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Multidrug-Resistant Organism Infections in US Nursing Homes: A National Study of Prevalence, Onset, and Transmission across Care Settings, October 1, 2010-December 31, 2011

Published online by Cambridge University Press:  10 May 2016

Daver Kahvecioglu ,
Kalpana Ramiah ,
Darcy McMaughan ,
Steven Garfinkel ,
Veronica E. McSorley ,
Quy Nhi Nguyen ,
Manshu Yang ,
Christopher Pugliese ,
David Mehr  and
Charles D. Phillips
Daver Kahvecioglu
Affiliation:
Fannie Mae, Washington, DC
Kalpana Ramiah
Affiliation:
American Institutes for Research, Washington, DC
Darcy McMaughan
Affiliation:
Texas A&M University, School of Public Health, College Station, Texas
Steven Garfinkel
Affiliation:
American Institutes for Research, Washington, DC
Veronica E. McSorley
Affiliation:
American Institutes for Research, Washington, DC
Quy Nhi Nguyen
Affiliation:
American Institutes for Research, Washington, DC
Manshu Yang
Affiliation:
American Institutes for Research, Washington, DC
Christopher Pugliese
Affiliation:
American Institutes for Research, Washington, DC
David Mehr
Affiliation:
University of Missouri, School of Medicine, Columbia, Missouri
Charles D. Phillips
Affiliation:
Texas A&M University, School of Public Health, College Station, Texas
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Objective.

To understand the prevalence of multidrug-resistant organism (MDRO) infections among nursing home (NH) residents and the potential for their spread between NHs and acute care hospitals (ACHs).

Methods.

Descriptive analyses of MDRO infections among NH residents using all NH residents in the Long-Term Care Minimum Data Set (MDS) 3.0 between October 1, 2010 and December 31, 2011.

Results.

Analysis of MDS data revealed a very high volume of bidirectional patient flow between NHs and ACHs, indicating the need to study MDRO infections in NHs as well as in hospitals. A total of 4.24% of NH residents had an active MDRO diagnosis on at least 1 MDS assessment during the study period. This rate significantly varied by sex, age, urban/rural status, and state. Approximately 2% of NH discharges to ACHs involved a resident with an active diagnosis of infection due to MDROs. Conversely, 1.8% of NH admissions from an ACH involved a patient with an active diagnosis of infection due to MDROs. Among residents who acquired an MDRO infection during the study period, 57% became positive in the NH, 41% in the ACH, and 2% in other settings (eg, at a private home or apartment).

Conclusion.

Even though NHs are the most likely setting where residents would acquire MDROs after admission to an NH (accounting for 57% of cases), a significant fraction of NH residents acquire MDRO infection at ACHs (41%). Thus, effective MDRO infection control for NH residents requires simultaneous, cooperative interventions among NHs and ACHs in the same community.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue S3: Preventing Healthcare–Associated Infections: Results and Lessons Learned from AHRQ's HAI Program , October 2014 , pp. S48 - S55
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

References

1. Scott RD II. The direct medical costs of healthcare-associated infections in U.S. hospitals and the benefits of prevention. Atlanta: Centers for Disease Control and Prevention, 2009. http://www.cdc.gov/HAI/pdfs/hai/Scott_CostPaper.pdf. Accessed May 20, 2014.Google Scholar
2. Blumenstock, J, Buchanan, A, Cairns, C, et al. Eliminating healthcare-associated infections: state policy options. Arlington, VA: Association of State and Territorial Health Officials, 2011. http://www.cdc.gov/hai/pdfs/toolkits/toolkit-hai-policy-final _01-2012.pdf.Accessed May 20, 2014.Google Scholar
3. Fenton, T. Healthcare reform pressures hospitals to control HAIs. Lenexa, KS: Thermo Fisher Scientific, 2010. http://www.remel.com/hai/Article.aspx?ID = 1. Accessed June 28, 2013.Google Scholar
4. Boucher, HW, Talbot, GH, Bradley, JS, et al. Bad bugs, no drugs: no ESKAPE! an update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48(1):1–12.CrossRefGoogle ScholarPubMed
5. Gaynes, R, Edwards, JR. Overview of nosocomial infections caused by gram-negative bacilli. Clin Infect Dis 2005;41(6):848–854.Google ScholarPubMed
6. Denkinger, CM, Grant, AD, Denkinger, M, Gautam, S, D'Agata, EM.Increased multi-drug resistance among the elderly on admission to the hospital—a 12-year surveillance study. Arch Gerontol Geriatr 2013;56(1):227–230.CrossRefGoogle Scholar
7. Bonomo, RA, Rice, LB. Emerging issues in antibiotic resistant infections in long-term care facilities. J Gerontol A Biol Sci Med Sci 1999;54(6):B260–B267.CrossRefGoogle ScholarPubMed
8. Raz, R. The clinical impact of multiresistant gram-positive microorganisms in long-term care facilities. J Am Med Dir Assoc 2003;4(3 suppl):S100–S104.CrossRefGoogle ScholarPubMed
9. Papia, G, Louie, M, Tralla, A, Johnson, C, Collins, V, Simor, AE. Screening high-risk patients for methicillin-resistant Staphylococcus aureus on admission to the hospital: is it cost effective. Infect Control Hosp Epidemiol 1999;20(7):473–477.CrossRefGoogle Scholar
10. Huang, SS1, Rifas-Shiman, SL, Warren, DK, et al. Improving methicillin-resistant Staphylococcus aureus surveillance and reporting in intensive care units. J Infect Dis 2007;195(3):330–338.Google Scholar
11. Lucet, JC, Chevret, S, Durand-Zaleski, I, Chastang, C, Regnier, B; Multicenter Study Group.Prevalence and risk factors for carriage of methicillin-resistant Staphylococcus aureus at admission to the intensive care unit: results of a multicenter study. Arch Intern Med 2003;163(2):181–188.CrossRefGoogle Scholar
12. Pop-Vicas, AE, D'Agata, EM. The rising influx of multidrug-resistant gram-negative bacilli into a tertiary care hospital. Clin Infect Dis 2005;40(12):1792–1798.CrossRefGoogle ScholarPubMed
13. Pop-Vicas, A, Mitchell, SL, Kandel, R, Schreiber, R, D'Agata, EM. Multidrug-resistant gram-negative bacteria in a long-term care facility: prevalence and risk factors. J Am Geriatr Soc 2008;56(7):1276–1280.CrossRefGoogle Scholar
14. O'Fallon, E, Pop-Vicas, A, D'Agata, E. The emerging threat of multidrug-resistant gram-negative organisms in long-term care facilities. J Gerontol A Biol Sci Med Sci 2009;64(1):138–141.Google Scholar
15. Loeb, MB, Craven, S, McGeer, AJ, et al. Risk factors of resistance to antimicrobial agents among nursing home residents. Am J Epidemiol 2003;157(1):40–47.CrossRefGoogle ScholarPubMed
16. Smith, PW, Bennett, G, Bradley, S, et al. SHEA/APIC guideline: infection prevention and control in the long-term care facility. Am J Infect Control 2008;36(7):504–535.CrossRefGoogle ScholarPubMed
17. Drinka, PJ, Crnich, CJ. An approach to endemic multi-drug-resistant bacteria in nursing homes. J Am Med Dir Assoc 2005; 6(2):132–136.CrossRefGoogle ScholarPubMed
18. Brennen, C, Wagener, MM, Muder, RR. Vancomycin-resistant Enterococcus faecium in a long-term care facility. J Am Geriatr Soc 1998;46(2):157–160.CrossRefGoogle ScholarPubMed
19. Strausbaugh, LJ, Crossley, KB, Nurse, BA, Thrupp, LD. Antimicrobial resistance in long-term-care facilities. Infect Control Hosp Epidemiol 1996;17(2):129–140.CrossRefGoogle ScholarPubMed
20. Bradley, SF. Issues in the management of resistant bacteria in long-term-care facilities. Infect Control Hosp Epidemiol 1999; 20(5):362–366.CrossRefGoogle ScholarPubMed
21. Bradley, SF. Methicillin-resistant Staphylococcus aureus: long-term care concerns. Am J Med 1999;106(5A):2S–10S; discussion 48S-52S.CrossRefGoogle ScholarPubMed
22. Wiener, J, Quinn, JP, Bradford, PA, et al. Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999;281(6):517–523.Google Scholar
23. McNeil, SA, Mody, L, Bradley, SF. Methicillin-resistant Staphylococcus aureus: management of asymptomatic colonization and outbreaks of infection in long-term care. Geriatrics 2002;57(6): 16–18, 21-24, 27.Google Scholar
24. Pacio, GA, Visintainer, P, Maguire, G, Wormser, GP, Raffalli, J, Montecalvo, MA. Natural history of colonization with vanco-mycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and resistant gram-negative bacilliamong long-term-care facility residents. Infect Control Hosp Epidemiol 2003;24(4): 246–250.Google Scholar
25. Rahimi, AR. Prevalence and outcome of methicillin-resistant Staphylococcus aureus colonization in two nursing centers in Georgia. J Am Geriatr Soc 1998;46(12):1555–1557.Google ScholarPubMed
26. Trick, WE, Weinstein, RA, DeMarais, PL, et al. Comparison of routine glove use and contact-isolation precautions to prevent transmission of multidrug-resistant bacteria in a long-term care facility. J Am Geriatr Soc 2004;52(12):2003–2009.Google Scholar
27. Ben-Ami, R1, Schwaber, MJ, Navon-Venezia, S, et al. Influx of extended-spectrum beta-lactamase-producing enterobacteri-aceae into the hospital. Clin Infect Dis 2006;42(7):925–934.CrossRefGoogle ScholarPubMed
28. Elizaga, ML, Weinstein, RA, Hayden, MK. Patients in long-term care facilities: a reservoir for vancomycin-resistant enterococci. Clin Infect Dis 2002;34(4):441–446.CrossRefGoogle ScholarPubMed
29. Siegel, JD, Rhinehart, E, Jackson, M, Chiarello, L; Healthcare Infection Control Practices Advisory Committee. Management of multidrug-resistant organisms in health care settings, 2006. Am J Infect Control 2007;35(10 suppl 2):S165–S193.CrossRefGoogle ScholarPubMed
30. Department of Health and Human Services Office of the Assistant Secretary for Planning and Evaluation; Centers for Medicare and Medicaid Services; Health Resource and Services Administration; Department of Labor's Office of the Assistant Secretary for Policy, Bureau of Labor Statistics and Employment and Training. The future supply of long-term care workers in relation to the aging baby boom generation: report to Congress. 2003. http://aspe.hhs.gov/daltcp/reports/ltcwork.pdf. Accessed May 20, 2014.Google Scholar
31. Centers for Medicare and Medicaid Services. Nursing home quality initiative. MDS 3.0 for nursing homes and swing bed providers. UpdatedSeptember 10, 2013. http://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/NursingHomeQualityInits/NHQIMDS30.html. Accessed May 20, 2014.Google Scholar