Abstract Background Staphylococcus aureus remains a major cause of morbidity and mortality worldwide. Methicillin-resistant S. aureus (MRSA) poses an enduring global health threat. In low- and middle-income countries (LMICs), few large-scale analyses integrate temporal and spatial epidemiology. This study assessed MRSA dynamics across a metropolitan population in São Paulo, Brazil. Methods We performed a retrospective analysis of 51,532 unique S. aureus cases (2011–2021) from a clinical laboratory network encompassing 600 healthcare facilities. Isolates were classified as infecting or colonizer, and as hospital- or community-associated based the healthcare setting type. Methicillin resistance was determined via cefoxitin susceptibility testing. Temporal trends were assessed using the Prais–Winsten regression model; spatial distribution was analyzed through choropleth and kernel density mapping. Results Among all unique S. aureus isolates, the MRSA rates were 42.6% from infections and 37.4% among colonizers. MRSA prevalence was higher among children 3 years and adults ≥65 years. Hospital-associated MRSA declined (annual percent change APC = −2.48; 95% CI − 3.09 to − 1.87), whereas community-associated MRSA increased (APC = 3.61; 95% CI 0.43–6.90). Clindamycin-susceptible MRSA, used as a phenotype proxy for community strains, rose more sharply (APC = 8.77; 95% CI 6.68–10.90). Geospatial mapping identified heterogeneous community clusters with MRSA rates exceeding 20%. Conclusions Over one decade, hospital MRSA rates declined while community MRSA expanded, indicating a significant epidemiological shift. This study, among the largest LMIC datasets integrating temporal and geospatial MRSA surveillance, underscores the importance of spatially targeted public health strategies.
Ibanês et al. (Thu,) studied this question.