scholarly journals High Prevalence of Multidrug-Resistant Organism Colonization in 28 Nursing Homes: An “Iceberg Effect”

2020 ◽  
Vol 21 (12) ◽  
pp. 1937-1943.e2
Author(s):  
James A. McKinnell ◽  
Loren G. Miller ◽  
Raveena D. Singh ◽  
Gabrielle Gussin ◽  
Ken Kleinman ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
High Prevalence

Healthcare associated pneumonia: An old concept at a hospital with high prevalence of antimicrobial resistance

MedPharmRes ◽  
2021 ◽  
Vol 5 (2) ◽  
pp. 17-21
Author(s):  
Lam Nguyen-Ho ◽  
Duong Hoang-Thai ◽  
Vu Le-Thuong ◽  
Ngoc Tran-Van
Keyword(s):  
Risk Factor ◽  
Antimicrobial Resistance ◽  
Multidrug Resistant ◽  
Community Acquired Pneumonia ◽  
Resistant Organism ◽  
Healthcare Associated Infection ◽  
Female Ratio ◽  
High Prevalence ◽  
Need To Evaluate ◽  
Healthcare Associated

Background: One of several reasons that the concept of healthcare-associated pneumonia (HCAP) was dismissed was the same presence of multidrug resistant organism (MDRO) between community-acquired pneumonia and HCAP at countries with the low prevalence of antimicrobial resistance (AMR). However, this finding could be unsuitable for countries with the high rates of AMR. Methods: A prospective observational study was conducted at the respiratory department of Cho Ray hospital from September 2015 to April 2016. All adult patients suitable for community acquired pneumonia (CAP) with risk factor for healthcare-associated infection were included. Results: We found out 130 subjects. The median age was 71 years (interquartile range 57-81). The male/female ratio was 1.55:1. Prior hospitalization was the most common risk factor for healthcare-associated infection. There were 35 cases (26.9%) with culture-positive (sputum and/or bronchial lavage). Isolated bacteria included Pseudomonas aeruginosa (9 cases), Klebsiella pneumoniae (9 cases), Escherichia coli (4 cases), Acinetobacter baumannii (6 cases), and Staphylococcus aureus (7 cases) with the characteristic of AMR similar to the bacterial spectrum associated with hospital-acquired pneumonia. Conclusion: MDROs were detected frequently in CAP patients with risk factor for healthcare-associated infection at the hospital with the high prevalence of AMR. This requires the urgent need to evaluate risk factors for MDRO infection in community-onset pneumonia when the concept of HCAP is no longer used.

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

2019 ◽  
Vol 69 (9) ◽  
pp. 1566-1573 ◽  
Author(s):  
James A McKinnell ◽  
Raveena D Singh ◽  
Loren G Miller ◽  
Ken Kleinman ◽  
Gabrielle Gussin ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Acute Care ◽  
Orange County ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Healthcare Intervention ◽  
Healthcare Facilities ◽  
Care Facilities ◽  
Acute Care Facilities

Abstract Background Multidrug-resistant organisms (MDROs) spread between hospitals, nursing homes (NHs), and long-term acute care facilities (LTACs) via patient transfers. The Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County is a regional public health collaborative involving decolonization at 38 healthcare facilities selected based on their high degree of patient sharing. We report baseline MDRO prevalence in 21 NHs/LTACs. Methods A random sample of 50 adults for 21 NHs/LTACs (18 NHs, 3 LTACs) were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum β-lactamase–producing organisms (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE) using nares, skin (axilla/groin), and peri-rectal swabs. Facility and resident characteristics associated with MDRO carriage were assessed using multivariable models clustering by person and facility. Results Prevalence of MDROs was 65% in NHs and 80% in LTACs. The most common MDROs in NHs were MRSA (42%) and ESBL (34%); in LTACs they were VRE (55%) and ESBL (38%). CRE prevalence was higher in facilities that manage ventilated LTAC patients and NH residents (8% vs <1%, P < .001). MDRO status was known for 18% of NH residents and 49% of LTAC patients. MDRO-colonized adults commonly harbored additional MDROs (54% MDRO+ NH residents and 62% MDRO+ LTACs patients). History of MRSA (odds ratio [OR] = 1.7; confidence interval [CI]: 1.2, 2.4; P = .004), VRE (OR = 2.1; CI: 1.2, 3.8; P = .01), ESBL (OR = 1.6; CI: 1.1, 2.3; P = .03), and diabetes (OR = 1.3; CI: 1.0, 1.7; P = .03) were associated with any MDRO carriage. Conclusions The majority of NH residents and LTAC patients harbor MDROs. MDRO status is frequently unknown to the facility. The high MDRO prevalence highlights the need for prevention efforts in NHs/LTACs as part of regional efforts to control MDRO spread.

scholarly journals Multidrug-resistant organism (MDRO) contamination of privacy curtains in nursing homes

2021 ◽  
pp. 1-3
Author(s):  
Kristen E. Gibson ◽  
John P. Mills ◽  
Julia A. Mantey ◽  
Bonnie J. Lansing ◽  
Marco Cassone ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Multidrug Resistant ◽  
Resistant Organism

scholarly journals Isolation Precautions Use for Multidrug-Resistant Organism Infection in Nursing Homes

2017 ◽  
Vol 65 (3) ◽  
pp. 483-489 ◽  
Author(s):  
Catherine C. Cohen ◽  
Andrew Dick ◽  
Patricia W. Stone
Keyword(s):  
Nursing Homes ◽  
Multidrug Resistant ◽  
Resistant Organism

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

2017 ◽  
Vol 19 (4) ◽  
Author(s):  
Ghinwa Dumyati ◽  
Nimalie D. Stone ◽  
David A. Nace ◽  
Christopher J. Crnich ◽  
Robin L. P. Jump
Keyword(s):  
Nursing Homes ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Challenges And Strategies

scholarly journals Correlation between Multidrug-Resistant Bacteria Colonization and Bloodstream Infections in Children with Hematolymphoid Malignancies at a Tertiary Cancer Center in India

2021 ◽  
Vol 42 (01) ◽  
pp. 061-066
Author(s):  
Nihad Salifu ◽  
Gaurav Narula ◽  
Maya Prasad ◽  
Sanjay Biswas ◽  
Rohini Kelkar ◽  
...  
Keyword(s):  
Febrile Neutropenia ◽  
Bloodstream Infections ◽  
Multidrug Resistant ◽  
Blood Cultures ◽  
Cancer Center ◽  
Resistant Bacteria ◽  
Resistant Organism ◽  
Significance Level ◽  
High Prevalence ◽  
Rectal Swabs

Abstract Background Bloodstream infections with drug-resistant bacteria are associated with a higher morbidity and mortality. Based on previous studies in our institution demonstrating a rising incidence of multidrug resistant organism (MDR) bacteria in bloodstream infections (BSI) and high prevalence of enteric colonization with MDR, the “de-escalation” strategy for empirical antibiotics was adopted in the management of febrile neutropenia in children with hematolymphoid malignancies and MDR colonization. An audit was carried out to determine whether surveillance rectal swabs correlated with blood cultures in febrile neutropenia. Methods Patient data from January 2015 to July 2016 was examined. Rectal swabs of children with hematolymphoid malignancies were obtained at presentation. Blood cultures were taken during febrile neutropenia. Data were analyzed using SPSS version 24.0. The significance level was set at p < 0.05. Results Most patients (62.1%) with confirmed BSI were colonized with either extended-spectrum β-lactamase producing organisms (ESBLO) (31.9%) or MDR (30.2%). Majority 116 (62.7%) developed BSI caused by either MDR or ESBLO. In contrast, only 12 (10.6%) patients colonized by sensitive bacteria, developed BSI caused by either MDR or ESBLO. These differences were statistically significant (p < 0.001). Thus, the baseline rectal swab had a sensitivity and a specificity of 90.6% and 59.4%, respectively, in predicting BSI with either MDR or ESBLO. Conclusions We conclude that high prevalence of MDR colonization at presentation significantly results in MDR BSI, which further results in a significant increase in intensive care unit admissions and mortality. This would justify the use of a “de-escalation” antibiotic policy. Whether such a strategy has been successful in impacting outcomes, would need further study.

scholarly journals Universal Decolonization Reduces MDRO Burden on High-Touch Objects in Nursing Home Resident Rooms and Common Areas

2020 ◽  
Vol 41 (S1) ◽  
pp. s54-s55
Author(s):  
Gabrielle M. Gussin ◽  
Raveena D. Singh ◽  
Raheeb Saavedra ◽  
Tabitha D. Catuna ◽  
Lauren Heim ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Cluster Randomized Trial ◽  
Baseline Period ◽  
Multidrug Resistant ◽  
Routine Care ◽  
Resistant Organism ◽  
Short Stay ◽  
Care Needs ◽  
The Impact

Background: More than half of nursing home (NH) residents harbor a multidrug-resistant organism (MDRO), and MDRO contamination of the environment is common. Whether NH decolonization of residents reduces MDRO contamination remains unclear. The PROTECT trial was a cluster-randomized trial of decolonization versus routine care in 28 California NHs from April 2017 through December 2018. Decolonization involved chlorhexidine bathing plus nasal iodophor (Monday–Friday, every other week), and it reduced resident nares and skin MDRO colonization by 36%. Methods: We swabbed high-touch objects in resident rooms and common areas for MDROs before and after the 3-month decolonization phase-in (April–July 2017). Five high-touch objects (bedrail, call button and TV remote, doorknob, light switch, and bathroom handles) were swabbed in 3 resident rooms per NH based on care needs (Alzheimer’s disease and related dementias (ADRD), ie, total care; ADRD, ambulatory care; and short stay). Five high-touch objects were also swabbed in the common area (nursing station, table, chair, railing, and drinking fountain). Swabs were processed for methicillin-resistant S. aureus (MRSA), vancomycin-resistant Enterococcus (VRE), extended-spectrum β-lactamase (ESBL) producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). We used generalized linear mixed models to assess the impact of decolonization on MDRO environmental contamination when clustering by NH and room and adjusting for room type and object because unclustered and unadjusted results are likely to be inaccurate. Results: A high proportion of rooms were contaminated with any MDRO in control NHs: 43 of 56 (77%) in the baseline period and 46 of 56 (82%) in the intervention period. In contrast, decolonization NHs had similar baseline contamination (45 of 56, 80%) but lower intervention MDRO contamination (29 of 48, 60%). When evaluating the intervention impact using multivariable models, decolonization was associated with significantly less room contamination for any MDRO (OR, 0.25; 95% CI, 0.06–0.96; P = .04) and MRSA (OR, 0.16; 95% CI, 0.05–0.55; P = .004) but nonsignificant reductions in VRE contamination (OR, 0.86; 95% CI, 0.23–3.13) and ESBL contamination (OR, 0.13; 95% CI, 0.01–1.62). CRE was not modeled due to rare counts (2 rooms total). In addition, room type was important, with common areas associated with 5-fold, 9-fold, and 3-fold higher contamination with any MDRO, MRSA, and VRE, respectively, compared with short-stay rooms. Conclusions: The high burden of MDROs in NHs calls for universal prevention strategies that can protect all residents. Although decolonization was associated with an 84% reduction in odds of MRSA contamination of inanimate room objects, significant reductions in VRE or ESBL contamination were not seen, possibly due to the lower proportion of baseline contamination due to these organisms. Multimodal strategies are needed to address high levels of MDRO contamination in NHs.Funding: NoneDisclosures: Gabrielle Gussin: Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

scholarly journals Gut Microbiota Modulation for Multidrug-Resistant Organism Decolonization: Present and Future Perspectives

2019 ◽  
Vol 10 ◽  
Author(s):  
Livia Gargiullo ◽  
Federica Del Chierico ◽  
Patrizia D’Argenio ◽  
Lorenza Putignani
Keyword(s):  
Gut Microbiota ◽  
Multidrug Resistant ◽  
Resistant Organism ◽  
Future Perspectives
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