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Residential proximity to large swine CAFOs is associated with increased risk of MRSA carriage at time of hospital admission in rural Iowa Veterans.

Carrel M, Schweizer ML, Vaughan-Sarrazin MS, Smith T, Perencevich EN. Residential proximity to large swine CAFOs is associated with increased risk of MRSA carriage at time of hospital admission in rural Iowa Veterans. Poster session presented at: Infectious Diseases Society of America Annual Meeting; 2013 Oct 3; San Francisco, CA.




Abstract:

Background: Methicillin-resistant S. aureus (MRSA) colonization has been documented in livestock, livestock workers and individuals living in areas of high livestock density in the US and Europe. Recently, the US Veterans Administration (VA) implemented procedures that screened all patients at time of admission for MRSA colonization via nasal swabs. We aimed to determine whether residential proximity to swine Confined Animal Feeding Operations (CAFOs) was associated with increased MRSA colonization in patients admitted to the Iowa City VA Health Care System (IC-VAHCS). Methods: Nasal swabs were taken from patients on admission to the IC-VAHCS from 12/1/2009 -12/31/2011 and MRSA status was assessed. Patient addresses were geocoded and assigned to either rural or urban residential status based on Census designations. The number of swine within 1 mile of the patient household was calculated using data provided by the Iowa Department of Natural Resources. Relative risk was estimated for rural residents based upon residential proximity to any swine or to large numbers of swine. Generalized estimating equations were used to determine the impact of residential proximity to any or large numbers of swine, controlling for age and number of prior admissions to the IC-VAHCS. Results: Overall MRSA colonization among rural IC-VAHCS patients was 7%. Residential proximity within 1 mile of large swine populations was independently associated with nearly double the risk of MRSA colonization at time of admission (RR = 1.8786, 95% CI = 1.0928, 3.2289, p = 0.0239). After adjusting for age and number of prior hospital admissions, residential proximity to large swine populations was associated with nearly triple the odds of MRSA colonization (OR = 2.76, 95% CI = 1.2728, 5.9875, p = .0101). The relationship between MRSA and no residential proximity to swine was not significant. Conclusions: Residential proximity to large swine CAFO populations in rural Iowans was associated with increased risk of MRSA colonization at time of hospital admission, while proximity to smaller swine populations was not associated with MRSA colonization. Healthcare facilities serving rural populations need to respond to increased risk MRSA introduction into healthcare settings.





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