title: Methicillin-resistant Staphylococcus aureus in horses and horse personnel: an investigation of several outbreaks.
abstract: At the Veterinary Microbiological Diagnostic Center, the Netherlands, the percentage of methicillin-resistant Staphylococcus aureus (MRSA) isolates found in equine clinical samples increased from 0% in 2002 to 37% in 2008. MRSA of spa-type t064, belonging to MLST ST8 and spa-types t011 and t2123, both belonging to the livestock-associated MLST ST398, predominated. During an outbreak of post-surgical MRSA infections in horses at a veterinary teaching hospital in 2006/2007, MRSA isolates of spa-type t2123 were cultured from 7 horses and 4/61 personnel which indicated zoonotic transmission. After intervention the outbreak stopped. However, another outbreak occurred in 2008, where 17 equine MRSA isolates of spa-type t011 (n=12), t2123 (n=4), and t064 (n=1) were found. This time, 16/170 personnel were positive for MRSA with spa-type t011 (n=11) and t2123 (n=5). Personnel in close contact with horses were more often MRSA-positive (15/106) than those without (1/64). Screening of horses upon admission showed that 9.3% were MRSA-positive predominantly with spa-type t011. Weekly cross-sectional sampling of all hospitalized horses for 5 weeks showed that 42% of the horses were MRSA-positive at least once, again predominantly with spa-type t011, which suggests that nosocomial transmission took place. Fifty-three percent of the environmental samples were MRSA-positive, including samples from students' and staff members' rooms, and all were spa-type t011. This indicates that humans contribute to spreading the organism. Culturing of samples employing high-salt pre-enrichment performed better than a comparable method without pre-enrichment. Our results show that nosocomial transmission occurs in equine clinics and suggests that personnel play a role in the transmission.
authors.affiliation: Department of Infectious Diseases and Immunology, Faculty of Veterinary Medicine, PO Box 80165, 3508 TD Utrecht, Utrecht University, The Netherlands. e.vanduijkeren@uu.nl
authors.forename: E
authors.initials: E
authors.lastname: van Duijkeren
authors.forename: M
authors.initials: M
authors.lastname: Moleman
authors.forename: M M
authors.initials: MM
authors.lastname: Sloet van Oldruitenborgh-Oosterbaan
authors.forename: J
authors.initials: J
authors.lastname: Multem
authors.forename: A
authors.initials: A
authors.lastname: Troelstra
authors.forename: A C
authors.initials: AC
authors.lastname: Fluit
authors.forename: W J B
authors.initials: WJ
authors.lastname: van Wamel
authors.forename: D J
authors.initials: DJ
authors.lastname: Houwers
authors.forename: A J
authors.initials: AJ
authors.lastname: de Neeling
authors.forename: J A
authors.initials: JA
authors.lastname: Wagenaar
mesh_terms: D000818:Animals; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology; D004196:Disease Outbreaks / Q000706:statistics & numerical data; D006734:Horse Diseases / Q000453:epidemiology* / Q000382:microbiology*; D006736:Horses; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000302:isolation & purification / Q000472:pathogenicity*; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*