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 Tabel A6.1 Variabelen van bedrijfsgegevens afgeleid van de enquête, met het aantal bedrijven en de bedrijfs- en poolprevalentie voor MRSA per categorie (n=171 bedrijven; n=1699 poolmonsters)

Variabele frequentie (n) bedrijfsprevalentie (%) poolprevalentie (%)

periode (2007-1; 2007-2; 2008-1; 2008-2)1 _{16;5;91;59 37,5;40,0;71,4;72,9 25,6; 25,0; 44,4; 46,5} seizoen (lente, zomer, herfst, winter) 71; 42; 32; 26 74,7; 64,3; 75,0; 46,2 48,2; 45,7; 43,4; 23,6 varkensdichtheid regio () 17; > 17 varkens/ha) 88; 83 60,2; 75,9 39,9; 46,2

bedrijfstype (A;B) 80; 91 76,3; 60,4 51,1; 35,8

aanvoer van gelten (ja; nee) 98; 73 66,3; 69,9 38,5; 48,9 aantal zeugen (<250; 250-600; > 600)1 _{59; 79; 33 49,2; 73,4; 87,9 24,3; 48,2; 63,6}

aanwezigheid van vleesvarkens (<100; > 100) 108; 63 71,3; 61,9 44,8; 39,8 aanwezigheid van andere dieren (ja;nee) 136;35 64,7; 80,0 38,9; 58.9 melkvee (gem. 56.7, range 1-160, mediaan 40) 18;153 38,9; 71,2

vleesvee (gem. 19.1, range 1-60, mediaan 6.5) 9; 162 100,0; 66,1 pluimvee (gem. 1988.7, range, 1-50000, mediaan 8) 26; 145 71,0; 71,2 schapen (gem. 31.2, range 2-200, mediaan 15) 25; 146 68,0; 67,8 geiten (gem. 5.1, range 1-30, mediaan 2) 10; 161 90,0; 66,5 paarden (gem. 5.4, range 1-80, mediaan 3) 44; 127 68,2; 67,7 honden/katten (gem. 2.4, range 1-11, mediaan 2) 109; 62 65,1; 72,6

hygiëne score (laag; gemiddeld; hoog)2 _{30; 98; 43 53,3; 69,4; 74,4 33,3; 42,6; 50,6}

reiniging en desinfectie (desinfectie; inweken; schoonspuiten;

geen)4 _{90; 11; 61; 9 71,1; 63,6; 65,6; 55,6 44,9; 44,7; 39,5; 28,1}

gebruik van desinfectiemiddelen (ja; nee)3 _{90; 80 71,1; 63,8 44,0; 41,4} ongediertebestrijding (zelf; professioneel) 100; 71 65,0; 71,8 40,4; 46,5

vliegenbestrijding (ja; nee) 146; 25 71,2; 48,0 46,4; 22,8

aparte stallen voor leeftijdsgroepen (ja; nee)3 _{115; 56 67,8; 67,9 41,2; 44,8} aparte kleding voor leeftijdsgroepen (ja; nee)3 _{23; 148 69,6; 67,6 47,8; 42,2} apart gereedschap voor leeftijdsgroepen (ja; nee)3 _{78; 93 73,1; 63,4 47,5; 39,1} huisvesting zeugen (ind; kleine groepen; grote groepen) 113; 33; 25 68,1; 66,7; 68,0 39,1; 47,1; 35,65

wassen kraamzeugen (ja; nee) 122; 49 69,7; 63,3 41,2; 30,65

overleggen van pasgeboren biggen (<24 hr; > 24 hr; beiden)4 _{96; 56; 19 66,7; 69,6; 68,4 51,8; 54,7; 58,3}5 groepsgrootte gespeende biggen (1-15; >15; geen gespeende

biggen) 110; 59; 2 63,6; 76,3; 50,0 48,0; 63,9; -5

groepsgrootte vleesvarkens () 10; > 10; geen vleesvarkens) 120; 22; 29 70,8; 59,1; 62,1 28,6; 37,95 vlotterton in drinkwatersysteem (ja; nee)3 _{78; 93 60,3; 74,2 47,9; 37,1}

voersysteem vleesvarkens (brij; droogvoer; trog; geen

vleesvarkens) 46; 58; 20; 29 71,7; 63,8; 70,0; 62,1 47,9;37,4; 57,0; 34,15 voeren van bijproducten aan vleesvarkens (ja; nee; geen

vleesvarkens) 35; 107; 29 68,6; 69,2; 62,1 53,7; 41,8; 34,15

aanzuren water bij vleesvarkens (ja; nee; geen vleesvarkens) 16; 126; 29 75,0; 68,3; 62,1 56,; 43,2; 34,15 dikgedrukte variabelen hadden een P-waarde < 0,25 in de univariate analyse op bedrijfs- en poolniveau

cursief weergegeven variabelen hadden een P-waarde < 0,25 in de univariate analyse op poolniveau 1 _{variabelen zijn als continue variabele meegenomen in het multivariate model (zie Figuur 2 en 3)}

2 _{variabele is hier in 3 klasses ingedeeld: laag () 3 hygiënemaatregelen), gemiddeld (4 of 5 hygiënemaatregelen) of hoog (* 6} hygiënemaatregelen); gescoorde hygiënemaatregelen: gebruik van douche, gebruik van water en zeep, aparte in- en uitgang hygiënesluis, gebruik desinfectiebak, gebruik hygiënesluis door veehouder zelf, aparte kleding en gereedschap per leeftijdsgroep 3 _{variabelen zijn hier voor alle leeftijdsgroepen gezamenlijk gepresenteerd; analyse van effect per leeftijdsgroep is ook uitgevoerd} 4 _{er waren geen bedrijven die pasgeboren biggen niet overleggen}

 

Tabel A6.2 Aantal pools, poolprevalentie voor MRSA en antibioticumtoepassing per leeftijdsgroep (totaal 1699 poolmonsters, afkomstig van 170 bedrijven)

leeftijdsgroep frequentie (n) poolprevalentie (%) std abtoepassing (%) std risico-ab (%)

zeugen 737 38,3 29,3 15,3

kraambiggen 322 53,4 65,5 56,2

speenbiggen 382 52,9 53,7 29,3

opfok 147 23,8 8,8 3,4

vleesvarkens 111 38,7 21,6 6,3

std = preventief toegepaste medicatie, vaak voorgeschreven voor een gehele groep/afdeling; ab=antibiotica; risico-ab = bèta-lactam antibiotica en/of tetracyclinen

Tabel A6.3 Verschillende indelingen van antibioticumtoepassing zoals gebruikt in de multivariate statistische analyse op poolniveau

model klassen (n) indeling van antibioticumtoepassing poolprevalentie

a 2 wel; geen ab 45,5; 32,6

b 3 std ; inc ; geen ab 51,0; 40,5; 32,6

c 5 std risico-ab ; inc risico-ab; std overig; inc overig; geen ab 55,5; 42,3; 39,5; 34,4; 32,6

d 3 std risico-ab; overig ab; geen ab 55,5; 41,3; 32,6

e 3 risico-ab; overig ab; geen ab 46,9; 37,2; 36,2

std = preventief toegepaste medicatie, vaak voorgeschreven voor een gehele groep/afdeling) ; inc = incidentele, curatieve toepassing van antibiotica; ab = antibiotica; risico-ab = bèta-lactam antibiotica en/of tetracyclinen

Tabel A6.4 Aantal bedrijven, gemiddelde bedrijfsgrootte, bedrijfs- en poolprevalentie voor MRSA, het totaal aantal isolaten en het aantal en percentage van meestvoorkomende en overige spa-typen per provincie

provincie1 _aantal bedrijven gemiddelde bedrijfs-grootte bedrijfs preva-lentie (%) pool- preva-lentie (%) totaal aantal isolaten t011 t108 t1457 overige spa-typen n % n % n % n % Drenthe 4 342 0,0 0,0 0 0 - 0 - 0 - 0 -Flevoland 2 350 0,0 0,0 0 0 - 0 - 0 - 0 -Friesland 2 345 100,0 50,0 11 6 54,6 0 - 0 - 5 45,4 Gelderland 30 447 76,7 52,0 202 82 40,6 92 45,5 2 1,0 26 12,9 Groningen 4 245 25,0 15,0 8 0 - 0 - 8 100,0 0 -Limburg 24 580 79,2 48,8 150 117 78,0 28 18,7 0 - 5 3,3 Noord-Brabant 63 428 73,0 44,7 345 139 40,3 162 47,0 1 0,3 43 12,4 Noord-Holland 1 220 0,0 0,0 0 0 - 0 - 0 - 0 -Overijssel 28 384 60,7 38,9 134 79 58,9 26 19,4 25 18,7 4 3,0 Utrecht 12 388 66,7 45,8 74 62 83,8 7 9,5 0 - 5 6,7 Zeeland 0 - - - -Zuid-Holland 1 100 0,0 0,0 0 0 - 0 - 0 - 0 -Totaal 171 4312 _{67,8 43,0 924 485 52,5 315 34,1 36 3,9 88 9,5}

1 _{in de analyse zijn de provincies niet als variabele meegenomen, de regio-indeling naar varkensdichtheid had de voorkeur} 2 _{mediaan = 320; Q1-Q3=220-500; range 24-2100}



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positief: humaan en veterinair

30%

26% 44%

negatief: humaan; positief: veterinair negatief: humaan en veterinair

Figuur A6.1 Prevalentie van MRSA in humane en/of veterinaire monsters per varkensbedrijf (totaal 50 bedrijven)

positief: pool en stof

47%

17% 4%

32%

positief: pool; negatief: stof positief: stof; negatief: pool negatief: pool en stof

Figuur A6.2 Bedrijfsuitslag voor MRSA van 202 varkensbedrijven gebaseerd op pool- en/of stofmonsters

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Tabel A6.5 Spa-type, repeat volgorde, MLST-type, frequentie van voorkomen (aantal en %) en het aantal bedrijven waar dit type gevonden werd

spa-type repeat volgorde1 _ST-type1 _{frequentie bedrijven}

n % n t002 26-23-17-34-17-20-17-12-17-17 ST-5 5 0,5 1 t011 08-16-02-25-34-24-25 ST-398 485 52,5 69 t034 08-16-02-25-02-25-34-24-25 ST-398 3 0,3 1 t108 08-16-02-25-24-25 ST-398 315 34,1 50 t1184 08-16-02-25-25 ST-398 12 1,3 4 t127 07-23-21-16-34-33-13 ST-1 16 1,7 2 t1451 08-16-02-25-34-25 ST-398 1 0,1 1 t1456 08-16-02-25 ST-398 8 0,9 2 t1457 08-16-02-25-34-02-25-34-24-25 ST-398 36 3,9 9 t2011 08-16-16-02-25-34-24-25 ST-398 1 0,1 1 t2330 08-16-02-25-34-24-25-25 ST-398 9 1,0 1 t2346 08-16-02-25-34-24-24-25 ST-398 4 0,4 1 t3479 08-16-02-25-24-24-25 ST-398 3 0,3 1 t4119 09-02-25-24-25 ST-398 1 0,1 1 t567 08-02-25-24-25 ST398 11 1,2 2 t571 08-16-02-25-02-25-34-25 ST-398 4 0,4 1 t588 08-16-02-24-25 ST-398 4 0,4 1 t899 07-16-23-02-34 ST-398 6 0,6 3

dikgedrukte spa-typen behoren niet tot ST398 1 _{afkomstig van www.spaserver.ridom.de}

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spa-type t0021 _{t011 t034 t108 t1184 t127}1 _{t1456 t1457 t2330 t2346 t567 t571 t588 totaal} aantal isolaten 5 202 1 94 3 1 1 15 1 4 11 1 4 344 Antibioticum Amikacine 0,0 3,5 0,0 0,0 0,0 0,0 0,0 0,0 0,0 25,0 0,0 0,0 0,0 2,3 Ciprofloxacine 100,0 4,0 0,0 5,3 0,0 0,0 0,0 0,0 0,0 0 0,0 0,0 0,0 5,2 Clindamycine 40,0 59,9 100,0 58,5 66,7 100,0 100,0 33,3 100,0 100,0 9,1 0,0 100,0 57,6 Erythromycine 40,0 59,9 100,0 61,7 66,7 100,0 100,0 33,3 100,0 100,0 9,1 0,0 100,0 58,4 Fusidinezuur 0,0 0,0 0,0 0,0 0,0 0,0 0,0 13,3 0,0 0,0 0,0 0,0 0,0 0,6 Gentamicine 60,0 66,3 0,0 4,3 0,0 100,0 0,0 0,0 0,0 100,0 0,0 0,0 0,0 42,4 Linezolid 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 Mupirocin 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 Neomycine 100,0 35,6 0,0 1,1 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 0,0 22,7 Rifampicine 0,0 0,0 0,0 10,6 33,3 0,0 0,0 26,7 0,0 0,0 0,0 0,0 100,0 5,5 Tetracycline 40,0 100 100,0 100,0 100,0 100,0 100,0 100,0 100,0 100,0 100,0 100,0 100,0 99,1 1 _{geen ST398}

Tabel A6.7 MRSA-prevalentie van personen woonachtig en/of werkzaam op varkensbedrijven (univariate logistische regressie) personen van alle bedrijven personen van MRSA-positieve bedrijven

totaal % MRSA totaal % MRSA

totaal 232 14,2% 139 23,7%

intensief contact met varkens 1 minimaal contact met varkens 2 geen contact met varkens

98 25 109 28,6% 12,0% 1,8% 57 14 68 49,1% 21,4% 2,9% zeugen en vleesvarkens aanwezig

alleen zeugen aanwezig alleen vleesvarkens aanwezig alleen opfokvarkens aanwezig

58 40 129 5 25,9% 12,5% 10,1% 0,0% 32 9 98 0 46,9% 55,6% 13,3% 0,0% dikgedrukte variabelen hadden een P-waarde < 0,05

1 _{intensief contact = personen dagelijks werkzaam in de varkenshouderij}



Tabel A6.8 Variabelen en hun effect in het multivariate eindmodel voor MRSA-positieve personen op MRSA-positieve varkensbedrijven

OR 95% btbhi P-waarde

intensief contact met varkens 1 minimaal contact met varkens 2 geen contact met varkens

39,9 9,4 ref 7,6-208,8 1,2-73,5 ref <0,0001 0,03 zeugen en vleesvarkens aanwezig

alleen zeugen aanwezig alleen vleesvarkens aanwezig

8,8 3,5 ref 2,6-29,9 0,8-16,6 ref 0,001 0,11

1 _{intensief contact = personen dagelijks werkzaam in de varkenshouderij}

2 _{minimaal contact = personen niet werkzaam in de veehouderij, maar minimaal 1x per week contact met varkens}

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% 0 250 500 750 1000

Bedrijfsgrootte (aantal zeugen)

1250 1500 1750 2000

MRSA positieve bedrijven (%)

= % positieve bedrijven

= % positieve pools op positieve bedrijven kans op MRSA-positief zijn: 100/(1 + exp(0.3846 - 0.00312 * aantal zeugen))

100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% -6

Maanden (1 = januari 2007; 24 = december 2008)

36 33 30 27 24 21 18 15 12 9 6 3 0 -3 = % positieve bedrijven

= % positieve pools op positieve bedrijven kans op MRSA-positief zijn: 100/(1 + exp(0.9328 - 0.1034 * maand)₎

MRSA positieve bedrijven (%)

Figuur A6.3. Percentage MRSA-positieve bedrijven en het percentage positieve pools op positieve bedrijven gerelateerd aan de bedrijfsgrootte (aantal zeugen)

Figuur A6.4. Het verloop van het percentage MRSA-positieve bedrijven en het percentage positieve pools op positieve bedrijven in de tijd (onderzoeksperiode in maanden; start onderzoek in maand 1)

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Tabel A6.9 Variabelen en hun effect in het multivariate eindmodel voor het risico MRSA-positief zijn van een bedrijf (n=171)

variabele categorie OR 95% btbhi P-waarde

aantal zeugen per 100 continu 1,32 1,11-1,57 0,0016



Tabel A6.10a Variabelen en hun effect in eindmodel a voor MRSA-positief zijn op poolmonsterniveau, gecorrigeerd voor bedrijfseffect (n=1699)

variabele categorie frequentie prevalentie OR 95% btbhi P-waarde P-overall

n %

aantal zeugen per 100 continu 1,30 1,17-1,45 < 0,0001

tijdsverloop per maand continu 1,10 1,01-1,19 0,0244

leeftijdsgroep opfok 147 8,7 23,8 0,23 0,13-0,41 < 0,0001 < 0,0001

vleesvarkens 111 6,5 38,7 1,84 0,94-3,60 0,0735

speenbiggen 382 22,5 52,9 4,60 3,10-6,81 < 0,0001 kraambiggen 322 19,0 53,4 3,65 2,44-5,45 < 0,0001

zeugen 737 43,4 38,3 ref ref ref

antibioticumtoepassing ja 1395 82,1 45,5 1,68 0,98-2,88 0,0614

nee 304 17,9 32,6 ref ref ref

Tabel A6.10b Variabelen en hun effect in eindmodel b voor MRSA-positief zijn op poolmonsterniveau, gecorrigeerd voor bedrijfseffect (n=1699)

variabele categorie frequentie prevalentie OR 95% btbhi P-waarde P-overall

n %

aantal zeugen per 100 continu 1,31 1,17-1,46 < 0,0001

tijdsverloop per maand continu 1,10 1,01-1,19 0,0245

leeftijdsgroep opfok 147 8,7 23,8 0,23 0,13-0,41 < 0,0001 < 0,0001

vleesvarkens 111 6,5 38,7 1,82 0,93-3,56 0,0809

speenbiggen 382 22,5 52,9 4,77 3,17-7,17 < 0,0001 kraambiggen 322 19,0 53,4 3,86 2,50-5,97 < 0,0001

zeugen 737 43,4 38,3 ref ref ref

antibioticumtoepassing standaard 669 39,4 51,0 1,80 1,01-3,21 0,0473 0,1396

incidenteel 726 42,7 40,5 1,56 0,87-2,79 0,1392

nee 304 17,9 32,6 ref ref ref



Tabel A6.10c Variabelen en hun effect in eindmodel c voor MRSA-positief zijn op poolmonsterniveau, gecorrigeerd voor bedrijfseffect (n=1699)

variabele categorie frequentie prevalentie OR 95% btbhi P-waarde P-overall

n %

aantal zeugen per 100 continu 1,31 1,17-1,46 < 0,0001

tijdsverloop per maand continu 1,10 1,01-1,19 0,0236

leeftijdsgroep opfok 147 8,7 23,8 0,23 0,13-0,40 < 0,0001

vleesvarkens 111 6,5 38,7 1,74 0,88-3,43 0,1090

speenbiggen 382 22,5 52,9 4,77 3,19-7,14 < 0,0001 kraambiggen 322 19,0 53,4 4,02 2,55-6,32 < 0,0001

zeugen 737 43,4 38,3 ref ref ref

antibioticumtoepassing risico-std 418 24,6 55,5 2,16 0,92-5,12 0,0790 0,2745

risico-inc 778 45,8 42,3 2,09 0,86-5,11 0,1042

overig-std 109 6,4 39,5 1,70 0,94-3,10 0,0814

overig-inc 90 5,3 34,4 1,40 0,75-2,61 0,2938

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variabele categorie frequentie prevalentie OR 95% btbhi P-waarde P-overall

n %

aantal zeugen per 100 continu 1,31 1,17-1,46 < 0,0001

tijdsverloop per maand continu 1,10 1,01-1,19 0,0241

leeftijdsgroep opfok 147 8,7 23,8 0,23 0,13-0,41 < 0,0001 < 0,0001

vleesvarkens 111 6,5 38,7 1,79 0,91-3,51 0,0921

speenbiggen 382 22,5 52,9 4,79 3,21-7,16 < 0,0001 kraambiggen 322 19,0 53,4 4,06 2,59-6,37 < 0,0001

zeugen 737 43,4 38,3 ref ref ref

antibioticumtoepassing risico-std 418 24,6 55,5 1,43 0,77-2,66 0,2542 0,1016

overig 977 57,5 41,3 1,83 1,04-3,22 0,0370

nee 304 17,9 32,6 ref ref ref

Tabel A6.10e Variabelen en hun effect in eindmodel e voor MRSA-positief zijn op poolmonsterniveau, gecorrigeerd voor bedrijfseffect (n=1699)

variabele categorie frequentie prevalentie OR 95% btbhi P-waarde P-overall

n %

aantal zeugen per 100 continu 1,31 1,17-1,46 < 0,0001

tijdsverloop per maand continu 1,10 1,01-1,19 0,0233

leeftijdsgroep opfok 147 8,7 23,8 0,23 0,13-0,40 < 0,0001 < 0,0001

vleesvarkens 111 6,5 38,7 1,77 0,90-3,47 0,0982

speenbiggen 382 22,5 52,9 4,62 3,11-6,85 < 0,0001 kraambiggen 322 19,0 53,4 3,68 2,46-5,51 < 0,0001

zeugen 737 43,4 38,3 ref ref ref

antibioticumtoepassing risico 1196 70,4 46,9 1,57 0,89-2,74 0,1168 0,1068

overig 199 11,7 37,2 2,09 1,04-4,17 0,0376

nee 304 17,9 32,6 ref ref ref

standaard = preventief toegepaste medicatie, vaak voorgeschreven voor een gehele groep/afdeling; incidenteel = incidentele, curatieve toepassing van antibiotica; risico-std = standaardtoepassing van bèta-lactam antibiotica en/of tetracyclinen; risico-inc = incidentele toepassing van bèta-lactam antibiotica en/of tetracyclinen; overig-std = standaardtoepassing van antibiotica anders dan bèta-lactam antibiotica en/of tetracyclinen; overig-inc = incidentele toepassing van antibiotica anders dan bèta-lactam antibiotica en/ of tetracyclinen; risico = toepassing van bèta-lactam antibiotica en/of tetracyclinen; overig = toepassing van antibiotica anders dan bèta-lactam antibiobica en/of tetracyclinen

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Tabel A6.12 Aantal en percentage positieve pools, stofmonsters en bedrijven voor het laboratorium van RIVM en GD.

Aantal positief

laboratorium pool stof bedrijf

n % N % n %

RIVM 58 72,5 20 50,0 8 100,0

GD 46 57,5 21 52,5 8 100,0

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Tabel A6.11 Gemiddelde bedrijfsgrootte per categorie van relevante variabelen gemiddelde bedrijfs-grootte variabele categorie bedrijfstype A 570a B 310b seizoen lente 386a zomer 488b herfst 442ab winter 452ab ongediertebestrijding zelf 312a professioneel 560b

aanvoer van gelten ja 511a

nee 373b

vliegenbestrijding ja 457a

nee 288b

aanwezigheid andere dieren ja 401a

nee 554b aanwezigheid vleesvarkens ja 355a nee 476b vlotterton ja 345a nee 503b dichtheid >17 varkens/ha 465a )17 varkens/ha 401b hygiënescore laag 323a gemiddeld 419b hoog 535c antibioticumtoepassing (model a) ja 449a nee 355b antibioticumtoepassing (model b) std 486a inc 415b nee 355c

antibioticumtoepassing (model c) risico-std 508b risico-inc 434a overig-std 419abd overig-inc 346ad nee 355cd antibioticumtoepassing (model d) risico-std 508a

overig 424b

nee 355c

antibioticumtoepassing (model e) risico 460a

overig 386b

nee 355b

abcd _{verschillend superscript binnen één variabele betekent dat de} waarden significant verschillend zijn (P<0,05; generalized linear regression, Proc GLM, SAS, versie 9.1)



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bedrijven zonder zeugen (n = 31) bedrijven met zeugen (n = 171)

pool en stof negatief pool positief; stof negatief pool en stof positief

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