Longitudinal Assessment of Multidrug-Resistant Organisms in Newly Admitted Nursing Facility Patients: Implications for an Evolving Population

Abstract

Background. The spread of multidrug-resistant organisms (MDROs) is a global concern, and much about transmission in healthcare systems remains unknown. To reduce hospital stays, nursing facilities (NFs) have increasingly assumed care of post-acute populations. We estimate the prevalence of MDRO colonization in NF patients on enrollment and discharge to community settings, risk factors for colonization, and rates of acquiring MDROs during the stay.Methods. We conducted a prospective, longitudinal cohort study of newly admitted patients in 6 NFs in southeast Michigan using active microbial surveillance of multiple anatomic sites sampled at enrollment, days 14 and 30, and monthly thereafter for up to 6 months.Results. We enrolled 651 patients and collected 7526 samples over 1629 visits, with an average of 29 days of follow-up per participant. Nearly all participants were admitted for post-acute care (95%). More than half (56.8%) were colonized with MDROs at enrollment: methicillin-resistant Staphylococcus aureus (MRSA), 16.1%; vancomycin-resistant enterococci (VRE), 33.2%; and resistant gram-negative bacilli (R-GNB), 32.0%. Risk factors for colonization at enrollment included prolonged hospitalization (>14 days), functional disability, antibiotic use, or device use. Rates per 1000 patient-days of acquiring a new MDRO were MRSA, 3.4; VRE, 8.2; 13.6. MDRO colonization at discharge was similar to that at enrollment (56.4%): MRSA, 18.4%; VRE, 30.3%; and R-GNB, 33.6%.Conclusions. Short-stay NF patients exhibit a high prevalence of MDROs near the time of admission, as well as at discharge, and may serve as a reservoir for spread in other healthcare settings. Future interventions to reduce MDROs should specifically target this population.

Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities

“…1 Methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and multi-drug resistant Gram negative bacteria (RGNB) are among the most common MDROs in nursing facilities. 1,2 Eleven to fifty-nine percent of nursing home residents are colonized with RGNB. 1,3 Furthermore, these bacteria have been shown to spread from patient-to-patient by healthcare personnel (HCP).…”

“…1,2 Eleven to fifty-nine percent of nursing home residents are colonized with RGNB. 1,3 Furthermore, these bacteria have been shown to spread from patient-to-patient by healthcare personnel (HCP). 4–6 …”

Contamination of Common Area and Rehabilitation Gym Environment with Multidrug‐Resistant Organisms

“…At the time of admission, 92.5% (602/651) of patients were expected to be short‐stay residents. Patient demographics and enrollment statistics were described further elsewhere . Complete common area data were collected from 85.9% (559/651) of enrolled patients.…”

“…Patients were approached for enrollment regardless of patient characteristics, unless they were receiving end‐of‐life care. Microbial surveillance of patient colonization and the patient room environment was conducted on patient enrollment, days 14, and monthly thereafter for a maximum of 6 months …”

“…After enrichment, specimens were cultured onto mannitol salt agar, MacConkey agar, and bile‐esculin agar with 6 μg/mL vancomycin for subsequent isolation. S. aureus , vancomycin‐resistant enterococci (VRE), and gram‐negative bacilli (GNB) were identified using standard microbiology techniques . S. aureus was identified using Staphaurex Latex Agglutination Test (Remel, Lenexa, KS) and the catalase test.…”