SUMMARYTo determine methicillin-resistant Staphylococcus aureus (MRSA) carriage in poultry and slaughterhouse personnel, 40 Dutch broiler flocks, in six slaughterhouses and 466 personnel were sampled. Of the employees, 26 were positive (5 . 6 %), indicating a higher risk of exposure when compared to the general Dutch population (0 . 1 %). This risk was significantly higher for personnel having contact with live animals (5 . 2 %) -especially hanging broilers on the slaughterline (20 . 0%) -than for all other personnel (1 . 9 %). Conventional electric stunning conferred a significantly higher risk of MRSA carriage for employees than CO 2 stunning (9 . 7% vs. 2 . 0%). A total of 405 broilers were sampled upon their arrival at the slaughterhouse, of which 6 . 9% were positive. These broilers originated from 40 Dutch slaughter flocks of which 35 . 0% were positive. MRSA contamination in the different compartments of slaughterhouses increased during the production day, from 8 % to 35 %. Of the 119 MRSA isolates, predominantly livestock-associated MRSA ST398 was found, although 27 . 7 % belonged to ST9 (spa type t1430). There is an increased risk of MRSA carriage in personnel working at broiler slaughterhouses, particularly those having contact with live animals.

The prevalence among people on broiler farms was higher than in previous studies involving patients and the general population. Furthermore, an increased risk of carriage was shown among individuals having a high degree of contact with live broilers. The (relative) contribution of transmission routes that might play a role in the dissemination of ESBL/AmpC-encoding resistance genes to humans on broiler farms should be pursued in future studies.

SUMMARYWe compared the prevalence of human and animal methicillin-resistant Staphylococcus aureus (MRSA) at pig farms in The Netherlands, and related this to individual and farm-level characteristics. More than half of the farms investigated (28/50) had MRSA in pigs or stable dust and about one third (15/50) of person(s) were identified as MRSA carriers. Human carriage was found only on farms with MRSA-positive pigs or dust. MRSA strains in human samples were the same spa-type as found in pigs and all were not typable by pulsed-field gel electrophoresis (NT-MRSA). Multivariate analyses showed that risk factors for human MRSA carriage were: working in pig stables (OR 40,) and the presence of sows and finishing pigs (OR 9, 95 % CI 3-30). Veterinary sample collectors sampling the pigs showed transient MRSA carriage only during the day of the farm visit. Working in pig stables with MRSA-positive pigs poses a high risk for acquiring MRSA, increasingly so when contact with live pigs is more intensive or long lasting.

The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) carriage in pig and veal calf farmers in the Netherlands is estimated at 25 to 35%. However, no information is available about MRSA carriage in humans after short-term occupational exposure to pigs or veal calves. This study examines the prevalence and duration of MRSA acquisition after short-term intensive exposure to pigs or veal calves for persons not exposed to livestock on a daily basis. The study was performed with field workers who took samples from the animals or the animal houses in studies on MRSA prevalence in pig and veal farms. They were tested for MRSA by taking nasal samples before, directly after, and 24 h after they visited the farms. There were 199 sampling moments from visits to 118 MRSA-positive farms. Thirty-four of these visits (17%) resulted in the acquisition of MRSA. Thirty-one persons (94%) appeared negative again after 24 h. There were 62 visits to 34 MRSAnegative farms; none of the field workers acquired MRSA during these visits. Except for that from one person, all spa types found in the field workers were identical to those found in the animals or in the dust in animal houses and belonged to the livestock-associated clone. In conclusion, MRSA is frequently present after short-term occupational exposure, but in most cases the strain is lost again after 24 h.

OBJECTIVERecerntly, the role of the healthcare network, defined as a set of hospitals linked by patient transfers, has been increasingly considered in the control of antimicrobial resistance. Here, we investigate the potential impact of nursing homes on the spread of antimicrobial-resistant pathogens across the healthcare network and its importance for control strategies.METHODSBased on patient transfer data, we designed a network model representing the Dutch healthcare system of hospitals and nursing homes. We simulated the spread of an antimicrobial-resistant pathogen across the healthcare network, and we modeled transmission within institutions using a stochastic susceptible–infected–susceptible (SIS) epidemic model. Transmission between institutions followed transfers. We identified the contribution of nursing homes to the dispersal of the pathogen by comparing simulations of the network with and without nursing homes.RESULTSOur results strongly suggest that nursing homes in the Netherlands have the potential to drive and sustain epidemics across the healthcare network. Even when the daily probability of transmission in nursing homes is much lower than in hospitals, transmission of resistance can be more effective because of the much longer length of stay of patients in nursing homes.CONCLUSIONSIf an antimicrobial-resistant pathogen emerges that spreads easily within nursing homes, control efforts aimed at hospitals may no longer be effective in preventing nationwide outbreaks. It is important to consider nursing homes in planning regional and national infection control and in implementing surveillance systems that monitor the spread of antimicrobial resistance.Infect Control Hosp Epidemiol 2016;37:761–767