Distribution of Extended-Spectrum β-Lactamase Genes and Antimicrobial Susceptibility among Residents in Geriatric Long-Term Care Facilities in Japan

A high prevalence of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) may call for monitoring in geriatric long-term care facilities (g-LTCFs). We surveyed the distribution of ESBL-causative gene types and antimicrobial susceptibility in ESBL-PE strains from residents in g-LTCFs, and investigated the association between ESBL-causative gene types and antimicrobial susceptibility. First, we analyzed the types of ESBL-causative genes obtained from 141 ESBL-PE strains collected from the feces of residents in four Japanese g-LTCFs. Next, we determined the minimum inhibitory concentration values for alternative antimicrobial agents against ESBL-PE, including β-lactams and non-β-lactams. Escherichia coli accounted for 96% of the total ESBL-PE strains. Most strains (94%) contained blaCTX-M group genes. The genes most commonly underlying resistance were of the blaCTX-M-9 and blaCTX-M-1 groups. Little difference was found in the distribution of ESBL-causative genes among the facilities; however, antimicrobial susceptibility differed widely among the facilities. No specific difference was found between antimicrobial susceptibility and the number of ESBL-causative genes. Our data showed that ESBL-PEs were susceptible to some antimicrobial agents, but the susceptibility largely differed among facilities. These findings suggest that each g-LTCF may require specific treatment strategies based on their own antibiogram. Investigations into drug resistance should be performed in g-LTCFs as well as acute medical facilities.

Identifying smart healthscape quality criteria for geriatric long-term care private hospitals in South Korea: Analytic Hierarchy Process (Preprint)

BACKGROUND In the field of healthcare services, intelligent technology is deeply merged in the healthcare services and many general hospitals tried to build smart hospitals for providing smart healthcare services to the patients. However, geriatric long-term care private hospitals (GHs), where providing the elderly patient-suited care services implemented by multiple service providers, should be considered differently than a general hospital. The purpose of this study is to identifying Smart Healthscape Quality (SHQ), to provide the evaluation criteria that can be applied to the context of private sector GHs in South Korea, and to select the priorities for service improvement. In order to specify healthcare services for geriatric patients, this study was based on two rationales: (1) Geriatric long-term care private hospitals (GHs) should be considered differently than a general hospital. (2) patients are perceived service from environments not only includes physical elements but also includes intangible elements such as intelligent system technologies. OBJECTIVE The purpose of this study is to identifying Smart Healthscape Quality (SHQ), to provide the evaluation criteria that can be applied to the context of private sector GHs in South Korea, and to select the priorities for service improvement. METHODS Previous studies and reviews of existing, well-regarded healthcare-related guidelines that focus predominantly on general hospitals were first reviewed and relevant points were extracted. Next, a group of academics was enlisted to review the proposed criteria and sub-criteria. Then, an analytic hierarchy process (AHP) was employed in which healthcare professionals evaluated the importance (weighting) of each criterion and sub-criterion. RESULTS The author identifies and describes 7 criteria (safety, accessibility and layout, ambiance, appealing decorations and facilities, sociality, service, and intelligent system) and 43 sub-criteria. Also, the author provides importance of each criterion and sub-criterion. CONCLUSIONS The result of this study provides not only the foundation of the service framework for GHs in South Korea from a healthscape perspective, but also suggests a basis for smart healthscape concerns in private hospital service environments. The main contributions of this study include. 1) a comprehensive framework of SHQ for GHs in South Korea, 2) SHQ that extended the existing healthscape concept, and 3) the strongest-weighted SHQ offer practical support for decision-makers to identify common requirements and areas of improvement when planning GHs services.

Prolonged Carriage of ESBL-producing Enterobacteriaceae and Potential Cross-transmission among Residents in Geriatric Long-term Care Facilities

Background: Previous studies indicated residents in geriatric long-term care facilities (LTCFs) had much higher prevalence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) carriage than the general population. Most ESBL-E carriers are asymptomatic. The study tested the hypothesis that residents with ESBL-E carriage may accumulate inside geriatric LTCFs through potential cross-transmission after exposure to residents with prolonged ESBL-E carriage.Methods: We evaluated 260 residents receiving long-term care in four LTCFs in Japan. All residents underwent initial ESBL-E testing of fecal specimens and were divided into two cohorts: Cohort 1, 95 patients with ≥2 months residence at study onset; Cohort 2, 165 patients with <2 months residence at study onset or new admission during the study period. Among the 260 residents with continuous LTCF residence, 126 underwent second testing 3–12 months after the first testing and 36 residents underwent third testing ≥12 months after the second testing. Three analyses were performed: (1) ESBL-E carriage statuses in Cohort 1 and Cohort 2; (2) changes in ESBL-E carriage statuses in the second testing and third testing; and (3) lengths of positive ESBL-E carriage statuses in patients who underwent the second testing and third testing.Results: Among all 260 residents, 95 (36.5%) were positive for ESBL-E carriage in the first testing. The prevalence of ESBL-E carriage was significantly higher in Cohort 2 than in Cohort 1 (40% vs. 28%; p<0.01). In the subsequent testing results, 18.3% of residents who were negative in the first testing showed positive conversion to ESBL-E carriage in the second testing, while no patients who were negative in the second testing showed positive conversion in the third testing. The maximum length of ESBL-E carriage was 17 months.Conclusions: ESBL-E was most likely to be carried into LTCFs through admission of new residents. Some residents acquired ESBL-E through potential cross-transmission within 3–12 months after admission. Despite possible ESBL-E carriage for >1 year, no residents showed positive conversion >12 months after admission, which suggests that residents with ESBL-E carriage may not accumulate inside LTCFs. Practical infection control and prevention measures against ESBL-E by care providers could improve the ESBL-E prevalence in geriatric LTCFs.

Association between length of residence and prevalence of MRSA colonization among residents in geriatric long-term care facilities

Background A high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization has been reported among residents in geriatric long-term care facilities (LTCFs). Some studies indicate that MRSA might be imported from hospitals into LTCFs via resident transfer; however, other studies report that high MRSA prevalence might be caused by cross-transmission inside LTCFs. We aimed to assess which factors have a large impact on the high MRSA prevalence among residents of geriatric LTCFs. Methods We conducted a cohort study among 260 residents of four geriatric LTCFs in Japan. Dividing participants into two cohorts, we separately analyzed (1) the association between prevalence of MRSA carriage and length of LTCF residence (Cohort 1: n = 204), and (2) proportion of residents identified as MRSA negative who were initially tested at admission but subsequently identified as positive in secondary testing performed at ≥2 months after their initial test (Cohort 2: n = 79). Results Among 204 residents in Cohort 1, 20 (9.8%) were identified as positive for MRSA. Compared with residents identified as MRSA negative, a larger proportion of MRSA-positive residents had shorter periods of residence from the initial admission (median length of residence: 5.5 vs. 2.8 months), although this difference was not statistically significant (p = 0.084). Among 79 residents in Cohort 2, 60 (75.9%) were identified as MRSA negative at the initial testing. Of these 60 residents, only one (1.7%) had subsequent positive conversion in secondary MRSA testing. In contrast, among 19 residents identified as MRSA positive in the initial testing, 10 (52.6%) were negative in secondary testing. Conclusions The prevalence of MRSA was lower among residents with longer periods of LTCF residence than among those with shorter periods. Furthermore, few residents were found to become MRSA carrier after their initial admission. These findings highlight that MRSA in LTCFs might be associated with resident transfer rather than spread via cross-transmission inside LTCFs.

Association Between Length of Residence and Prevalence of Mrsa Colonization Among Residents in Geriatric Long-term Care Facilities

Background: A high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization has been reported among residents in geriatric long-term care facilities (LTCFs). Some studies indicate that MRSA might be imported from hospitals into LTCFs via resident transfer; however, other studies report that high MRSA prevalence might be caused by cross-transmission inside LTCFs. We aimed to assess which factors have a large impact on the high MRSA prevalence among residents of geriatric LTCFs.Methods: We conducted a cohort study among 260 residents of four geriatric LTCFs in Japan. Dividing participants into two cohorts, we separately analyzed (1) the association between prevalence of MRSA carriage and length of LTCF residence (Cohort 1: n=204), and (2) proportion of residents identified as MRSA negative who were initially tested at admission but subsequently identified as positive in secondary testing performed at ≥2 months after their initial test (Cohort 2: n=79).Results: Among 204 residents in Cohort 1, 20 (9.8%) were identified as positive for MRSA. Compared with residents identified as MRSA negative, a larger proportion of MRSA-positive residents had shorter periods of residence from the initial admission (median length of residence: 5.5 vs. 2.8 months), although this difference was not statistically significant (p=0.084). Among 79 residents in Cohort 2, 60 (75.9%) were identified as MRSA negative at the initial testing. Of these 60 residents, only one (1.7%) had subsequent positive conversion in secondary MRSA testing. In contrast, among 19 residents identified as MRSA positive in the initial testing, 10 (52.6%) were negative in secondary testing.Conclusions: The prevalence of MRSA was lower among residents with longer periods of LTCF residence than among those with shorter periods. Furthermore, few residents were found to become MRSA carrier after their initial admission. These findings highlight that MRSA in LTCFs is most likely to be associated with resident transfer rather than spread via cross-transmission inside LTCFs.