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Acquisition of Multidrug-Resistant Gram-Negative Bacteria: Incidence and Risk Factors within a Long-Term Care Population

Published online by Cambridge University Press:  02 January 2015

Erin O'Fallon ,
Ruth Kandell ,
Robert Schreiber  and
Erika M. C. D'Agata
Erin O'Fallon*
Affiliation:
Department of Medicine, Hebrew Senior Life, Boston, Massachusetts
Ruth Kandell
Affiliation:
Department of Medicine, Hebrew Senior Life, Boston, Massachusetts
Robert Schreiber
Affiliation:
Department of Medicine, Hebrew Senior Life, Boston, Massachusetts
Erika M. C. D'Agata*
Affiliation:
the Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts
*
Department of Medicine, Hebrew Senior Life, 1200 Centre Street, Boston, MA 02131 (erinofallon@hrca.harvard.edu)
Division of Infectious Disease, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02115 (edagata@bidmc.harvard.edu)
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Extract

Background and Objective.

An improved understanding of the transmission dynamics of multidrug-resistant (MDR) gram-negative bacteria and the mechanism of acquisition in long-term care facilities (LTCFs) could aid in the development of prevention strategies specific to LTCFs. We thus investigated the incidence of acquisition of these pathogens among an LTCF population.

Design.

Prospective cohort study.

Setting.

Three separate wards at a 600-bed LTCF in metropolitan Boston, Massachusetts, during the period October 31, 2006, through October 22, 2007.

Participants.

One hundred seventy-two LTCF residents.

Methods.

A series of rectal samples were cultured to determine acquisition of MDR gram-negative bacteria, defined as absence of MDR gram-negative bacterial colonization at baseline and de novo recovery of MDR gram-negative bacteria from a follow-up culture. Molecular typing was performed to identify genetically linked strains. A nested matched case-control study was performed to identify risk factors associated with acquisition.

Results.

Among 135 residents for whom at least 1 follow-up culture was performed, 52 (39%) acquired at least 1 MDR gram-negative organism during the study period. Thirty-two residents (62%) had not been colonized at baseline and had acquired at least 1 MDR gram-negative species at follow-up culture, and 20 residents (38%) were colonized at baseline and had acquired at least I MDR gram-negative species at follow-up culture. The most common coresistance pattern was resistance to extended-spectrum penicillins, ciprofloxacin, and gentamicin (57 isolates [42.5%]). Genetically related strains of MDR gram-negative bacteria were identified among multiple residents and between roommates. On conditional logistic regression analysis, antibiotic exposure during the study period was significantly associated with acquisition of MDR gram-negative bacteria (odds ratio, 5.6 [95% confidence interval, 1.1-28.7]; P = .04).

Conclusions.

Acquisition of MDR gram-negative bacteria occurred frequently through resident-to-resident transmission. Existing infection control interventions need to be reevaluated.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 31 , Issue 11 , November 2010 , pp. 1148 - 1153
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2010

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References

1.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 Sei Med Sci 2009;64:138–141.Google Scholar
2.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: 1792–1798.CrossRefGoogle ScholarPubMed
3.Fluit, AC, Verhoef, J, Schmitz, FJ. Frequency of isolation and antimicrobial resistance of gram-negative and gram-positive bacteria from patients in intensive care units of 25 European university hospitals participating in the European arm of the SENTRY Antimicrobial Surveillance Program 1997-1998. Eur J Clin Microbiol Infect Dis 2001;20:617–625.Google Scholar
4.Viray, M, Linkin, D, Maslow, JN, et al.Longitudinal trends in antimicrobial susceptibilities across long-term-care facilities: emergence of fluoroquinolone resistance. Infect Control Hosp Epidemiol 2005;26:56–62.Google Scholar
5.Hyle, EP, Lipworth, AD, Zaoutis, TE, et al.Risk factors for increasing multidrug resistance among extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella species. Clin Infect Dis 2005;40:1317–1324.Google Scholar
6.Cosgrove, SE. The relationship between antimicrobial resistance and patient outcomes: mortality, length of hospital stay, and health care costs. Clin Infect Dis 2006;42(suppl 2):S82–S89.CrossRefGoogle ScholarPubMed
7.Daxboeck, F, Budic, T, Assadian, O, Reich, M, Koller, W. Economic burden associated with multi-resistant gram-negative organisms compared with that for methicillin-resistant Staphylococcus aureus in a university teaching hospital. J Hosp Infect 2006;62:214–218.Google Scholar
8.The Brooklyn Antibiotic Resistance Task Force. The cost of antibiotic resistance: effect of resistance among Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, and Pseudmonas aeruginosa on length of hospital stay. Infect Control Hosp Epidemiol 2002;23:106–108.Google Scholar
9.Giske, CG, Monnet, DL, Cars, O, Carmeli, Y. Clinical and economic impact of common multidrug-resistant gram-negative bacilli. Antimicrob Agents Chemother 2008;52:813–821.CrossRefGoogle ScholarPubMed
10.Gasink, LB, Edelstein, PH, Lautenbach, E, Synnesrvedt, M, Fishman, NO. Risk factors and clinical impact of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae. Infect Control Hosp Epidemiol 2009;30:1180–1185.Google Scholar
11.Safdar, N, Maki, DG. The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, Enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 2002;136:834–844.Google Scholar
12.Pop-Vicas, A, Tacconelli, E, Grevenstein, S, Bing, L, D'Agata, E. Influx of multidrug-resistant, gram-negative bacteria in the hospital setting and the role of elderly patients with bacterial bloodstream infection. Infect Control Hosp Epidemiol 2009;30:325–331.CrossRefGoogle ScholarPubMed
13.Rooney, PJ, O'Leary, MC, Loughrey, AC, et al.Nursing homes as a reservoir of extended-spectrum β-lactamase (ESBL)-producing ciproflox-acin-resistant Escherichia coli. J Antimicrob Chemother 2009;64:635–641.Google Scholar
14.Hebrew Rehabilitation Center. Multidrug-resistant organisms. In: Infection Control Policies and Procedures. Boston, MA: Hebrew Rehabilitation Center, 2006.Google Scholar
15.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
16.Hawes, C, Morris, JN, Phillips, CD, Mor, V, Fries, BE, Nonemaker, S. Reliability estimates for the Minimum Data Set for nursing home resident assessment and care screening (MDS). Gerontologist 1995;35:172–178.CrossRefGoogle ScholarPubMed
17.Morris, JN, Hawes, C, Fries, BE, et al.Designing the national resident assessment instrument for nursing homes. Gerontologist 1990;30:293–307.Google Scholar
18.Reisberg, B, Ferris, SH, de Leon, MJ, Crook, T. The global deterioration scale for assessment of primary degenerative dementia. Am J Psychiatry 1982;139:1136–1139.Google Scholar
19.Katz, S. Assessing self-maintenance: activities of daily living, mobility, and instrumental activities of daily living. J Am Geriatr Soc 1983;31:721–727.Google Scholar
20.Charlson, ME, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373–383.CrossRefGoogle ScholarPubMed
21.D'Agata, E, Venkataraman, L, DeGirolami, P, Samore, M. Molecular epidemiology of acquisition of ceftazidime-resistant gram-negative bacilli in a nonoutbreak setting. J Clin Microbiol 1997;35:2602–2605.Google Scholar
22.Tenover, FC, Arbeit, RD, Goering, RV, et al.Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.CrossRefGoogle ScholarPubMed
23.Lautenbach, E, Marsicano, R, Tolomeo, P, Heard, M, Serrano, S, Stieritz, DD. Epidemiology of antimicrobial resistance among gram-negative organisms recovered from patients in a multistate network of long-term care facilities. Infect Control Hosp Epidemiol 2009;30:790–793.Google Scholar
24.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;56:1276–1280.CrossRefGoogle Scholar
25.Huang, SS, Datta, R, Platt, R. Risk of acquiring antibiotic-resistant bacteria from prior room occupants. Arch Intern Med 2006;166:1945–1951.Google Scholar
26.Bures, S, Fishbain, JT, Uyehara, CF, Parker, JM, Berg, BW. Computer keyboards and faucet handles as reservoirs of nosocomial pathogens in the intensive care unit. Am J Infect Control 2000;28:465–471.Google Scholar
27.Shlaes, DM, Lehman, MH, Currie-McCumber, CA, Kim, CH, Floyd, R. Prevalence of colonization with antibiotic resistant gram-negative bacilli in a nursing home care unit: the importance of cross-colonization as documented by plasmid analysis. Infect Control 1986;7:538–545.Google Scholar
28.Drinka, PJ, Stemper, ME, Gauerke, CD, Miller, JM, Reed, KD. The identification of genetically related bacterial isolates using pulsed field gel electrophoresis on nursing home units: a clinical experience. J Am Geriatr Soc 2004;52:1373–1377.Google Scholar
29.Wingard, E, Shlaes, JH, Mortimer, EA, Shlaes, DM. Colonization and cross-colonization of nursing home patients with trimethoprim-resistant gram-negative bacilli. Clin Infect Dis 1993;16:75–81.Google Scholar
30.O'Fallon, E, Schreiber, R, Kandel, R, D'Agata, E. Multidrug-resistant gram-negative bacteria within a long-term care facility: assessment of residents, health care workers, and inanimate surfaces. Infect Control Hosp Epidemiol 2009;30:1172–1179.Google Scholar
31.Centers for Disease Control and Prevention. Handwashing and glove use in a long-term-care facility-Maryland, 1992. MMWR Morb Mortal Wkly Rep 1993;42:672–675.Google Scholar
32.Thompson, BL, Dwyer, DM, Ussery, XT, Denman, S, Vacek, P, Schwartz, B. Handwashing and glove use in a long-term-care facility. Infect Control Hosp Epidemiol 1997;18:97–103.CrossRefGoogle ScholarPubMed
33.O'Fallon, E, Harper, I, Shaw, S, Lynfield, R. Antibiotic and infection tracking in Minnesota long-term care facilities. J Am Geriatr Soc 2007;55:1243–1247.CrossRefGoogle ScholarPubMed
34.Smith, PW, Bennett, G, Bradley, S, et al.SHEA/APIC guideline: infection prevention and control in the long-term care facility, July 2008. Infect Control Hosp Epidemiol 2008;29:785–814.Google Scholar
35.Roup, BJ, Roche, JC, Pass, M. Infection control program disparities between acute and long-term care facilities in Maryland. Am J Infect Control 2006;34:122–127.Google Scholar
36.Donskey, CJ. Antibiotic regimens and intestinal colonization with antibiotic-resistant gram-negative bacilli. Clin Infect Dis 2006;43(suppl 2): S62–S69.CrossRefGoogle ScholarPubMed