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Prevalence of MRSA in Organic and Confinement Swine Operations
- 1. Prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in organic and confinement swine operations in Iowa and Illinois Abby L. Harper, MPH University of Iowa Center for Emerging Infectious Diseases 10-09-2009
- 2. Introduction to MRSA Methicillin-resistant Staphylococcus aureus (MRSA) Gram positive bacterium Leading cause of hospital-associated infections Image: http://trouble.philadelphiaweekly.com/archives/MRSA220207_400x379%5B1%5D.jpg
- 3. Introduction to MRSA Not only a hospital problem anymore Reference: NEJM 2005;352:468-75 NEJM 2008;358:11. Images: : http://www.foodpoisonblog.com/dog_cat.jpg http://agebb.missouri.edu/commag/swine/pigs.jpg http://www.smh.com.au/ffximage/2006/07/26/cattle26706_wideweb__470x313,0.jpg
- 4. MRSA and Swine First identified in the Netherlands, 2005 Pig farmers: higher rate of colonization with methicillin-susceptible S. aureus (MSSA) and MRSA Reference: EID 2005;11:1965-66
- 5. MRSA and Swine Swine-associated MRSA also found in Denmark, Germany, Austria, France, Canada USA?
- 6. Swine MRSA in the USA? Iowa: #1 pork producing state in the USA 16 million hogs = 25% of hogs raised in the U.S. = $4 billion/year Image: http://en.wikipedia.org/wiki/Iowa
- 8. Multi-state study 18 farms per investigator 24 animals tested per farm Nasal + pharyngeal sampling, humans 17 farms tested
- 9. Summary – Results in Swine No MRSA found to date on organic farms in Iowa Overall prevalence, swine: 45/408 (11%) Confinement swine: 45/192 (24%)
- 10. Summary – Results in Humans Humans: 27/86 (31.4%) Humans working in confinement: 27/61 (44.3%) Confirmed as ST398; first identification in US
- 12. Confinements as amplifiers and reservoirs 1000s of animals in small space Ventilation systems Low-tech environmental sampling All but 1 grew MRSA Map created by: Abby L. Harper Sources: Abby Harper Iowa Geologic Survey – DNR
- 13. Follow-up Environmental Sampling PhD student in Industrial Hygiene Anderson impact sampler CFUs / volume of air May indicate MRSA particle size Source: http://www.teagasc.ie/research/reports/dairyproduction/3989/eopr-3989.asp http://www.pacwill.ca/en/ProductsServices/6stage.htm
- 14. Summary MRSA is present in U.S. swine and swine workers in confinement facilities Potential to spread to larger community Reservoir of resistance Image: http://cuteoverload.com/2009/04/27/pucker-up-behbeh/
- 15. Future directions More general study of MRSA in rural Iowa Population prevalence & strain types Animals other than swine Role of antibiotics?
- 16. Co-authors and team members Tara Smith (PI) Mike Male, Anne Dressler, Blake Hanson, Shylo Wardyn (MS students) Jennifer Kroeger (PhD student) Phil Scheibel (undergraduate) Loreen Herwaldt MD, Dan Diekema MD (UIHC) http://www.public-health.uiowa.edu/CEID/ abby-harper@uiowa.edu
Notes de l'éditeur
- S. aureus is a common type of bacteria that normally lives on the skin and sometimes in the nasal passages.Although approximately one-third of the population carries a strain of S. aureus, colonization with Staph resistant to methicillin are much less common. In 2008, MRSA was associated with 94 thousand infections and 18 thousand deaths. Deaths from MRSA infections in the U.S. have exceeded mortality from many other infectious diseases, including HIV/AIDS.MRSA is the leading cause of HA infections. The bacteria can cause clinical infection when they enter the body through a cut, sore, catheter, or breathing tube. Staph skin infections cause a red, swollen, and painful area on the skin.~1.5% colonized with MRSA
- While MRSA was originally associated with hospitalization and surgery, community acquired MRSA cases are increasing. Community-associated MRSA (CA-MRSA) infections are ones that occur in otherwise healthy people who have not had healthcare contact. The infections have occurred among athletes who share equipment or personal items (such as towels or razors),children in daycare facilities, and family pets (dogs and cats).
- The Netherlands was the first to report the prevalence of MRSA among swine farmers. The study reported pig farmers had 760 times higher prevalence of MRSA than that among patients admitted to Dutch hospitals. Multi locus sequence typing suggested these isolates belonged to sequence type 398, commonly seen in swine. The study indicated the MRSA had been transmitted from pigs to pig farmers and their family members. A following study found that 4.6% of veterinarians and veterinary students were colonized with MRSA, compared with a population-based estimate of 1%
- Additional studies have shown that isolates obtained from swine and their human caretakers are frequently indistinguishable, suggesting transmission between the two species. This documents the importance of considering livestock and other animals when examining the epidemiology of MRSA. Despite the research in other countries, the prevalence of MRSA in swine or in their caretakers is unknown in the United States.
- In a rural state such as Iowa, which produces 25% of the swine raised in the US, transmission of MRSA on swine farms could complicate efforts to reduce MRSA transmission. With Iowa raising 16 million hogs a year in a $4 billion a year industry, we conducted a study to examine the prevalence of MRSA in swine and swine workers from the Midwestern United States.
- We are collaborating with the University of Minnesota and Ohio State University who are doing identical studies to determine the prevalence of MRSA in their respective state.
- Each state was instructed to investigate a total of 18 farms – 9 confinement operations and 9 organic or antibiotic free. At each farm, the nares of 24 pigs between the ages of 6 and 9 weeks old were swabbed. Human caretakers provided nasal and throat swabs. Employees filled out questionnaires, providing demographic data, potential risk factors, and information about contact with the swine. We have collected samples from swine on 17 different farms (8 confinement, 9 organic/antibiotic free) in Iowa and Illinois .
- To date, no MRSA has been found on organic farms in Iowa. Nasal swabs were taken from 408 swine. Overall MRSA prevalence in swine was found to be 11%. MRSA prevalence in confinement swine was 24%. These results show that colonization of swine by MRSA is very common on the farm systems we examined in the Midwestern U.S., This adds to the concern about domestic animal species as a reservoir of this bacterium.
- Overall MRSA prevalence in humans was 31.4%. Humans working in confinement operations had a prevalence of 44.3%. All 28 isolates examined to date were negative for the pvl gene and found to be sequence type 398 by multi locus sequence typing. This strain has also been found in The Netherlands, Germany, Denmark and Canada. This was the first identification of ST398 in the United States. To date, ST398 has not been linked with any deaths. Of those tested, all isolates from swine and from humans were resistant to penicillin, oxacillin and tetracycline.
- From this data, we concluded individuals exposed to swine, especially in confinement operations, are at increased risk for MRSA carriage. Other risk factors, such as age, gender, orunderlying medical conditions, are still being analyzed.
- In confinement operations, thousands of animals are enclosed in small areas. The map to the right illustrates the vast number of swine confinement operations registered with the State of Iowa. As you can see, there are quite a few!Another concern in confinement operations are ventilations systems. We suspected the ventilation could circulate aerosolized bacteria. In order to test this theory, we performed low tech environmental sampling. Ten plates were left open to the air in a confinement operation. All but one plate grew MRSA.
- In a subsequent study, a PhD student is an Anderson sampler was used to produce more quantitative data. Talk about how many colony forming units (CFUs) were present per liter of air. Discuss stages and size of particles in relation to placement in the respiratory system.
- In conclusion, MRSA is present in swine and swine workers. Swine strains of MRSA may be transmitted to exposed swine workersMRSA carriage in swine varies by herd and genetic originAnd swine are a reservoir for MRSAGenetic testing for the pvl gene and spa typing are in the process of being completed.
- Our lab is currently looking at a general study to determine the prevalence of MRSA in rural areas of Iowa. In particular, we are trying to establish a general population prevalence and the strain types.
- I would like to thank my PI Tara Smith and the American Society for Microbiology for inviting me to come present at this conference.Are there any questions?