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MRSA Carriage in Community Outpatients: A Cross-Sectional Prevalence Study in a High-Density Livestock Farming Area along the Dutch-German Border.

Paget J, Aangenend H, Kühn M, Hautvast J, van Oorschot D, Olde Loohuis A, van der Velden K, Friedrich AW, Voss A, Köck R - PLoS ONE (2015)

Bottom Line: Cross-sectional prevalence study carried out between November 2011 and June 2012.There were striking similarities in livestock-associated MRSA carriage and clonal spread in the outpatient populations seeing their GP in both countries.In contrast, urologist outpatients in Germany were colonized with spa types indicative of healthcare-associated MRSA.

View Article: PubMed Central - PubMed

Affiliation: Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, the Netherlands.

ABSTRACT

Objectives: MRSA poses a considerable public health threat to the community. The objectives of this study were to assess the prevalence of MRSA carriage and determine factors that were associated with MRSA carriage among outpatients who had used antibiotics in the previous three months and who lived in a high-density livestock farming area along the Dutch-German border.

Methods: Cross-sectional prevalence study carried out between November 2011 and June 2012. Nasal swabs and questionnaires were collected in patients (>4 years) who had used antibiotics in the previous three months from twelve Dutch General Practitioners (GPs), seven German GPs and two German outpatient urologists. To assess nasal carriage, swabs were analyzed using selective MRSA agars after broth enrichment. MRSA positive samples were spa typed.

Results: Data were collected from 513 GP outpatients in the Netherlands, 261 GP outpatients in Germany and 200 urologist outpatients in Germany. The overall prevalence of MRSA carriage was 0.8%, 1.1% and 2.0%, respectively. In the GP outpatient populations, the prevalence was similar in both countries (0.8% and 1.1%, respectively, p = 0.879), all spa types were indicative for livestock-associated MRSA (4xt011 in the Netherlands; 2xt034 and t011 in Germany) and being a farmer, living on or near (<5km) to a farm were associated with MRSA carriage. In the urologist outpatient population, the prevalence was higher (2.0%), all spa types were indicative for healthcare-associated MRSA (t068, t032, t003, t10231) and being a farmer, living on or near to a farm were factors not associated with MRSA carriage.

Conclusions: The prevalence of MRSA carriage in these community outpatient populations along the Dutch-German border was low. There were striking similarities in livestock-associated MRSA carriage and clonal spread in the outpatient populations seeing their GP in both countries. In contrast, urologist outpatients in Germany were colonized with spa types indicative of healthcare-associated MRSA.

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Related in: MedlinePlus

Map of the Netherlands and the German federal state of North Rhine-Westphalia: pig-density rates (pigs per km2) and location of GPs and outpatient urologists.Note: The pig-density data for the Netherlands is from 2012 and for North Rhine-Westphalia it is from 2010 (the most recent data available for both countries).
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pone.0139589.g001: Map of the Netherlands and the German federal state of North Rhine-Westphalia: pig-density rates (pigs per km2) and location of GPs and outpatient urologists.Note: The pig-density data for the Netherlands is from 2012 and for North Rhine-Westphalia it is from 2010 (the most recent data available for both countries).

Mentions: The objective of this study was to assess the prevalence and factors that were associated with MRSA carriage among persons who visited their GP and had used antibiotics in the previous three months. To our knowledge this is the first study carried out in persons who had used antibiotics, and we expected a higher prevalence of MRSA as studies have shown a causal link between bacterial resistance and antibiotic usage at an individual patient level [7, 11], with the greatest effect in the month immediately after treatment and probable persistence for up to 12 months [7]. The research was carried out in an area of high density livestock farming (see Fig 1), which increased the risk of MRSA carriage [5,6], specifically, along the border of the Netherlands (Gelderland, Brabant, Limburg; Dutch region) and Germany (Münsterland, Arnsberg in North Rhine-Westphalia; German region).


MRSA Carriage in Community Outpatients: A Cross-Sectional Prevalence Study in a High-Density Livestock Farming Area along the Dutch-German Border.

Paget J, Aangenend H, Kühn M, Hautvast J, van Oorschot D, Olde Loohuis A, van der Velden K, Friedrich AW, Voss A, Köck R - PLoS ONE (2015)

Map of the Netherlands and the German federal state of North Rhine-Westphalia: pig-density rates (pigs per km2) and location of GPs and outpatient urologists.Note: The pig-density data for the Netherlands is from 2012 and for North Rhine-Westphalia it is from 2010 (the most recent data available for both countries).
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4664395&req=5

pone.0139589.g001: Map of the Netherlands and the German federal state of North Rhine-Westphalia: pig-density rates (pigs per km2) and location of GPs and outpatient urologists.Note: The pig-density data for the Netherlands is from 2012 and for North Rhine-Westphalia it is from 2010 (the most recent data available for both countries).
Mentions: The objective of this study was to assess the prevalence and factors that were associated with MRSA carriage among persons who visited their GP and had used antibiotics in the previous three months. To our knowledge this is the first study carried out in persons who had used antibiotics, and we expected a higher prevalence of MRSA as studies have shown a causal link between bacterial resistance and antibiotic usage at an individual patient level [7, 11], with the greatest effect in the month immediately after treatment and probable persistence for up to 12 months [7]. The research was carried out in an area of high density livestock farming (see Fig 1), which increased the risk of MRSA carriage [5,6], specifically, along the border of the Netherlands (Gelderland, Brabant, Limburg; Dutch region) and Germany (Münsterland, Arnsberg in North Rhine-Westphalia; German region).

Bottom Line: Cross-sectional prevalence study carried out between November 2011 and June 2012.There were striking similarities in livestock-associated MRSA carriage and clonal spread in the outpatient populations seeing their GP in both countries.In contrast, urologist outpatients in Germany were colonized with spa types indicative of healthcare-associated MRSA.

View Article: PubMed Central - PubMed

Affiliation: Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, the Netherlands.

ABSTRACT

Objectives: MRSA poses a considerable public health threat to the community. The objectives of this study were to assess the prevalence of MRSA carriage and determine factors that were associated with MRSA carriage among outpatients who had used antibiotics in the previous three months and who lived in a high-density livestock farming area along the Dutch-German border.

Methods: Cross-sectional prevalence study carried out between November 2011 and June 2012. Nasal swabs and questionnaires were collected in patients (>4 years) who had used antibiotics in the previous three months from twelve Dutch General Practitioners (GPs), seven German GPs and two German outpatient urologists. To assess nasal carriage, swabs were analyzed using selective MRSA agars after broth enrichment. MRSA positive samples were spa typed.

Results: Data were collected from 513 GP outpatients in the Netherlands, 261 GP outpatients in Germany and 200 urologist outpatients in Germany. The overall prevalence of MRSA carriage was 0.8%, 1.1% and 2.0%, respectively. In the GP outpatient populations, the prevalence was similar in both countries (0.8% and 1.1%, respectively, p = 0.879), all spa types were indicative for livestock-associated MRSA (4xt011 in the Netherlands; 2xt034 and t011 in Germany) and being a farmer, living on or near (<5km) to a farm were associated with MRSA carriage. In the urologist outpatient population, the prevalence was higher (2.0%), all spa types were indicative for healthcare-associated MRSA (t068, t032, t003, t10231) and being a farmer, living on or near to a farm were factors not associated with MRSA carriage.

Conclusions: The prevalence of MRSA carriage in these community outpatient populations along the Dutch-German border was low. There were striking similarities in livestock-associated MRSA carriage and clonal spread in the outpatient populations seeing their GP in both countries. In contrast, urologist outpatients in Germany were colonized with spa types indicative of healthcare-associated MRSA.

Show MeSH
Related in: MedlinePlus