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To enable the targeting of CYTH4 control strategies for MUO, the magnitude of the problem was measured and the differences were determined between MUO and MRSA of known origin (MKO; comprising MRSA risk groups and contact tracing described in the targeted surveillance). Data from the national MRSA surveillance database at the National Institute for Public Health and Environmental Protection (RIVM) between 1 January 2008 and 31 December 2009 were used. All MRSA strains sent to the RIVM by 68 Dutch laboratories, covering the whole country, are registered in this database. Of the cultures positive for MRSA taken from a single person, one, usually the first detected, strain is sent to the RIVM. A check on duplicates in the database further ensured one MRSA strain per person. At the RIVM the MRSA strains were confirmed by testing for the presence of the mecA gene and the coagulase gene. For all confirmed MRSA the spa-type, as described by Harmsen et?al. [4], and the presence of the Panton�CValentine leukocidin gene (PVL-gene) were determined [5]. As there was no significant difference in the number and data of reported isolates and carriers between the 2?years, data were pooled to increase power. Based on spa-types we distinguished CC398 (livestock-associated strains) and non-CC398 [6]. CC398 was checked by RIVM with multiple-locus variable number tandem repeat analysis (http://www.mlva.net/). CC398 was analysed Metformin as a separate group from non-CC398. Each strain was submitted with a form, with background information on hospital, demographic patient information, risk factors when applicable (Table?1), and other relevant epidemiological information. Laboratories were approached by the RIVM to complete their missing data as much as possible. Two defined groups, MUO and MKO, were classified based on the included information on defined risk factors requested. The absence of either defined risk factors or of risk factors found through contact tracing, led to a classification of MUO. Additional remarks were usually made on the form and/or the box for ��Unknown MRSA�� was ticked. Isolates with no or incomplete additional epidemiological data (No data), which made classification impossible, were not included in further descriptive and multivariate analysis. Finally, additional remarks on ISRIB cell line the form were categorized to gain insight into new sources and risk factors. The most prevalent spa-types were determined for the total amount of MRSA, CC398, non-CC398 MRSA, MUO and MKO. The spa-types were ranked with rank 1 being the most prevalent spa-type within the (sub)group; rank 2 the second most prevalent, etc. SAS statistical software (Enterprise guide version 4.2) was used for descriptive analysis, univariate analysis (Fisher��s exact test) and multiple regression analysis (log-binomial regression model, proc genmod). A p value of