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Multidrug-Resistant Gram-Negative Bacteria at a Long-Term Care Facility: Assessment of Residents, Healthcare Workers, and Inanimate Surfaces

Published online by Cambridge University Press:  02 January 2015

Erin O'Fallon ,
Robert Schreiber ,
Ruth Kandel  and
Erika M. C. D'Agata
Erin O'Fallon*
Affiliation:
Department of Medicine, Hebrew Senior Life, Boston, Massachusetts
Robert Schreiber
Affiliation:
Department of Medicine, Hebrew Senior Life, Boston, Massachusetts
Ruth Kandel
Affiliation:
Department of Medicine, Hebrew Senior Life, Boston, Massachusetts
Erika M. C. D'Agata
Affiliation:
Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts
*
Hebrew Senior Life, Department of Medicine, 1200 Centre Street, Boston, MA 02131 (erinofallon@hrca.harvard.edu)
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Abstract

Objective.

To characterize the clinical and molecular epidemiology of multidrug-resistant (MDR) organisms in residents, in healthcare workers (HCWs), and on inanimate surfaces at a long-term care facility (LTCF).

Design.

Point-prevalence study in 4 separate wards at a 600-bed urban LTCF that was conducted from October 31, 2006 through February 5, 2007.

Participants.

One hundred sixty-one LTCF residents and 13 HCWs.

Methods.

Nasal and rectal samples were obtained for culture from each resident, selected environmental surfaces in private and common rooms, and the hands and clothing of HCWs in each ward. All cultures were evaluated for the presence of MDR gram-negative bacteria, methicillin-resistant Staphylococcus aureus, and vancomycin-resistant enterococci. Clinical and demographic information were collected for each enrolled resident. Molecular typing was performed to identify epidemiologically related strains.

Results.

A total of 37 (22.8%), 1 (0.6%), and 18 (11.1%) residents were colonized with MDR gram-negative bacteria, vancomycin-resistant enterococci, and methicillin-resistant S. aureus, respectively. MDR gram-negative bacteria were recovered from 3 (1.8%) of the 175 environmental samples cultured, all of which were obtained from common areas in LTCF wards. One (7.7%) of the 13 HCWs harbored MDR gram-negative bacteria. Molecular typing identified clonally related MDR gram-negative strains in LTCF residents. After multivariable analysis, length of hospital stay of at least 4 years, fecal incontinence, and antibiotic exposure for at least 8 days were independent risk factors associated with harboring MDR gram-negative bacteria among LTCF residents.

Conclusions.

The prevalence of MDR gram-negative bacteria is high among LTCF residents and exceeds that of vancomycin-resistant enterococci and methicillin-resistant S. aureus. Common areas in LTCFs may provide a unique opportunity for person-to-person transmission of MDR gram-negative bacteria.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 12 , December 2009 , pp. 1172 - 1179
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

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References

1.Cosgrove, SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis 2006;42:S82–89.Google Scholar
2.Daxboeck, F, Budic, T, Assadian, O, Reich, M, Koller, W. Economic burden associated with multi-resistant Gram-negative organisms compared with that for methicillin-resistant Staphylococcus aureus in a university teaching hospital. J Hosp Infect 2006;62:214–218.Google Scholar
3.The cost of antibiotic resistance: effect of resistance among Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudmonas aeruginosa on length of hospital stay. Infect Control Hosp Epidemiol 2002;23:106–108.Google Scholar
4.Giske, CG, Monnet, DL, Cars, O, Carmeli, Y. Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrob Agents Chemother 2008;52:813–821.Google Scholar
5.Evans, HL, Lefrak, SN, Lyman, J, et al.Cost of gram-negative resistance. Crit Care Med 2007;35:89–95.Google Scholar
6.Safdar, N, Maki, DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002;136:834–844.Google ScholarPubMed
7.Greenberg, BM, Atmar, RL, Stager, CE, Greenberg, SB. Bacteraemia in the elderly: predictors of outcome in an urban teaching hospital. J Infect 2005;50:288–295.Google Scholar
8.Mylotte, JM, Tayara, A, Goodnough, S. Epidemiology of bloodstream infection in nursing home residents: evaluation in a large cohort from multiple homes. Clin Infect Dis 2002;35:1484–1490.Google Scholar
9.Pop-Vicas, AE, D'Agata, EM. The rising influx of multidrug-resistant gram-negative bacilli into a tertiary care hospital. Clin Infect Dis 2005;40:1792–1798.CrossRefGoogle ScholarPubMed
10.Pop-Vicas, A, Tacconelli, E, Gravenstein, S, Bing, L, D'Agata, E. Influx of multidrug-resistant, gram-negative bacteria in the hospital setting and the role of elderly patients with bacterial bloodstream infection. Infect Control Hosp Epidemiol 2009;30:325–31.Google Scholar
11.O'Fallon, E, Pop-Vicas, A, D'Agata, E. The emerging threat of multidrug-resistant gram-negative organisms in long-term care facilities. J Gerontol A Biol Sci Med Sci 2009;64:138–141.CrossRefGoogle ScholarPubMed
12.Wiener, J, Quinn, JP, Bradford, PA, et al.Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999;281:517–523.CrossRefGoogle ScholarPubMed
13.Smith, PW, Bennett, G, Bradley, S, et al.SHEA/APIC guideline: infection prevention and control in the long-term care facility, 2008. Infect Control Hosp Epidemiol 2008;29:785–814.Google Scholar
14.Bradley, SE. Double, double, toil and trouble: infections still spreading in long-term-care facilities. Infect Control Hosp Epidemiol 2005;26:227–230.Google Scholar
15.Bradley, SF. Issues in the management of resistant bacteria in long-term-care facilities. Infect Control Hosp Epidemiol 1999;20:362–366.Google Scholar
16.Bonomo, RA. Multiple antibiotic-resistant bacteria in long-term-care facilities: an emerging problem in the practice of infectious diseases. Clin Infect Dis 2000;31:1414–1422.Google Scholar
17.Trick, WE, Weinstein, RA, DeMarais, PL, et al.Colonization of skilled-care facility residents with antimicrobial-resistant pathogens. J Am Geriatr Soc 2001;49:270–276.CrossRefGoogle ScholarPubMed
18.Pop-Vicas, A, Mitchell, SL, Kandel, R, Schreiber, R, D'Agata, EM. Multidrug-resistant gram-negative bacteria in a long-term care facility: prevalence and risk factors. J Am Geriatr Soc 2008;56:1276–1280.CrossRefGoogle Scholar
19.Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35:S165–193.Google Scholar
20.D'Agata, E, Venkataraman, L, DeGirolami, P, Samore, M. Molecular epidemiology of acquisition of ceftazidime-resistant gram-negative bacilli in a nonoutbreak setting. J Clin Microbiol 1997;35:2602–2605.CrossRefGoogle Scholar
21.Wingard, E, Shlaes, JH, Mortimer, EA, Shlaes, DM. Colonization and cross-colonization of nursing home patients with trimethoprim-resistant gram-negative bacilli. Clin Infect Dis 1993;16:75–81.Google Scholar
22.MacArthur, RD, Lehman, MH, Currie-McCumber, CA, Shlaes, DM. The epidemiology of gentamicin-resistant Pseudomonas aeruginosa on an intermediate care unit. Am J Epidemiol 1988;128:821–827.CrossRefGoogle Scholar
23.Bradley, SF, Terpenning, MS, Ramsey, MA, et al.Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417–422.Google Scholar
24.Hawes, C, Morris, JN, Phillips, CD, Mor, V, Fries, BE, Nonemaker, S. Reliability estimates for the Minimum Data Set for nursing home resident assessment and care screening (MDS). Gerontologist 1995;35:172–178.Google Scholar
25.Morris, JN, Hawes, C, Fries, BE, et al.Designing the national resident assessment instrument for nursing homes. Gerontologist 1990;30:293–307.Google Scholar
26.Reisberg, B, Ferris, SH, de Leon, MJ, Crook, T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am I Psychiatry 1982;139:1136–1139.Google Scholar
27.Katz, S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 1983;31:721–727.Google Scholar
28.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.Google Scholar
29.Facklam, RR, Sahm, DF. Enterococcus. In: Murray, PR, Baron, EJ, Pfaller, MA, Tenover, FC, Yolken, RH. Manual of Clinical Microbiology. 6th ed. Washington, DC: ASM Press; 1995:308–314.Google Scholar
30.Murray, PR, Barron, EJ, Pfaller, MA. Manual of Clinical Microbiology. Washington DC: ASM Press; 1998.Google Scholar
31.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
32.Lemmen, SW, Hafner, H, Zolldann, D, Stanzel, S, Lutticken, R. Distribution of multi-resistant gram-negative versus gram-positive bacteria in the hospital inanimate environment. J Hosp Infect 2004;56:191–197.CrossRefGoogle ScholarPubMed
33.Scott, E, Bloomfield, SF. The survival and transfer of microbial contamination via cloths, hands and utensils. J Appl Bacteriol 1990;68:271–278.Google Scholar
34.Bures, S, Fishbain, JT, Uyehara, CF, Parker, JM, Berg, BW. Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit. Am J Infect Control 2000;28:465–471.Google Scholar
35.Catalano, M, Quelle, LS, Jeric, PE, Di Martino, A, Maimone, SM. Survival of Acinetobacter baumannii on bed rails during an outbreak and during sporadic cases. J Hosp Infect 1999;42:27–35.CrossRefGoogle ScholarPubMed
36.Neely, AN. A survey of gram-negative bacteria survival on hospital fabrics and plastics. J Burn Care Rehabil 2000;21:523–527.Google Scholar
37.D'Agata, EM, Venkataraman, L, DeGirolami, P, Samore, M. Molecular epidemiology of ceftazidime-resistant gram-negative bacilli on inanimate surfaces and their role in cross-transmission during nonoutbreak periods. J Clin Microbiol 1999;37:3065–3067.Google Scholar
38.Drinka, PJ, Stemper, ME, Gauerke, CD, Miller, JM, Reed, KD. The identification of genetically related bacterial isolates using pulsed field gel electrophoresis on nursing home units: a clinical experience. J Am Geriatr Soc 2004;52:1373–1377.CrossRefGoogle ScholarPubMed
39.Terpenning, MS, Bradley, SF, Wan, JY, Chenoweth, CE, Jorgensen, KA, Kauffman, CA. Colonization and infection with antibiotic-resistant bacteria in a long-term care facility. J Am Geriatr Soc 1994;42:1062–1069.Google Scholar
40.Wendt, C, Svoboda, D, Schmidt, C, Bock-Hensley, O, von Baum, H. Characteristics that promote transmission of Staphylococcus aureus nursing homes in German nursing homes. Infect Control Hosp Epidemiol 2005;26:816–821.CrossRefGoogle ScholarPubMed