Newly identified risk factors for MRSA carriage in The Netherlands

W S N Lekkerkerk; A Haenen; M A B van der Sande; T Leenstra; S de Greeff; A Tjon-A-Tsien; J H Richardus; N van de Sande-Bruinsma; M C Vos; Aura Timen

doi:10.1371/journal.pone.0188502

Newly identified risk factors for MRSA carriage in The Netherlands

W S N Lekkerkerk, A Haenen, M A B van der Sande, T Leenstra, S de Greeff, A Tjon-A-Tsien, J H Richardus, N van de Sande-Bruinsma, M C Vos, Aura Timen

Research output: Contribution to Journal › Article › Academic › peer-review

Abstract

OBJECTIVES: To 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.

METHODS: We 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.

RESULTS: Significant 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.

CONCLUSIONS: 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.

Original language	English
Article number	e0188502
Pages (from-to)	e0188502
Journal	PLoS ONE
Volume	12
Issue number	11
DOIs	https://doi.org/10.1371/journal.pone.0188502
Publication status	Published - 2017
Externally published	Yes

Funding

This study was financed by The Netherlands Organisation for Health Research and Development (ZonMw; https://www.zonmw.nl/en/)(125020010). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. We would like to thank Arina Groenheide, Annelies van Ginkel, Yolanda van Weert, Dineke Frentz and Sjoukje Woudt for their supportive work in this study. Furthermore we would like to thank the participants, as well as the medical microbiologists, infection preventionists and other personnel of the following medical microbiological laboratories in The Netherlands that helped make this national study a success: Academic Medical Center, University of Amsterdam, Amsterdam, Admiraal de Ruyter Ziekenhuis, Goes/Vlissingen, ATAL-Medical Diagnostic Centre, Amsterdam, Atrium Medical Center Parkstad, Heerlen, Bronovo Hospital, The Hague, De Heel Zaans Medisch Centrum, Zaandam, Deventer Hospital, Deventer, Diacones-senhuis Leiden, Leiden, Diakonessenhuis Utrecht, Utrecht, Erasmus MC, University Medical Center Rotterdam, Rotterdam, Gelderse Vallei Hospital, Ede, Gelre Hospital, Apeldoorn, Groene Hart Ziekenhuis, Gouda, Haga Hospital, The Hague, IJsselland Hospital, Capelle aan den IJssel, Ikazia Hospital, Rotterdam, Isala Klinieken, Zwolle, Jeroen Bosch Hospital, ’s-Her-togenbosch, Laboratory for Infectious Diseases, Groningen, Laboratory for Pathology and Medical Microbiology (PAMM), Veldhoven, Laurentius Hospital, Roermond, Maasstad Hospital, Rotterdam, Maastricht University Medical Center, Maastricht, Medical Center Alkmaar, Alkmaar, Medical Center Leeuwarden, Izore Center for Infectious Diseases Friesland, Leeuwarden, Orbis Medical Center, Sittard-Geleen, Regional Public Health Laboratory Ken-nemerland, Haarlem, Reinier de Graaf Groep, Delft, Rijnland Hospital, Leiderdorp, Rijnstate Hospital, Arnhem, SALTRO, Utrecht, SHL-group, Etten-Leur, Slingeland Hospital, Doe-tinchem, St. Antonius Hospital, Nieuwegein, St. Franciscus Gasthuis, Rotterdam, St. Jans Gasthuis, Weert, St. Jansdal Hospital, Harderwijk, Tergooi Hospitals Hilversum, Hilversum, UMC Utrecht, Utrecht, University Medical Center Groningen, Groningen, VieCuri Medical Center, Venlo, Vlietland Hospital, Schiedam, Westfries Gasthuis, Hoorn, Ziekenhuis Zeeuws-Vlaanderen, Terneuzen, Zuwe Hofpoort Hospital, Woerden, The Netherlands. This study was financed by ZonMw (125020010) and listed in the Dutch Trial Register (NTR2041). Data were presented at the International Symposium on Staphylococci and Staphylococcal infections 2016, Seoul, South Korea. Poster S01-02.

Funders	Funder number
ZonMw	125020010

Keywords

Carrier State/microbiology
Case-Control Studies
Humans
Methicillin-Resistant Staphylococcus aureus/isolation & purification
Netherlands/epidemiology
Population Surveillance
Prospective Studies
Risk Factors
Staphylococcal Infections/epidemiology

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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title = "Newly identified risk factors for MRSA carriage in The Netherlands",

abstract = "OBJECTIVES: To 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.METHODS: We 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.RESULTS: Significant 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.CONCLUSIONS: 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.",

keywords = "Carrier State/microbiology, Case-Control Studies, Humans, Methicillin-Resistant Staphylococcus aureus/isolation & purification, Netherlands/epidemiology, Population Surveillance, Prospective Studies, Risk Factors, Staphylococcal Infections/epidemiology",

author = "Lekkerkerk, {W S N} and A Haenen and {van der Sande}, {M A B} and T Leenstra and {de Greeff}, S and A Tjon-A-Tsien and Richardus, {J H} and {van de Sande-Bruinsma}, N and Vos, {M C} and Aura Timen",

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doi = "10.1371/journal.pone.0188502",

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AU - Lekkerkerk, W S N

AU - Haenen, A

AU - van der Sande, M A B

AU - Leenstra, T

AU - de Greeff, S

AU - Tjon-A-Tsien, A

AU - Richardus, J H

AU - van de Sande-Bruinsma, N

AU - Vos, M C

AU - Timen, Aura

PY - 2017

Y1 - 2017

N2 - OBJECTIVES: To 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.METHODS: We 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.RESULTS: Significant 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.CONCLUSIONS: 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.

AB - OBJECTIVES: To 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.METHODS: We 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.RESULTS: Significant 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.CONCLUSIONS: 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.

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KW - Humans

KW - Methicillin-Resistant Staphylococcus aureus/isolation & purification

KW - Netherlands/epidemiology

KW - Population Surveillance

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KW - Risk Factors

KW - Staphylococcal Infections/epidemiology

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Newly identified risk factors for MRSA carriage in The Netherlands

Abstract

Funding

Keywords

UN SDGs

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