Natural History of Colonization With Vancomycin-Resistant Enterococci, Methicillin-Resistant Staphylococcus Aureus, And Resistant Gram-Negative Bacilli Among Long-Term–Care Facility Residents

2003 ◽  
Vol 24 (4) ◽  
pp. 246-250 ◽  
Author(s):  
Glenn A. Pacio ◽  
Paul Visintainer ◽  
George Maguire ◽  
Gary P. Wormser ◽  
John Raffalli ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Gram Negative ◽  
Long Term Care Facility ◽  
Vancomycin Resistant Enterococci ◽  
History Of ◽  
Vancomycin Resistant

AbstractObjective:To determine the natural history of colonization with vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and resistant gram-negative bacilli among long-term–care facility (LTCF) residents.Design:Observational cohort study.Setting:A 355-bed LTCF with a ventilator unit and a subacute unit.Participants:Residents with colonization or infection with VRE, MRSA or resistant gram-negative bacilli housed at the LTCF between December 1,1999, and February 29, 2000.Methods:Cultures of clinical and surveillance sites were performed at regular intervals. Charts were reviewed for clinical characteristics associated with clearance of colonization. Kaplan–Meier curves were constructed to analyze the number of days to clearance of colonization.Results:Forty-nine residents had 65 episodes of colonization (27 VRE, 30 MRSA and 8 resistant gram-negative bacilli). Eighteen (28%) of the episodes cleared. The clearance rate was 2.7 episodes per 1,000 person-days. Clearance occurred significantly more often with resistant gram-negative bacilli colonization compared with VRE or MRSA colonization (6 [75%] vs 12 [21%]; P = .007; relative risk, 4.17; 95% confidence interval, 1.26 to 11.8). There was a trend toward longer use of antimicrobial agents among residents with persistent colonization. Infections occurred most frequently with MRSA The urinary tract was the most common site of infection.Conclusion:Among LTCF residents, colonization with resistant gram-negative bacilli is four times more likely to clear than colonization with VRE or MRSA. Performance of surveillance cultures at regular intervals may reduce the need for contact precautions for LTCF residents with resistant gram-negative bacilli colonization.

Preventing the Spread of Vancomycin-Resistant Enterococci in a Long-Term Care Facility

2000 ◽  
Vol 48 (10) ◽  
pp. 1211-1215 ◽  
Author(s):  
Fredric J. Silverblatt ◽  
Cynthia Tibert ◽  
Dennis Mikolich ◽  
Julia Blazek-D'Arezzo ◽  
Josephine Alves ◽  
...  
Keyword(s):  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

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

2009 ◽  
Vol 30 (12) ◽  
pp. 1172-1179 ◽  
Author(s):  
Erin O'Fallon ◽  
Robert Schreiber ◽  
Ruth Kandel ◽  
Erika M. C. D'Agata
Keyword(s):  
Care Facility ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Methicillin Resistant ◽  
Long Term Care Facility ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

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-resistantStaphylococcus 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-resistantS. 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-resistantS. aureus. Common areas in LTCFs may provide a unique opportunity for person-to-person transmission of MDR gram-negative bacteria.

scholarly journals Risk factors for development of aminoglycoside resistance among gram-negative rods

2019 ◽  
Vol 76 (22) ◽  
pp. 1838-1847
Author(s):  
Stefan E Richter ◽  
Loren Miller ◽  
Jack Needleman ◽  
Daniel Z Uslan ◽  
Douglas Bell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Long Term Care ◽  
Care Facility ◽  
Aminoglycoside Resistance ◽  
Term Care ◽  
Gram Negative ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
C Statistic

Abstract Purpose Development of scoring systems to predict the risk of aminoglycoside resistance and to guide therapy is described. Methods Infections due to aminoglycoside-resistant gram-negative rods (AR-GNRs) are increasingly common and associated with adverse outcomes; selection of effective initial antibiotic therapy is necessary to reduce adverse consequences and shorten length of stay. To determine risk factors for AR-GNR recovery from culture, cases of GNR infection among patients admitted to 2 institutions in a major academic hospital system during the period 2011–2016 were retrospectively analyzed. Gentamicin and tobramycin resistance (GTR-GNR) and amikacin resistance (AmR-GNR) patterns were analyzed separately. A total of 26,154 GNR isolates from 12,516 patients were analyzed, 6,699 of which were GTR, and 2,467 of which were AmR. Results In multivariate analysis, risk factors for GTR-GNR were presence of weight loss, admission from another medical or long-term care facility, a hemoglobin level of <11 g/dL, receipt of any carbapenem in the prior 30 days, and receipt of any fluoroquinolone in the prior 30 days (C statistic, 0.63). Risk factors for AmR-GNR were diagnosis of cystic fibrosis, male gender, admission from another medical or long-term care facility, ventilation at any point prior to culture during the index hospitalization, receipt of any carbapenem in the prior 30 days, and receipt of any anti-MRSA agent in the prior 30 days (C statistic, 0.74). Multinomial and ordinal models demonstrated that the risk factors for the 2 resistance patterns differed significantly. Conclusion A scoring system derived from the developed risk prediction models can be applied by providers to guide empirical antimicrobial therapy for treatment of GNR infections.

Transmission Clusters of Methicillin-Resistant Staphylococcus Aureus in Long-Term Care Facilities Based on Whole-Genome Sequencing

2016 ◽  
Vol 37 (6) ◽  
pp. 685-691 ◽  
Author(s):  
O. Colin Stine ◽  
Shana Burrowes ◽  
Sophia David ◽  
J. Kristie Johnson ◽  
Mary-Claire Roghmann
Keyword(s):  
Staphylococcus Aureus ◽  
Genome Sequencing ◽  
Long Term Care ◽  
Care Facility ◽  
Whole Genome ◽  
Term Care ◽  
Long Term Care Facility ◽  
Care Facilities ◽  
Mrsa Colonization

OBJECTIVETo define how often methicillin-resistant Staphylococcus aureus (MRSA) is spread from resident to resident in long-term care facilities using whole-genome sequencingDESIGNProspective cohort studySETTINGA long-term care facilityPARTICIPANTSElderly residents in a long-term care facilityMETHODSCultures for MRSA were obtained weekly from multiple body sites from residents with known MRSA colonization over 12-week study periods. Simultaneously, cultures to detect MRSA acquisition were obtained weekly from 2 body sites in residents without known MRSA colonization. During the first 12-week cycle on a single unit, we sequenced 8 MRSA isolates per swab for 2 body sites from each of 6 residents. During the second 12-week cycle, we sequenced 30 MRSA isolates from 13 residents with known MRSA colonization and 3 residents who had acquired MRSA colonization.RESULTSMRSA isolates from the same swab showed little genetic variation between isolates with the exception of isolates from wounds. The genetic variation of isolates between body sites on an individual was greater than that within a single body site with the exception of 1 sample, which had 2 unrelated strains among the 8 isolates. In the second cycle, 10 of 16 residents colonized with MRSA (63%) shared 1 of 3 closely related strains. Of the 3 residents with newly acquired MRSA, 2 residents harbored isolates that were members of these clusters.CONCLUSIONSPoint prevalence surveys with whole-genome sequencing of MRSA isolates may detect resident-to-resident transmission more accurately than routine surveillance cultures for MRSA in long-term care facilities.Infect Control Hosp Epidemiol 2016;37:685–691

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