Antibiotic Resistance in Non–Major Metropolitan Skilled Nursing Facilities: Prevalence and Interfacility Variation

Crnich, Christopher J.; Duster, Megan; Hess, Timothy; Zimmerman, David; Drinka, Paul J.

doi:10.1086/668018

Cited by 18 publications

(24 citation statements)

References 10 publications

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“…14 Twenty-two percent of patients in 6 skilled nursing facilities in Wisconsin were colonized with MRSA in nares, skin of the axilla and groin, or perianal skin. 15 …”

Section: Discussionmentioning

confidence: 99%

Transmission of Methicillin-Resistant Staphylococcus aureus (MRSA) to Healthcare Worker Gowns and Gloves During Care of Nursing Home Residents

Roghmann

Johnson

Sorkin

et al. 2015

Infect. Control Hosp. Epidemiol.

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Objective To estimate the frequency of MRSA transmission to gowns and gloves worn by healthcare personnel (HCP) interacting with nursing home residents in order to inform infection prevention policies in this setting Design Observational study Setting and Participants Residents and HCP from 13 community-based nursing homes in Maryland and Michigan Methods Residents were cultured for MRSA at the anterior nares and perianal or perineal skin. HCP wore gowns and gloves during usual care activities. At the end of each activity, a research coordinator swabbed the HCP’s gown and gloves. Results 403 residents were enrolled; 113 were MRSA colonized. Glove contamination was higher than gown contamination (24% vs. 14% of 954 interactions, p<0.01). Transmission varied greatly by type of care from 0% to 24% for gowns and 8% to 37% for gloves. We identified high risk activities (OR >1.0, p< 0.05) including: dressing, transferring, providing hygiene, changing linens and toileting the resident. We identified low risk activities (OR <1.0, p< 0.05) including: giving medications and performing glucose monitoring. Residents with chronic skin breakdown had significantly higher rates of gown and glove contamination. Conclusions MRSA transmission from MRSA positive residents to HCP gown and gloves is substantial with high contact activities of daily living conferring the highest risk. These activities do not involve overt contact with body fluids, skin breakdown or mucous membranes suggesting the need to modify current standards of care involving the use of gowns and gloves in this setting.

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“…14 Twenty-two percent of patients in 6 skilled nursing facilities in Wisconsin were colonized with MRSA in nares, skin of the axilla and groin, or perianal skin. 15 …”

Section: Discussionmentioning

confidence: 99%

Transmission of Methicillin-Resistant Staphylococcus aureus (MRSA) to Healthcare Worker Gowns and Gloves During Care of Nursing Home Residents

Roghmann

Johnson

Sorkin

et al. 2015

Infect. Control Hosp. Epidemiol.

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“…29 The six nursing homes were located in 5 counties in South Central Wisconsin. Subjects participating in this study were screened for MRSA colonization during a baseline examination and every three months thereafter for a period of up to one year or until they were discharged from the study facility, whichever occurred sooner.…”

Section: Methodsmentioning

confidence: 99%

“…Due to the small number of transitions observed in each facility, the data from the six study nursing homes were combined, so that the estimated parameters would be representative of the hypothetical “average” nursing home (the characteristics of the individual facilities were published elsewhere 29 ). Models to predict the steady state of MRSA in individual nursing homes, while underpowered, were fit separately.…”

Section: Methodsmentioning

confidence: 99%

Models to predict prevalence and transition dynamics of methicillin-resistant Staphylococcus aureus in community nursing homes

Batina

Crnich

Anderson

et al. 2016

American Journal of Infection Control

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Background Recent spread of USA300 methicillin-resistant Staphylococcus aureus (MRSA) to nursing homes has been of particular concern. We sought to predict the ultimate prevalence of USA300 and non-USA300 MRSA and to examine the influence of potential risk factors on MRSA acquisition in community nursing homes. Methods The data was collected during a longitudinal MRSA surveillance study that involved 449 residents in six community nursing homes in Wisconsin. The subjects were screened every three months for up to one year. Markov chain models were employed to predict strain-specific prevalence of MRSA at steady state, and to assess the impact of potential risk factors, including recent hospitalizations, invasive medical devices, and antibiotic exposure on MRSA acquisition rates and average duration of colonization. Results At steady-state, 20% (95% CI, 15–25%) of residents were predicted to remain colonized with non-USA300 and 4% (95% CI, 2–7%) with USA300 MRSA. Residents who used antibiotics in the previous 3 months were twice more likely to acquire MRSA than those who did not (acquisition rates 0.052 (95% CI, 0.038–0.075) and 0.025 (95% CI, 0.018–0.037), respectively). Conclusions Non-USA300 was predicted to remain the dominant MRSA strain in community nursing homes. The higher rate of MRSA acquisition among residents with recent antibiotic exposure suggests that antibiotic stewardship may reduce MRSA colonization in this setting.

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“…In NH studies conducted in different regions within the US, the prevalence of MRSA among S. aureus isolates hovers around 30%, but can be as high as 60%. 8 to 10% of all NH residents are colonized with MRSA ([8•, 11, 22–25]. The likelihood of acquiring new MRSA colonization may be greatly influenced by the type of care received.…”

Section: Nursing Homes and The Changing Epidemiology Of Antimicrobialmentioning

confidence: 99%

“…The prevalence and resistance patterns vary greatly depending on type and location of the facility [37] with prevalence rates averaging around 20% [38], but as high as 50% or more in some institutions. Resident-to-resident spread has been demonstrated [9, 11, 25, 37, 39, 40]. Focusing on residents with established risk factors uncovers worrisome trends: Fisch et al observed a prevalence of ciprofloxacin resistance of > 50% in NH residents with indwelling devices [8•].…”

Section: Nursing Homes and The Changing Epidemiology Of Antimicrobialmentioning

confidence: 99%

Colonization with Multidrug-Resistant Organisms in Nursing Homes: Scope, Importance, and Management

Cassone

Mody

2015

Curr Geri Rep

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Bacterial infections are among the most common causes of morbidity and mortality in Nursing Homes (NH) and other long term care facilities. Multi-drug resistant organisms (MDROs) represent an ever-increasing share of causative agents of infection, and their prevalence in NHs is now just as high as in acute-care facilities, or even higher. Indeed, NHs are now considered a major reservoir of MDROs for the community at large. Asymptomatic colonization is usually a prerequisite to development of symptomatic infection. While progress has been made in defining epidemiology of MDROs in NHs, few studies have evaluated the role of changing healthcare delivery in introducing and further transmitting MDROs in this setting. Furthermore, the factors influencing the spread of colonization and the key prognostic indicators leading to symptomatic infections in the burgeoning short stay population need to be explored further. The difficulty of this task lies in the heterogeneity of NHs in terms of focus of care, organization and resources, and on the diversity among the many MDRO species encountered, which harbor different resistance genes and with a different prevalence depending on the geographic location, local antimicrobial pressure and residents risk factors such as use of indwelling devices, functional disability, wounds and other comorbidities. We present literature findings on the scope and importance of colonization as a pathway to infection with MDROs in NHs, underline important open questions that need further research, and discuss the strength of the evidence for current and proposed screening, prevention, and management interventions.

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Antibiotic Resistance in Non–Major Metropolitan Skilled Nursing Facilities: Prevalence and Interfacility Variation

Cited by 18 publications

References 10 publications

Transmission of Methicillin-Resistant Staphylococcus aureus (MRSA) to Healthcare Worker Gowns and Gloves During Care of Nursing Home Residents

Transmission of Methicillin-Resistant Staphylococcus aureus (MRSA) to Healthcare Worker Gowns and Gloves During Care of Nursing Home Residents

Models to predict prevalence and transition dynamics of methicillin-resistant Staphylococcus aureus in community nursing homes

Colonization with Multidrug-Resistant Organisms in Nursing Homes: Scope, Importance, and Management

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