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Retrospective analysis of multidrug-resistant clinical and environmental isolates for the presence of the colistin-resistance gene mcr-1

associated, multidrug-susceptible SCCmec IV–harboring MRSA.6 Even though our inference is limited by lack of strain and SCCmec typing, the findings are consistent with our recent identification of SCCmec type II in MRSA-colonizing nares and oropharynges of acute-care and long-term admissions of psychiatric patients.9 We also analyzed a time series of 15 years using a robust statistical model to detect sudden changes in trends. In a classic article, Deurenberg and Stobberingh10 describe the blurring of distinctions between CAand HA-MRSA and argue for a pure molecular definition, based on SCCmec typing. Because strain typing is not widely available, especially in low-to-middle income countries, careful long-term follow-up of resistant profiles may provide a reasonable proxy for detecting ecological changes in MRSA infections. Those trends also have therapeutic relevance. Although TMP/SMX is not a reasonable choice for treating MRSA BSI, other less-severe infections (eg, skin infections or phlebitis) acquired during hospital admissions may benefit from that antimicrobial. Further studies combining long-term analysis of time series withmolecular typingmay provide insights on the past, present, and future of healthcare-associated infectious caused by MRSA.