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Antimicrobial Resistance in Long-Term–Care Facilities

Published online by Cambridge University Press:  02 January 2015

Larry J. Strausbaugh ,
Kent B. Crossley ,
Brenda A. Nurse ,
Lauri D. Thrupp  and
SHEA Long-Term–Care Committee
Larry J. Strausbaugh*
Affiliation:
Medical Service, Veterans Affairs Medical Center and Division of Infectious Diseases, Department of Medicine, School of Medicine, Oregon Health Sciences University, Portland, Oregon
Kent B. Crossley
Affiliation:
Department of Medicine, St Paul Ramsey Medical Center, St Paul, Minnesota, and Division of Infectious Diseases, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
Brenda A. Nurse
Affiliation:
Hospital for Special Care, New Britain, Connecticut, and School of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
Lauri D. Thrupp
Affiliation:
Infectious Disease Service, Department of Medicine, University of California–Irvine Medical Center and Department of Medicine, University of California–Irvine College of Medicine, Orange, California
*
Medical Service (111F), Portland VA Medical Center, PO Box 1034, Portland, OR 97207
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Abstract

During the last quarter century, numerous reports have indicated that antimicrobial resistance commonly is encountered in long-term–care facilities (LTCFs). Gramnegative uropathogens resistant to penicillin, cephalosporin, aminoglycoside, or fluoroquinolone antibiotics and methicillin-resistant Staphylococcus aureus have received the greatest attention, but other reports have described the occurrence of multiply-resistant strains of Haemophilus influenzae and vancomycin-resistant enterococci (VRE) in this setting. Antimicrobial-resistant bacteria may enter LTCFs with colonized patients transferred from the hospital, or they may arise in the facility as a result of mutation or gene transfer. Once present, resistant strains tend to persist and become endemic. Rapid dissemination also has been documented in some facilities. Person-to-person transmission via the hands of healthcare workers appears to be the most important means of spread. The LTCF patients most commonly affected are those with serious underlying disease, poor functional status, wounds such as pressure sores, invasive devices such as urinary catheters, and prior antimicrobial therapy. The presence of antimicrobial-resistant pathogens in LTCFs has serious consequences not only for residents but also for LTCFs and hospitals. Experience with control strategies for antimicrobial-resistant pathogens in LTCFs is limited; however, strategies used in hospitals often are inapplicable. Six recommendations for controlling antimicrobial resistance in LTCFs are offered, and four priorities for future research are identified.

Type
SHEA Position Paper
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 2 , February 1996 , pp. 129 - 140
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

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Footnotes

*

Other members of the SHEA Long-Term–Care Committee include David W. Bentley, MD; Richard A. Garibaldi, MD; Ellen G. Neuhaus, MD; Lindsay E. Nicolle, MD; and Philip W. Smith, MD.

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