Lifestyle-Associated Risk Factors for Community-Acquired Methicillin-Resistant Staphylococcus aureus Carriage in the Netherlands: An Exploratory Hospital-Based Case-Control Study

Miranda M.L. van Rijen; Marjolein F.Q. Kluytmans-van den Bergh; Erwin J.M. Verkade; Peter B.G. ten Ham; Beth J. Feingold; Jan A.J.W. Kluytmans; Yvonne Hendriks; Daniëlle op den Kamp; Jan Kluytmans; Marjolein Kluytmans - van den Bergh; Renée Ladestein; Rudolf Punselie; Miranda van Rijen; Erwin Verkade; Marieke Ernest; Mireille Wulf; Mariëlla Brekelmans; Patricia Willemse; Mireille Wulf; Nelleke ten Feld; Rob Wintermans; Bent Postma; Marja Terwee; Truus de Ruiter; Eric van der Vorm; Antoinette Wijker; Ellen Silbergeld; Henk Hamers; Rob Wintermans; Philo Das; Ellen Sanders; Kees Verduin; Dick van Dam; Jan Diederen; Peter ten Ham; Loes Nolles; Eric van der Vorm; Anouk Smeulders; Kees Verduin; Anton Buiting; Helma Hörmann; Ellen Nieuwkoop; Diana Haverkate; Paul Verweij; Marc Bonten; Marischka van der Jagt-Zwetsloot; Annet Troelstra; Hanneke Berkhout; Liduine van den Hout; Annie Kaiser; Christina Vandenbroucke-Grauls

doi:10.1371/journal.pone.0065594

Lifestyle-Associated Risk Factors for Community-Acquired Methicillin-Resistant Staphylococcus aureus Carriage in the Netherlands: An Exploratory Hospital-Based Case-Control Study

Miranda M.L. van Rijen, Marjolein F.Q. Kluytmans-van den Bergh, Erwin J.M. Verkade, Peter B.G. ten Ham, Beth J. Feingold, Jan A.J.W. Kluytmans, Yvonne Hendriks, Daniëlle op den Kamp, Jan Kluytmans, Marjolein Kluytmans - van den Bergh, Renée Ladestein, Rudolf Punselie, Miranda van Rijen, Erwin Verkade, Marieke Ernest, Mireille Wulf, Mariëlla Brekelmans, Patricia Willemse, Mireille Wulf, Nelleke ten FeldRob Wintermans, Bent Postma, Marja Terwee, Truus de Ruiter, Eric van der Vorm, Antoinette Wijker, Ellen Silbergeld, Henk Hamers, Rob Wintermans, Philo Das, Ellen Sanders, Kees Verduin, Dick van Dam, Jan Diederen, Peter ten Ham, Loes Nolles, Eric van der Vorm, Anouk Smeulders, Kees Verduin, Anton Buiting, Helma Hörmann, Ellen Nieuwkoop, Diana Haverkate, Paul Verweij, Marc Bonten, Marischka van der Jagt-Zwetsloot, Annet Troelstra, Hanneke Berkhout, Liduine van den Hout, Annie Kaiser, Christina Vandenbroucke-Grauls

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Abstract

Background:Community-acquired MRSA (CA-MRSA) is rapidly increasing. Currently, it is unknown which reservoirs are involved. An exploratory hospital-based case-control study was performed in sixteen Dutch hospitals to identify risk factors for CA-MRSA carriage in patients not belonging to established risk groups.Methods:Cases were in- or outpatients from sixteen Dutch hospitals, colonised or infected with MRSA without healthcare- or livestock-associated risk factors for MRSA carriage. Control subjects were patients not carrying MRSA, and hospitalised on the same ward or visited the same outpatients' clinic as the case. The presence of potential risk factors for CA-MRSA carriage was determined using a standardised questionnaire.Results:Regular consumption of poultry (OR 2{dot operator}40; 95% CI 1{dot operator}08-5{dot operator}33), cattle density per municipality (OR 1{dot operator}30; 95% CI 1{dot operator}00-1{dot operator}70), and sharing of scuba diving equipment (OR 2{dot operator}93 95% CI 1{dot operator}19-7{dot operator}21) were found to be independently associated with CA-MRSA carriage. CA-MRSA carriage was not related to being of foreign origin.Conclusions:The observed association between the consumption of poultry and CA-MRSA carriage suggests that MRSA in the food chain may be a source for MRSA carriage in humans. Although sharing of scuba diving equipment was found to be associated with CA-MRSA carriage, the role played by skin abrasions in divers, the lack of decontamination of diving materials, or the favourable high salt content of sea water is currently unclear. The risk for MRSA MC398 carriage in areas with a high cattle density may be due to environmental contamination with MRSA MC398 or human-to-human transmission. Further studies are warranted to confirm our findings and to determine the absolute risks of MRSA acquisition associated with the factors identified.

Original language	English (US)
Article number	e65594
Journal	PloS one
Volume	8
Issue number	6
DOIs	https://doi.org/10.1371/journal.pone.0065594
State	Published - Jun 19 2013
Externally published	Yes

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van Rijen, M. M. L., Kluytmans-van den Bergh, M. F. Q., Verkade, E. J. M., ten Ham, P. B. G., Feingold, B. J., Kluytmans, J. A. J. W., Hendriks, Y., op den Kamp, D., Kluytmans, J., Kluytmans - van den Bergh, M., Ladestein, R., Punselie, R., van Rijen, M., Verkade, E., Ernest, M., Wulf, M., Brekelmans, M., Willemse, P., Wulf, M., ... Vandenbroucke-Grauls, C. (2013). Lifestyle-Associated Risk Factors for Community-Acquired Methicillin-Resistant Staphylococcus aureus Carriage in the Netherlands: An Exploratory Hospital-Based Case-Control Study. PloS one, 8(6), Article e65594. https://doi.org/10.1371/journal.pone.0065594

Lifestyle-Associated Risk Factors for Community-Acquired Methicillin-Resistant Staphylococcus aureus Carriage in the Netherlands: An Exploratory Hospital-Based Case-Control Study. / van Rijen, Miranda M.L.; Kluytmans-van den Bergh, Marjolein F.Q.; Verkade, Erwin J.M. et al.
In: PloS one, Vol. 8, No. 6, e65594, 19.06.2013.

Research output: Contribution to journal › Article › peer-review

van Rijen, MML, Kluytmans-van den Bergh, MFQ, Verkade, EJM, ten Ham, PBG, Feingold, BJ, Kluytmans, JAJW, Hendriks, Y, op den Kamp, D, Kluytmans, J, Kluytmans - van den Bergh, M, Ladestein, R, Punselie, R, van Rijen, M, Verkade, E, Ernest, M, Wulf, M, Brekelmans, M, Willemse, P, Wulf, M, ten Feld, N, Wintermans, R, Postma, B, Terwee, M, de Ruiter, T, van der Vorm, E, Wijker, A, Silbergeld, E, Hamers, H, Wintermans, R, Das, P, Sanders, E, Verduin, K, van Dam, D, Diederen, J, ten Ham, P, Nolles, L, van der Vorm, E, Smeulders, A, Verduin, K, Buiting, A, Hörmann, H, Nieuwkoop, E, Haverkate, D, Verweij, P, Bonten, M, van der Jagt-Zwetsloot, M, Troelstra, A, Berkhout, H, van den Hout, L, Kaiser, A & Vandenbroucke-Grauls, C 2013, 'Lifestyle-Associated Risk Factors for Community-Acquired Methicillin-Resistant Staphylococcus aureus Carriage in the Netherlands: An Exploratory Hospital-Based Case-Control Study', PloS one, vol. 8, no. 6, e65594. https://doi.org/10.1371/journal.pone.0065594

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title = "Lifestyle-Associated Risk Factors for Community-Acquired Methicillin-Resistant Staphylococcus aureus Carriage in the Netherlands: An Exploratory Hospital-Based Case-Control Study",

abstract = "Background:Community-acquired MRSA (CA-MRSA) is rapidly increasing. Currently, it is unknown which reservoirs are involved. An exploratory hospital-based case-control study was performed in sixteen Dutch hospitals to identify risk factors for CA-MRSA carriage in patients not belonging to established risk groups.Methods:Cases were in- or outpatients from sixteen Dutch hospitals, colonised or infected with MRSA without healthcare- or livestock-associated risk factors for MRSA carriage. Control subjects were patients not carrying MRSA, and hospitalised on the same ward or visited the same outpatients' clinic as the case. The presence of potential risk factors for CA-MRSA carriage was determined using a standardised questionnaire.Results:Regular consumption of poultry (OR 2{dot operator}40; 95% CI 1{dot operator}08-5{dot operator}33), cattle density per municipality (OR 1{dot operator}30; 95% CI 1{dot operator}00-1{dot operator}70), and sharing of scuba diving equipment (OR 2{dot operator}93 95% CI 1{dot operator}19-7{dot operator}21) were found to be independently associated with CA-MRSA carriage. CA-MRSA carriage was not related to being of foreign origin.Conclusions:The observed association between the consumption of poultry and CA-MRSA carriage suggests that MRSA in the food chain may be a source for MRSA carriage in humans. Although sharing of scuba diving equipment was found to be associated with CA-MRSA carriage, the role played by skin abrasions in divers, the lack of decontamination of diving materials, or the favourable high salt content of sea water is currently unclear. The risk for MRSA MC398 carriage in areas with a high cattle density may be due to environmental contamination with MRSA MC398 or human-to-human transmission. Further studies are warranted to confirm our findings and to determine the absolute risks of MRSA acquisition associated with the factors identified.",

author = "{van Rijen}, {Miranda M.L.} and {Kluytmans-van den Bergh}, {Marjolein F.Q.} and Verkade, {Erwin J.M.} and {ten Ham}, {Peter B.G.} and Feingold, {Beth J.} and Kluytmans, {Jan A.J.W.} and Yvonne Hendriks and {op den Kamp}, Dani{\"e}lle and Jan Kluytmans and {Kluytmans - van den Bergh}, Marjolein and Ren{\'e}e Ladestein and Rudolf Punselie and {van Rijen}, Miranda and Erwin Verkade and Marieke Ernest and Mireille Wulf and Mari{\"e}lla Brekelmans and Patricia Willemse and Mireille Wulf and {ten Feld}, Nelleke and Rob Wintermans and Bent Postma and Marja Terwee and {de Ruiter}, Truus and {van der Vorm}, Eric and Antoinette Wijker and Ellen Silbergeld and Henk Hamers and Rob Wintermans and Philo Das and Ellen Sanders and Kees Verduin and {van Dam}, Dick and Jan Diederen and {ten Ham}, Peter and Loes Nolles and {van der Vorm}, Eric and Anouk Smeulders and Kees Verduin and Anton Buiting and Helma H{\"o}rmann and Ellen Nieuwkoop and Diana Haverkate and Paul Verweij and Marc Bonten and {van der Jagt-Zwetsloot}, Marischka and Annet Troelstra and Hanneke Berkhout and {van den Hout}, Liduine and Annie Kaiser and Christina Vandenbroucke-Grauls",

year = "2013",

month = jun,

day = "19",

doi = "10.1371/journal.pone.0065594",

language = "English (US)",

volume = "8",

journal = "PloS one",

issn = "1932-6203",

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TY - JOUR

T1 - Lifestyle-Associated Risk Factors for Community-Acquired Methicillin-Resistant Staphylococcus aureus Carriage in the Netherlands

T2 - An Exploratory Hospital-Based Case-Control Study

AU - van Rijen, Miranda M.L.

AU - Kluytmans-van den Bergh, Marjolein F.Q.

AU - Verkade, Erwin J.M.

AU - ten Ham, Peter B.G.

AU - Feingold, Beth J.

AU - Kluytmans, Jan A.J.W.

AU - Hendriks, Yvonne

AU - op den Kamp, Daniëlle

AU - Kluytmans, Jan

AU - Kluytmans - van den Bergh, Marjolein

AU - Ladestein, Renée

AU - Punselie, Rudolf

AU - van Rijen, Miranda

AU - Verkade, Erwin

AU - Ernest, Marieke

AU - Wulf, Mireille

AU - Brekelmans, Mariëlla

AU - Willemse, Patricia

AU - Wulf, Mireille

AU - ten Feld, Nelleke

AU - Wintermans, Rob

AU - Postma, Bent

AU - Terwee, Marja

AU - de Ruiter, Truus

AU - van der Vorm, Eric

AU - Wijker, Antoinette

AU - Silbergeld, Ellen

AU - Hamers, Henk

AU - Wintermans, Rob

AU - Das, Philo

AU - Sanders, Ellen

AU - Verduin, Kees

AU - van Dam, Dick

AU - Diederen, Jan

AU - ten Ham, Peter

AU - Nolles, Loes

AU - van der Vorm, Eric

AU - Smeulders, Anouk

AU - Verduin, Kees

AU - Buiting, Anton

AU - Hörmann, Helma

AU - Nieuwkoop, Ellen

AU - Haverkate, Diana

AU - Verweij, Paul

AU - Bonten, Marc

AU - van der Jagt-Zwetsloot, Marischka

AU - Troelstra, Annet

AU - Berkhout, Hanneke

AU - van den Hout, Liduine

AU - Kaiser, Annie

AU - Vandenbroucke-Grauls, Christina

PY - 2013/6/19

Y1 - 2013/6/19

N2 - Background:Community-acquired MRSA (CA-MRSA) is rapidly increasing. Currently, it is unknown which reservoirs are involved. An exploratory hospital-based case-control study was performed in sixteen Dutch hospitals to identify risk factors for CA-MRSA carriage in patients not belonging to established risk groups.Methods:Cases were in- or outpatients from sixteen Dutch hospitals, colonised or infected with MRSA without healthcare- or livestock-associated risk factors for MRSA carriage. Control subjects were patients not carrying MRSA, and hospitalised on the same ward or visited the same outpatients' clinic as the case. The presence of potential risk factors for CA-MRSA carriage was determined using a standardised questionnaire.Results:Regular consumption of poultry (OR 2{dot operator}40; 95% CI 1{dot operator}08-5{dot operator}33), cattle density per municipality (OR 1{dot operator}30; 95% CI 1{dot operator}00-1{dot operator}70), and sharing of scuba diving equipment (OR 2{dot operator}93 95% CI 1{dot operator}19-7{dot operator}21) were found to be independently associated with CA-MRSA carriage. CA-MRSA carriage was not related to being of foreign origin.Conclusions:The observed association between the consumption of poultry and CA-MRSA carriage suggests that MRSA in the food chain may be a source for MRSA carriage in humans. Although sharing of scuba diving equipment was found to be associated with CA-MRSA carriage, the role played by skin abrasions in divers, the lack of decontamination of diving materials, or the favourable high salt content of sea water is currently unclear. The risk for MRSA MC398 carriage in areas with a high cattle density may be due to environmental contamination with MRSA MC398 or human-to-human transmission. Further studies are warranted to confirm our findings and to determine the absolute risks of MRSA acquisition associated with the factors identified.

AB - Background:Community-acquired MRSA (CA-MRSA) is rapidly increasing. Currently, it is unknown which reservoirs are involved. An exploratory hospital-based case-control study was performed in sixteen Dutch hospitals to identify risk factors for CA-MRSA carriage in patients not belonging to established risk groups.Methods:Cases were in- or outpatients from sixteen Dutch hospitals, colonised or infected with MRSA without healthcare- or livestock-associated risk factors for MRSA carriage. Control subjects were patients not carrying MRSA, and hospitalised on the same ward or visited the same outpatients' clinic as the case. The presence of potential risk factors for CA-MRSA carriage was determined using a standardised questionnaire.Results:Regular consumption of poultry (OR 2{dot operator}40; 95% CI 1{dot operator}08-5{dot operator}33), cattle density per municipality (OR 1{dot operator}30; 95% CI 1{dot operator}00-1{dot operator}70), and sharing of scuba diving equipment (OR 2{dot operator}93 95% CI 1{dot operator}19-7{dot operator}21) were found to be independently associated with CA-MRSA carriage. CA-MRSA carriage was not related to being of foreign origin.Conclusions:The observed association between the consumption of poultry and CA-MRSA carriage suggests that MRSA in the food chain may be a source for MRSA carriage in humans. Although sharing of scuba diving equipment was found to be associated with CA-MRSA carriage, the role played by skin abrasions in divers, the lack of decontamination of diving materials, or the favourable high salt content of sea water is currently unclear. The risk for MRSA MC398 carriage in areas with a high cattle density may be due to environmental contamination with MRSA MC398 or human-to-human transmission. Further studies are warranted to confirm our findings and to determine the absolute risks of MRSA acquisition associated with the factors identified.

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Lifestyle-Associated Risk Factors for Community-Acquired Methicillin-Resistant Staphylococcus aureus Carriage in the Netherlands: An Exploratory Hospital-Based Case-Control Study

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