Multidrug-resistant infections in long-term care facilities: extended-spectrum β-lactamase–producing Enterobacteriaceae and hypervirulent antibiotic resistant Clostridium difficile

Giufrè, Maria; Accogli, Marisa; Ricchizzi, Enrico; Barbanti, Fabrizio; Farina, Claudio; Fazii, Paolo; Mattei, Romano; Sarti, Mario; Barozzi, Agostino; Buttazzi, Rossella; Cosentino, Michele; Nardone, Maria Rosaria; Savini, Vincenzo; Spigaglia, Patrizia; Moro, Maria Luisa; Cerquetti, Marina

doi:10.1016/j.diagmicrobio.2018.02.018

Cited by 17 publications

(14 citation statements)

References 36 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…For culture based or molecular screening of MDROs, microbiology methods routinely used in the referring microbiology laboratory can be applied. Prospective surveys for MDROs based on culturing specimens from clinically suspected infections can also give significant laboratory-based surveillance results [17]. Molecular typing of the associated isolates is important for identification of resistance plasmids and of hyperepidemic clonal groups [34], and may be helpful in assessing whether resident-to-resident transmission has occurred.…”

Section: Theme Of the Recommendationmentioning

confidence: 99%

“…An Italian multicenter study, investigating the frequency of ESBL-producing Enterobacterales in urine specimens from LTCF residents, found a median ESBL-rate of 32.1%, with E. coli as the most frequent ESBL-producing pathogen [ 17 ].…”

Section: Mdr Bacteria In Italian Ltcfsmentioning

confidence: 99%

Section: Prospective Mdro Surveillance Surveys (Third Level Laboratormentioning

confidence: 99%

See 2 more Smart Citations

Recommendations for the surveillance of multidrug-resistant bacteria in Italian long-term care facilities by the GLISTer working group of the Italian Association of Clinical Microbiologists (AMCLI)

Aschbacher

Pagani

Migliavacca

et al. 2020

Antimicrob Resist Infect Control

Self Cite

View full text Add to dashboard Cite

Long-term care facilities (LTCFs) are an important reservoir of multidrug-resistant organisms (MDROs). Colonization of LTCF residents by MDROs is generally higher in Italy compared to other European countries. The present review by the working group for the study of infections in LTCFs (GLISTer) of the Italian Association of Clinical Microbiologists (AMCLI) aims to propose criteria for a laboratory-based surveillance of MDROs in Italian LTCFs. We recommend the adhesion to three levels of laboratory-based MDROs surveillance in LTCFs: i) mandatory MDRO surveillance by cumulative retrospective analysis of antimicrobial susceptibility data, obtained as part of routine care of clinical specimens. ii) strongly recommended surveillance by active rectal swab cultures or molecular screening to determine colonization with carbapenemase-producing Enterobacterales, should a resident be proven infected. iii) voluntary surveillance by prospective MDRO surveys, mainly based on point prevalence colonization studies, allowing to determine the MDROs baseline prevalence in the facility. Laboratory-based surveillance of MDROs in LTCFs is aimed at providing useful epidemiological information to healthcare providers operating in the facility, but it is only effective if the collected data are used for infection prevention and control purposes, targeting the peculiar aspects of LTCFs.

show abstract

Section: Theme Of the Recommendationmentioning

confidence: 99%

Section: Mdr Bacteria In Italian Ltcfsmentioning

confidence: 99%

Section: Prospective Mdro Surveillance Surveys (Third Level Laboratormentioning

confidence: 99%

See 1 more Smart Citation

Recommendations for the surveillance of multidrug-resistant bacteria in Italian long-term care facilities by the GLISTer working group of the Italian Association of Clinical Microbiologists (AMCLI)

Aschbacher

Pagani

Migliavacca

et al. 2020

Antimicrob Resist Infect Control

Self Cite

View full text Add to dashboard Cite

show abstract

“…Thus, there is considerable scope for improving antibiotic use in LTCFs. This goal is especially important given that residents of LTCFs are at increased risk of colonisation with resistant organisms and facilitate the spread of these organisms due to their close proximity to other residents and regular contact with hospitals, LTCF workers and the community 13–18. The widespread use of antibiotics by LTCF residents also puts them at risk of related infections, such as Clostridioides difficile , which are subsequently easily spread to contacts 19…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

Raban

Gasparini

et al. 2020

BMJ Open

View full text Add to dashboard Cite

ObjectivesThere are high levels of inappropriate antibiotic use in long-term care facilities (LTCFs). Our objective was to examine evidence of the effectiveness of interventions designed to reduce antibiotic use and/or inappropriate use in LTCFs.DesignSystematic review and meta-analysis.Data sourcesMEDLINE, Embase and CINAHL from 1997 until November 2018.Eligibility criteriaControlled and uncontrolled studies in LTCFs measuring intervention effects on rates of overall antibiotic use and/or appropriateness of use were included. Secondary outcomes were intervention implementation barriers from process evaluations.Data extraction and synthesisTwo reviewers independently applied the Cochrane Effective Practice and Organisation of Care group’s resources to classify interventions and assess risk of bias. Meta-analyses used random effects models to pool results.ResultsOf include studies (n=19), 10 had a control group and 17 had a high risk of bias. All interventions had multiple components. Eight studies (with high risk of bias) showed positive impacts on outcomes and included one of the following interventions: audit and feedback, introduction of care pathways or an infectious disease team. Meta-analyses on change in the percentage of residents on antibiotics (pooled relative risk (RR) (three studies, 6862 residents): 0.85, 95% CI: 0.61 to 1.18), appropriateness of decision to treat with antibiotics (pooled RR (three studies, 993 antibiotic orders): 1.10, 95% CI: 0.64 to 1.91) and appropriateness of antibiotic selection for respiratory tract infections (pooled RR (three studies, 292 orders): 1.15, 95% CI: 0.95 to 1.40), showed no significant intervention effects. However, meta-analyses only included results from intervention groups since most studies lacked a control group. Insufficient data prevented meta-analysis on other outcomes. Process evaluations (n=7) noted poor intervention adoption, low physician engagement and high staff turnover as barriers.ConclusionsThere is insufficient evidence that interventions employed to date are effective at improving antibiotic use in LTCFs. Future studies should use rigorous study designs and tailor intervention implementation to the setting.

show abstract

“…This is because patients in LTCFs especially the elderly and those with multiple diseases and significant psychophysical disability, require increased care, which results in the increased risk of HAIs and MDROs. The most common infections in this group of people are pneumonia (5.7% -1.1% prevalence) and urinary tract infections (2.6% -0.5% prevalence) [8], most often caused by ESBL-producing enterobacteriaceae [9]. Also, other MRDOs may pose a problem in LTCFs, including the development of carbapenem-resistant enterobacteriaceae [10].…”

Section: Discussionmentioning

confidence: 99%

Selected aspects of the knowledge and practice concerning hand hygiene guidelines in the context of infection control structures in hospitals and long-term care facilities – findings of a questionnaire survey

Puto¹,

Wójkowska‐Mach²,

Wałszek³

et al. 2020

Med Pr

View full text Add to dashboard Cite

Background: Hand hygiene (HH) is the simplest and the most fundamental means of hospital-acquired infection (HAI) prevention in both hospitals and long-term care facilities (LTCFs) which differ as to their structure, organization and epidemiology. The objective of this study was to evaluate the knowledge of, and attitudes towards, compliance with the HH guidelines by medical staff of LTCFs and hospitals, in the context of infection control organization. Material and Methods: The study was carried out among medical staff of LTCFs and hospitals using an anonymous questionnaire designed by the authors. The questionnaire was composed of 22 questions. Results: Among 237 healthcare workers from LTCFs and hospitals (51.5% vs. 48.5%), the vast majority were women (97.5% vs. 94.8%), who were nurses (86.9% vs. 91.3%) with 21-30 years of experience (28.5% vs. 44.3%). The respondents, both working in hospitals and in LTCFs, declared that there was some surveillance of HAIs in their workplace-78.8% vs. 87.8%, respectively, p = 0.082. However, the respondents from LTCFs significantly more often than those working in hospitals declared the lack of HAI registration (12.3% vs. 0.9%, p = 0.002), as well as the lack of surveillance of multidrug-resistant microorganisms (16.4% vs. 4.3%, p = 0.010). Although the knowledge of WHO HH guidelines was declared by over 90% of the respondents, only about 70% of them (with no significant difference between both types of facilities) properly indicated the 5 moments of HH. Conclusions: The results of the study indicate that the organizational conditions and practice of HH in LTCFs and hospitals present some differences. Therefore, there is a need for observational studies concerning HH in the context of the structure and organization of infection control, as they are necessary for the development and implementation of effective programs to improve the situation in this field.

show abstract

Multidrug-resistant infections in long-term care facilities: extended-spectrum β-lactamase–producing Enterobacteriaceae and hypervirulent antibiotic resistant Clostridium difficile

Cited by 17 publications

References 36 publications

Recommendations for the surveillance of multidrug-resistant bacteria in Italian long-term care facilities by the GLISTer working group of the Italian Association of Clinical Microbiologists (AMCLI)

Recommendations for the surveillance of multidrug-resistant bacteria in Italian long-term care facilities by the GLISTer working group of the Italian Association of Clinical Microbiologists (AMCLI)

Effectiveness of interventions targeting antibiotic use in long-term aged care facilities: a systematic review and meta-analysis

Selected aspects of the knowledge and practice concerning hand hygiene guidelines in the context of infection control structures in hospitals and long-term care facilities – findings of a questionnaire survey

Contact Info

Product

Resources

About