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Persistence of Fluoroquinolone-Resistant, Multidrug-Resistant Streptococcus pneumoniae in a Long-Term–Care Facility Efforts to Reduce Intrafacility Transmission

Published online by Cambridge University Press:  21 June 2016

Alicia M. Fry ,
Chi Chi N. Udeagu ,
Montse Soriano-Gabarro ,
Scott Fridkin ,
Diana Musinski ,
Leslie LaClaire ,
John Elliott ,
Debra J. P. Cook ,
John Kornblum  and
Marcelle Layton
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Alicia M. Fry
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
Chi Chi N. Udeagu
Affiliation:
Bureau of Communicable Diseases, New York City Department of Health, New York City, New York
Montse Soriano-Gabarro
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
Scott Fridkin
Affiliation:
Division of Health Care Quality Promotion, National Center for Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Diana Musinski
Affiliation:
Northeast Counties Infection Control Practitioner Network, Brooklyn, New York
Leslie LaClaire
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
John Elliott
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
Debra J. P. Cook
Affiliation:
Public Health Laboratories, New York City Department of Health, New York City, New York
John Kornblum
Affiliation:
Public Health Laboratories, New York City Department of Health, New York City, New York
Marcelle Layton
Affiliation:
Bureau of Communicable Diseases, New York City Department of Health, New York City, New York
Cynthia G. Whitney*
Affiliation:
Respiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia
*
Centers for Disease Control and Prevention, Mailstop C-23, 1600 Clifton Road NE, Atlanta, GA 30333cgw3@cdc.gov
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Abstract

Objective:

We describe an effort to reduce transmission of a multidrug-resistant Streptococcus pneumoniae (MDRSP) in a long-term-care facility (LTCF).

Design:

Longitudinal cross-sectional study.

Setting:

An LTCF in New York City with ongoing disease due to an MDRSP strain among residents with AIDS since a 1995 outbreak. The MDRSP outbreak strain was susceptible to vancomycin but not to other antimicrobials tested, including fluoroquinolones.

Participants:

Residents and staff members of the LTCF during 1999 through 2001.

Intervention:

Implementing standard infection control measures, and developing and implementing "enhanced standard" infection control measures, modified respiratory droplet prevention measures to reduce inter-resident transmission.

Results:

Before the intervention, nasopharyngeal carriage of the MDRSP outbreak strain was detected in residents with AIDS and residents with tracheostomies who were not dependent on mechanical ventilation. The prevalence of nasopharyngeal carriage of the MDRSP outbreak strain was 7.8% among residents who had AIDS and 14.6% among residents with tracheostomies. After training sessions on standard and enhanced standard infection control measures, the staff appeared to have good knowledge and practice of the infection control measures. After the intervention, new transmission among residents with tracheostomies was prevented; however, these residents were prone to persistent tracheal carriage and needed ongoing enhanced standard infection control measures. Ongoing transmission among residents with AIDS, a socially active group, was documented, although fewer cases of disease due to the outbreak strain occurred.

Conclusions:

Infection control contributed to less transmission of MDRSP in the LTCF. Additional strategies are needed to reduce transmission and carriage among certain resident populations.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 3 , March 2005 , pp. 239 - 247
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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