Meticillin-resistant Staphylococcus aureus (MRSA) is a significant cause of mortality and morbidity in healthcare and community settings; however, there is a paucity of large-scale, longitudinal studies monitoring the occurrence of MRSA in the care home setting.

To determine the molecular epidemiology of MRSA colonizing elderly residents of care homes.

Residents in 65 care homes in Leeds, UK, were screened for MRSA nasal colonization in four consecutive years (2006–2009). Isolates were characterized using antibiotic susceptibility testing, detection of the Panton–Valentine leucocidin (PVL) locus, accessory gene regulator allotyping, characterization of the staphylococcal cassette chromosome mec element, spa-typing and pulsed-field gel electrophoresis.

MRSA was recovered from 888 nasal swabs of 2492 residents and prevalence was similar (19–22%) throughout the study. Resistance to ≥3 antibiotic classes was common (34%), but resistance to only β-lactam agents was rare (3%); no PVL-positive isolates were identified. Most isolates were related to healthcare-associated epidemic-MRSA type 15 (EMRSA-15, ST22-IV); such isolates decreased in prevalence during the study (86–72%; P < 0.0001, χ²-test). The remainder belonged to five different multi-locus sequence type clonal complexes (CC). Most notably, CC59 strains increased in prevalence (10–25%; P < 0.0001, χ²-test) and were associated with high-level mupirocin resistance.

The molecular epidemiology of MRSA in care homes is complex and dynamic. There was a high, consistent prevalence of MRSA nasal colonization, dominated by healthcare-associated strains. Vigilance is recommended; however, as high-level mupirocin resistance was associated with a single clonal group (CC59) that significantly increased in prevalence during the study.