Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review

• Published in: Antibiotics (Basel) Vol. 10; no. 6; p. 680
• Main Authors: Rodríguez-Villodres, Ángel, Martín-Gandul, Cecilia, Peñalva, Germán, Guisado-Gil, Ana Belén, Crespo-Rivas, Juan Carlos, Pachón-Ibáñez, María Eugenia, Lepe, José Antonio, Cisneros, José Miguel
• Format: Journal Article
• Language: English
• Published: Basel MDPI AG 07.06.2021; MDPI
• Subjects: Antibiotic resistance; Antibiotics; Antiinfectives and antibacterials; Antimicrobial agents; antimicrobial stewardship; Bacteria; Colonization; E coli; Enterobacterales; Epidemiology; Gram-positive bacteria; Health risks; long term care facilities; Long term health care; Long-term care; Medical equipment; Methicillin; Multidrug resistance; Multidrug resistant organisms; multidrug-resistant organism; Nursing homes; Older people; prevalence; Pseudomonas aeruginosa; Public health; Resistance factors; Review; Risk analysis; Risk factors; Staphylococcus aureus; Staphylococcus infections; Vancomycin; β Lactamase; South America; Asia; North America; Europe; Oceania
• ISSN: 2079-6382; 2079-6382
• DOI: 10.3390/antibiotics10060680

Elderly people confined to chronic care facilities face an increased risk of acquiring infections by multidrug-resistant organisms (MDROs). This review presents the current knowledge of the prevalence and risk factors for colonization by MDROs in long-term care facilities (LTCF), thereby providing a useful reference to establish objectives for implementing successful antimicrobial stewardship programs (ASPs). We searched in PubMed and Scopus for studies examining the prevalence of MDROs and/or risk factors for the acquisition of MDROs in LTCF. One hundred and thirty-four studies published from 1987 to 2020 were included. The prevalence of MDROs in LTCF varies between the different continents, where Asia reported the highest prevalence of extended-spectrum ß-lactamase (ESBL) Enterobacterales (71.6%), carbapenem resistant (CR) Enterobacterales (6.9%) and methicillin-resistant Staphylococcus aureus (MRSA) (25.6%) and North America the highest prevalence to MDR Pseudomonas aeruginosa (5.4%), MDR Acinetobacter baumannii (15.0%), vancomycin-resistant Enterococcus spp. (VRE) (4.0%), and Clostridioides difficile (26.1%). Furthermore, MDRO prevalence has experienced changes over time, with increases in MDR P. aeruginosa and extended spectrum ß-lactamase producing Enterobacterales observed starting in 2015 and decreases of CR Enterobacterales, MDR A. baumannii, VRE, MRSA and C. difficile. Several risk factors have been found, such as male sex, chronic wounds, the use of medical devices, and previous antibiotic use. The last of these aspects represents one of the most important modifiable factors for reducing colonization with MDROs through implementing ASPs in LTCF.