Epidemiology of Antimicrobial Resistance Genes in Staphylococcus aureus Isolates from a Public Database from a One Health Perspective-Sample Origin and Geographical Distribution of Isolates

Staphylococcus aureus are commensal bacteria that are found in food, water, and a variety of settings in addition to being present on the skin and mucosae of both humans and animals. They are regarded as a significant pathogen as well, with a high morbidity that can cause a variety of illnesses. The Centers for Disease Control and Prevention (CDC) has listed them among the most virulent and resistant to antibiotics bacterial pathogens, along with Escherichia coli, Staphylococcus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterococcus faecalis, and Enterococcus faecium. Additionally, S. aureus is a part of the global threat posed by the existence of antimicrobial resistance (AMR). Using 26,430 S. aureus isolates from a global public database (NPDIB; NCBI Pathogen Detection Isolate Browser), epidemiological research was conducted. The results corroborate the evidence of notable variations in isolate distribution and ARG (Antimicrobial Resistance Gene) clusters between isolate sources and geographic origins. Furthermore, a link between the isolates from human and animal populations is suggested by the ARG cluster patterns. This result and the widespread dissemination of the pathogens among animal and human populations highlight how crucial it is to learn more about the epidemiology of these antibiotic-resistance-related infections using a One Health approach.

Detection of mecA positive staphylococcal species in a wastewater treatment plant in South Africa

We investigated the prevalence of antibiotic resistant staphylococci and detection of resistant, virulence, and Spa genes in a South African wastewater treatment plant. Species identified were Staphylococcus aureus, S. lentus, S. arlettae, S. cohnii, S. haemolyticus, S. nepalensis, S. sciuri (now Mammaliicoccus sciuri), and S. xylosus. Isolates showed high resistance to methicillin (91%), ampicillin (89%), ciprofloxacin (86%), amoxycillin (80%), ceftazidime (74%), and cloxacillin (71%). Multiple antibiotic resistance (MAR) index for the isolates exceeded 0.2 (0.50-0.70). Among the isolates, 77% were mecA-positive. All S. aureus strains were positive for nuc and 7 Spa gene types. The present study highlights possibility of treated wastewaters being potential reservoir for antibiotic-resistant staphylococci. This is a cause for concern as wastewater effluents are decanted into environmental waters and these are, in many cases, used for various purposes including recreation (full contact), religious (full body submersion), and drinking water for some rural communities and water for livestock.

Effects of water turbidity on the survival of Staphylococcus aureus in environmental fresh and brackish waters

Staphylococcus aureus is an opportunistic pathogen frequently detected in environmental waters and commonly causes skin infections to water users. S. aureus concentrations in fresh, brackish, and marine waters are positively correlated with water turbidity. To reduce the risk of S. aureus infections from environmental waters, S. aureus survival (stability and multiplication) in turbid waters needs to be investigated. The aim of this study was to measure S. aureus in turbid fresh and brackish water samples and compare the concentrations over time to determine which conditions are associated with enhanced S. aureus survival. Eighteen samples were collected from fresh and brackish water sources from two different sites on the east side of O'ahu, Hawai'i. S. aureus was detected in microcosms for up to 71 days with standard microbial culturing techniques. On average, the greatest environmental concentrations of S. aureus were in high turbidity fresh waters followed by high turbidity brackish waters. Models demonstrate that salinity and turbidity significantly predict environmental S. aureus concentrations. S. aureus persistence over the extent of the experiment was the greatest in high turbidity microcosms with T90 's of 147.8 days in brackish waters and 80.8 days in freshwaters. This study indicates that saline, turbid waters, in the absence of sunlight, provides suitable conditions for enhanced persistence of S. aureus communities that may increase the risk of exposure in environmental waters. PRACTITIONER POINTS: Staphylococcus aureus concentrations, survival, and persistence were assessed in environmental fresh and brackish waters. Experimental design preserved in situ conditions to measure S. aureus survival. Higher initial S. aureus concentrations were observed in fresh waters with elevated turbidity, while sustained persistence was greater in brackish waters. Water turbidity and salinity were both positively associated with S. aureus concentrations and persistence. Climate change leads to more intense rainfall events which increase water turbidity and pathogen loading, heightening the exposure risk to S. aureus.

Recreational water exposures and illness outcomes at a freshwater beach in Toronto, Canada: A prospective cohort pilot study

BACKGROUND

Swimming and other recreational water activities in surface waters are popular in Canada during the summer. However, these activities can also increase the risk of recreational water illness. While routine monitoring of beach water quality is conducted by local authorities each summer, little research is available in Canada about beach exposures and illness risks.

METHODS

We conducted a pilot of a prospective cohort study at a popular beach in Toronto, Ontario, Canada, in 2022 to determine characteristics of beachgoers, common water and sand exposures, the incidence of recreational water illness, and the feasibility for a larger, national cohort study. We enrolled beachgoers on-site and surveyed about their exposures at the beach and conducted a follow-up survey 7 days following their beach visit to ascertain acute gastrointestinal, respiratory, skin, ear, and eye illness outcomes. We descriptively tabulated and summarized the collected data.

RESULTS

We enrolled 649 households, consisting of 831 beachgoers. Water contact activities were reported by 56% of beachgoers, with swimming being the most common activity (44% of participants). Similarly, 56% of beachgoers reported digging in the sand or burying themselves in the sand. Children (≤14 years) and teenagers (15-19 years) were most likely to report engaging in water contact activities and swallowing water, while children were most likely to report sand contact activities and getting sand in their mouth. Boys and men were more likely than women and girls to report swallowing water (15.2% vs. 9.4%). Water and sand exposures also differed by household education level and participant ethno-racial identity. E. coli levels in beach water were consistently low (median = 20 CFU/100 mL, range = 10-58). The incidence of illness outcomes was very low (0.3-2.8%) among the 287 participants that completed the follow-up survey.

CONCLUSIONS

The identified beach exposure patterns can inform future risk assessments and communication strategies. Excellent water quality was observed at the studied beach, likely contributing to the low incidence of illnesses. A larger, national cohort study is needed in Canada to examine risks of illness at beaches at higher risk of fecal contamination.

Antibacterial Properties and Potential Mechanism of Serum from Chinese Alligator

The Chinese alligator (Alligator sinensis) is an ancient reptile with strong immunity that lives in wetland environments. This study tested the antibacterial ability of Chinese alligator serum (CAS) against Klebsiella pneumoniae, Escherichia coli, Staphylococcus aureus, and Pseudomonas aeruginosa and analyzed the potential underlying mechanisms. Results showed that the CAS had a marked antibacterial effect on K. pneumoniae, E. coli, and P. aeruginosa, while S. aureus was only mildly affected. However, these effects disappeared when Protease K was added to the serum. The serum proteome analysis revealed that the antibacterial ability of CAS was produced by interactions among various proteins and that the complement proteins played a major antibacterial role. Therefore, we made relevant predictions about the structure and function of complement component 3. In addition, sequence alignment and phylogenetic analysis of complement component 3d (C3d) in four mammalian species and two alligator species showed that the amino acids that make up the acid pocket on the concave surface of alligator C3d are not identical to those in mammals. This study provided evidence that CAS elicits significant antibacterial effects against some pathogens and provides the basis for further development of novel antibacterial drugs.

Environmental Surveillance and Characterization of Antibiotic Resistant Staphylococcus aureus at Coastal Beaches and Rivers on the Island of Hawai'i

Staphylococcus aureus are human facultative pathogenic bacteria and can be found as contaminants in the environment. The aim of our study was to determine whether methicillin-resistant Staphylococcus aureus (MRSA) and methicillin-susceptible S. aureus (MSSA) isolated from coastal beach and river waters, anchialine pools, sand, and wastewater on the island of Hawaiʻi, Hawaiʻi, are a potential health risk. Samples were collected from three regions on Hawaiʻi Island from July to December 2020 during the COVID-19 pandemic and were characterized using whole-genome sequencing (WGS). From WGS data, multilocus sequence typing (MLST), SCCmec type, antimicrobial resistance genes, virulence factors, and plasmids were identified. Of the 361 samples, 98.1% were positive for Staphylococcus spp. and 7.2% were S. aureus positive (n = 26); nine MRSA and 27 MSSA strains were characterized; multiple isolates were chosen from the same sample in two sand and seven coastal beach water samples. The nine MRSA isolates were multi-drug resistant (6–9 genes) sequence type (ST) 8, clonal complex (CC) 8, SCCmec type IVa (USA300 clone), and were clonally related (0–16 SNP differences), and carried 16–19 virulence factors. The 27 MSSA isolates were grouped into eight CCs and 12 STs. Seventy-eight percent of the MSSA isolates carried 1–5 different antibiotic resistance genes and carried 5–19 virulence factors. We found S. aureus in coastal beach and river waters, anchialine pools, and sand at locations with limited human activity on the island of Hawaiʻi. This may be a public health hazard.

Antibiotic Resistance in Recreational Waters: State of the Science

Ambient recreational waters can act as both recipients and natural reservoirs for antimicrobial resistant (AMR) bacteria and antimicrobial resistant genes (ARGs), where they may persist and replicate. Contact with AMR bacteria and ARGs potentially puts recreators at risk, which can thus decrease their ability to fight infections. A variety of point and nonpoint sources, including contaminated wastewater effluents, runoff from animal feeding operations, and sewer overflow events, can contribute to environmental loading of AMR bacteria and ARGs. The overall goal of this article is to provide the state of the science related to recreational exposure and AMR, which has been an area of increasing interest. Specific objectives of the review include (1) a description of potential sources of antibiotics, AMR bacteria, and ARGs in recreational waters, as documented in the available literature; (2) a discussion of what is known about human recreational exposures to AMR bacteria and ARGs, using findings from health studies and exposure assessments; and (3) identification of knowledge gaps and future research needs. To better understand the dynamics related to AMR and associated recreational water risks, future research should focus on source contribution, fate and transport-across treatment and in the environment; human health risk assessment; and standardized methods.

Molecular interaction between methicillin-resistant Staphylococcus aureus (MRSA) and chicken breast reveals enhancement of pathogenesis and toxicity for food-borne outbreak

To study pathogenesis and toxicity of Staphylococcus aureus in foods, FORC_062 was isolated from a human blood sample and complete genome sequence has a type II SCCmec gene cluster and a type II toxin-antitoxin system, indicating an MRSA strain. Its mobile gene elements has many pathogenic genes involved in host infection, biofilm formation, and various enterotoxin and hemolysin genes. Clinical MRSA is often found in animal foods and ingestion of MRSA-contaminated foods causes human infection. Therefore, it is very important to understand the role of contaminated foods. To elucidate the interaction between clinical MRSA FORC_062 and raw chicken breast, transcriptome analysis was conducted, showing that gene expressions of amino acid biosynthesis and metabolism were specifically down-regulated, suggesting that the strain may import and utilize amino acids from the chicken breast, but not able to synthesize them. However, toxin gene expressions were up-regulated, suggesting that human infection of S. aureus via contaminated food may be more fatal. In addition, the contaminated foods enhance multiple-antibiotic resistance activities and virulence factors in this clinical MRSA. Consequently, MRSA-contaminated food may play a role as a nutritional reservoir as well as in enhancing factor for pathogenesis and toxicity of clinical MRSA for severe food-borne outbreaks.

Evaluation of water quality guidelines for public swimming ponds

Swimming ponds are artificial ecosystems for bathing in which people imitate the conditions of natural waters. Swimming in natural water may pose health risks if the water quality is microbiologically poor. Swimming ponds are small water bodies that may be used by relatively large groups of people, moreover, the water is not disinfected, e.g. by using chlorine. The draft new swimming pool legislation in the Netherlands includes water quality requirements for swimming ponds. This study focused on the examination and evaluation of the new microbiological water quality requirements, including Escherichia coli, intestinal enterococci, Pseudomonas aeruginosa and Staphylococcus aureus, in thirteen public swimming pools. In eight of thirteen swimming ponds the water quality met the requirements for fecal indicators; 93-95% of the samples met the requirement for E. coli (≤100/100 ml) and intestinal enterococci (≤50/100 ml). The requirement for P. aeruginosa (≤10/100 ml) was met in eleven of thirteen swimming ponds (99% of the samples). In 68% of the samples the requirement for S. aureus (<1/100 ml) was met. A linear mixed effect analysis showed that E. coli and intestinal enterococci concentrations were significantly dependent on the log₁₀ of turbidity. P. aeruginosa concentrations were significantly dependent on water temperature. 31-45% of the variation between swimming ponds was explained by considering 'pond' as a random effect in the analysis. The monitoring of microbiological parameters in swimming pond water needs selective analytical methods, such as those used in this study, due to large numbers of background bacteria. The draft new Dutch swimming pool legislation provides proper guidance to ensure the microbiological safety of swimming pond water; it would benefit from inclusion of turbidity as an extra parameter. S. aureus is a relevant parameter for non-fecal shedding, although scientific literature does not provide evidence for a norm value based on a dose-response relation for exposure to S. aureus in water.

Freshwater environments as reservoirs of antibiotic resistant bacteria and their role in the dissemination of antibiotic resistance genes

Freshwater environments are susceptible to possible contamination by residual antibiotics that are released through different sources, such as agricultural runoffs, sewage discharges and leaching from nearby farms. Freshwater environment can thus become reservoirs where an antibiotic impact microorganisms, and is an important public health concern. Degradation and dilution processes are fundamental for predicting the actual risk of antibiotic resistance dissemination from freshwater reservoirs. This study reviews major approaches for detecting and quantifying antibiotic resistance bacteria (ARBs) and genes (ARGs) in freshwater and their prevalence in these environments. Finally, the role of dilution, degradation, transmission and the persistence and fate of ARB/ARG in these environments are also reviewed. Culture-based single strain approaches and molecular techniques that include polymerase chain reaction (PCR), quantitative polymerase chain reaction (qPCR) and metagenomics are techniques for quantifying ARB and ARGs in freshwater environments. The level of ARBs is extremely high in most of the river systems (up to 98% of the total detected bacteria), followed by lakes (up to 77% of the total detected bacteria), compared to dam, pond, and spring (<1%). Of most concern is the occurrence of extended-spectrum β-lactamase producing Enterobacteriaceae, methicillin resistant Staphylococcus aureus (MRSA) and vancomycin resistant Enterococcus (VRE), which cause highly epidemic infections. Dilution and natural degradation do not completely eradicate ARBs and ARGs in the freshwater environment. Even if the ARBs in freshwater are effectively inactivated by sunlight, their ARG-containing DNA can still be intact and capable of transferring resistance to non-resistant strains. Antibiotic resistance persists and is preserved in freshwater bodies polluted with high concentrations of antibiotics. Direct transmission of indigenous freshwater ARBs to humans as well as their transitory insertion in the microbiota can occur. These findings are disturbing especially for people that rely on freshwater resources for drinking, crop irrigation, and food in form of fish.

New approach to address antibiotic resistance: Miss loading of functional membrane microdomains (FMM) of methicillin-resistant Staphylococcus aureus (MRSA)

The synthesized potent piperazine analog ChDiPiCa was characterised by various spectroscopic techniques and for the first time evaluated functional membrane microdomain (FMM) disassembly in methicillin-resistant Staphylococcus aureus (MRSA). The ChDiPiCa showed excellent in vitro biocidal activity against MRSA at 26 μg/mL compared to the antibiotic streptomycin and bacitracin 14 μg/mL and 13 μg/mL at 10 μg concentration respectively. The membrane damaging property was confirmed by the SEM analysis. Further, we addressed the new approach for the first time to overcome antibiotic resistance of MRSA through membrane microdomain miss loading to lipids. By which, the ChDiPiCa confirms the significant activity in miss loading of FMM of MRSA which is validated by the fatty acid profile and lipid analysis. The result shows that, altered saturated (Lauric acid and Myristic acid), mono unsaturated (Oleic acid), and poly unsaturated (Linoleic acid and Linolenic acid) fatty acids and hypothesises, altered the membrane functional lipids. For the better understanding of miss loading of FMM by the ChDiPiCa, the in-silico molecular docking studies was analyzed and confirmed the predicted role. This suggests the way to develop ChDiPiCa in medicinal chemistry as anti-MRSA candidates and also this report opens up new window to treat microbial pathogens and infections.

Total staphylococci as performance surrogate for greywater treatment

Faecal indicator bacteria (FIB) are commonly used as water quality indicators; implying faecal contamination and therefore the potential presence of pathogenic enteric bacteria, viruses, and protozoa. Hence in wastewater treatment, the most commonly used treatment process measures (surrogates) are total coliforms, faecal coliforms, Escherichia coli (E. coli), and enterococci. However, greywater potentially contains skin pathogens unrelated to faecal load, and E. coli and other FIB may grow within greywater unrelated to pathogens. Overall, FIB occurs at fluctuating and relatively low concentrations compared to other endogenous greywater bacteria affecting their ability as surrogates for pathogen reduction. Therefore, unlike municipal sewage, FIB provides a very limited and unreliable log-reduction surrogate measure for on-site greywater treatment systems. Based on our recent metagenomic study of laundry greywater, skin-associated bacteria such as Staphylococcus, Corynebacterium, and Propionibacterium spp. dominate and may result in more consistent treatment surrogates than traditional FIB. Here, we investigated various Staphylococcus spp. as potential surrogates to reliably assay over 4-log10 reduction by the final-stage UV disinfection step commonly used for on-site greywater reuse, and compare them to various FIB/phage surrogates. A collimated UV beam was used to determine the efficacy of UV inactivation (255, 265 and 285 nm) against E. coli, Enterococcus faecalis, E. faecium, E. casseliflavus, Staphylococcus aureus, and S. epidermidis. Staphylococcus spp. was estimated by combining the bi-linear dose-response curves for S. aureus and S. epidermidis and was shown to be less resistant to UV irradiation than the other surrogates examined. Hence, a relative inactivation credit is suggested; whereas, the doses required to achieve a 4 and 5-log10 reduction of Staphylococcus spp. (13.0 and 20.9 mJ cm-2, respectively) were used to determine the relative inactivation of the other microorganisms investigated. The doses required to achieve a 4 and 5-log10 reduction of Staphylococcus spp. resulted in a log10 reduction of 1.4 and 4.1 for E. coli, 0.8 and 2.8 for E. faecalis, 0.8 and 3.6 for E. casseliflavus and 0.8 and 1.2 for MS2 coliphage, respectively. Given the concentration difference of Staphylococcus spp. and FIB (3 to 5-log10 higher), we propose the use of Staphylococcus spp. as a novel endogenous performance surrogate to demonstrate greywater treatment performance given its relatively high and consistent concentration and therefore ability to demonstrate over 5-log10 reductions.

Prevalence and Characterization of Staphylococcus aureus and Methicillin-Resistant Staphylococcus aureus on Public Recreational Beaches in Northeast Ohio

Staphylococcus aureus can cause severe life-threatening illnesses such as sepsis and endocarditis. Although S. aureus has been isolated from marine water and intertidal beach sand, only a few studies have been conducted to assess prevalence of S. aureus at freshwater recreational beaches. As such, we aimed to determine prevalence and molecular characteristics of S. aureus in water and sand at 10 freshwater recreational beaches in Northeast Ohio, USA. Samples were analyzed using standard microbiology methods, and resulting isolates were typed by spa typing and multilocus sequence typing. The overall prevalence of S. aureus in sand and water samples was 22.8% (64/280). The prevalence of methicillin-resistant S. aureus (MRSA) was 8.2% (23/280). The highest prevalence was observed in summer (45.8%; 55/120) compared to fall (4.2%; 5/120) and spring (10.0%; 4/40). The overall prevalence of Panton-Valentine leukocidin genes among S. aureus isolates was 21.4% (15/70), and 27 different spa types were identified. The results of this study indicate that beach sand and freshwater of Northeast Ohio were contaminated with S. aureus, including MRSA. The high prevalence of S. aureus in summer months and presence of human-associated strains may indicate the possibility of role of human activity in S. aureus contamination of beach water and sand. While there are several possible routes for S. aureus contamination, S. aureus prevalence was higher in sites with wastewater treatment plants proximal to the beaches.

Diversity of species and antimicrobial resistance determinants of staphylococci in superficial waters in Spain

The objectives were to determine the presence and diversity of staphylococcal species in surface waters in La Rioja region (Spain), and to characterize recovered isolates. Staphylococci were detected in 42 of 47 evaluable samples, and 72 isolates were obtained, of which 13 were coagulase-positive (CoPS) and 59 were coagulase-negative (CoNS). Twelve CoPS were identified as S. aureus and typed as follows (number of strains): t002/t502/ST5 (four), t10668/ST425 (one), t10712//ST1643 (one), t843/ST130 (one), t10855/ST2461 (one), t3369/ST2657 (one), t1166/ST133 (one), t8083/ST2049 (one) and t045/ST2460 (one); and one as S. pseudintermedius ST147. Virulence genes tst, cna and lukS/F-I were detected, and one strain showed the immune evasion cluster type F. Regarding CoNS, 12 different species were recovered (number of strains): S. epidermidis (11), S. vitulinus (10), S. sciuri (nine), S. fleurettii (seven), S. lentus (six), S. simulans (five), S. xylosus (four), S. chromogenes (two), S. hominis (two), and S. equorum, S. succinus and S. warneri (one each). Fourteen CoNS isolates presented a multidrug resistance phenotype, with the following resistance genes: blaZ, mecA, fusB, fusC, erm(C), mph(C), erm(A), msr(A)/(B), mph(C), ant(4')-Ia, tet(K), tet(L), cat_pc194 and str The high diversity of staphylococcal species, as well as multiple resistance and virulence genes, highlights the importance of surface waters as a temporary reservoir and source of transmission.

Non-hospital environment contamination with Staphylococcus aureus and methicillin-resistant Staphylococcus aureus: proportion meta-analysis and features of antibiotic resistance and molecular genetics

BACKGROUND

Staphylococcus aureus (S. aureus), including methicillin-resistant Staphylococcus aureus (MRSA), survives in dry conditions and can persist for long periods on surfaces touched by humans. Studies that estimate the proportions and characteristics of S. aureus and MRSA contamination in non-hospital environments are lacking. Therefore, we conducted a proportion meta-analysis and reviewed the features of antibiotic resistance and molecular genetics.

METHODS

Articles published between January 2005 and December 2015 that studied proportions of S. aureus and MRSA contamination in non-hospital environments were retrieved from the Medline database, Ovid database and Science Direct database. All statistics were analyzed by STATA 14.1.

RESULTS

Twenty-nine articles were included. The overall proportions of S. aureus and MRSA contamination were 41.1% (95%CI 29-54%) and 8.6% (95%CI 5-13%), respectively. The proportion of MRSA contamination increased over time. From the articles, the proportion of Panton-Valentine Leukociden (PVL) genes among MRSA isolates was 54.5%, and the proportion of the qac gene was 100.0%. Distribution of the multilocus sequence type (MLST) and pulsed-field gel electrophoresis (PFGE) of MRSA indicated that MRSA strains were from both hospitals and communities.

CONCLUSION

The overall proportions of S. aureus and MRSA contamination in non-hospital environments were high. The outcomes of antibiotic resistance and high proportions of PVL genes indicated that the antibiotic resistance of S. aureus and MRSA were notable. According to the different distributions of MLST and SCCmec of MRSA, we can infer that cross-circulation is within hospitals, communities, and livestock. The results also show that the risk from the MRSA strains was cross-transmitted among the population. High proportions of the qac gene of MRSA might indicate that current disinfection of MRSA has not been achieved, and it might be better to further identify the efficiency of the sterilization processes in a non-hospital environment so that relevant departments can take measures to improve disinfection of MRSA in non-hospital environments.