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

Pop-Vicas, Aurora; Mitchell, Susan L.; Kandel, Ruth; Schreiber, Robert; D’Agata, Erika M. C.

doi:10.1111/j.1532-5415.2008.01787.x

Cited by 126 publications

(125 citation statements)

References 28 publications

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“…The MRSA prevalence we observed was lower than in MRSA surveys in recent years in the US [41][42][43][44][45], China [46], the UK [16], France [20], Ireland [15], and Italy [24], but higher than in the Netherlands and Sweden [14,22] (Table 3). …”

Section: Discussioncontrasting

confidence: 65%

Current prevalence of multidrug-resistant organisms in long-term care facilities in the Rhine-Main district, Germany, 2013

Hogardt

Proba

Mischler³

et al. 2015

Eurosurveillance

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Multidrug-resistant organisms (MDRO) and in particular multidrug-resistant Gram-negative organisms (MRGN) are an increasing problem in hospital care. However, data on the current prevalence of MDRO in long-term care facilities (LTCFs) are rare. To assess carriage rates of MDRO in LTCF residents in the German Rhine-Main region, we performed a point prevalence survey in 2013. Swabs from nose, throat and perineum were analysed for meticillin-resistant Staphylococcus aureus (MRSA), perianal swabs were analysed for extended-spectrum beta-lactamase (ESBL)-producing organisms, MRGN and vancomycin-resistant enterococci (VRE). In 26 LTCFs, 690 residents were enrolled for analysis of MRSA colonisation and 455 for analysis of rectal carriage of ESBL/MRGN and VRE. Prevalences for MRSA, ESBL/MRGN and VRE were 6.5%, 17.8%, and 0.4%, respectively. MRSA carriage was significantly associated with MRSA history, the presence of urinary catheters, percutaneous endoscopic gastrostomy tubes and previous antibiotic therapy, whereas ESBL/ MRGN carriage was exclusively associated with urinary catheters. In conclusion, this study revealed no increase in MRSA prevalence in LTCFs since 2007. In contrast, the rate of ESBL/MRGN carriage in German LTCFs was remarkably high. In nearly all positive residents, MDRO carriage had not been known before, indicating a lack of screening efforts and/or a lack of information on hospital discharge.

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Section: Discussioncontrasting

confidence: 65%

Current prevalence of multidrug-resistant organisms in long-term care facilities in the Rhine-Main district, Germany, 2013

Hogardt

Proba

Mischler³

et al. 2015

Eurosurveillance

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“…It is estimated that one-third of the 1.6 million skilled nursing facility (SNF) residents in the United States are colonized with at least one ARO. MRSA is the most common ARO studied, and cross-sectional point prevalence studies in SNFs show a wide range of colonization rates, with 10 to 50% of residents being colonized with MRSA (20,22,26,31,33). Multidrug-resistant (MDR) Gramnegative bacteria have been found to colonize over 20% of residents of long-term care facilities (23), while prevalence rates for VRE are found to be lower at 4 to 9.6% (2, 3, 26).…”

mentioning

confidence: 99%

“…MRSA is the most common ARO studied, and cross-sectional point prevalence studies in SNFs show a wide range of colonization rates, with 10 to 50% of residents being colonized with MRSA (20,22,26,31,33). Multidrug-resistant (MDR) Gramnegative bacteria have been found to colonize over 20% of residents of long-term care facilities (23), while prevalence rates for VRE are found to be lower at 4 to 9.6% (2,3,26). The presence of indwelling devices, functional impairment, prior hospitalization, and antimicrobial usage are all considered to increase the risk of multiple ARO colonization (7,12,20,32,35,36).…”

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confidence: 99%

New Acquisition of Antibiotic-Resistant Organisms in Skilled Nursing Facilities

et al. 2012

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The epidemiology of new acquisition of antibiotic-resistant organisms (AROs) in community-based skilled nursing facilities (SNFs) is not well studied. To define the incidence, persistence of, and time to new colonization with methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and ceftazidime-resistant (CAZ r ) and ciprofloxacin-resistant (CIP r ) Gram-negative bacteria (GNB) in SNFs, SNF residents were enrolled and specimens from the nares, oropharynx, groin, perianal area, and wounds were prospectively cultured monthly. Standard microbiological tests were used to identify MRSA, VRE, and CAZ r and CIP r GNB. Residents with at least 3 months of follow-up were included in the analysis. Colonized residents were categorized as having either preexisting or new acquisition. The time to colonization for new acquisition of AROs was calculated. Eighty-two residents met the eligibility criteria. T he prevalence of antibiotic-resistant organisms (AROs), such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), and resistant Gram-negative bacteria (GNB) has been well studied (4,11,18,28,30). It is estimated that one-third of the 1.6 million skilled nursing facility (SNF) residents in the United States are colonized with at least one ARO. MRSA is the most common ARO studied, and cross-sectional point prevalence studies in SNFs show a wide range of colonization rates, with 10 to 50% of residents being colonized with MRSA (20,22,26,31,33). Multidrug-resistant (MDR) Gramnegative bacteria have been found to colonize over 20% of residents of long-term care facilities (23), while prevalence rates for VRE are found to be lower at 4 to 9.6% (2, 3, 26). The presence of indwelling devices, functional impairment, prior hospitalization, and antimicrobial usage are all considered to increase the risk of multiple ARO colonization (7,12,20,32,35,36).In contrast to the large quantity of cross-sectional data available, there are limited prospective studies that document new acquisition rates in SNFs. In one prospective study by Bradley et al. (5), specimens from multiple body sites were cultured monthly for a year, and it was found that 25% of SNF veterans were colonized with MRSA upon initial culturing. Over the course of the year of study, 10% of admitted residents newly acquired MRSA at the facility. Another study by Stone et al. (29) found a 48% prevalence of MRSA on weekly cultures obtained over an 8-week period in a long-term care facility. Only 29% of newly admitted residents were colonized on their initial culture, indicating a relatively large number of new acquisitions at the facility. A recent prospective study documented that 39% of long-term care residents acquired at least 1 MDR Gram-negative organism during a 1-year sampling period (24). Other short-term prospective studies documented new acquisition of ceftazidime-resistant (CAZ r )GNB in 22 of 86 (25.6%) colonized surgical intensive care unit patients during their stay over the 5-month s...

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“…Colonization by MDR Gram negative bacteria of enteric origin has been detected in 51% of residents in long-term care facilities, especially if affected by advanced dementia or confined in the bed. 23 In patients residing in nursing home is very high the risk of aspiration pneumonia, because of frequent deterioration of consciousness and swallowing dysfunction. The term of nursing-home-acquired pneumonia (NHAP) has been proposed for this entity.…”

Section: Residence In Nursing Homementioning

confidence: 99%

Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections

Pistella

Santini

2016

Ital J Med

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In the nosocomial setting, antimicrobial-resistant Enterobacteriaceae are a growing challenge, and alarming trends in resistance are currently reported all over the world. Isolates of Enterobacteriaceae producing ampC β-lactamases and extended spectrum β-lactamases are endemic in many hospitals, and are frequently resistant also to other classes of antibiotics, such as fluoroquinolones and aminoglycosides. The risk of infections due to multi-drug resistant strains should be considered also for outpatients who have had recent contact with the health system. Both nosocomial and health-care associated infections should be treated with a combination of antibiotics active against multi-drug resistant Gram negative and methicillin-resistant Staphylococcus aureus. In the absence of effective antimicrobial stewardship programs, this aggressive therapeutic approach might lead to abuse of broad-spectrum antibiotics, with consequent increase in resistances. To contain the possible antibiotic overuse, several decisional strategies, often based on risk-score systems supporting the clinical decisions, have been proposed. In this context of high antibiotic selection pressure, carbapenem-resistant pathogens recently began to spread in many hospitals. Carbapenem-resistant Klebsiella pneumoniae, as well as carbapenem-resistant Acinetobacter baumannii and P. aeruginosa, represent the new major challenges to patient safety. Against these organisms the initial empiric treatment is generally ineffective. The poor clinical outcome associated with carbapenem- resistant K. pneumoniae infections is probably due to the delete in the beginning of an appropriate antibiotic treatment, rather than to the increased virulence of pathogens. Only few therapeutic options are available, including colistin, tigecycline, aminoglycosides and carbapenems in selected cases. Several combinations of these antibiotics have been used, but no ideal regimen has been currently established.

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

Abstract: Colonization with MDRGN is common in the LTC setting. A diagnosis of advanced dementia is a major risk factor for harboring MDRGN.

Cited by 126 publications

References 28 publications

Current prevalence of multidrug-resistant organisms in long-term care facilities in the Rhine-Main district, Germany, 2013

Current prevalence of multidrug-resistant organisms in long-term care facilities in the Rhine-Main district, Germany, 2013

New Acquisition of Antibiotic-Resistant Organisms in Skilled Nursing Facilities

Risk factors and outcomes of carbapenem-resistant Klebsiella pneumoniae infections

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