Categorical variables are presented as percentages and analyzed using a Chi-squared test. P-values <0.05 were considered statistically significant. For all analyses IBM Statistical Package for the Social Sciences Solutions (SPSS) version 25 (IBM Corp., Armonk, New York, USA) was used. Ethical approval This study was approved by the medical ethical research committee of the Erasmus MC (MEC-2017-1011), and was not subject to the Medical Research Involving Human Subjects Act. Written informed consent was obtained from patients included in the MOVE study. Passive informed consent was accepted for patients admitted to the ICU and for patients who did not participate in the MOVE study, but from whom clinical cultures were included. Patients who did not allow that their data were to be used for research were not included in the study population. This study was registered in the Dutch National Trial Register (NL8406) in February 2020. Results Nasal screening samples Admission and discharge nasal samples were taken from 673 patients (Figure 2a). Three hundred fifteen (46.8%) patients were female, the median duration of hospital stay was six days (range: 2-146 days). In total, 197 (29.2%) patients had ≥1 MSSA positive nasal sample (79 (40.1%) patients had one positive sample and 118 (59.9%) had two positive samples), and one (0.1%) patient was positive for MRSA upon admission (Figure 2a). Twenty-one patients were hospitalized multiple times during the study period; 18 patients twice and three patients three times. No significant differences between the period in the old and the new hospital building were found in the number of MSSA positive patients at admission, positive at discharge, for acquisition, and for loss. Therefore, data from both buildings were combined (data not shown). In total, 161/182 (88.5%) admission isolates and 125/133 (94.0%) discharge isolates were available for spa typing (Figure 3). The 286 isolates belonged to 110 different strain types, of which 45 (40.9%) spa types were observed once (Simpson’s diversity index 0.984 for admission isolates and 0.986 for discharge isolates). The most prevalent spa types were t084 (N=22, 8.1%), t091 (N=20, 7.3%), and t002 (N=11, 4.2%) (Supplementary file 3). Ninety out of 106 (84.9%) of patients were colonized with S. aureus and 16 (15.1%) patients acquired S. aureus. The 14 typed acquired MSSA isolates belonged to 13 different spa types, of which 12 observed once. All typing results can be found in Supplementary file 3. 102 Chapter 2.4
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