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.

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.

Multidrug-Resistant Gram-Negative Bacteria in a Long-Term Care Facility: Prevalence and Risk Factors

2008 ◽  
Vol 56 (7) ◽  
pp. 1276-1280 ◽  
Author(s):  
Aurora Pop-Vicas ◽  
Susan L. Mitchell ◽  
Ruth Kandel ◽  
Robert Schreiber ◽  
Erika M. C. D'Agata
Keyword(s):  
Risk Factors ◽  
Long Term Care ◽  
Care Facility ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Term Care Facility ◽  
Long Term Care Facility

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 Incidence and Outcomes Associated With Infections Caused by Vancomycin-Resistant Enterococci in the United States: Systematic Literature Review and Meta-Analysis

2016 ◽  
Vol 38 (2) ◽  
pp. 203-215 ◽  
Author(s):  
Hsiu-Yin Chiang ◽  
Eli N. Perencevich ◽  
Rajeshwari Nair ◽  
Richard E. Nelson ◽  
Matthew Samore ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Meta Analysis ◽  
Care Facility ◽  
The United States ◽  
Multicenter Studies ◽  
Term Care ◽  
Long Term Care Facility ◽  
Vancomycin Resistant Enterococci ◽  
Vancomycin Resistant

BACKGROUNDInformation about the health and economic impact of infections caused by vancomycin-resistant enterococci (VRE) can inform investments in infection prevention and development of novel therapeutics.OBJECTIVETo systematically review the incidence of VRE infection in the United States and the clinical and economic outcomes.METHODSWe searched various databases for US studies published from January 1, 2000, through June 8, 2015, that evaluated incidence, mortality, length of stay, discharge to a long-term care facility, readmission, recurrence, or costs attributable to VRE infections. We included multicenter studies that evaluated incidence and single-center and multicenter studies that evaluated outcomes. We kept studies that did not have a denominator or uninfected controls only if they assessed postinfection length of stay, costs, or recurrence. We performed meta-analysis to pool the mortality data.RESULTSFive studies provided incidence data and 13 studies evaluated outcomes or costs. The incidence of VRE infections increased in Atlanta and Detroit but did not increase in national samples. Compared with uninfected controls, VRE infection was associated with increased mortality (pooled odds ratio, 2.55), longer length of stay (3-4.6 days longer or 1.4 times longer), increased risk of discharge to a long-term care facility (2.8- to 6.5-fold) or readmission (2.9-fold), and higher costs ($9,949 higher or 1.6-fold more).CONCLUSIONSVRE infection is associated with large attributable burdens, including excess mortality, prolonged in-hospital stay, and increased treatment costs. Multicenter studies that use suitable controls and adjust for time at risk or confounders are needed to estimate the burden of VRE infections.Infect Control Hosp Epidemiol. 2017;38:203–215

Low prevalence of colonization with multidrug-resistant gram-negative bacteria in long-term care facilities in Graz, Austria

2018 ◽  
Vol 46 (1) ◽  
pp. 76-80 ◽  
Author(s):  
Eva Leitner ◽  
Elisabeth Zechner ◽  
Elisabeth Ullrich ◽  
Gernot Zarfel ◽  
Josefa Luxner ◽  
...  
Keyword(s):  
Long Term Care ◽  
Multidrug Resistant ◽  
Gram Negative Bacteria ◽  
Term Care ◽  
Gram Negative ◽  
Care Facilities ◽  
Low Prevalence
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