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Prevalence of and Risk Factors for Multidrug-Resistant Acinetobacter baumannii Colonization Among High-Risk Nursing Home Residents

Published online by Cambridge University Press:  15 June 2015

Lona Mody*
Affiliation:
Division of Geriatric and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
Kristen E. Gibson
Affiliation:
Division of Geriatric and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Amanda Horcher
Affiliation:
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
Katherine Prenovost
Affiliation:
Veterans Affairs Center for Clinical Management Research, Ann Arbor, Michigan
Sara E. McNamara
Affiliation:
Division of Geriatric and Palliative Care Medicine, University of Michigan Medical School, Ann Arbor, Michigan
Betsy Foxman
Affiliation:
Department of Epidemiology, School of Public Health, University of Michigan, Ann Arbor, Michigan
Keith S. Kaye
Affiliation:
Division of Infectious Diseases, Detroit Medical Center and Wayne State University, Detroit, Michigan
Suzanne Bradley
Affiliation:
Infectious Diseases Section, Veterans Affairs Ann Arbor Healthcare System and the University of Michigan Medical School, Ann Arbor, Michigan
*
Address correspondence to Lona Mody, MD, MSc, Division of Geriatric and Palliative Care Medicine, University of Michigan Medical School, 300 N. Ingalls Rd, Rm 905, Ann Arbor, MI 48109 (lonamody@umich.edu).

Abstract

OBJECTIVE

To characterize the epidemiology of multidrug-resistant (MDR) Acinetobacter baumannii colonization in high-risk nursing home (NH) residents.

DESIGN

Nested case-control study within a multicenter prospective intervention trial.

SETTING

Four NHs in Southeast Michigan.

PARTICIPANTS

Case patients and control subjects were NH residents with an indwelling device (urinary catheter and/or feeding tube) selected from the control arm of the Targeted Infection Prevention study. Cases were residents colonized with MDR (resistant to ≥3 classes of antibiotics) A. baumannii; controls were never colonized with MDR A. baumannii.

METHODS

For active surveillance cultures, specimens from the nares, oropharynx, groin, perianal area, wounds, and device insertion site(s) were collected upon study enrollment, day 14, and monthly thereafter. A. baumannii strains and their susceptibilities were identified using standard microbiologic methods.

RESULTS

Of 168 NH residents, 25 (15%) were colonized with MDR A. baumannii. Compared with the 143 controls, cases were more functionally disabled (Physical Self-Maintenance Score >24; odds ratio, 5.1 [95% CI, 1.8–14.9]; P<.004), colonized with Proteus mirabilis (5.8 [1.9–17.9]; P<.003), and diabetic (3.4 [1.2–9.9]; P<.03). Most cases (22 [88%]) were colonized with multiple antibiotic-resistant organisms and 16 (64%) exhibited co-colonization with at least one other resistant gram-negative bacteria.

CONCLUSION

Functional disability, P. mirabilis colonization, and diabetes mellitus are important risk factors for colonization with MDR A. baumannii in high-risk NH residents. A. baumannii exhibits widespread antibiotic resistance and a preference to colonize with other antibiotic-resistant organisms, meriting enhanced attention and improved infection control practices in these residents.

Infect Control Hosp Epidemiol 2015;36(10):1155–1162

Type
Original Articles
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

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