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SummaryTitleSpatial analysis of methicillin-resistantStaphylococcus aureuscarriage (MRSA) screening yield at hospital admission in a livestock-dense regionPurposeIn the Netherlands, patients with a risk factor for methicillin-resistantStaphylococcus aureus(MRSA) carriage, such as foreign hospital stay and contact with livestock (pigs, veal calves and/or broilers) are actively screened upon hospital admission. This study aimed to give insight in the geographical clustering patterns of MRSA carriage among these patients in a livestock-dense region.MethodsA retrospective study was performed using medical records and laboratory results of MRSA screened patients admitted to seven hospitals in the provinces of Gelderland and Noord-Brabant, covering the period from 01/2011 to 02/2017. SaTScan spatial scanning identified cluster areas with an increased MRSA carriage risk in postal codes compared to the surrounding areas.Results15 546 patients were included, among which 10.0% (n=1499) were MRSA carriers. Four significant, typically highly pig-dense MRSA carriage hotspots were identified, where the relative risk of carriage ranged from 2.1 to 3.4 compared to the surrounding area.ConclusionMRSA carriage risk clustered in certain areas, suggesting an association between livestock density (mainly pigs) and the MRSA carriage risk for the screened population at hospital admission. It needs to be explored when proximity (not contact) to livestock should be considered a risk factor. Considering analytical difficulties we encountered it is recommended to harmonize culture methods and data acquisition across hospitals to facilitate analysis for improving MRSA screening policy.ImpactsThe fraction MRSA carriers among patients with livestock contact notified in the hospital system in this study was 22.7%, showing the effectiveness of the Search and Destroy policy.MRSA carriage in the Dutch Province Gelderland is clustered in certain hotspots, located in pig-dense areas.Culture methods and data acquisition should be harmonized across hospitals to facilitate analysis for improving MRSA screening policy.

BACKGROUND The Netherlands, like most European countries, has a robust influenza surveillance system in primary care. However, there is a lack of real-time nationally representative data on hospital admissions for complications of influenza. Anecdotal information about hospital capacity problems during influenza epidemics can, therefore, not be substantiated. OBJECTIVE The aim of this study was to assess whether media reports could provide relevant information for estimating the impact of influenza on hospital capacity, in the absence of hospital surveillance data. METHODS Dutch news articles on influenza in hospitals during the influenza season (week 40 of 2017 until week 20 of 2018) were searched in a Web-based media monitoring program (Coosto). Trends in the number of weekly articles were compared with trends in 5 different influenza surveillance systems. A content analysis was performed on a selection of news articles, and information on the hospital, department, problem, and preventive or response measures was collected. RESULTS The trend in weekly news articles correlated significantly with the trends in all 5 surveillance systems, including severe acute respiratory infections (SARI) surveillance. However, the peak in all 5 surveillance systems preceded the peak in news articles. Content analysis showed hospitals (N=69) had major capacity problems (46/69, 67%), resulting in admission stops (9/46, 20%), postponement of nonurgent surgical procedures (29/46, 63%), or both (8/46, 17%). Only few hospitals reported the use of point-of-care testing (5/69, 7%) or a separate influenza ward (3/69, 4%) to accelerate clinical management, but most resorted to ad hoc crisis management (34/69, 49%). CONCLUSIONS Media reports showed that the 2017/2018 influenza epidemic caused serious problems in hospitals throughout the country. However, because of the time lag in media reporting, it is not a suitable alternative for near real-time SARI surveillance. A robust SARI surveillance program is important to inform decision making.

A novel linker strategy for the efficient side-chain anchoring of arginine is described. The utility of this approach was demonstrated by the facile synthesis of arginine-specific fluorogenic peptide substrates by standard Fmoc solid phase peptide synthesis methods.

In a large series of post-vaccination samples we compared the result of three commercially available anti-HBs assays (AxSYM, Architect and Access) on the quantitation of anti-HBs after immunisation with Engerix-B (HBsAg/ad) and GenHevacB (HBsAg/ay) vaccine. Two of the assays (AxSYM, Architect: Abbott Laboratories) gave related but not identical results with HBsAg from different sources. The result of the third assay (Access, Beckman Coulter) was related to that of AxSYM and Architect only for GenHevacB anti-HBs but differed for Engerix-B anti-HBs (P