title: Livestock-associated MRSA carriage in patients without direct contact with livestock.
abstract: BACKGROUND
  Livestock-associated MRSA (MC398) has emerged and is related to an extensive reservoir in pigs and veal calves. Individuals with direct contact with these animals and their family members are known to have high MC398 carriage rates. Until now it was assumed that MC398 does not spread to individuals in the community without pig or veal calf exposure. To test this, we identified the proportion of MC398 in MRSA positive individuals without contact with pigs/veal calves or other known risk factors (MRSA of unknown origin; MUO).
  
  
  METHODS
  In 17 participating hospitals, we determined during two years the occurrence of MC398 in individuals without direct contact with livestock and no other known risk factor (n = 271) and tested in a post analysis the hypothesis whether hospitals in pig-dense areas have higher proportions of MC398 of all MUO.
  
  
  RESULTS
  Fifty-six individuals (20.7%) without animal contact carried MC398. In hospitals with high pig-densities in the adherence area, the proportion of MC398 of all MUO was higher than this proportion in hospitals without pigs in the surroundings.
  
  
  CONCLUSIONS
  One fifth of the individuals carrying MUO carried MC398. So, MC398 is found in individuals without contact to pigs or veal calves. The way of transmission from the animal reservoir to these individuals is unclear, probably by human-to-human transmission or by exposure to the surroundings of the stables. Further research is needed to investigate the way of transmission.
authors.affiliation: Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands.
authors.forename: Miranda M L
authors.initials: MM
authors.lastname: van Rijen
authors.affiliation: Center for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: Thijs
authors.initials: T
authors.lastname: Bosch
authors.affiliation: Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands; Laboratory for Medical Microbiology and Immunology, St. Elisabeth Hospital, Tilburg, the Netherlands.
authors.forename: Erwin J M
authors.initials: EJ
authors.lastname: Verkade
authors.affiliation: Center for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: Leo
authors.initials: L
authors.lastname: Schouls
authors.affiliation: Laboratory for Microbiology and Infection Control, Amphia Hospital, Breda, the Netherlands; Department of Medical Microbiology and Infection ControlJK, VUmc Medical University, Amsterdam, the Netherlands.
authors.forename: Jan A J W
authors.initials: JA
authors.lastname: Kluytmans
mesh_terms: D000818:Animals; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology*; D005843:Geography; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D058751:Livestock / Q000382:microbiology*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification / Q000502:physiology*; D009426:Netherlands / Q000453:epidemiology; D012307:Risk Factors; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology*; D034421:Sus scrofa