Prevalence of Multidrug-Resistant Organisms and Risk Factors for Carriage among Patients Transferred from Long-Term Care Facilities

Abstract

Background: Patient transport between acute care hospitals and long-term care facilities (LTCFs) plays a significant role in microbial migration. The study aimed to estimate the prevalence and risk factors associated with the colonization of multidrug-resistant organisms (MDROs) among patients transferred from LTCFs. Materials and Methods: We retrospectively reviewed medical records to examine the colonization of MDROs. All patients who were transferred from LTCFs and admitted to an acute care hospital with 800 beds in Daejeon between March 2018 and February 2019 were included in the study. We surveyed rectal cultures and nasal swabs obtained for screening vancomycinresistant Enterococcus (VRE), carbapenem-resistant Enterobacteriaceae (CRE), and methicillinresistant Staphylococcus aureus (MRSA) at the time of hospitalization. We conducted a multivariable logistic regression to assess the association between clinical variables and the carriage of MDROs. Results: Four hundred and fifteen patients from 86 LTCFs were enrolled. A total of 31.1% (130/415) of participants carried MDROs; VRE colonization was detected in 17.1% (71/415) of participants, and MRSA colonization was shown in 19.5% (81/415) of participants. No CRE was isolated. Previous use of antibiotics within three months [odds ratio (OR) 2.28; (95% confidence interval (CI) 1.30-4.00), P = 0.004], use of antibiotics for longer than two weeks [OR 2.16; (95% CI 1.03-4.53), P = 0.040], and previous colonization of MDROs within one year [OR 2.01; (95% CI 1.15-3.54), P = 0.015] were independently associated with increased risk for carriage of MDROs. Conclusion: Our study showed that a third of patients transferred from LTCFs carried VRE or MRSA, and prior antibiotic therapy was highly associated with the carriage of MDROs, which suggested more efficient management approaches for high-risk patients.

Epidemiological Characteristics of Carbapenemase Producing Carbapenem-Resistant Enterobacteriaceae Colonization

“…However, when compared with the non-CRE group, the isolation of MDROs except for CRE, particularly VRE, was confirmed as a major risk factor. A previous study showed that the presence of MDRO colonization within one year in patients admitted to acute-care hospitals from long-term care facilities is a risk factor for new MDRO colonization [34]. However, it is difficult to find results suggesting that other types of MDRO are risk factors for CP-CRE.…”

Approaches to multidrug-resistant organism prevention and control in long-term care facilities for older people: a systematic review and meta-analysis

“…Absence of invasive infections in both groups 2 The sample size was not specified. We reported the number of beds in nursing homes 3 Statistically significant reduction 4 Extended study from Bellini et al [44] 5 Since the information was insufficient in survey two and three, we only included participants from survey one and four 6 In Phase one, residents were decolonized in their anterior nares only for seven months 7 In Phase two, residents were decolonized in both their anterior nares and wound for five months 8 We only included results from Phase one in the quantitative analysis since the results from Phase two might be affected by the carryover effect 9 Reductions were reported when decolonization was applied in both nares and wounds but not nares only 10 A structured 30-min observations monitored HCW activities and their use of barrier precautions, but results were not reported 11 The authors used self-reported questionnaires to monitor the staff compliance before and after the interventions implemented 12 Schora et al [57] and Peterson et al [56] are based on the same study with the same study sample 13 The authors reported there were a total of 9,288,098 resident days. We estimated there were around 9381 residents after dividing the number of resident days with 30 days and 33 months 57], all but one were at high risk of bias [49].…”

“…They have long been regarded as reservoirs for antimicrobial resistance (AMR). Prevalence studies reported approximately three out of ten residents were colonized with methicillin-resistant Staphylococcus aureus (MRSA) [5][6][7]. Risk factors for MDRO colonization and acquisition have been well characterized [8].…”

Approaches to multidrug-resistant organism prevention and control in long-term care facilities for older people: a systematic review and meta-analysis

“…They have long been regarded as reservoirs for antimicrobial resistance (AMR). Prevalence studies reported up to 32% of residents in LTCFs were colonized with Methicillin-resistant Staphylococcus aureus (MRSA) [5][6][7]. The homelike environment, where residents assemble in close proximity, such as frequently share recreation and dining areas, increases the risk of MRSA acquisition [8,9].…”