Quantifying the Exposure to Antibiotic-Resistant Pathogens Among Patients Discharged From a Single Hospital Across All California Healthcare Facilities

Abstract

OBJECTIVETo assess the time-dependent exposure of California healthcare facilities to patients harboring methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase (ESBL)–producing Escherichia coli and Klebsiella pneumoniae, and Clostridium difficile infection (CDI) upon discharge from 1 hospital.METHODSRetrospective multiple-cohort study of adults discharged from 1 hospital in 2005–2009, counting hospitals, nursing homes, cities, and counties in which carriers were readmitted, and comparing the number and length of stay of readmissions and the number of distinct readmission facilities among carriers versus noncarriers.RESULTSWe evaluated 45,772 inpatients including those with MRSA (N=1,198), VRE (N=547), ESBL (N=121), and CDI (N=300). Within 1 year of discharge, MRSA, VRE, and ESBL carriers exposed 137, 117, and 45 hospitals and 103, 83, and 37 nursing homes, generating 58,804, 33,486, and 15,508 total exposure-days, respectively. Within 90 days of discharge, CDI patients exposed 36 hospitals and 35 nursing homes, generating 7,318 total exposure-days. Compared with noncarriers, carriers had more readmissions to hospitals (MRSA:1.8 vs 0.9/patient; VRE: 2.6 vs 0.9; ESBL: 2.3 vs 0.9; CDI: 0.8 vs 0.4; all P<.001) and nursing homes (MRSA: 0.4 vs 0.1/patient; VRE: 0.7 vs 0.1; ESBL: 0.7 vs 0.1; CDI: 0.3 vs 0.1; all P<.001) and longer hospital readmissions (MRSA: 8.9 vs 7.3 days; VRE: 8.9 vs 7.4; ESBL: 9.6 vs 7.5; CDI: 12.3 vs 8.2; all P<.01).CONCLUSIONSPatients harboring antibiotic-resistant pathogens rapidly expose numerous facilities during readmissions; regional containment strategies are needed.Infect. Control Hosp. Epidemiol. 2015;36(11):1275–1282

Transmission ofClostridium difficilefrom asymptomatically colonized or infected long-term care facility residents

“…These findings have broad implications for control of C. difficile because interfacility transfer of CDI patients occurs frequently among LTCFs and hospitals. 31 Moreover, LTCF residents have been linked to local and regional dissemination of other healthcare-associated pathogens, including multidrug-resistant gram-negative bacilli, vancomycin-resistant enterococci, and methicillin-resistant Staphylococcus aureus. [32][33][34][35][36][37] Greater emphasis on infection control measures and antimicrobial stewardship in LTCFs is needed, and these efforts should focus on LTCF residents during hospital admissions.…”

Challenges and Strategies for Prevention of Multidrug-Resistant Organism Transmission in Nursing Homes

“…The interconnectedness between the acute healthcare facilities and nursing homes suggests that coordinated approaches across care settings may be needed to reduce the burden of MDROs [62]. At a regional level, creating a multidisciplinary task force can facilitate the standardization of infection prevention and control guidelines, improve inter-facility communication about MDROs during care transitions [63], and provide infection prevention and control expertise.…”

The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California

“…[7][8][9][15][16][17][18][19][20][21][22] For example, methicillin-resistant Staphylococcus aureus (MRSA) spread from ACHs to NHs within the Veterans Affairs medical system. [23] Other MDROs have spread from hospitals into NHs [24,25] More recently, NH residents and LTAC patients were associated with transmission of carbapenem-resistant Enterobacteriaceae (CRE) across a region. [26] Investment of resources in regional infection prevention programs that focus on NHs and LTACs has potential to attenuate the spread of MDROs and prevent morbidity and mortality across the U.S. healthcare system.…”