title: MRSA Carriage in Community Outpatients: A Cross-Sectional Prevalence Study in a High-Density Livestock Farming Area along the Dutch-German Border.
abstract: OBJECTIVE
  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.
authors.affiliation: Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, the Netherlands.|Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands.
authors.forename: John
authors.initials: J
authors.lastname: Paget
authors.affiliation: Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, the Netherlands.|GGD Gelderland-Zuid (Municipal Health Service Gelderland-South), Nijmegen, the Netherlands.
authors.forename: Helen
authors.initials: H
authors.lastname: Aangenend
authors.affiliation: University Hospital Münster, Institute of Hygiene, Münster, Germany.
authors.forename: Malte
authors.initials: M
authors.lastname: Kühn
authors.affiliation: Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, the Netherlands.|GGD Gelderland-Zuid (Municipal Health Service Gelderland-South), Nijmegen, the Netherlands.
authors.forename: Jeannine
authors.initials: J
authors.lastname: Hautvast
authors.affiliation: Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, the Netherlands.
authors.forename: Desiree
authors.initials: D
authors.lastname: van Oorschot
authors.affiliation: Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, the Netherlands.
authors.forename: Alphons
authors.initials: A
authors.lastname: Olde Loohuis
authors.affiliation: Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, the Netherlands.
authors.forename: Koos
authors.initials: K
authors.lastname: van der Velden
authors.affiliation: University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, the Netherlands.
authors.forename: Alexander W
authors.initials: AW
authors.lastname: Friedrich
authors.affiliation: Canisius-Wilhelmina Hospital, Department of Clinical Microbiology and Infectious Diseases, Nijmegen, the Netherlands.|Radboud University Medical Center, Department of Medical Microbiology, Nijmegen, the Netherlands.
authors.forename: Andreas
authors.initials: A
authors.lastname: Voss
authors.affiliation: University Hospital Münster, Institute of Hygiene, Münster, Germany.
authors.forename: Robin
authors.initials: R
authors.lastname: Köck
mesh_terms: D000368:Aged; D000383:Agriculture; D015373:Bacterial Typing Techniques; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D003430:Cross-Sectional Studies; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification; D008875:Middle Aged; D009296:Nasal Cavity / Q000382:microbiology; D009426:Netherlands / Q000453:epidemiology; D010045:Outpatients; D015995:Prevalence; D013203:Staphylococcal Infections / Q000453:epidemiology* / Q000382:microbiology