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

• Published in: Journal of the American Geriatrics Society (JAGS) Vol. 56; no. 7; pp. 1276 - 1280
• Main Authors: Pop-Vicas, Aurora, Mitchell, Susan L., Kandel, Ruth, Schreiber, Robert, D'Agata, Erika M. C.
• Format: Journal Article
• Language: English
• Published: Malden, USA Blackwell Publishing Inc 01.07.2008; Blackwell; Wiley Subscription Services, Inc
• Subjects: Activities of Daily Living; advanced dementia; Aged; Aged, 80 and over; antimicrobial resistance; Biological and medical sciences; Boston - epidemiology; Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases; Dementia - complications; Disease transmission; Drug resistance; Drug Resistance, Multiple, Bacterial; Female; General aspects; Gram-negative bacteria; Gram-Negative Bacterial Infections - epidemiology; Gram-Negative Bacterial Infections - microbiology; Gram-Negative Bacterial Infections - transmission; Health facilities; Humans; Long term health care; Long-Term Care; long-term care facility; Male; Medical sciences; Methicillin Resistance; methicillin-resistant Staphylococcus aureus; Middle Aged; Miscellaneous; multidrug-resistant gram-negative bacteria; Neurology; Nursing Homes; Prevalence; Public health. Hygiene; Public health. Hygiene-occupational medicine; Risk Factors; Staphylococcus aureus; Vancomycin Resistance; vancomycin-resistant enterococci; Boston; USA, Massachusetts, Boston; Prevalence; Peptides; Drug susceptibility test; methicillin-resistant Staphylococcus aureus; Vancomycin; Antimicrobial agent; Glycopeptide; antimicrobial resistance; Multiple resistance; Bacteria; Micrococcales; Advanced stage; Degenerative disease; Micrococcaceae; Public health; Staphylococcus aureus; Gram negative bacteria; Human; Enterococcus; Treatment resistance; vancomycin-resistant enterococci; long-term care facility; multidrug-resistant gram-negative bacteria; Care; Streptococcaceae; Antibiotic; Health care facility; Polypeptide; Risk factor; Antibacterial agent; Elderly; Long term care; Dementia; Geriatrics; advanced dementia
• ISSN: 0002-8614; 1532-5415; 1532-5415
• DOI: 10.1111/j.1532-5415.2008.01787.x

OBJECTIVES: To quantify the prevalence, risk factors, and mode of transmission associated with colonization by multidrug‐resistant gram‐negative bacteria (MDRGN) in the long‐term care (LTC) setting. DESIGN: Cross‐sectional. SETTING: Four nursing units in a 648‐bed LTC facility in Boston, Massachusetts. PARTICIPANTS: Eighty‐four long‐term care residents. MEASUREMENTS: Nasal and rectal swabs were obtained to determine colonization with MDRGN; if present, molecular typing was performed. The prevalence of methicillin‐resistant Staphylococcus aureus (MRSA) and vancomycin‐resistant enterococci (VRE) was also determined. Demographic and clinical characteristics were obtained from the medical record. Multivariable analysis was used to identify factors independently associated with MDRGN colonization. RESULTS: A total of 51%, 28%, and 4% subjects were colonized with MDRGN, MRSA, and VRE, respectively. After multivariable adjustment, advanced dementia (adjusted odds ratio (AOR)=2.9, 95% confidence interval (CI)=1.2–7.35, P=.02) and nonambulatory status (AOR=5.7, 95% CI=1.1–28.9, P=.04) were the only independent risk factors for harboring MDRGN. Molecular typing indicated person‐to‐person transmission. CONCLUSION: Colonization with MDRGN is common in the LTC setting. A diagnosis of advanced dementia is a major risk factor for harboring MDRGN.