title: Livestock-associated MRSA in household members of pig farmers: transmission and dynamics of carriage, a prospective cohort study.
abstract: This prospective cohort study describes carriage of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in household members from 49 farrowing pig farms in the Netherlands (2010-2011). Of 171 household members, 4% were persistent MRSA nasal carriers, and the MRSA prevalence on any given sampling moment was 10% (range 7-11%). Working in the stables (of which 98% was MRSA-positive, prevalence ratio (PR) = 2.11 per 10 hours), working with sows (PR=1.97), and living with an MRSA-positive pig farmer (PR=4.63) were significant determinants for MRSA carriage. Significant protective factors were carriage of methicillin-susceptible Staphylococcus aureus (MSSA) (PR=0.50), and wearing a facemask when working in the stables (37% decreased prevalence). All MRSA strains during the study period were known livestock-associated types. The bacteriophage φ3 was not found in household members. Transmission from pigs and the environment appeared to be important determinants; human-to-human transmission could not sufficiently be differentiated. Wearing a facemask when working in the stables and carriage of MSSA are potential interventional targets.
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; Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: Brigitte A G L
authors.initials: BA
authors.lastname: van Cleef
authors.affiliation: Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment, Bilthoven, the Netherlands.
authors.forename: Birgit H B
authors.initials: BH
authors.lastname: van Benthem
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: 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: Amphia Academy Infectious Disease Foundation, Amphia Hospital, Breda, the Netherlands; Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht, the Netherlands.
authors.forename: Marjolein F Q
authors.initials: MF
authors.lastname: Kluytmans-van den Bergh
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands; Department of Infectious Diseases and Immunology, Utrecht University, Utrecht, the Netherlands.
authors.forename: Haitske
authors.initials: H
authors.lastname: Graveland
authors.affiliation: Centre 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: Department of Infectious Diseases and Immunology, Utrecht University, Utrecht, the Netherlands.
authors.forename: Koen M H W
authors.initials: KM
authors.lastname: Verstappen
authors.affiliation: Department of Infectious Diseases and Immunology, Utrecht University, Utrecht, the Netherlands; Central Veterinary Institute of Wageningen UR, Lelystad, the Netherlands.
authors.forename: Jaap A
authors.initials: JA
authors.lastname: Wagenaar
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
authors.forename: Marian E H
authors.initials: ME
authors.lastname: Bos
authors.affiliation: Institute for Risk Assessment Sciences, Utrecht University, Utrecht, the Netherlands.
authors.forename: Dick
authors.initials: D
authors.lastname: Heederik
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; Department of Medical Microbiology and Infection prevention, VU University medical center, Amsterdam, the Netherlands.
authors.forename: Jan A J W
authors.initials: JA
authors.lastname: Kluytmans
mesh_terms: D000818:Animals; D002353:Carrier State / Q000453:epidemiology*; D000067565:Farmers; D006801:Humans; D058751:Livestock / Q000382:microbiology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D009426:Netherlands / Q000453:epidemiology; D009666:Nose / Q000382:microbiology; D009960:Oropharynx / Q000382:microbiology; D011446:Prospective Studies; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control* / Q000635:transmission* / Q000662:veterinary; D013552:Swine / Q000382:microbiology*