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

Abstract

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.

Healthcare-associated infections in the elderly: what's new

“…Multi-drug resistant organisms (MDRO), including methicillin resistant S. aureus (MRSA) and antibiotic resistant gram negative rods, are now more common in long-term care facilities than in acute care [6*], and the need to address this problem has never been more critical. Over 35% of nursing home residents are colonized with MDROs [6*7*8** 9] (Table 2), and new acquisition is common [9]; these facilities and long term acute care hospitals now serve as reservoirs for resistant organisms in the community.…”

“…Over 35% of nursing home residents are colonized with MDROs [6*7*8** 9] (Table 2), and new acquisition is common [9]; these facilities and long term acute care hospitals now serve as reservoirs for resistant organisms in the community.…”

“…While it is relatively easy in acute care facilities to screen, isolate, and cohort patients colonized with MDROs, this is difficult in LTC, where patients regularly dine together and participate in communal activities. Compounding these issues is a dramatic overuse of antibiotics in the LTC setting; 47–79% of nursing home (NH) residents have been reported to receive at least one round of antibiotics in the course of a year [10], and NH residents are more likely to receive antibiotics at least once than any other medication [6*]. …”

Network of microbial and antibiotic interactions drive colonization and infection with multidrug-resistant organisms

“…In particular, residents in long-term care facilities (LTCFs) often have underlying medical conditions that make them particularly vulnerable to infections. Moreover, the high rates of MDRO colonization (6) and antibiotic use (7-9) among LTCF residents further put this population at risk for contracting infections. Furthermore, the frequent transfers between LTCFs and other healthcare facilities leads to the dissemination of MDROs throughout the healthcare network, creating a substantial economic and clinical burden that permeates healthcare systems (10,11).…”

Template for an Antibiotic Stewardship Policy for Post-Acute and Long-Term Care Settings

“…The impetus for this new federal requirement arose in part from the recognition of the over 2 million infections caused each year by multi-drug resistant organisms (MDROs) and Clostridium difficile [3,4]. Being a resident in a nursing home is one of the most notable risk factors for colonization with an MDRO [5]. Some estimates indicate that the rate of methicillin-resistant Staphylococcus aureus (MRSA) colonization among nursing home residents may exceed 50% [6,7], surpassing the estimated rate of 5–10% among hospitalized patients [8,9].…”