Newly identified risk factors for MRSA carriage in The Netherlands.

W S N Lekkerkerk,S De Greeff,A Haenen,A Tjon-A-Tsien,N Van De Sande-Bruinsma,J H Richardus,M A B Van Der Sande,M C Vos,A Timen,T Leenstra

doi:10.1371/journal.pone.0188502

W S N Lekkerkerk, S De Greeff + Show 8 more

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https://doi.org/10.1371/journal.pone.0188502

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Abstract

ObjectivesTo elucidate new risk factors for MRSA carriers without known risk factors (MRSA of unknown origin; MUO). These MUO carriers are neither pre-emptively screened nor isolated as normally dictated by the Dutch Search & Destroy policy, thus resulting in policy failure.MethodsWe performed a prospective case control study to determine risk factors for MUO acquisition/carriage (Dutch Trial Register: NTR2041).Cases were MUO carriers reported by participating medical microbiological laboratories to the RIVM from September 1st 2011 until September 1st 2013. Controls were randomly selected from the community during this period.ResultsSignificant risk factors for MUO in logistic multivariate analysis were antibiotic use in the last twelve months, aOR 8.1 (5.6–11.7), screened as contact in a contact tracing but not detected as a MRSA carrier at that time, aOR 4.3 (2.1–8.8), having at least one foreign parent, aOR 2.4 (1.4–3.9) and receiving ambulatory care, aOR 2.3 (1.4–3.7). Our found risk factors explained 83% of the MUO carriage.ConclusionsIdentifying new risk factors for MRSA carriers remains crucial for countries that apply a targeted screening approach as a Search and Destroy policy or as vertical infection prevention measure.

Highlights

In The Netherlands MRSA prevalence is low, measured at 0.12% at hospital admission in 2005– 2007[1] and 0.8% in Dutch outpatients in the Dutch-German border region in 2012.[2]
Identifying new risk factors for MRSA carriers remains crucial for countries that apply a targeted screening approach as a Search and Destroy policy or as vertical infection prevention measure
We report the results from our prospective case control study to determine the risk factors for carriage of MRSA of Unknown Origin (MUO)

Summary

Introduction

In The Netherlands MRSA prevalence is low, measured at 0.12% at hospital admission in 2005– 2007[1] and 0.8% in Dutch outpatients in the Dutch-German border region in 2012.[2] Among S.aureus blood-cultures the MRSA prevalence was 1.0% (24/2,386).[3] To keep MRSA prevalence low, prudent use of antibiotics is instigated and a Search and Destroy policy (S&D) is in place. One of the revisions on MRSA risk groups, was due to the discovery of livestock-associated MRSA with sequence type 398 (LA-MRSA ST398) in The Netherlands.[5] The risk groups for S&D were subsequently updated with pig and veal calf farmers. In 2016, LA-MRSA accounted for 26% (892/3,478) of MRSA isolates.[3]

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