Poultry Workers and Livestock-Associated MRSA (ST398): Infection Control, Screening, and Treatment
Occupational Risk Assessment
Poultry workers face substantial occupational exposure to livestock-associated MRSA ST398, with colonization rates of 77-86% documented among workers with direct animal contact, though the actual infection risk remains lower than colonization rates. 1, 2
The transmission pattern is predominantly unidirectional from animals to humans, with colonization typically lost when occupational exposure ceases. 3 Family members living on the same farms show much lower colonization rates (4-5%), and community spread beyond this group is infrequent. 2
Screening Protocols for Poultry Workers
Pre-Hospital Admission Screening
Screen all poultry workers with nasal swabs for MRSA colonization prior to elective medical interventions and hospital admissions to prevent nosocomial infections. 1, 2
Hospitals should implement automated flagging systems to identify livestock workers upon admission as high-risk patients for MRSA carriage. 4, 5
Active MRSA surveillance cultures should be performed rapidly using validated microbiological methods, particularly before high-risk surgeries such as cardiothoracic and orthopedic procedures. 4, 5
Routine Occupational Screening
No specific guidance currently exists for routine screening of asymptomatic poultry workers outside the healthcare setting. 1
Screening is most justified when workers require hospitalization or surgical procedures, rather than as routine occupational health surveillance. 1, 2
Infection Control Measures
Standard Precautions for All Poultry Workers
Implement rigorous hand hygiene using alcohol-based solutions after animal contact and before eating or touching the face. 4, 6
Avoid sharing personal items (razors, towels, clothing) that contact skin between work and home environments. 6
Keep any draining wounds covered with clean, dry bandages at all times. 7, 6
Clean high-touch surfaces regularly, focusing on doorknobs, counters, and bathroom fixtures using standard commercial cleaners. 6
Hospital-Based Infection Control
Place colonized poultry workers requiring hospitalization in single rooms or cohort with other MRSA-positive patients, with healthcare workers wearing gowns and gloves for all patient contact. 4, 7
Contact precautions should be maintained throughout hospitalization unless three consecutive negative cultures from multiple body sites (taken at least one week apart) are documented. 7
Enhanced environmental cleaning with performance monitoring is essential in hospital settings. 7
Decolonization Strategies
Pre-Surgical Decolonization (Strongest Evidence)
- For poultry workers undergoing elective surgery (especially cardiothoracic or orthopedic), implement decolonization starting at least 48 hours before surgery: 5, 6
Decolonization for Recurrent Infections
Consider decolonization only for poultry workers with recurrent MRSA skin and soft tissue infections despite optimized wound care and hygiene measures. 6, 1
Use the same mupirocin/chlorhexidine protocol as pre-surgical decolonization. 6
Critical Limitation for Active Workers
Long-term decolonization success rates are low (40-60% recolonization within 3 months) in workers with continuous livestock contact. 6, 1
Decolonization provides only temporary clearance while occupational exposure continues. 1
Do not perform routine decolonization for asymptomatic colonization in active poultry workers, as recolonization is inevitable with ongoing exposure. 1
Treatment of Active Infections
Outpatient Skin and Soft Tissue Infections
For purulent skin infections, perform incision and drainage plus oral antibiotics: 5
LA-MRSA ST398 strains are typically susceptible (>95%) to mupirocin and retain susceptibility to multiple antibiotic classes despite multi-drug resistance patterns. 1, 2
Hospitalized Patients with Complicated Infections
For complicated skin and soft tissue infections requiring hospitalization, use intravenous therapy: 5
For uncomplicated MRSA bacteremia, treat with vancomycin or daptomycin for at least 2 weeks with follow-up cultures to document clearance. 5
Clinical Characteristics of LA-MRSA Infections
LA-MRSA CC398 causes the same spectrum of infections as other S. aureus strains, including bacteremia, pneumonia, osteomyelitis, endocarditis, and surgical site infections. 2, 8
Patients infected with LA-MRSA CC398 generally show less severe complications, younger age, and shorter hospital stays compared to other MRSA lineages. 8
LA-MRSA CC398 typically lacks Panton-Valentine leukocidin and enterotoxin genes, potentially contributing to lower virulence. 3
Household Contact Management
Symptomatic household contacts should be evaluated and treated for possible MRSA infection. 6
Asymptomatic household contacts may be considered for decolonization only if ongoing transmission within the household is documented despite hygiene interventions. 6
Educate all household members on hand hygiene, avoiding shared personal items, and environmental cleaning of high-touch surfaces. 5, 6
Critical Pitfalls and Caveats
The occupational health risk from LA-MRSA ST398 is not well understood, with insufficient data on the true incidence of occupation-related infections. 1
While colonization rates are extremely high (77-86%), the proportion of colonized workers who develop clinical infections remains unclear. 1, 2
LA-MRSA accounts for approximately 10% of sporadic MRSA infections in Germany, with higher proportions (up to 15%) in geographic areas with high livestock density. 2
Intrahospital dissemination of LA-MRSA is rare compared to traditional hospital-associated MRSA, but nosocomial transmission can occur. 2
Monitor local mupirocin resistance patterns, as high-level resistance can develop with repeated decolonization attempts. 6
Do not use hexachlorophane in children under 2 months due to neurological complications risk. 6
Currently, no specific evidence supports measures to prevent community-acquired LA-MRSA infections in active poultry workers beyond standard hygiene practices. 1