Project 12: MRSA ST398 in de varkensproductiepiramide



3URMHFWOHLGHU

3YDQGHU:ROI*'

3URMHFWWHDP

(0%URHQV49(:85HQ&,E5,90 ($0*UDDW0&0GH-RQJ49(:85 -/RPPHUVH0DDLNH0HLMHULQNHQ ODERUDWRULXPPHGHZHUNHUV*' ;:+XLMVGHQV&,E5,90 '-0HYLXV&9,:85

6DPHQZHUNLQJ

9HHKRXGHUV

6DPHQYDWWLQJ

(HQQLHXZHNORRQYDQPHWKLFLOOLQHUHVLVWHQWH 6WDSK\ORFRFFXVDXUHXV056$67LVLQ YRRUKHWHHUVWEHVFKUHYHQLQYDUNHQVHQPHQVHQLQ FRQWDFWPHWYDUNHQV*H]LHQGHSLUDPLGHYRUPYDQ GHYDUNHQVSURGXFWLHNHWHQLQ1HGHUODQGNXQQHQ SDWKRJHQHQLQFOXVLHI056$]LFKRYHUHHQJURRWDDQWDO EHGULMYHQYHUVSUHLGHQYLDGHKDQGHOLQYDUNHQV+HW GRHOYDQGH]HVWXGLHZDVGHUROYDQGH056$VWDWXV YDQKHWDDQOHYHUHQGHEHGULMIRSGH056$VWDWXVYDQ KHWDIQHPHQGHEHGULMIWHNZDQWLÀ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$DQYRHUYDQHHQ056$SRVLWLHI EHGULMIYHUNODDUWGDDUPHHYDQGH056$SRVLWLHYH EHGULMYHQPHWHHQSRVLWLHYHOHYHUDQFLHU(UZHUGHQ]HYHQ VSDW\SHVJHYRQGHQGLHDOOHEHKRUHQWRW67

'H UHVXOWDWHQ YDQ GH]H VWXGLH SOHLWHQ YRRU HHQ WRS GRZQVWUDWHJLH ELM WRHNRPVWLJH EHVWULMGLQJVSURJUDPPD·V (FKWHUDDQJH]LHQYDQGHEHGULMYHQPHWDDQYRHUYDQ HHQQHJDWLHIEHGULMISRVLWLHI]LMQHQGDDUQDDVWYDQGH EHGULMYHQ ]RQGHU DDQYRHU RRN SRVLWLHI EHYRQGHQ ]LMQ LV RQGHU]RHNQDDUDQGHUHULVLFRIDFWRUHQYRRUKHWYRRUNRPHQ YDQ056$QRRG]DNHOLMN

6XPPDU\

$GLVWLQFWFORQHRIPHWKLFLOOLQUHVLVWDQW6WDSK\ORFRFFXV DXUHXV056$67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

,QOHLGLQJ

,Q1HGHUODQG]LMQLQGHHHUVWHKXPDQHJHYDOOHQ EHVFKUHYHQYDQ056$GLHJHUHODWHHUGZDUHQDDQ FRQWDFWPHWYDUNHQV>@+HWEOHHNWHJDDQRPHHQ VSHFLÀHNHNORRQGLHQLHWW\SHHUEDDUZDVPHWGHLQ 1HGHUODQGJHEUXLNWHVWDQGDDUGPHWKRGH3XOVHG)LHOG*HO (OHFWURIRUHVH>@2RNLQDQGHUHODQGHQZRUGWGH]HNORRQ JHYRQGHQLQYDUNHQV>@'DDUQDDVWEOLMNWGH]HNORRQ RRNELMDQGHUHGLHUVRRUWHQJHYRQGHQWHZRUGHQ>@$OOH LVRODWHQEHKRUHQWRWKHW]HOIGH0XOWL/RFXV6HTXHQFH7\SH 0/67HQGDDURPZRUGWYHHODOGHWHUP056$67 JHKDQWHHUG>@ *H]LHQGHRSERXZYDQGHYDUNHQVSURGXFWLHSLUDPLGH LQ1HGHUODQGZDDUELMIRNEHGULMYHQLQGHWRSYDQ GHYDUNHQVSLUDPLGHOHYHUHQDDQYHUVFKLOOHQGH YHUPHHUGHULQJVEHGULMYHQGLHYHUYROJHQVZHHUDDQ YHUVFKLOOHQGHYOHHVYDUNHQVEHGULMYHQOHYHUHQNXQQHQ SDWKRJHQHQLQFOXVLHI056$]LFKRYHUHHQJURRWDDQWDO EHGULMYHQYHUVSUHLGHQYLDGHKDQGHOLQYDUNHQV5HVXOWDWHQ XLWHHQHHUGHUHVWXGLHRSYDUNHQVEHGULMYHQVXJJHUHUHQ

$33(1',;

3URMHFW056$67LQGHYDUNHQVSURGXFWLHSLUDPLGH

 GDWDDQNRRSYDQJHOWHQFTYOHHVELJJHQYDQHHQ056$ SRVLWLHIEHGULMIHHQULVLFRIDFWRU]RXNXQQHQ]LMQYRRUGH LQWURGXFWLHYDQ056$RSYHUPHHUGHULQJVUHVSHFWLHYHOLMN YOHHVYDUNHQVEHGULMYHQ>@,QGH]HVWXGLHYDQ9DQ 'XLMNHUHQHWDOLVVOHFKWVELMHHQEHSHUNWDDQWDOEHGULMYHQ Q QDDUGH056$VWDWXVYDQKHWDDQOHYHUHQGH EHGULMIJHNHNHQ+HWGRHOYDQGHKLHURQGHUEHVFKUHYHQ VWXGLHZDVRPGHUROYDQGH056$VWDWXVYDQKHW DDQOHYHUHQGHEHGULMILQGHYHUVSUHLGLQJYDQ056$WXVVHQ YDUNHQVEHGULMYHQWHNZDQWLÀFHUHQRSEDVLVYDQHHQJURWHU DDQWDOEHGULMYHQ

0DWHULDDOHQPHWKRGHQ

%HGULMYHQGLHLQKHWNDGHUYDQGHULVLFRIDFWRUHQDQDO\VH SURMHFWZDUHQEH]RFKWZHUGHQJHVHOHFWHHUGZDDUQD PHWEHKXOSYDQKHWLGHQWLÀFDWLHHQUHJLVWUDWLHV\VWHHP DDQHQDIYRHUDGUHVVHQZHUGHQJHwGHQWLÀFHHUGHQ EHQDGHUGYRRUPHGHZHUNLQJ,QWRWDDO]LMQHULQ EHGULMYHQEHPRQVWHUGYRRUGLWSURMHFW'LW ZDUHQIRNEHGULMYHQIRNYHUPHHUGHULQJVEHGULMYHQ YHUPHHUGHULQJVEHGULMYHQYHUPHHUGHULQJV YOHHVYDUNHQVEHGULMYHQHQYOHHVYDUNHQVEHGULMYHQ 'HWLMGWXVVHQEHPRQVWHULQJYDQEHGULMYHQELQQHQppQ SLUDPLGHYDULHHUGHYDQHHQKDOYHGDJWRWUXLPPDDQGHQ (UZHUGHQQHXVVZDEV0HGLFDO:LUHDQG(TXLSPHQW 0:8.XLWppQQHXVJDWYDQYDUNHQV YHU]DPHOG'HPRQVWHUVZHUGHQYHUVSUHLGRYHUKHWEHGULMI HQRYHUGHDDQZH]LJHOHHIWLMGVJURHSHQYHU]DPHOG0HW GH]HVWHHNSURHIJURRWWHLVKHWPRJHOLMNRP056$RS HHQEHGULMIDDQWHWRQHQDOVGHELQQHQEHGULMIVSUHYDOHQWLH PLQLPDDOLV>@2SEHGULMYHQZHUGHQQDDVW GLHUPRQVWHUVRRNRPJHYLQJVPRQVWHUV6RGLER[VNLW ULQJHUVROXWLRQ)UDQNULMNJHQRPHQ0LFURELRORJLVFKH DQDO\VHZHUGJHGDDQRSLQGLYLGXHOHRPJHYLQJVPRQVWHUV HQRSJHSRROGHGLHUPRQVWHUVVZDEVSHUSRRO (ONHSRROEHYDWWHVZDEVYDQYDUNHQVXLWppQDIGHOLQJHQ ppQOHHIWLMGVJURHS]XLJHQGHELJJHQJHVSHHQGHELJJHQ RSIRNYOHHVYDUNHQV]HXJHQ+HWEDFWHULRORJLVFK RQGHU]RHNEHVWRQGXLWWZHHDFKWHUHHQYROJHQGHVHOHFWLHYH RSKRSLQJVVWDSSHQZDDUQDJHNZHHNWZHUGRSHHQ056$ VHOHFWLHYHSODDW056$VFUHHQ2[RLG8.9HUGDFKWH NRORQLHVZHUGHQEHYHVWLJGPHWEHKXOSYDQHHQPXOWLSOH[ 3&5>@,VRODWHQZHUGHQYHUGHUJHW\SHHUGPHWEHKXOS YDQVSDW\SHULQJRSKHW5,90>@HQHUZHUGHHQ DQWLELRWLFXPJHYRHOLJKHLGVEHSDOLQJJHGDDQYDQPLQVWHQV LVRODDWSHUEHGULMIRSKHW&9,,VRODWHQZHUGHQJHWHVW RSKXQJHYRHOLJKHLGYRRUHU\WKURP\FLQHFOLQGDP\FLQH ULIDPSLFLQHIXVLGLQH]XXUJHQWDPLFLQHDPLNDFLQH QHRP\FLQHFLSURÁR[DFLQHWHWUDF\FOLQHPXSLURFLQHHQ OLQH]ROLG 9RRUGHGDWDDQDO\VHZHUGHQRRN056$ SRVLWLHYHEHGULMYHQXLWGHVWXGLHYDQ9DQ'XLMNHUHQ HWDOJHEUXLNW>@'LWZDUHQIRNEHGULMYHQIRN YHUPHHUGHULQJVEHGULMIYHUPHHUGHULQJVEHGULMYHQ HQYOHHVYDUNHQVEHGULMYHQ,QGHVWXGLHYDQ9DQ 'XLMNHUHQHWDOZHUGHQQHXVVZDEVYDQEHLGHQHXVJDWHQ YDQLQGLYLGXHOHYDUNHQVJHDQDO\VHHUG0HWGLH VWHHNSURHIJURRWWHLVKHWPRJHOLMNRP056$RSHHQ EHGULMIDDQWHWRQHQDOVGHELQQHQEHGULMIVSUHYDOHQWLH PLQLPDDOLV>@1HJDWLHIJHWHVWHEHGULMYHQNXQQHQ GDQYDOVQHJDWLHI]LMQDOVPLQGHUGDQYDQGHYDUNHQV RSHHQEHGULMI056$SRVLWLHILV9DQGDDUGDWQHJDWLHI JHWHVWHEHGULMYHQXLWGH]HVWXGLHZHUGHQXLWJHVORWHQ0HW EHKXOSYDQKHWLGHQWLÀFDWLHHQUHJLVWUDWLHV\VWHHPZHUGHQ DDQHQDIYRHUDGUHVVHQYDQGH]HEHGULMYHQJHwGHQWLÀFHHUG HQEHQDGHUGYRRUPHGHZHUNLQJ'H056$LVRODWHQ ZHUGHQELMKHW90'&JHWHVWRSKXQJHYRHOLJKHLGYRRU HU\WKURP\FLQHOLQFRP\FLQHJHQWDPLFLQHDPLNDFLQH FLSURÁR[DFLQHWHWUDF\FOLQHHQWULPHWKRSULPVXOID 'HEHGULMYHQPDDNWHQGHHOXLWYDQFRPSOHWH EHGULMYHQHQLQFRPSOHWHEHGULMYHQSLUDPLGHV9DQ GHLQFRPSOHWHSLUDPLGHVZDVHUPD[LPDDOEHGULMIQLHW EHPRQVWHUG2SEHGULMYHQ]LMQQDDVWPRQVWHUVYDQ GHYDUNHQVRRNJHJHYHQVRYHUDQWLELRWLFXPWRHSDVVLQJ YHU]DPHOG7DEHO$ (HQEHGULMIZHUGDOVSRVLWLHIDDQJHPHUNWDOVPLQVWHQV YDQGHPRQVWHUVSRVLWLHIRS056$ZHUGJHWHVW'H DVVRFLDWLHWXVVHQGH056$VWDWXVYDQEHGULMYHQELQQHQ HHQSLUDPLGHHQGHDVVRFLDWLHWXVVHQVWDQGDDUGEHKDQGHOLQJ PHWDQWLELRWLFDHQ056$VWDWXVZHUGHQEHUHNHQGPHW EHKXOSYDQH[DFWHORJLVWLVFKHUHJUHVVLHLQ6$6YHUVLH >@6SDW\SHQHQJHYRHOLJKHLGVSDWURQHQZHUGHQ YHUJHOHNHQELQQHQHHQSLUDPLGH

5HVXOWDWHQ

,QSLUDPLGHVWHVWWHQDOOHEHGULMYHQ056$SRVLWLHILQ SLUDPLGHVWHVWWHQDOOHEHGULMYHQ056$QHJDWLHIHQ LQSLUDPLGHVZHUGHQ056$SRVLWLHYHHQQHJDWLHYH EHGULMYHQJHYRQGHQ7DEHO$YDQGH EHGULMYHQPHWDDQYRHUYDQHHQ056$SRVLWLHIEHGULMI ZDV]HOIRRNSRVLWLHIWHUZLMOGLWSHUFHQWDJHELMEHGULMYHQ PHWDDQYRHUYDQHHQ056$QHJDWLHIEHGULMIODJRS 'LWEHWHNHQWHHQNHHUKRJHUULVLFRRS056$ SRVLWLHI]LMQZDQQHHUKHWWRHOHYHUHQGHEHGULMISRVLWLHILV LQYHUJHOLMNLQJPHWHHQQHJDWLHIDDQYRHUEHGULMI25  3 7DEHO$'HDWWULEXWDEOHIUDFWLRQLV 'LWKRXGWLQGDWYDQGH056$SRVLWLHYHEHGULMYHQ PHWDDQYRHUYDQHHQ056$SRVLWLHIEHGULMIYHUNODDUG ZRUGWGRRUGLHDDQYRHU



Tabel A11.1

Aantal (positieve) bedrijven en monsters, MRSA-status, spa-typen, resistentiepatroon en standaardtoepassing van ant

ibiotica per piramide

piramide bedrijf bedrijfs MRSA n pools N stof n ind spa-type resistentie- standaard-toegepaste id nummer type status pos (tot) pos (tot) pos (tot) patroon antibiotica antibiotica negatieve piramides A 1 a neg 0 (20) -2 c neg 0 (15) -3 e neg 0 (10) 0 (5) -nee -B 4 a neg 0 (20) - -5 a neg 0 (20) -6 d neg 0 (10) 0 (5) -ja tetra, tmps C 7 a neg 0 (20) - -8 c neg 0 (15) -9 e neg 0 (10) 0 (5) -nee -D 10 a neg 0 (20) - -11 d neg 0 (10) 0 (5) -ja macro, pen, tmps E 12 a neg 0 (15) -nee -13 d neg 0 (20) ----j a tmps 14 d neg 0 (20) -nee -gemengde piramides F 15 a pos 1 (20) -t108 (1) EClRANT (1) - -16 c neg 0 (15) - -17 b pos 14 (15) -t943 (13) EClRT (13) - -t2503 (1) EClRT (1) 18 e pos 10 (10) -t108 (1) EClRT (1) - -t011 (1) EClRNT (1) -t943 (7) EClRT (7) -t2503 (1) EClRT (1) G 19 a pos 2 (20) -t108 (2) EClRT (2) - -20 c neg 0 (10) 0 (5) ---j a

amino, pen, poly

, tmps 21 e pos 2 (10) -t011 (2) RFGA T (1) nee -RGT (1) H* 22 c neg 0 (10) 0 (5) -ja pen 23 e pos 1 (10) -t011 (1) RT (1) - - I 24 a pos 6 (10) 1 (5) -t011 (7) GT (1) ja

cefa, macro, poly

25 c pos 5 (10) 0 (5) -t108 (5) ET (1) ja pen 26 e neg 0 (10) 0 (5) -nee -J 27 a neg 0 (10) 0 (5) -nee -28 d pos 5 (10) 1 (5) -t108 (6) GT (1) ja tmps 29 c neg 0 (10) 0 (5) -ja tmps 30 e neg 0 (10) 0 (5) -- nee

-

V

ervolg T

abel A11.1

Aantal (positieve) bedrijven en monsters, MRSA-status, spa-typen, resistentiepatroon en standaardtoepassin

g van antibiotica per piramide

positieve piramides K 31 a pos 4 (20) -t011 (3) RT (1) ja pen, tmps -EClRFGNT (2) -t108 (1) EClRT (1) 32 c pos -1 (-10) t108 (1) EClT (1) nee -33 e pos -3 (10) t108 (3) EClT (3) ja macro, tetra L* 34 b pos -8 (10) t108 (8) EClT (8) ja tetra 35 e pos -2 (10) t011 (1) EClT (1) ja tetra t108 (1) EClT (1) M* 36 c pos -8 (10) t899 (7) EClT (7) ja pen t1939 (1) EClT(1) 37 e pos -2 (10) t899 (2) T (2) ja tmps N* 38 a pos -2 (10) t108 (2) ET (2) ja tmps 39 c pos -3 (10) t108 (3) ET (3) ja poly O* 40 a pos -4 (10) t567 (4) T (2) ja pen, tetra ClT (2) 41 c pos -9 (10) t567 (9) ClT (5) ja pen T (4) P 42 b pos 9 (10) 1 (5) -t011 (6) EClCiT (1) ja macro, tetra, tmps t108 (4) 43 e pos 6 (10) 2 (5) -t108 (7) EClCiT (1) ja pen t011 (1) Q 44 b pos 7 (10) 1 (5) -t011 (8) EClGA T (1) ja

macro, pen, tetra, tmps

45 b pos 6 (10) 0 (5) -t011 (6) EClT (1) ja amino, pen 46 e pos 10 (10) 3 (5) -t011 (13) EClGNT (1) ja pen, tetra R 47 b pos 5 (10) 0 (5) -t011 (5) NT (1) ja pen 48 e pos 9 (10) 1 (5) -t011 (10) EClNT (1) -

-*incomplete piramide (1 bedrijf ontbreekt) a = fokbedrijf; b = fok-/vermeerderingsbedrijf; c = vermeerderingsbedrijf; d= vermeerderings-/vleesvarkensbedrijf; e = vleesvar

kensbedrijf

E = erythromycine, Cl = clindamycine/lincomycine, R = rifampicine, F = fusidinezuur

, G = gentamicine, A = amikacine, N = neomyc

ine, Ci = ciprofloxacine, T = tetracycline, M = mupirocine, L =

linezolid amino=aminoglycosiden, cefa=cefalosporinen, macro=macroliden, pen=penicillinen, poly=polymixinen, tetra=tetracyclinen

 =HVHQYLMIWLJSURFHQWEWEKLYDQ GHEHGULMYHQKDGPLQLPDDOppQ056$SRVLWLHIPRQVWHU 'HDDQWDOOHQHQSHUFHQWDJHVSHUEHGULMIVW\SHVWDDQLQ 7DEHO$2SEHGULMYHQZDDU056$LVJHYRQGHQ ZDUHQJHPLGGHOGYDQGHLQGLYLGXHOHYDUNHQV EHGULMYHQYDQGHSRROPRQVWHUVEHGULMYHQ HQYDQGHVWRIPRQVWHUVEHGULMYHQSRVLWLHI 2SYDQGHEHGULMYHQZDDUQDDVWSRROPRQVWHUV RRNRPJHYLQJVPRQVWHUVZHUGHQYHU]DPHOGZDUHQGH RPJHYLQJVPRQVWHUVQHJDWLHIWHUZLMOKHWEHGULMIDOV 056$SRVLWLHIJHFODVVLÀFHHUGZHUGRSEDVLVYDQppQ RIPHHUSRVLWLHYHSRROPRQVWHUV2SGHUHVWHUHQGH EHGULMYHQZDVGHEHGULMIVXLWVODJRSEDVLVYDQSRROHQ VWRIPRQVWHUVLQRYHUHHQVWHPPLQJPHWHONDDU'H&RKHQ·V NDSSDDOVPDDWYRRUGHRYHUHHQNRPVWWXVVHQUHVXOWDWHQ YRRUSRROHQVWRIPRQVWHUVZDDUELMRYHUHHQNRPVWYROJHQV WRHYDOLVXLWJHVORWHQZDVEWEKL 'H]HRYHUHHQNRPVWNDQDOVUXLPYROGRHQGHZRUGHQ JHFODVVLÀFHHUG

Tabel A11.3. Totaal aantal bedrijven, aantal en percentage MRSA-positieve bedrijven per bedrijfstype

bedrijfstype n totaal n positief % positief

fok 13 6 46 fok/vermeerdering 6 6 100 vermeerdering 11 5 45 vermeerdering/ vleesvarkens 5 1 20 vleesvarkens 13 9 69 totaal 48 27 56 9DQGHLQWRWDDOPRQVWHUVYDQppQPRQVWHULV JHHQXLWVODJEHNHQGZHUGHQHU056$SRVLWLHI EHYRQGHQEWEKL9DQDOOHSRVLWLHYH LVRODWHQZHUGKHWVSDW\SHEHSDDOG(UZHUGHQ ]HYHQVSDW\SHVJHYRQGHQGLHDOOHQEHKRUHQWRW67 6SDW\SHQWHQWZHUGHQKHWPHHVWIUHTXHQWHQ RSYHUVFKLOOHQGHEHGULMYHQELQQHQPHHUGHUHSLUDPLGHV JHYRQGHQUHVSHFWLHYHOLMNLQHQYDQGHLVRODWHQ HQLQUHVSHFWLHYHOLMNHQYDQDOOHEHGULMYHQ 0HHU]HOG]DPHVSDW\SHQWWWWHQ WZHUGHQDOOHHQJHYRQGHQRSEHGULMYHQELQQHQppQ SLUDPLGHVSDW\SHWVDPHQPHWWHQVSDW\SH WVDPHQPHWW7DEHO$ 2SGH056$SRVLWLHYHEHGULMYHQZHUGHQSHUEHGULMI WRWYHUVFKLOOHQGHVSDW\SHQJHYRQGHQ2SEHGULMYHQ ZHUGVSDW\SHJHYRQGHQRSEHGULMYHQZHUGHQ YHUVFKLOOHQGHVSDW\SHQJHYRQGHQHQRSEHGULMIZHUGHQ YHUVFKLOOHQGHVSDW\SHQJHYRQGHQ 7DEHO$

Tabel A11.4. Spa-typen: aantal isolaten, totaal, per bedrijf en per piramide

spa-type isolaten bedrijven piramides

n % n % n % t011 64 41,6 13 48,1 9 69,2 t108 45 28,2 14 51,9 8 61,5 t943 20 13,0 2 7,4 1 7,7 t567 13 8,4 2 7,4 1 7,7 t899 9 5,8 2 7,4 1 7,7 t2503 2 1,3 2 7,4 1 7,7 t1939 1 0,7 1 3,7 1 7,7 9DQLQWRWDDOLVRODWHQLVHHQDQWLELRWLFXPJHYRHOLJKHLGV EHSDOLQJXLWJHYRHUG'HUHVLVWHQWLHSDWURQHQ]LMQ ZHHUJHJHYHQLQ7DEHO$,Q7DEHO$]LMQSHU VSDW\SHHQSHUDQWLELRWLFXPGHIUHTXHQWLHYDQYRRUNRPHQ YDQUHVLVWHQWLHZHHUJHJHYHQ$OOHJHWHVWHLVRODWHQZDUHQ UHVLVWHQWWHJHQWHWUDF\FOLQHHQJHYRHOLJYRRUPXSLURFLQH OLQH]ROLGHQWPSV5HVLVWHQWLHWHJHQHU\WKURP\FLQHFOLQGD OLQFRP\FLQHHQULIDPSLFLQHNZDPUHJHOPDWLJYRRULQ PHHUGHUHVSDW\SHQ,QVSDW\SHWZHUGWHJHQKHW KRRJVWHDDQWDODQWLELRWLFDQ UHVLVWHQWLHJHYRQGHQ 0XOWLUHVLVWHQWLHLQVSDW\SHWZHUGLQPHHUGHUH LVRODWHQJHYRQGHQELMYRRUEHHOGRSEHGULMIZHUGLQ VSDW\SHWWZHHPDDOUHVLVWHQWLHJHYRQGHQWHJHQ YHUVFKLOOHQGHDQWLELRWLFD,QSLUDPLGH3ZHUGRSEHLGH EHGULMYHQUHVLVWHQWLHJHYRQGHQWHJHQFLSURÁR[DFLQH HHQPDDOLQVSDW\SHWHQHHQPDDOLQVSDW\SHW UHVLVWHQWLHWHJHQFLSURÁR[DFLQHZHUGLQJHHQHQNHOH DQGHUHSLUDPLGHJHYRQGHQ 2SYDQGHEHGULMYHQZDDUJHJHYHQV PHWEHWUHNNLQJWRWDQWLELRWLFXPWRHSDVVLQJ]LMQ YHU]DPHOGZRUGHQVWDQGDDUGEHKDQGHOLQJHQPHW DQWLELRWLFDWRHJHSDVW7DEHO$9DQGHEHGULMYHQ GLHVWDQGDDUGEHKDQGHOLQJHQPHWDQWLELRWLFDWRHSDVVHQ LV056$SRVLWLHIWHUZLMOYDQGHEHGULMYHQ GLHJHHQVWDQGDDUGEHKDQGHOLQJHQWRHSDVVHQ056$ SRVLWLHILV25 3 7DEHO$'LW EHWHNHQWHHQNHHUKRJHUULVLFRRSSRVLWLHI]LMQ ZDQQHHUVWDQGDDUGEHKDQGHOLQJHQPHWDQWLELRWLFDZRUGHQ WRHJHSDVWLQYHUJHOLMNLQJPHWLQFLGHQWHOHWRHSDVVLQJYDQ Tabel A11.2 Aantallen, frequentie, prevalentie en OR met het 95% betrouwbaarheidsinterval voor bedrijven met aanvoer van een MRSA- positief versus aanvoer van een MRSA-negatief bedrijf (totaal

27 bedrijven)

variabele categorie freq (n) freq (%) prev MRSA (%) OR 95% btbhi P-exact

status van aanvoer

positief 14 51,9 78,6 10,8 1,5 -110,1 0,011

negatief 13 48,2 23,1 ref

 DQWLELRWLFD:DQQHHUHUHFKWHUJHFRUULJHHUGZRUGWYRRUGH VWDWXVYDQKHWDDQYRHUHQGHEHGULMIZRUGWKHWULVLFRYDQ VWDQGDDUGEHKDQGHOLQJHQPHWDQWLELRWLFDYHUODDJGQDDU HHQNHHUYHUKRRJGULVLFRGDWQLHWODQJHUVLJQLÀFDQWLV 3 7DEHO$+HWULVLFRRSSRVLWLHI]LMQGRRUHHQ SRVLWLHYHOHYHUDQFLHUZRUGWQLHWDQGHUVGRRUWHFRUULJHUHQ YRRUWRHSDVVLQJYDQDQWLELRWLFDHQEOLMIWNHHU]RKRRJ 7DEHO$

'LVFXVVLH

(ULVHHQVWHUNHHQVLJQLÀFDQWHDVVRFLDWLHJHYRQGHQWXVVHQ GH056$VWDWXVYDQKHWDDQOHYHUHQGHEHGULMIHQGH 056$VWDWXVYDQKHWRQWYDQJHQGHEHGULMI'HUHVXOWDWHQ XLWGH]HVWXGLHRQGHUVFKULMYHQGDDUPHHGHVXJJHVWLHYDQ 9DQ'XLMNHUHQHWDO>@GDWDDQYRHUYDQYDUNHQVYDQ HHQ056$SRVLWLHIEHGULMIHHQULVLFRIDFWRULVYRRUKHW DIQHPHQGHEHGULMIQDPHOLMNHHQFLUFDWLHQNHHUYHUKRRJG ULVLFR$OKRHZHOLQVOHFKWVHHQSDDULVRODWHQJHYRQGHQ OLMNWKHWHURSGDWGHPHHU]HOG]DPHVSDW\SHQDOOHHQLQ ppQSLUDPLGHYRRUNRPHQ'LW]RXHUHYHQHHQVRSNXQQHQ GXLGHQGDWDDQYRHUYDQYDUNHQVHHQEHODQJULMNHURONDQ VSHOHQLQGHYHUVSUHLGLQJYDQ056$WXVVHQEHGULMYHQ 'LWNDQHFKWHUPHWGHKXLGLJHGDWDQLHWRQGHUERXZG ZRUGHQHQ]RXGXVRSJURWHUHVFKDDORQGHU]RFKWPRHWHQ ZRUGHQ$OVGLW]R]RX]LMQ]RXKHWSOHLWHQYRRUHHQWRS GRZQVWUDWHJLHELMWRHNRPVWLJHEHVWULMGLQJVSURJUDPPD·V (FKWHUDDQJH]LHQYDQGHEHGULMYHQ]RQGHUDDQYRHU RRNSRVLWLHIEHYRQGHQ]LMQHQYDQGHEHGULMYHQGLH DDQYRHUHQYDQHHQQHJDWLHIEHGULMIRRNSRVLWLHI]LMQLV RQGHU]RHNQDDUDQGHUHULVLFRIDFWRUHQYRRUYRRUNRPHQYDQ 056$QRRG]DNHOLMN 'HPHHU]HOG]DPHVSDW\SHQNRPHQDOOHHQLQppQ SLUDPLGHYRRU6SDW\SHQWHQWZRUGHQLQHHQ JURRWDDQWDOYDQGHSLUDPLGHVJHYRQGHQHQRRNELQQHQ SLUDPLGHVZRUGWRSELMYRRUEHHOGKHWDDQOHYHUHQGHEHGULMI WJHYRQGHQHQRSKHWDIQHPHQGHEHGULMIW2SKHW Tabel A11.5 Aantal geteste isolaten en percentage resistentie tegen verschillende antibiotica

spa-type t011 t108 t567 t899 t943 t1939 t2503 alle isolaten antibioticum n % n % n % n % n % n % n % n % erythromycine 15 60,0 26 96,2 13 0,0 9 77,8 20 100,0 1 100,0 2 100,0 86 74,4 clinda/lincomycine 15 60,0 26 73,1 13 53,9 9 77,8 20 100,0 1 100,0 2 100,0 86 75,6 rifampicine 14 50,0 8 62,5 0 - 0 - 20 100,0 0 - 2 100,0 44 77,3 fusidinezuur 14 21,4 8 0,0 0 - 0 - 20 0,0 0 - 2 0,0 44 6,8 gentamicine 15 46,7 26 3,9 13 0,0 9 0,0 20 0,0 1 0,0 2 0,0 86 9,3 amikacine 15 13,3 26 3,9 13 0,0 9 0,0 20 0,0 1 0,0 2 0,0 86 3,5 neomycine 14 42,9 8 12,5 0 - 0 - 20 0,0 0 - 2 0,0 44 15,9 ciprofloxacine 15 6,7 26 3,9 13 0,0 9 0,0 20 0,0 1 0,0 2 0,0 86 2,3 tetracycline 15 100,0 26 100,0 13 100,0 9 100,0 20 100,0 1 100,0 2 100,0 86 100,0 mupirocine 14 0,0 8 0,0 0 - 0 - 20 0,0 0 - 2 0,0 44 0,0 linezolid 14 0,0 8 0,0 0 - 0 - 20 0,0 0 - 2 0,0 44 0,0 tmps 1 0,0 18 0,0 13 0,0 8 0,0 0 - 1 0,0 0 - 41 0,0 tmps = trimethoprim-sulfa

Tabel A11.6 Aantallen, frequentie, prevalentie en OR met het 95% betrouwbaarheidsinterval voor bedrijven die standaard antibioticum toepassen versus bedrijven die dat niet doen (totaal 34 bedrijven)

variabele categorie freq (n) freq (%) prev MRSA (%) OR 95% btbhi P-exact

standaard ja 25 73,5 76,0 10,2 1,4-126,1 0,015

antibiotica nee 9 26,5 22,2 ref

Tabel A11.7 Aantallen, frequentie, prevalentie en OR met het 95% betrouwbaarheidsinterval voor de risicofactoren positieve leverancier en standaardantibioticumtoepassing in een bivariate analyse (totaal 21 bedrijven met informatie over beide factoren)

variabele categorie freq (n) freq (%) prev MRSA (%) OR 95%btbhi P-exact

status positief 11 52,4 81,8 10,2 1,1-156,8 0,042

aanvoer negatief 10 47,6 20,0 ref

standaard ja 14 66,7 64,3 2,3 0,1-48,0 0,836

 DIQHPHQGHEHGULMI]RX056$ELQQHQJHNRPHQNXQQHQ ]LMQRQDIKDQNHOLMNYDQGHDDQYRHUYDQHHQ056$ SRVLWLHIEHGULMI(FKWHUVSDW\SHWHQWNXQQHQ GRRUHHQHQNHOHPXWDWLHLQHONDDURYHUJDDQRSKHW VWDSK\ORFRFFDOSURWHLQ$VSDZLMNHQ]HRSVOHFKWVppQ UHSHDWDI ,QRQ]HVWXGLH]LMQQDDVWFRPSOHHW056$SRVLWLHYHHQ FRPSOHHW056$QHJDWLHYHSLUDPLGHVRRNJHPHQJGH SLUDPLGHVJHYRQGHQ(HQYHUNODULQJKLHUYRRU]RXNXQQHQ ]LMQGDWHUVRPVZHNHQWRWPDDQGHQWLMG]LWWXVVHQ EHPRQVWHULQJYDQYHUVFKLOOHQGHEHGULMYHQELQQHQppQ SLUDPLGH,QGHWLMGWXVVHQEHPRQVWHULQJHQNDQHHQVWDWXV YDQHHQEHGULMIYHUDQGHUHQ'LWJHOGWYRRUDOOHEHGULMYHQ PDDU]RXPHWQDPHHHQYHUNODULQJNXQQHQ]LMQYRRU KHWYLQGHQYDQSLUDPLGHVZDDULQSRVLWLHYHHQQHJDWLHYH EHGULMYHQYRRUNRPHQ,QGHWXVVHQOLJJHQGHSHULRGHNDQ GH056$VWDWXVYDQHHQEHGULMIJHZLM]LJG]LMQ'DDUQDDVW ]LMQYDQGHSRVLWLHYHSLUDPLGHVQLHWFRPSOHHWRPGDW GHYHHKRXGHUVJHHQPHGHZHUNLQJZLOGHQYHUOHQHQDDQGH VWXGLH 'HUHVXOWDWHQYDQGHSRROHQVWRIPRQVWHUVNRPHQUXLP YROGRHQGHRYHUHHQ'H&RKHQ·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ÀFDQWGRRU KHWNOHLQHDDQWDOEHGULMYHQZDWRYHUEOHHIYRRUGHDQDO\VH %LMGHFRQFOXVLHVYRRU]RZHOGHULVLFRIDFWRUDDQYRHUYDQ 056$SRVLWLHYHEHGULMYHQDOVGHULVLFRIDFWRUVWDQGDDUG DQWLELRWLFXPWRHSDVVLQJPRHWHUUHNHQLQJZRUGHQ JHKRXGHQPHWKHWIHLWGDWKHWKLHUJDDWRPXQLYDULDWH FTELYDULDWHDQDO\VHVPHWDQGHUHZRRUGHQHULVQLHW JHFRUULJHHUGYRRUDQGHUHIDFWRUHQRSKHWEHGULMIGLHHHQ SRVLWLHYHVWDWXV]RXGHQNXQQHQYHUNODUHQ+HWHIIHFWYDQ HHQ056$SRVLWLHYHOHYHUDQFLHUEOHHIJHOGLJQDFRUUHFWLH YRRUVWDQGDDUGDQWLELRWLFXPWRHSDVVLQJPDDUYHOHDQGHUH IDFWRUHQNXQQHQWHQJURQGVODJOLJJHQDDQKHWSRVLWLHI ]LMQYDQHHQEHGULMI+HWEHSHUNWHDDQWDOEHGULMYHQHQ EHGULMIVJHJHYHQVLQGH]HVWXGLHODDWHHQPXOWLYDULDWH DQDO\VHQDDUULVLFRIDFWRUHQQLHWWRH9RRUHHQGHUJHOLMNH DQDO\VHLVHHQPHHUXLWJHEUHLGHVWXGLHQRRG]DNHOLMN 9DQGHQ%URHNHWDO>@VXJJHUHUHQGDWGHPDWHYDQ UHVLVWHQWLHWHJHQEHSDDOGHDQWLELRWLFDDIKDQNHOLMNLV YDQKHWVSDW\SH2RNLQRQ]HGDWDEDVHOLMNWKHWHURS GDWEHSDDOGHVSDW\SHQPHHUUHVLVWHQWLHWHJHQEHSDDOGH DQWLELRWLFDODWHQ]LHQGDQDQGHUHVSDW\SHQ'DDUQDDVW YLQGHQZHUHVLVWHQWLHWHJHQVSHFLÀHNHDQWLELRWLFDLQ YHUVFKLOOHQGHVSDW\SHQLQGH]HOIGHSLUDPLGH$DQJH]LHQ GHPHHU]HOG]DPHVSDW\SHQVOHFKWVLQNOHLQHDDQWDOOHQ HQLQppQSLUDPLGHYRRUNRPHQLVKHWUHVLVWHQWLHSDWURRQ YDQGH]HVSDW\SHQYDDNJHOLMN+HWDDQWDOLVRODWHQSHU VSDW\SHZDDURSHHQJHYRHOLJKHLGVEHSDOLQJLVJHGDDQHQ KHWDDQWDOSLUDPLGHV]LMQWHEHSHUNWRPKDUGHXLWVSUDNHQ WHGRHQRYHUUHVLVWHQWLHSDWURQHQELQQHQVSDW\SHQFT SLUDPLGHV+LHUYRRULVPHHULQIRUPDWLHQRGLJ

$DQEHYHOLQJHQ

$DQJH]LHQEHGULMYHQ]RQGHUDDQYRHUHQEHGULMYHQPHW DDQYRHUYDQHHQ056$QHJDWLHIEHGULMIRRNSRVLWLHI NXQQHQ]LMQLVLQKHW/19056$SURJUDPPDRRN HHQULVLFRIDFWRUHQDQDO\VHRSYDUNHQVEHGULMYHQ RSJHQRPHQ/19056$SURMHFW'HUHVXOWDWHQ GDDUYDQZRUGHQJHSUHVHQWHHUGLQGHHLQGUDSSRUWDJHYDQ GDWSURMHFW+HWULVLFRYDQDQWLELRWLFXPWRHSDVVLQJLV GDDULQRRNRSJHQRPHQ %LMREVHUYDWLRQHOHVWXGLHVLQKHWYHOGLVKHWODVWLJRPKHW HIIHFWYDQHHQHQNHOHIDFWRUWHNXQQHQEHSDOHQDDQJH]LHQ WDOOR]HDQGHUHIDFWRUHQWHJHOLMNHUWLMGVSHOHQRIYDULsUHQ WLMGHQVGHVWXGLHSHULRGH,QH[SHULPHQWHHORQGHU]RHN ]DOJHPDNNHOLMNHUKHWHIIHFWYDQHHQHQNHOHIDFWRURI LQWHUYHQWLHPDDWUHJHOJHWRHWVWNXQQHQZRUGHQ,QKRHYHUUH HHQPRJHOLMNHLQWHUYHQWLHELMYRRUEHHOGUHVWULFWLHYH WRHSDVVLQJYDQDQWLELRWLFDOHLGWWRWUHGXFWLHYDQ056$ LVHHQYUDDJGLHEHDQWZRRUGGLHQWWHZRUGHQGRRU JHJHYHQVXLWREVHUYDWLRQHOHVWXGLHVWHFRPELQHUHQPHW H[SHULPHQWHHORQGHU]RHN.OHLQVFKDOLJHH[SHULPHQWHQ ]LMQUHHGVJDDQGHLQ/HO\VWDGXLWYRHUGHU(OV%URHQV :855,90 /RQJLWXGLQDDORQGHU]RHNRSYDUNHQVEHGULMYHQNDQ LQIRUPDWLHRSOHYHUHQRYHUWUDQVPLVVLHURXWHVVQHOKHLGHQ IDFWRUHQYDQLQYORHGGDDURS2RNNDQGH056$VWDWXV YDQHHQEHGULMIJHGXUHQGHODQJHUHWLMGJHYROJGZRUGHQ %LQQHQWZHH(XURSHVHSURMHFWHQQDPHOLMN3LOJULPHQ 6DIHJXDUGZRUGWUHHGVRSEHSHUNWHVFKDDOORQJLWXGLQDDO RQGHU]RHNJHGDDQ 5HVXOWDWHQXLWGLWRQGHU]RHNSOHLWHQYRRUHHQWRS GRZQVWUDWHJLH0RJHOLMNKHGHQYRRUKHW056$YULM ZRUGHQHQEOLMYHQYDQWRSIRNEHGULMYHQYHUJHQQDGHU RQGHU]RHN

*HUHODWHHUGHSURMHFWHQ

 3UHYDOHQWLHVWXGLHHQULVLFRIDFWRUHQDQDO\VHYRRU 056$RS]HXJHQEHGULMYHQ/19056$SURMHFW  7UDQVPLVVLH056$VODFKWKXLV/19056$SURMHFW   5HVLVWHQWLHRQGHU]RHN056$VWDPHQ/19056$ SURMHFW  7\SHULQJ056$LVRODWHQ/19056$SURMHFW  /RQJLWXGLQDDORQGHU]RHNQDDU056$WUDQVPLVVLH ELQQHQYDUNHQVEHGULMYHQ6DIHJXDUGHQ3LOJULP  7UDQVPLVVLHH[SHULPHQWHQYRRU056$LQYDUNHQV :85



2XWSXW

 %URHQV(0*UDDW($0YDQGHU:ROI3-YDQ 'XLMNHUHQ(YDQ1HV$:DJHQDDU-$YDQGHU *LHVVHQ$:HQGH-RQJ0&0&DQ056$EH WUDQVPLWWHGWKURXJKWKHSLJSURGXFWLRQFKDLQ" SRVWHUSUHVHQWDWLHRS:,$66FLHQFH'D\²PDDUW :DJHQLQJHQ1HGHUODQG  %URHQV(0*UDDW($0YDQGHU:ROI3-YDQ 'XLMNHUHQ(YDQ1HV$:DJHQDDU-$YDQGHU *LHVVHQ$:HQGH-RQJ0&0&DQ056$EH WUDQVPLWWHGWKURXJKWKHSLJSURGXFWLRQFKDLQ"OH]LQJ RSHQDEVWUDFWLQ3URFHHGLQJVYDQWK,396FRQJUHV ²MXQL'XUEDQ6RXWK$IULFD  %URHQV(0*UDDW($0YDQGHU:ROI3-YDQ 'XLMNHUHQ(YDQ1HV$:DJHQDDU-$YDQGHU *LHVVHQ$:HQGH-RQJ0&0056$67 LQWKHSLJSURGXFWLRQFKDLQ:KDWLVWKHUROHRIWKH VXSSOLHURISLJV"²SRVWHUSUHVHQWDWLHRSHQDEVWUDFW LQ3URFHHGLQJVYDQ$60FRQIHUHQWLH¶0HWKLFLOOLQ UHVLVWDQWVWDSK\ORFRFFLLQDQLPDOV·²VHSWHPEHU /RQGHQ8.  %URHQV(0*UDDW($0YDQGHU:ROI3-YDQ 'XLMNHUHQ(YDQ1HV$:DJHQDDU-$YDQGHU *LHVVHQ$:HQGH-RQJ0&0056$67 LQWKHSLJSURGXFWLRQFKDLQ:KDWLVWKHUROHRIWKH VXSSOLHURISLJV"SRVWHUSUHVHQWDWLHRSHQSDSHULQ 3URFHHGLQJVYDQ6DIHSRUN²VHSWHPEHU 4XHEHF&DQDGD  ZHWHQVFKDSSHOLMNHSXEOLFDWLHLQHHQGRXEOHUHIHUHHG WLMGVFKULIWLQSURJUHVV

/LWHUDWXXU

 9RVV$HWDO0HWKLFLOOLQUHVLVWDQW6WDSK\ORFRFFXV DXUHXVLQSLJIDUPLQJ(PHUJLQJ,QIHFWLRXV'LVHDVHV S  %HQV&&$9RVVDQG&+.ODDVVHQ3UHVHQFH RIDQRYHO'1$PHWK\ODWLRQHQ]\PHLQPHWKLFLOOLQ UHVLVWDQW6WDSK\ORFRFFXVDXUHXVLVRODWHVDVVRFLDWHG ZLWKSLJIDUPLQJOHDGVWRXQLQWHUSUHWDEOHUHVXOWVLQ VWDQGDUGSXOVHGÀHOGJHOHOHFWURSKRUHVLVDQDO\VLV -RXUQDORI&OLQLFDO0LFURELROS  .KDQQD7HWDO0HWKLFLOOLQUHVLVWDQW6WDSK\ORFRFFXV DXUHXVFRORQL]DWLRQLQSLJVDQGSLJIDUPHUV 9HWHULQDU\0LFURELRORJ\S  6PLWK7&HWDO0HWKLFLOOLQUHVLVWDQW 6WDSK\ORFRFFXVDXUHXV056$VWUDLQ67LV SUHVHQWLQPLGZHVWHUQ86VZLQHDQGVZLQHZRUNHUV 3/R621(SH  9DQGHQ(HGH$HWDO+LJKRFFXUUHQFHRI PHWKLFLOOLQUHVLVWDQW6WDSK\ORFRFFXVDXUHXV67LQ HTXLQHQDVDOVDPSOHV9HWHULQDU\0LFURELRORJ\ S  *UDYHODQG+HWDO0HWKLFLOOLQUHVLVWDQW 6WDSK\ORFRFFXVDXUHXV056$LQYHDOFDOIIDUPHUV DQGYHDOFDOYHVLQ7KH1HWKHUODQGV3URFHHGLQJV RIWKHVW$PHULFDQ6RFLHW\RI0LFURELRORJ\RQ $QWLPLFURELDOUHVLVWDQFHLQ]RRQRWLFEDFWHULDDQG IRRGERUQHSDWKRJHQV-XQH&RSHQKDJHQ 'HQPDUN  +XLMVGHQV;:HWDO&RPPXQLW\DFTXLUHG056$ DQGSLJIDUPLQJ$QQDOVRI&OLQLFDO0LFURELRORJ\DQG $QWLPLFURELDOVS  9DQ'XLMNHUHQ(HWDO7UDQVPLVVLRQRIPHWKLFLOOLQ UHVLVWDQW6WDSK\ORFRFFXVDXUHXVVWUDLQVEHWZHHQ GLIIHUHQWNLQGVRISLJIDUPV9HWHULQDU\0LFURELRORJ\ S  7KUXVÀHOG0HWDO:,1(3,6&23(LPSURYHG HSLGHPLRORJLFDOVRIWZDUHIRUYHWHULQDU\PHGLFLQH 9HWHULQDU\5HFRUGS  'H1HHOLQJ$-HWDO+LJKSUHYDOHQFHRIPHWKLFLOOLQ UHVLVWDQW6WDSK\ORFRFFXVDXUHXVLQSLJV9HWHULQDU\ 0LFURELRORJ\S  +DUPVHQ'HWDO7\SLQJRIPHWKLFLOOLQUHVLVWDQW 6WDSK\ORFRFFXVDXUHXVLQDXQLYHUVLW\KRVSLWDOVHWWLQJ E\XVLQJQRYHOVRIWZDUHIRUVSDUHSHDWGHWHUPLQDWLRQ DQGGDWDEDVHPDQDJHPHQW-RXUQDORI&OLQLFDO 0LFURELRORJ\S  6$6,QVWLWXWH,QF6$667$78VHU·V*XLGH9 6$6,QVWLWXWH,QF&DU\1RUWK&DUROLQD  9DQGHQ%URHN,9)HWDO0HWKLFLOOLQUHVLVWDQW 6WDSK\ORFRFFXVDXUHXVLQSHRSOHOLYLQJDQGZRUNLQJ LQSLJIDUPV(SLGHPLRORJ\DQG,QIHFWLRQ S



3URMHFWOHLGHU

3YDQGHU:ROI*'

3URMHFWWHDP

(0%URHQV49(:85HQ&,E5,90 ($0*UDDW0&0GH-RQJ49(:85 /DE%DFWHULRORJLHHQ3&5*' ;:+XLMVGHQV&,E5,90 '-0HYLXV&9,:85

6DPHQZHUNLQJ

'HUN2RUEXUJHQNZDOLWHLWVPHGHZHUNHUV9,21 9HHKRXGHUV 9DUNHQVWUDQVSRUWHXUV

6DPHQYDWWLQJ

(HQQLHXZHNORRQYDQPHWKLFLOOLQHUHVLVWHQWH 6WDSK\ORFRFFXVDXUHXV056$67LVLQYRRU KHWHHUVWEHVFKUHYHQLQYDUNHQVHQPHQVHQLQFRQWDFWPHW YDUNHQV,Q1HGHUODQGZHUGHHQGLVFUHSDQWLHJHYRQGHQ WXVVHQKHWSHUFHQWDJHSRVLWLHYHEHGULMYHQYRRU056$ JHPHWHQRSYDUNHQVVODFKWKXL]HQHQJHPHWHQRS YDUNHQVEHGULMYHQUHVSHFWLHYHOLMNHQ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ÀUPHHUG9DQSRVLWLHYHLVRODWHQZHUGHQKHWVSDW\SH HQGHDQWLELRWLFXPJHYRHOLJKHLGEHSDDOG $OOHRQGHU]RFKWHYDUNHQVQ ZDUHQ056$ QHJDWLHIELMRSODGHQRSKHWEHGULMI'HWLMGWXVVHQRSHQ XLWODGHQYDULHHUGHWXVVHQHQXXU1DWUDQVSRUWZDUHQ YDUNHQVYDQEHGULMYHQQRJQHJDWLHIHQYDQEHGULMYHQ 056$SRVLWLHIUHVSHFWLHYHOLMNHQYDQGH RQGHU]RFKWHYDUNHQV,QEHLGHYUDFKWZDJHQVZDDULQ GH]HYDUNHQVYHUYRHUGZDUHQWHVWWHRRNYHHJPRQVWHU 056$SRVLWLHI9DUNHQVGLHYHUYRHUGZHUGHQLQHHQ JHFRQWDPLQHHUGHYUDFKWZDJHQKDGGHQHHQKRJHUULVLFR RP056$SRVLWLHIWH]LMQQDWUDQVSRUWSRVLWLHIGDQ YDUNHQVGLHYHUYRHUGZHUGHQLQHHQQLHWJHFRQWDPLQHHUGH YUDFKWZDJHQSRVLWLHI25 9HUYROJHQV YHUEOHYHQGHYDUNHQVWRWXXULQGHZDFKWUXLPWH YRRUGDW]HJHVODFKWZHUGHQ,QYDQGHZDFKWUXLPWHQ ZDUHQGHYHHJPRQVWHUV056$SRVLWLHI2SGHVWHHNWDIHO ZHUGHQWHQVORWWHLQDOOHNRSSHOV056$SRVLWLHYHYDUNHQV JHYRQGHQYDULsUHQGYDQWRWYDQGHYDUNHQVSHU NRSSHO9DUNHQVGLHLQHHQJHFRQWDPLQHHUGHZDFKWUXLPWH KDGGHQJHVWDDQKDGGHQHHQYHUKRRJGULVLFRRP]HOIRRN 056$SRVLWLHIWH]LMQWHQRS]LFKWHYDQYDUNHQV GLHLQHHQQLHWJHFRQWDPLQHHUGHRPJHYLQJVWRQGHQ 25 2RNDOVYDUNHQVGLHSRVLWLHIZDUHQ ELMDDQNRPVWZHUGHQXLWJHVORWHQZDVGLWULVLFRVWHUN YHUKRRJGYHUVXV25 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

6XPPDU\

$GLVWLQFWFORQHRIPHWKLFLOOLQUHVLVWDQW6WDSK\ORFRFFXV DXUHXV056$67ZDVIRXQGLQSLJVDQGSHRSOHLQ FRQWDFWZLWKSLJV7KHGLVFUHSDQF\EHWZHHQSUHYDOHQFHV IRUIDUPVSRVLWLYHIRU056$67IRXQGRQ'XWFK VODXJKWHUKRXVHVDQGRQ'XWFKSLJIDUPVDQG PLJKWEHH[SODLQHGE\WKHWUDQVPLVVLRQRI056$ 67GXULQJWUDQVSRUWIURPSLJVWRVODXJKWHUKRXVHV DQGGXULQJUHVWLQJWLPHLQVODXJKWHUKRXVHV7KLVKDV EHHQGHVFULEHGIRU6DOPRQHOOD7\SKLPXULXPHDUOLHU7KH REMHFWLYHRIWKLVVWXG\ZDVWRHYDOXDWHWKHSRVVLELOLW\RI QHJDWLYHWHVWHGSLJVEHFRPLQJ056$67SRVLWLYH ZLWKLQWKHSHULRGEHWZHHQORDGLQJDWWKHIDUPDQG VWXQQLQJ 6ODXJKWHUSLJVQ IURP056$QHJDWLYHIDUPVZHUH VHOHFWHG$QDVDOVZDEZDVWDNHQIURPWKHSLJVMXVWEHIRUH ORDGLQJIRUWUDQVSRUWDWDUULYDODWWKHVODXJKWHUKRXVH DQGMXVWDIWHUVWXQQLQJ$GGLWLRQDOO\HQYLURQPHQWDO ZLSHVZHUHWDNHQIURPWKHWUDQVSRUWORUU\DQGWKH ODLUDJH0LFURELRORJLFDODQDO\VLVZDVGRQHRQLQGLYLGXDO VDPSOHV&RQÀUPDWLRQRI056$VXVSHFWHGFRORQLHVZDV GRQHE\PXOWLSOH[3&56SDW\SHVDQGDQWLPLFURELDO VXVFHSWLELOLWLHVZHUHGHWHUPLQHG 2QDOOIDUPVDOOSLJVQ WHVWHGQHJDWLYHDWWKH PRPHQWRIORDGLQJEHIRUHWUDQVSRUW7LPHEHWZHHQ

$33(1',;

3URMHFW056$WUDQVPLVVLHWLMGHQVWUDQVSRUWHQLQKHWVODFKWKXLV

 ORDGLQJRQWKHIDUPDQGDUULYDORQWKHVODXJKWHUKRXVH YDULHGEHWZHHQDQGKRXUV$IWHUWUDQVSRUWSLJV IURPIDUPVVWLOOZHUHQHJDWLYHLQWKHRWKHUIDUP EDWFKHV056$SRVLWLYHSLJVZHUHIRXQGUHVSHFWLYHO\ DQG)RUHDFKRIWKHVHEDWFKHVRXWRI HQYLURQPHQWDOZLSHVWDNHQIURPWKHORUU\ZDVSRVLWLYH DVZHOO3LJVWKDWVWD\HGLQFRQWDPLQDWHGORUULHVKDG DKLJKHUULVNRIEHLQJ056$SRVLWLYHDIWHUWUDQVSRUW SRVLWLYHWKDQSLJVWKDWVWD\HGLQORUULHVWKDWWHVWHG QHJDWLYHIRU056$25 6XEVHTXHQWO\WKH SLJVVSHQWIURPWRKRXUVLQWKHODLUDJHVEHIRUH HQWHULQJWKHVODXJKWHUSURFHVV$IWHUWKLVSHULRGLQRXW RIODLUDJHV056$ZDVIRXQGLQWRHQYLURQPHQWDO ZLSHV)LQDOO\LQDOOVODXJKWHUEDWFKHV056$ZDVIRXQG LQWRRIWKHWHVWHGSLJV3LJVWKDWVWD\HGLQD FRQWDPLQDWHGODLUDJHKDGDKLJKHUULVNRIEHLQJ056$ SRVLWLYHWKDQSLJVWKDWVWD\HGLQODLUDJHVWKDWWHVWHG QHJDWLYHIRU056$25 :KHQSLJVSRVLWLYH DIWHUDUULYDOLQWKHVODXJKWHUKRXVHZHUHH[FOXGHGWKLVULVN ZDVVWLOOVLJQLÀFDQWSRVLWLYHYV25  7KHVHUHVXOWVGHPRQVWUDWHWKDWSLJVFDQJHW056$ SRVLWLYHZLWKLQVHYHUDOKRXUVZKHQSODFHGLQD FRQWDPLQDWHGHQYLURQPHQW)RULQWURGXFWLRQRI056$ LQWKHIRRGSURGXFWLRQFKDLQEULQJLQJWRJHWKHUSLJVIURP YDULRXVIDUPVRQWUDQVSRUWORUULHVDQGLQODLUDJHIDFLOLWLHV VHHPVWREHDQLPSRUWDQWULVNIDFWRU)XUWKHUUHVHDUFKLV QHHGHGWRHOXFLGDWHWKHURXWHRIWUDQVPLVVLRQDQGIDFWRUV DIIHFWLQJLW7KHSRVVLEOHKHDOWKKD]DUGIRUORUU\GULYHUV VODXJKWHUKRXVHSHUVRQQHODQGFRQVXPHUVRISRUNQHHGV IXUWKHULQYHVWLJDWLRQ

,QOHLGLQJ

,Q1HGHUODQG]LMQLQGHHHUVWHKXPDQHJHYDOOHQ EHVFKUHYHQYDQ056$GLHJHUHODWHHUGZDUHQDDQ FRQWDFWPHWYDUNHQV>@+HWEOHHNWHJDDQRPHHQ VSHFLÀHNHNORRQGLHQLHWW\SHHUEDDUEOHHNPHWGHLQ 1HGHUODQGJHEUXLNWHVWDQGDDUGPHWKRGH3XOVHG)LHOG*HO (OHFWURIRUHVH>@2RNLQDQGHUHODQGHQZRUGWGH]HNORRQ JHYRQGHQLQYDUNHQV>@'DDUQDDVWEOLMNWGH]HNORRQRRN ELMDQGHUHGLHUVRRUWHQJHYRQGHQWHZRUGHQ>@$OOH LVRODWHQEHKRUHQWRWKHW]HOIGH0XOWL/RFXV6HTXHQFH7\SH 0/67HQGDDURPZRUGWYHHODOGHWHUP056$67 JHKDQWHHUG>@ (HQVWXGLHLQ1HGHUODQGVHYDUNHQVVODFKWKXL]HQYRQGRS GHVWHHNWDIHOYDQGHVODFKWEDWFKHVSRVLWLHIYRRU 056$>@,HGHUHVODFKWEDWFKZDVDINRPVWLJYDQpp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

0DWHULDDOHQPHWKRGHQ

7XVVHQMXOLHQDSULOZHUGHQYHUPHHUGHULQJV YOHHVYDUNHQVEHGULMYHQJHVHOHFWHHUGGLH056$QHJDWLHI JHWHVWZDUHQLQGHORSHQGHULVLFRIDFWRUHQDQDO\VH/19 056$SURMHFW'HEHGULMIVJURRWWHYDULHHUGHYDQ WRW]HXJHQ'HEHGULMYHQOHYHUGHQYDUNHQVDDQ YHUVFKLOOHQGHJURWHFRPPHUFLsOHYDUNHQVVODFKWKXL]HQ LQ1HGHUODQG2SGHEHGULMYHQZHUGHQYDQ VODFKWYDUNHQVQHXVVZDEV0HGLFDO:LUHDQG(TXLSPHQW 0:8.DIJHQRPHQELMKHWRSODGHQRSKHW EHGULMIELMKHWXLWODGHQRSKHWVODFKWKXLVHQRSGH VWHHNWDIHO'LUHFWQDKHWYHUEOLMIYDQGHYDUNHQVZHUGHQ YDQGHFRPSDUWLPHQWHQYDQGHYUDFKWZDJHQHQGH ZDFKWUXLPWHQZDDULQGHYDUNHQVKDGGHQJH]HWHQ RPJHYLQJVPRQVWHUV6RGLER[VNLWULQJHUVROXWLRQ )UDQNULMNJHQRPHQ ,Q7DEHO$]LMQGHWDLOVYDQGHEHGULMYHQHQGHYDUNHQV ZHHUJHJHYHQ2SDOOHEHGULMYHQZHUGHQGHYDUNHQVRS HHQOHJHJHUHLQLJGHYUDFKWZDJHQJHODGHQ'HWLMGWXVVHQ RSODGHQWRWDDQNRPVWRSKHWVODFKWKXLVYDULHHUGHYDQ WRWXXU%LMGHNRSSHOVYDQEHGULMI$%HQ&ZHUGHQ RQGHUZHJQDDUKHWVODFKWKXLVYDUNHQVDINRPVWLJYDQ DQGHUHEHGULMYHQELMJHODGHQRSGHYUDFKWZDJHQ9DUNHQV DINRPVWLJYDQppQEHGULMIZHUGHQRSGHYUDFKWZDJHQHQ LQGHZDFKWUXLPWHYDQKHWVODFKWKXLVELMHONDDUJHKRXGHQ LQHHQDIJHVFKHLGHQUXLPWHHQQLHWJHPHQJGPHWYDUNHQV YDQDQGHUHNRSSHOV2SGHYUDFKWZDJHQZDVGLUHFWFRQWDFW PHWYDUNHQVEHGULMI$%HQ&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9HUGDFKWHLVRODWHQZHUGHQ JHFRQÀUPHHUGPHWEHKXOSYDQHHQPXOWLSOH[3&5>@ 3RVLWLHYHLVRODWHQZHUGHQYRRUVSDW\SHULQJQDDUKHW 5,90JHVWXXUGHQRSPLQVWHQVLVRODDWSHUEHGULMIZHUG HHQDQWLELRWLFXPJHYRHOLJKHLGVEHSDOLQJJHGDDQELMKHW &9,>@ 2PDVVRFLDWLHVWXVVHQGH056$VWDWXVYDQGH RPJHYLQJVPRQVWHUVHQGH056$VWDWXVYDQGHYDUNHQV LQGLHRPJHYLQJWHEHUHNHQHQZHUGXQLYDULDWHH[DFWH ORJLVWLVFKHUHJUHVVLHXLWJHYRHUGPHWEHKXOSYDQ6$6 YHUVLH>@



5HVXOWDWHQ

$OOHRQGHU]RFKWHYDUNHQVQ ZDUHQ056$QHJDWLHI ELMRSODGHQRSKHWEHGULMI1DWUDQVSRUWQDDUKHWVODFKWKXLV ZDVYDQDOOHYDUNHQV056$SRVLWLHI 'H]HYDUNHQVZDUHQDINRPVWLJYDQEHGULMI&HQ'PHW UHVSHFWLHYHOLMNHQSRVLWLHYH YDUNHQV,QEHLGHYUDFKWZDJHQVGLHGHYDUNHQVYDQEHGULMI &HQ'YHUYRHUGHQZHUGRRNLQYDQGHYHHJPRQVWHUV 056$JHYRQGHQ'HRQGHU]RFKWHYDUNHQVDINRPVWLJYDQ EHGULMI$HQ%ZDUHQDOOH056$QHJDWLHIELMDDQNRPVW RSKHWVODFKWKXLV2RNLQYHHJPRQVWHUVDINRPVWLJXLWGH YUDFKWZDJHQVZDDULQGH]HYDUNHQVYHUYRHUGZDUHQZHUG JHHQ056$DDQJHWRRQG7DEHO$

2S GH VWHHNWDIHO ZDV   YDQ GH YDUNHQV 056$SRVLWLHI ,Q DOOH NRSSHOV ZHUG 056$ JHYRQGHQ 'H SUHYDOHQWLH ELQQHQ HHQ NRSSHO YDULHHUGH YDQ  WRW  SRVLWLHYH YDUNHQV ,Q VODFKWKXLV ,, HQ ,,, [ ZHUG RRN056$LQYHHJPRQVWHUVYDQGHZDFKWUXLPWHJHYRQGHQ 7DEHO$  9DUNHQVGLHLQHHQJHFRQWDPLQHHUGHYUDFKWZDJHQ YHUYRHUGZHUGHQKDGGHQHHQJURWHUULVLFRRP056$ SRVLWLHIWHWHVWHQQDWUDQVSRUWSRVLWLHIGDQYDUNHQV GLHLQHHQQLHWJHFRQWDPLQHHUGHYUDFKWZDJHQYHUYRHUG ZHUGHQ25 EWEKL’3 9RRU GHZDFKWUXLPWHYDQKHWVODFKWKXLVJROGKHW]HOIGHDOOHHQ ZDVKHWULVLFRKLHUQRJJURWHUUHVSHFWLHYHOLMNHQ SRVLWLHI25 EWEKL3,QGH EHUHNHQLQJYDQGHODDWVWHRGGVUDWLRZHUGHQRRNYDUNHQV JHwQFOXGHHUGGLHDOSRVLWLHIZDUHQQDWUDQVSRUWDINRPVWLJ YDQEHGULMI&HQ'9DQGDDUGDWKHWEHUHNHQGHULVLFRYDQ HHQJHFRQWDPLQHHUGHZDFKWUXLPWH]HHUZDDUVFKLMQOLMNHHQ RYHUVFKDWWLQJLVYDQGHZHUNHOLMNKHLG,PPHUVGH056$ SRVLWLHYHYDUNHQVNXQQHQRRNELMJHGUDJHQKHEEHQDDQ WUDQVPLVVLHELQQHQGHZDFKWUXLPWH(HQEHWHUHVFKDWWLQJ YDQKHWULVLFRYDQYHUEOLMILQHHQJHFRQWDPLQHHUGH ZDFKWUXLPWHNDQJHPDDNWZRUGHQGRRUDOOHHQGHYDUNHQV YDQEHGULMI$HQ%PHHWHQHPHQLQGHEHUHNHQLQJ Tabel A12.1 Bedrijfsgegevens en resultaten van bemonstering voor en na transport naar het slachthuis en op de steektafel

Bedrijf A Bedrijf B Bedrijf C Bedrijf D Totaal

bedrijfsgrootte (# zeugen) 160 160 320 380

monsterdatum 16/07/2008 27/02/2009 11/03/2009 08/04/2009

-koppelgrootte afgevoerde varkens 60 65 27 63

# bemonsterde varkens 30 30 27 30 117

geslacht van de varkens Ƃƃ ƃ ƃ Ƃ

id slachthuis I II III III

-koppels bijgeladen ja ja ja nee

-# uren tussen op- en uitladen 5 5 4 2

-# uren tussen uitladen en slachten 9 1,75 11,5 2

-totale tijd tussen opladen en slachten 14 6,75 15,5 4

-# varkens gelijktijdig aanwezig in wachtruimte 1000 500 800 500

soort hokafscheidingin wachtruimte open dicht open open

-# varkens MRSA-positief bij opladen 0 0 0 0 0

# varkens MRSA-positief bij uitladen 0 0 7 5 12

# varkens MRSA-positief op steektafel 2 13 27 28 70

% MRSA-positieve varkens op steektafel 6,7 43,3 100 93,3 59,8

# monsters MRSA-positief uit vrachtwagen (totaal) 0 (3) 0 (5) 1 (5) 1 (5) 2 (18) # monsters MRSA-positief uit wacthruimte (totaal) 0 (3) 4 (5) 1 (5) 1 (5) 6 (18)

Tabel A12.2 Associatie tussen MRSA-status van omgeving en varkens die hierin verblijven

variabele categorie varkens n % % MRSA- positief OR 95% btbhi P-exact vrachtwagen positief 57 48,7 21,1 21,7 3,4-' 0,0002 negatief 60 51,3 0 ref - -wachtruimte positief 87 74,4 78,2 48,0 10,6-452,2 <0,0001

(alle varkens) negatief 30 25,6 6,7 ref -

-wachtruimte positief 30 50,0 43,3 10,3 2,0-105,0 0,0021

(varkens negatief na aankomst) negatief 30 50,0 6,7 ref -

 DDQJH]LHQGH]HDOOHQHJDWLHIZDUHQQDWUDQVSRUW'H]H YDUNHQVKDGGHQHHQODJHUPDDUHYHQHHQVHHQYHUKRRJG ULVLFRRP056$SRVLWLHIWHWHVWHQQDYHUEOLMILQHHQ JHFRQWDPLQHHUGHZDFKWUXLPWHSRVLWLHIGDQQD HHQYHUEOLMILQHHQQLHWJHFRQWDPLQHHUGHZDFKWUXLPWH SRVLWLHI25 EWEKL3  'HWDLOVYDQGHEHUHNHQLQJHQVWDDQLQ7DEHO$ ,Q7DEHO$]LMQGHJHYRQGHQVSDW\SHQHQ UHVLVWHQWLHSDWURQHQZHHUJHJHYHQ(U]LMQ YHUVFKLOOHQGHVSDW\SHQJHYRQGHQGLHDOOHHHUGHU JHYRQGHQ]LMQLQYDUNHQVHQWRWKHW67W\SHKRUHQ 6SDW\SHWHQWNZDPHQKHWPHHVWIUHTXHQWYRRU UHVSHFWLHYHOLMNLQHQYDQGHLVRODWHQZDDUYDQ QXHHQVSDW\SHULQJEHNHQGLV'HJHWHVWHLVRODWHQQ  ZDUHQDOOHUHVLVWHQWWHJHQWHWUDF\FOLQHHQJHYRHOLJYRRU ULIDPSLFLQHIXVLGLQH]XXUJHQWDPLFLQHDPLNDFLQH QHRP\FLQHFLSURÁR[DFLQHPXSLURFLQHHQOLQH]ROLG

'LVFXVVLH

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YHUEOLMILQHHQJHFRQWDPLQHHUGHRPJHYLQJ LHYUDFKWZDJHQHQRIZDFKWUXLPWHXLWVFKHLGLQJYDQ 056$GRRUODWHQWHGUDJHUVDOVJHYROJYDQVWUHVVGRRU WUDQVSRUWHQPHQJHQYDQYDUNHQVHQWUDQVPLVVLH YDQ056$WXVVHQYDUNHQVDINRPVWLJYDQYHUVFKLOOHQGH EHGULMYHQ +XPDDQZRUGWGLUHFWFRQWDFWWXVVHQSDWLs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ppQUHSHDWYDQ HONDDURSKHWVWDSK\ORFRFFDOSURWHLQ$VSD'HRRU]DDN YDQKHWWLMGHQVWUDQVSRUWHQRILQGHZDFKWUXLPWHSRVLWLHI ZRUGHQNDQGXVGRRUHHQJHFRQWDPLQHHUGHYUDFKWZDJHQ HQRIZDFKWUXLPWH]LMQPDDURRNYLDGHYDUNHQVYDQ DQGHUHNRSSHOVZDDUPHHLQGLUHFWFRQWDFWZDV9DQGH]H NRSSHOVLVJHHQ056$VWDWXVEHNHQG(UNDQGDQRRN JHHQRRUGHHOJHYHOGZRUGHQRYHUKHWHIIHFWYDQUHLQLJLQJ HQGHVLQIHFWLHSURWRFROOHQGLHLQ1HGHUODQGWRHJHSDVW ZRUGHQYRRUYUDFKWZDJHQVHQVODFKWKXL]HQ1DGHU RQGHU]RHNQDDUGHH[DFWHWUDQVPLVVLHURXWHVHQKHWHIIHFW YDQJHKDQWHHUGHUHLQLJLQJHQGHVLQIHFWLHSURWRFROOHQLV QRRG]DNHOLMNRPWRWHIIHFWLHYHEHKHHUVPDDWUHJHOHQWH NRPHQ +XPDDQZRUGWRQGHUVFKHLGJHPDDNWWXVVHQ Tabel A12.3 Spa-type en resistentiepatroon van de positieve MRSA-isolaten per bedrijf

bedrijf spa-type in varkens (n)

bij uitladen op steektafel

spa-type in omgeving (n) vrachtwagen slachthuis resistentiepatroon A t1457 (2) - - EClT (2) B t108 (6) - t011 (3) T (1)a t011 (6) t108 (1) t2330 (1) C t108 (4) t108 (8) t108 (1) t011 (1) EClT (1)b t011 (3) t011 (18) t2123 (1) D t1457(5) t108(3) t1457(1) t011(1) ? 1 t011(22) t1457 (3) E=erythromycine; Cl=clindamycine; T=tetracycline

a _{van isolaat met spa-type t108 geïsoleerd uit varken op steektafel} b _{van isolaat met spa-type t108 geïsoleerd uit varken bij uitladen}

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GLUHFWFRQWDFWLV PRJHOLMNYLDKDOIRSHQKRNDIVFKHLGLQJHQVHHQH[FUHWD HQYLDGHOXFKW$DQJH]LHQKHWDDQWDO056$SRVLWLHYH YOHHVYDUNHQVEHGULMYHQLQ1HGHUODQGDDQ]LHQOLMNLV>@ LVGHNDQVYULMJURRWGDWYDUNHQVYDQ056$SRVLWLHYH EHGULMYHQVDPHQPHWYDUNHQVYDQ056$QHJDWLHYH EHGULMYHQYHUYRHUGZRUGHQHQYHUYROJHQVYHUEOLMYHQLQGH VODFKWKXL]HQ7UDQVPLVVLHYDQ056$WXVVHQYDUNHQV]RX GDQRRNHHQYRRUGHKDQGOLJJHQGHYHUNODULQJNXQQHQ]LMQ YRRURQ]HEHYLQGLQJHQ'HSUHYDOHQWLHVXLW7DEHO$ ODWHQ]LHQGDWJURIJH]HJGGHKHOIWYDQKHWWRWDOH DDQWDO056$SRVLWLHYHYDUNHQVRSGHVWHHNWDIHO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·VPHW]LFKPHHYRRUPHQVHQZHUN]DDP LQKHWYDUNHQVWUDQVSRUWHQLQGHYDUNHQVVODFKWKXL]HQ2P NULWLHNHRQGHUGHOHQHQHYHQWXHOHEHKHHUVPDDWUHJHOHQDDQ WHNXQQHQZLM]HQLVQDGHURQGHU]RHNQRRG]DNHOLMN

$DQEHYHOLQJHQ

2QGHU]RHNQDDUWUDQVPLVVLHURXWHVVQHOKHLGHQIDFWRUHQ YDQLQYORHGGDDURSNDQKHWEHVWLQHHUVWHLQVWDQWLHRQGHU H[SHULPHQWHOHRPVWDQGLJKHGHQXLWJHYRHUGZRUGHQ .OHLQVFKDOLJHH[SHULPHQWHQ]LMQUHHGVJDDQGHLQ/HO\VWDG /RQJLWXGLQDDORQGHU]RHNRSYDUNHQVEHGULMYHQNDQ GDDUQDDVWRRNLQIRUPDWLHRSOHYHUHQRYHUWUDQVPLVVLHURXWHV HQVQHOKHLGELQQHQEHGULMYHQHQIDFWRUHQYDQLQYORHG GDDURS%LQQHQWZHH(XURSHVHSURMHFWHQQDPHOLMN 3LOJULPHQ6DIHJXDUGLVLQPLGGHOVRSEHSHUNWHVFKDDO ORQJLWXGLQDDORQGHU]RHNYDQVWDUWJHJDDQ 2QGHU]RHNQDDU056$NRORQLVDWLHHQUHSOLFDWLH LQKHWGLHUPRHWRSKHOGHULQJYHUVFKDIIHQRYHU HYHQWXHOHFRPSHWLWLHWXVVHQPHWKLFLOOLQHJHYRHOLJHHQ PHWKLFLOOLQHUHVLVWHQWH6WDSK\ORFRFFXVDXUHXVVWDPPHQ GHJDVWKHHUSDWKRJHHQLQWHUDFWLHHQIDFWRUHQYDQLQYORHG RSLQWHUPLWWHUHQGHHQSHUVLVWHUHQGHNRORQLVDWLHGDQ ZHOLQIHFWLH+HWH[SHULPHQWHOHYDUNHQVPRGHONDQGDQ HYHQHHQVLQIRUPDWLHYHUVFKDIIHQRYHUGHKXPDQHVLWXDWLH 2QGHU]RHNQDDUKHWHIIHFWYDQUHLQLJLQJHQ GHVLQIHFWLHSURWRFROOHQRS056$OLMNWHYHQHHQV]LQYRO

*HUHODWHHUGHSURMHFWHQ

 3UHYDOHQWLHVWXGLHHQULVLFRIDFWRUHQDQDO\VHYRRU056$ RS]HXJHQEHGULMYHQ/19056$SURMHFW  056$ LQ GH YDUNHQVSURGXFWLHNHWHQ /19 056$ SURMHFW  5HVLVWHQWLHRQGHU]RHN056$VWDPPHQ/19056$ SURMHFW  7\SHULQJ056$LVRODWHQ/19056$SURMHFW  2QGHU]RHN QDDU GH 056$EHVPHWWLQJ YDQ

VODFKWKXLVSHUVRQHHO HQ VODFKWKXLVRPJHYLQJ 9:$ SURMHFWXLWJHYRHUGGRRU5,90

 /RQJLWXGLQDDO RQGHU]RHN QDDU 056$WUDQVPLVVLH ELQQHQYDUNHQVEHGULMYHQ6DIHJXDUGHQ3LOJULP  7UDQVPLVVLHH[SHULPHQWHQ YRRU 056$ LQ YDUNHQV

:85

2XWSXW

 %URHQV (0 *UDDW ($0 YDQ GHU :ROI 3- YDQ

GH *LHVVHQ $: GH -RQJ_{0&0 7UDQVPLVVLRQ RI}

056$ 67 GXULQJ WUDQVSRUW RI SLJV IURP IDUP WR VODXJKWHUKRXVHDQGGXULQJWLPHVSHQWLQODLUDJHVDWWKH VODXJKWHUKRXVHOH]LQJRSHQDEVWUDFWLQ3URFHHGLQJV

YDQ $60 FRQIHUHQWLH ¶0HWKLFLOOLQ UHVLVWDQW

6WDSK\ORFRFFLLQDQLPDOV·²VHSWHPEHU/RQGHQ 8.

 %URHQV (0 *UDDW ($0 YDQ GHU :ROI 3- YDQ

GH *LHVVHQ $: GH -RQJ_{0&0 7UDQVPLVVLRQ RI}

056$ 67 GXULQJ WUDQVSRUW RI SLJV IURP IDUP WR VODXJKWHUKRXVHDQGGXULQJWLPHVSHQWLQODLUDJHVDWWKH VODXJKWHUKRXVHOH]LQJRSHQSDSHULQ3URFHHGLQJVYDQ 6DIHSRUN²VHSWHPEHU4XHEHF&DQDGD  ZHWHQVFKDSSHOLMNH SXEOLFDWLH LQ HHQ GRXEOH UHIHUHHG



5HIHUHQWLHV

 9RVV$HWDO0HWKLFLOOLQUHVLVWDQW6WDSK\ORFRFFXV DXUHXVLQSLJIDUPLQJ(PHUJLQJ,QIHFWLRXV'LVHDVHV S  %HQV&&$9RVVDQG&+.ODDVVHQ3UHVHQFH RIDQRYHO'1$PHWK\ODWLRQHQ]\PHLQPHWKLFLOOLQ UHVLVWDQW6WDSK\ORFRFFXVDXUHXVLVRODWHVDVVRFLDWHG ZLWKSLJIDUPLQJOHDGVWRXQLQWHUSUHWDEOHUHVXOWVLQ VWDQGDUGSXOVHGÀHOGJHOHOHFWURSKRUHVLVDQDO\VLV -RXUQDORI&OLQLFDO0LFURELRORJ\S   .KDQQD7HWDO0HWKLFLOOLQUHVLVWDQW6WDSK\ORFRFFXV DXUHXVFRORQL]DWLRQLQSLJVDQGSLJIDUPHUV 9HWHULQDU\0LFURELRORJ\S  9DQGHQ(HGH$HWDO+LJKRFFXUUHQFHRI PHWKLFLOOLQUHVLVWDQW6WDSK\ORFRFFXVDXUHXV67LQ HTXLQHQDVDOVDPSOHV9HWHULQDU\0LFURELRORJ\  *UDYHODQG+HWDO0HWKLFLOOLQUHVLVWDQW 6WDSK\ORFRFFXVDXUHXV056$LQYHDOFDOIIDUPHUV DQGYHDOFDOYHVLQ7KH1HWKHUODQGV3URFHHGLQJV RIWKHVW$PHULFDQ6RFLHW\RI0LFURELRORJ\RQ $QWLPLFURELDOUHVLVWDQFHLQ]RRQRWLFEDFWHULDDQG IRRGERUQHSDWKRJHQV-XQH&RSHQKDJHQ 'HQPDUN  +XLMVGHQV;:HWDO&RPPXQLW\DFTXLUHG056$ DQGSLJIDUPLQJ$QQDOVRI&OLQLFDO0LFURELRORJ\DQG $QWLPLFURELDOVS  'H1HHOLQJ$-HWDO+LJKSUHYDOHQFHRIPHWKLFLOOLQ UHVLVWDQW6WDSK\ORFRFFXVDXUHXVLQSLJV9HWHULQDU\ 0LFURELRORJ\S  9DQ'XLMNHUHQ(HWDO7UDQVPLVVLRQRIPHWKLFLOOLQ UHVLVWDQW6WDSK\ORFRFFXVDXUHXVVWUDLQVEHWZHHQ GLIIHUHQWNLQGVRISLJIDUPV9HWHULQDU\0LFURELRORJ\ S  9DQGHQ%URHN,9)HWDO0HWKLFLOOLQUHVLVWDQW 6WDSK\ORFRFFXVDXUHXVLQSHRSOHOLYLQJDQGZRUNLQJ LQSLJIDUPV(SLGHPLRORJ\DQG,QIHFWLRQ S  +XUG+6HWDO5DSLGLQIHFWLRQLQPDUNHW ZHLJKWVZLQHIROORZLQJH[SRVXUHWRD6DOPRQHOOD 7\SKLPXULXPFRQWDPLQDWHGHQYLURQPHQW$PHULFDQ -RXUQDORI9HWHULQDU\5HVHDUFKS   %RXJKWRQ&HWDO5DSLGLQIHFWLRQRISLJVIROORZLQJ H[SRVXUHWRHQYLURQPHQWVFRQWDPLQDWHGZLWKGLIIHUHQW OHYHOVRI6DOPRQHOOD7\SKLPXULXP)RRGERUQH 3DWKRJHQVDQG'LVHDVHS  +DUPVHQ'HWDO7\SLQJRIPHWKLFLOOLQUHVLVWDQW 6WDSK\ORFRFFXVDXUHXVLQDXQLYHUVLW\KRVSLWDOVHWWLQJ E\XVLQJQRYHOVRIWZDUHIRUVSDUHSHDWGHWHUPLQDWLRQ DQGGDWDEDVHPDQDJHPHQW-RXUQDORI&OLQLFDO 0LFURELRORJ\S  6$6LQVWLWXWH,QF6$667$78VHU·V*XLGH9 6$6,QVWLWXWH,QF&DU\1RUWK&DUROLQD  $OEULFK:&DQG6+DUEDUWK+HDOWKFDUHZRUNHUV VRXUFHYHFWRURUYLFWLPRI056$"/DQFHW,QIHFW 'LVHDVHVS  :LOOLDPV95HWDO7KHUROHRIFRORQL]DWLRQ SUHVVXUHLQQRVRFRPLDOWUDQVPLVVLRQRIPHWKLFLOOLQ UHVLVWDQW6WDSK\ORFRFFXVDXUHXV$PHULFDQ-RXUQDORI ,QIHFWLRQ&RQWURO  %R\FH-0(QYLURQPHQWDOFRQWDPLQDWLRQPDNHVDQ LPSRUWDQWFRQWULEXWLRQWRKRVSLWDOLQIHFWLRQ-RXUQDORI +RVSLWDO,QIHFWLRQV6XSSOS  .QLHKO($%HFNHUDQG'+)RUVWHU%HGEDWKDQG EH\RQGSLWIDOOVLQSURPSWHUDGLFDWLRQRIPHWKLFLOOLQ UHVLVWDQW6WDSK\ORFRFFXVDXUHXVFDUULHUVWDWXVLQ KHDOWKFDUHZRUNHUV-RXUQDORI+RVSLWDO,QIHFWLRQV S  9DQ%HONXP$6WDSK\ORFRFFDOFRORQL]DWLRQDQG LQIHFWLRQKRPHRVWDVLVYHUVXVGLVEDODQFHRIKXPDQ LQQDWHLPPXQLW\DQGEDFWHULDOYLUXOHQFH&XUUHQW 2SLQLRQRQ,QIHFWLRXV'LVHDVHVS   6FDQYLF$HWDO'XUDWLRQRIFRORQL]DWLRQE\ PHWKLFLOOLQUHVLVWDQW6WDSK\ORFRFFXVDXUHXVDIWHU KRVSLWDOGLVFKDUJHDQGULVNIDFWRUVIRUSURORQJHG FDUULDJH&OLQLFDO,QIHFWLRXV'LVHDVHV S  6WHLQHU,3*.HQQHG\DQG$53DFKQHU7KH QHXURWURSLFKHUSHVYLUXVHVKHUSHVVLPSOH[DQG YDULFHOOD]RVWHU/DQFHW1HXURORJ\S   %URHQV(0HWDO3UHYDOHQFHVWXG\DQGULVNIDFWRU DQDO\VLVRI17056$LQSLJVLQ7KH1HWKHUODQGV 3URFHHGLQJVRIWKHVW$PHULFDQ6RFLHW\RI 0LFURELRORJ\RQ$QWLPLFURELDOUHVLVWDQFHLQ]RRQRWLF EDFWHULDDQGIRRGERUQHSDWKRJHQV-XQH &RSHQKDJHQ'HQPDUN  'H%RHU(HWDO3UHYDOHQFHRIPHWKLFLOOLQUHVLVWDQW 6WDSK\ORFRFFXVDXUHXVLQPHDW,QWHUQDWLRQDO-RXUQDO RI)RRG0LFURELRORJ\