A systematic study was undertaken from 2000 to 2002 to determine the occurrence of methicillin resistant Staphylococcus aureus (MRSA) in nursing homes in four regions of the Netherlands (1), including Amsterdam, which was also investigated 10 years ago (2). The three other regions were selected for the study because prior to this, MRSA had emerged in local hospitals and nursing homes. The study included 16 nursing homes in total. All participants in the study were tested by obtaining a nasal swab, and, where possible, a wound swab. Eight of the 1218 residents tested (0.7%) were found to be carrying MRSA (1). As shown by pulsed field gel electrophoresis (PFGE), the MRSA isolates were indistinguishable from each other and to MRSA from local hospitals. Indistinguishable strains were assumed to have arisen from the same source, or by cross infection.Therefore MRSA may have been transmitted from local hospitals to nursing homes through transfer of patients or vice versa.

This low prevalence of MRSA carriage, even though this carriage can last for months or years, indicates a very low rate of transmission.The prevalence of 0.7% MRSA in these Dutch nursing homes was higher than the prevalence of 0.2% found in a similar survey in the Netherlands carried out 10 years ago in nursing homes in Amsterdam and Rotterdam (2), but lower than the prevalence of 4.9% in Belgian nursing homes (5). In studies of German nursing homes (3,4), a prevalence of 1.1-2.4% was found, although in the first study (3), 30 of the 36 MRSA cases detected were of the same strain, probably picked up from a nearby hospital. So the transmission of MRSA in German nursing homes also appears to be low. Although this study observed a higher prevalence in the Dutch nursing homes than the previous Dutch study, it should be borne in mind that this percentage is still low and that the homes participating in the study had had elevated levels of MRSA incidence in the past, or received patients from hospitals with MRSA outbreaks.

This conclusion is in line with the relatively low prevalence of MRSA in Dutch hospitals in comparison with the surrounding countries (see website of European Antimicrobial Resistance Surveillance System (EARSS), http://www.earss.rivm.nl/).The low prevalence may be due to the relatively restrained use of antibiotics in the Netherlands compared with other European countries (see website of European Surveillance of Antimicrobial Consumption (ESAC), http://www.ua.ac.be/main.asp?c=*ESAC) and the adherence to strict infection control guidelines as issued by the Werkgroep Infectie Preventie (WIP, Dutch working party on infection prevention, guidelines available at http://www.wip.nl/).