One Reservoir: Redefining the Community Origins of Antimicrobial-resistant Infections

This article reviews the evidence concerning the emergence of community-acquired MRSA and highlights the relevance of reservoirs of antimicrobial resistance in humans and animals in the community environment. Although hospital use of antimicrobials has been assumed to generate the highest risk of resistance and transmission of resistant infections, the greater load of antimicrobial use is found in food animal production. The authors conclude that it is important to assess accurately and evaluate the interactions between hospital and community; improve surveillance for resistance of community origin, including agriculture; and to implement policies that prevent increases in community reservoirs of antibiotic resistance.