Association between Institutionalization and Carriage of Multiresistant Bacteria in the Elderly at the Time of Admission to a General Hospital

Abstract

The impact of institutionalization on the carriage of multiresistant bacteria among the elderly was assessed prospectively by comparing the carriage rate in institutionalized patients over 70 years of age to the carriage rate in patients over 70 living at home (58 patients/group). Nares, skin, and rectal swabs were obtained within 24 h of admission to the hospital. Among the 20 carriers identified, 75% came from institutions. Significantly, institutionalized patients were incontinent (P < 0.001), less autonomous than those living at home (P < 10(-6)), and had taken antibiotics recently (P < 0.02). The primary characteristics associated with bacterial colonization were institutional living (P < 0.02), having at least one underlying disease (P < 0.001), dependence (Karnofsky index < or = 50; P < 0.02), recent treatment with antibiotics (P < 0.02), and the presence of skin lesions (P < 0.02). Among the risk factors identified, institutionalization can be readily determined upon admission; systematic communication of carrier status of transfer patients would improve overall patient care.

Multidrug‐Resistant Gram‐Negative Bacteria in a Long‐Term Care Facility: Prevalence and Risk Factors

“…This subgroup of LTCF residents captures the great majority of previously identified individual‐level factors associated with harboring antimicrobial‐resistant bacteria. These risk factors include frequent infections requiring antimicrobial exposure, advanced age, multiple comorbidities, poor functional status, feeding tubes, and skin ulcers 6,8,21–27 . Moreover, the severe cognitive and functional impairment in residents with advanced dementia results in a patient population that requires substantial or full assistance from healthcare workers with eating, toileting, and other ADLs.…”

“…These risk factors include frequent infections requiring antimicrobial exposure, advanced age, multiple comorbidities, poor functional status, feeding tubes, and skin ulcers. 6,8,[21][22][23][24][25][26][27] Moreover, the severe cognitive and functional impairment in residents with advanced dementia results in a patient population that requires substantial or full assistance from healthcare workers with eating, toileting, and other ADLs. This increase in contact could further contribute to the spread of antimicrobial-resistant bacteria through healthcare workers' hands and clothes, the main vectors of antimicrobial-resistant bacteria.…”

“…The role of antimicrobial treatment of infections or febrile episodes in residents with advanced dementia also warrants further evaluation, because antimicrobial exposure is one of the main risk factors for the emergence and spread of antimicrobial-resistant bacteria. 20,[25][26][27] A recent study quantifying antimicrobial exposure in 214 residents with advanced dementia from 21 nursing homes documented that 42% of these subjects had received antimicrobials before death, a substantial proportion of which were administered parenterally. 27 The extensive use of antimicrobials near the end of life, when palliation is often the main goal, 29 raises concerns at the individual level with regard to the burden associated with antimicrobial exposure.…”

Association Between Hospital-Acquired Infections and Patients' Transfers

“…In our hospital, such screening already is performed at the time of admission for the elderly transferred from nursing homes or long-term-care facilities. 18…”

Prevention and control of multi-drug-resistant Gram-negative bacteria: recommendations from a Joint Working Party

“…Care homes are recognized as potential reservoirs of MDR pathogens, which can spread among residents, generally as colonizers, and can be re-introduced into hospitals. 325 Publicity may alarm residents, their relatives and carers. Clear information on the standards of infection prevention and control should be available to promote confidence in the quality of care provided.…”