The purpose of this study was to evaluate the impact of the emergence of animal related methicillin resistant Staphylococcus aureus ST398 in an area with a high density of pig farms. A retrospective analysis was performed of all MRSA isolates in the laboratory database from 2002 till 2008 including typing results and clinical data from infection control archives and patient charts. The implementation of the screening of people in contact with pigs and veal calves for MRSA led to an increase in the average number of newly identified carriers from 16 per year between July 2002 and July 2006 to 148 between July 2006 and December 2008. This is a 925% increase of which 82% (108/132) was due to ST398. The majority (74%) came from targeted screening but 7% was due to unexpected findings. A wide range of infections with ST398 occurred in patients with and without contact with livestock varying from post-operative wound infections to sepsis and post-trauma osteomyelitis with an overrepresentation of spa type t567 among the clinical isolates. ST398 isolates were more often multi-resistant than isolates of other spa-types. The emergence of MRSA ST398 led to an increase in both MRSA carriers and MRSA infections.