title: Staphylococcus aureus, Including Meticillin-Resistant Staphylococcus aureus, among General Practitioners and Their Patients: A Cross-Sectional Study.
abstract: BACKGROUND
  The role of general practitioners (GPs) as reservoir and potential source for Staphylococcus aureus (SA) transmission is unknown. Our primary objective was to evaluate the prevalence of SA and community-acquired methicillin resistant SA (CA-MRSA) carrier status (including spa typing) among GPs and their patients in Belgium. The secondary objective was to determine the association between SA/CA-MRSA carriage in patients and their characteristics, SA carriage in GPs, GP and practice characteristics.
  
  
  METHODS
  The Belgian GPs, who swabbed their patients in the APRES study (which assessed the prevalence of SA nasal carriage in nine European countries; November 2010 -June 2011), were asked to swab themselves as well (May-June 2011). GPs and their patients had to complete a questionnaire on factors related to SA carriage and transmission. SA isolation including CA-MRSA and spa typing was performed on the swabs.
  
  
  RESULTS
  In eighteen practices 34 GPs swabbed patients of which 25 GPs provided personal swabs. The analysis was performed on 3008 patient records. Among GPs SA carriage (28%) was more prevalent than among their patients (19.2%), but CA-MRSA carriage was not present. SA was more prevalent among younger patients and those living with cattle. Spa typing SA and MRSA strains did not suggest correlation within practices or between patients and GPs, but chronic skin conditions of GPs and always handshaking patients by SA positive GPs were associated with more SA among patients, and hand washing after every patient contact with less SA among patients in practices with high antibiotic prescribing rates.
  
  
  CONCLUSIONS
  No MRSA was found among GPs, although their SA carriership was higher compared to their patients'. Spa types did not cluster within practices, possibly due to difference in timing of swabbing. To minimise SA transmission to their patients GPs should consider taking appropriate care of their chronic skin diseases, antibiotic prescribing behaviour, handshaking and hand washing habits.
authors.affiliation: Department of Primary and Interdisciplinary Care Antwerp-Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: Barbara
authors.initials: B
authors.lastname: Michiels
authors.affiliation: Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: Lien
authors.initials: L
authors.lastname: Appelen
authors.affiliation: Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: Barbara
authors.initials: B
authors.lastname: Franck
authors.affiliation: Department of Medical Microbiology, Maastricht University Medical Centre/CAPHRI, Maastricht, the Netherlands.
authors.forename: Casper D J
authors.initials: CD
authors.lastname: den Heijer
authors.affiliation: Department of Primary and Interdisciplinary Care Antwerp-Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: Stefaan
authors.initials: S
authors.lastname: Bartholomeeusen
authors.affiliation: Department of Primary and Interdisciplinary Care Antwerp-Centre for General Practice, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium; Vaccine & Infectious Disease Institute (VAXINFECTIO)-Laboratory of Medical Microbiology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001530:Belgium / Q000453:epidemiology; D002417:Cattle; D003430:Cross-Sectional Studies / Q000379:methods; D005260:Female; D058005:General Practitioners / Q000706:statistics & numerical data; D006235:Hand Disinfection; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000502:physiology*; D008875:Middle Aged; D015995:Prevalence; D017192:Skin Diseases, Bacterial / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000502:physiology*
chemical_list: D000900:Anti-Bacterial Agents