Prevalence of multidrug-resistant organisms in nursing homes in Belgium in 2015

Abstract

Objectives Following two studies conducted in 2005 and 2011, a third prevalence survey of multidrug-resistant microorganisms (MDRO) was organised in Belgian nursing homes (NHs) using a similar methodology. The aim was to measure the prevalence of carriage of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase producing Enterobacteriaceae (ESBLE) and carbapenemase-producing Enterobacteriaceae (CPE) in NH residents. Risk factors for MDRO carriage were also explored. Methods Up to 51 randomly selected residents per NH were screened for MDRO carriage by trained local nurses between June and October 2015. Rectal swabs were cultured for ESBLE, CPE and VRE, while pooled samples of nose, throat and perineum and chronic wound swabs were obtained for culture of MRSA. Antimicrobial susceptibility testing, molecular detection of resistance genes and strain genotyping were performed. Significant risk factors for MDRO colonization MDRO was determined by univariate and multivariable analysis. Results Overall, 1447 residents from 29 NHs were enrolled. The mean weighted prevalence of ESBLE and MRSA colonization was 11.3% and 9.0%, respectively. Co-colonization occurred in 1.8% of the residents. VRE and CPE carriage were identified in only one resident each. Impaired mobility and recent treatment with fluoroquinolones or with combinations of sulphonamides and trimethoprim were identified as risk factors for ESBLE carriage, while for MRSA these were previous MRSA carriage/infection, a stay in several different hospital wards during the past year, and a recent treatment with nitrofuran derivatives. Current antacid use was a predictor for both ESBL and MRSA carriage. Conclusions In line with the evolution of MRSA and ESBL colonization/infection in hospitals, a decline in MRSA carriage and an increase in ESBLE prevalence was seen in Belgian NHs between 2005 and 2015. These results show that a systemic approach, including surveillance and enhancement of infection control and antimicrobial stewardship programs is needed in both acute and chronic care facilities.

Evaluation of the Association Between Gastric Acid Suppression and Risk of Intestinal Colonization With Multidrug-Resistant Microorganisms

“…In the primary analysis, we included the 12 studies that adjusted for confounding. [8][9][10]37,39,40,43,45,47,54,55,57 This showed that acid suppression was associated with MDRO colonization (OR = 1.74; 95% CI, 1.40-2.16) ( Figure 2). Among these studies, heterogeneity, as measured using the I 2 method, was 68%.…”

“…Søgaard et al, 2017 54 Latour et al, 2019 45 Ben-Ami et al, 2006 37 Cheng et al, 2016 39 Falk et al, 2000 40 Hamprecht ters et al 31,34,35 Excluding both studies of UTI did not affect publication bias estimators (eFigure 7 in the Supplement).…”

“…[8][9][10]37,39,40,43,45,47,54,55,57 Overall, the 12 studies included 22 305 participants (8491 [38.1%] were acid suppressant users; 12 714 [57.0%] were female). Of these, 7 studies were cross-sectional, 9,10,37,43,45,55,57 3 were case control, 39,40,54 and 2 were cohort studies. 8,47 We summarized the study characteristics in the Table. Studies were published between 1996 and 2019; most were of adult populations (age ≥18 years).…”

“…A secondary analysis of all 26 studies revealed odds consistent with those found in the primary analysis and showed that acid suppression was associated with MDRO colonization (OR = 1.70; 95% CI, 1.44-1.99; I 2 = 54%) (eFigure 1 in the Supplement). Analysis of the 24 studies [8][9][10]15,[36][37][38][39][40][41][42][43][44][45][47][48][49][50][51][52][53][55][56][57] that directly evaluated intestinal carriage yielded an OR of 1.77 (95% CI, 1.48-2.10; I 2 = 56%).…”

“…Hagel et al, 2019 42 Kuenzli et al, 2014 44 Lee et al, 2018 46 Rodríguez-Baño et al, 2008 51 Vading et al, 2016 56 Őstholm-Balkhed et al, 2013 48 Subtotal (95% CI) Heterogeneity: τ 2 = 0.00; χ 2 = 4.83, df = 5 (P = .44); I 2 = 0 Test for overall effect: z = 0.91 (P = .36) Total (95% CI) Heterogeneity: τ 2 = 0.03; χ 2 = 20.39, df = 13 (P = .09); I 2 = 36% Test for overall effect: z Ben-Ami et al, 2006 37 Hamprecht et al, 2016 43 Huizinga et al, 2017 9 Latour et al, 2019 45 Reuland et al, 2016 10 Søgaard et al, 2017 54 Wielders et al, 2017 57 Subtotal (95% CI) Heterogeneity: τ 2 = 0.04; χ 2 = 15.42, df = 7 (P = .03); I 2 = 55% Test for overall effect: z Okamoto et al, 2017 15 Prasad et al, 2016 49 Seekatz et al, 2018 52…”