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To the Editor Livestock density in the Netherlands has been identified as a risk factor for livestock-associated methicillin-resistant Staphylococcus aureus (MRSA) in individuals not engaged in livestock production.1 Thus, we read with interest the report by Casey et al2 that identified proximity to swine manure application to crop fields as a risk factor for MRSA infection and skin and soft-tissue infection. While the analysis appears sound, we have questions concerning how infections were identified in the study and the specific strains identified.
Perencevich EN, Skov R, Kluytmans J. Identifying Livestock-Associated Methicillin-Resistant Staphylococcus aureus in the United States. JAMA Intern Med. 2014;174(5):824-825. doi:10.1001/jamainternmed.2014.45