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PLoS One. 2015 Nov 30;10(11):e0139589. doi: 10.1371/journal.pone.0139589. eCollection 2015.

MRSA Carriage in Community Outpatients: A Cross-Sectional Prevalence Study in a High-Density Livestock Farming Area along the Dutch-German Border.

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Radboud University Medical Center, Department of Primary and Community Care, Nijmegen, the Netherlands.
Netherlands Institute for Health Services Research (NIVEL), Utrecht, the Netherlands.
GGD Gelderland-Zuid (Municipal Health Service Gelderland-South), Nijmegen, the Netherlands.
University Hospital Münster, Institute of Hygiene, Münster, Germany.
University of Groningen, University Medical Center Groningen, Department of Medical Microbiology, Groningen, the Netherlands.
Canisius-Wilhelmina Hospital, Department of Clinical Microbiology and Infectious Diseases, Nijmegen, the Netherlands.
Radboud University Medical Center, Department of Medical Microbiology, Nijmegen, the Netherlands.



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.


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.


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.


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.

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