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Multidrug-Resistant Gram-Negative Bloodstream Infections among Residents of Long-Term Care Facilities

Published online by Cambridge University Press:  10 May 2016

Indumathi Venkatachalam*
Affiliation:
National University of Singapore, National University Health System, Singapore
Hsu Li Yang
Affiliation:
National University of Singapore, National University Health System, Singapore
Dale Fisher
Affiliation:
National University of Singapore, National University Health System, Singapore
David C. Lye
Affiliation:
Communicable Diseases Centre, Tan Tock Seng Hospital, Singapore
Ling Moi Lin
Affiliation:
Singapore General Hospital, Singapore
Paul Tambyah
Affiliation:
National University of Singapore, National University Health System, Singapore
Trish M. Perl
Affiliation:
Johns Hopkins University, Baltimore, Maryland
*
Department of Medicine, National University Health Service Tower Block, Level 10 IE Kent Ridge Road, Singapore119228 (indumathi_venkatachalam@nuhs.edu.sg)

Abstract

Objective.

Prevalence of multidrug-resistant (MDR) gram-negative (GN) bacteria is increasing globally and is complicated by patient movement between acute and long-term care facilities (LTCFs). In Asia, the contribution of LTCFs as a source of MDR GN infections is poorly described. We aimed to define the association between residence in LTCFs and MDR GN bloodstream infections (BSIs).

Design.

Secondary analysis of data from an observational cohort.

Setting.

Two tertiary referral hospitals in Singapore, including the 1,400-bed Tan Tock Seng Hospital and the 1,600-bed Singapore General Hospital.

Participants.

Adult patients with healthcare-onset (HCO) or hospital-onset (HO) GN BSI.

Methods.

Patients were identified from hospital databases using standard definitions. Risk factors for both MDR GN HCO and HO BSI were analyzed using a multivariable logistic regression model.

Results.

A total of 675 episodes of GN BSI occurred over a 31-month period. Residence in a LTCF was an independent risk factor for developing MDR GN BSI (odds ratio [OR], 5.1 [95% confidence interval (CI), 2.2–11.9]; P < .01) when antibiotics were not used within the preceding 30 days. This risk persisted beyond the first 48 hours of hospitalization (OR, 3.4 [95% CI, 1.3–9.0]; P = .01). Previous culture growing an MDR organism (OR, 1.8 [95% CI, 1.3–2.7]; P < .01), previous antibiotic use (OR, 1.8 [95% CI, 1.2–2.6]; P < .01), and intensive care unit stay (OR, 2.2 [95% CI, 1.2–3.9]; P = .01), increased the risk of MDR GN BSI.

Conclusions.

Residence in a LTCF is an independent risk factor for MDR GN BSI. Attempts to contain MDR GN bacteria in large Asian cities, where the proportion of the population that is elderly is projected to increase, should include infection prevention strategies that engage LTCFs.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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References

1. Hsu, LY, Tan, T, Tam, V et al. Surveillance and correlation of antibiotic prescription and resistance of gram-negative bacteria in Singaporean hospitals. Antimicrob Agents Chemother 2010;54(3)11731178.Google Scholar
2. van Duijn, P, Dautzenberg, M, Oostdijk, E. Recent trends in antibiotic resistance in European ICUs. Curr Opin Crit Care 2011;17(6):658665.Google Scholar
3. Boucher, H, Talbot, G, Bradley, J, et al. Bad bugs, no drugs: no ESKAPE! an update from the Infectious Diseases Society of America. Clin Infect Dis 2009;48(1)112.Google Scholar
4. Lo, W, Lin, W, Chiueh, T et al. Changing trends in antimicrobial resistance of major bacterial pathogens, 1985–2005: a study from a medical center in northern Taiwan. J Microbiol Immunol Infect 2011;44(2)131138.Google Scholar
5. Klevens, RM, Edwards, JR, Gaynes, RP. The impact of antimicrobial-resistant health care-associated infections on mortality in the United States. Clin Infect Dis 2008;47:927930.Google Scholar
6. Walsh, TR, Weeks, J, Livermore, DM, Toleman, MA. Dissemination of NDM-1 positive bacteria in the New Delhi environment and its implications for human health: an environmental point prevalence study. Lancet Infect Dis 2011;11:355362.Google Scholar
7. Nordmann, P, Cuzon, G, Naas, T. The real threat of Klebsiella pneumoniae carbapenemase-producing bacteria. Lancet Infect Dis 2009;9:228236.Google Scholar
8. Hsu, LY, Tan, T, Jureen, R, et al. Antimicrobial drug resistance in hospitals. Emerg Infect Dis 2007;13(12)25.Google Scholar
9. Kiratisin, P, Chongthaleong, A, Tan, TY, et al. Comparative in vitro activity of carbapenems against major gram-negative pathogens: results of Asia-Pacific surveillance from the COMPACT II study. Int J Antimicrob Agents 2012;39(4)311316.CrossRefGoogle ScholarPubMed
10. O'Fallon, E, Schreiber, R, Kandel, R, D'Agata, EMC. Multidrug-resistant gram-negative bacteria at a long-term care facility: assessment of residents, healthcare workers, and inanimate surfaces. Infect Control Hosp Epidemiol 2009;30(12)11721179.Google Scholar
11. Won, SY, Munoz-Price, LS, Lolans, K, Hota, B, Weinstein, R, Hayden, M. Emergence and rapid regional spread of Klebsiella pneumoniae carbapenemases-producing Enterobacteriaceae . Clin Infect Dis 2011;53(6)532540.Google Scholar
12. O'Fallon, E, Schreiber, R, Kandel, R, D'Agata, EMC. Multidrug-resistant gram-negative bacteria at a long-term care facility: assessment of residents, healthcare workers, and inanimate surfaces. Infect Control Hosp Epidemiol 2009;30(12):11721179.Google Scholar
13. Prabaker, K, Lin, M, McNally, M, et al. Transfer from high-acuity long-term care facilities is associated with carriage of Klebsiella pneumoniae carbapenemase-producing Enterobacteriaceae: a multihospital study. Infect Control Hosp Epidemiol 2012;33(12):11931199.Google Scholar
14. Stuart, R, Kotsana, D, Webb, B, et al. Prevalence of antimicrobial-resistant organisms in residential aged care facilities. Med J Aust 2011;195(9)530533.Google Scholar
15. March, A, Aschbacher, R, Dhanji, H, et al. Colonization of residents and staff of a long-term-care facility and adjacent acute-care hospital geriatric unit by multiresistant bacteria Clin Microbiol Infect 2010;16(7)934944.CrossRefGoogle ScholarPubMed
16. World population ageing 2009. United Nations Department of Economie and Social Affairs Population Division. http://www.un.org/en/development/desa/publications/world-population-ageing-2009.html. Accessed on April 2, 2013.Google Scholar
17. Lye, D, Earnest, A, Ling, M, et al. The impact of multidrug resistance in healthcare-associated and nosocomial gram-negative bacteremia on mortality and length of stay: cohort study. Clin Microbiol Infect 2012;18(5)502508.Google Scholar
18. Bone, RC, Balk, RA, Cerra, FB, et al. Definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis. The ACCP/SCCM Consensus Conference of Chest Physcians/Society of Critical Care Medicine. Chest 1992;101:16441655.CrossRefGoogle Scholar
19. Friedman, ND, Kaye, KS, Stout, JE, et al. Health care-associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002;137:791797.Google Scholar
20. Horan, TC, Andrus, M, Dudeck, MA. CDC/NHSN surveillance definition of health care-associated infection and criteria for specific types of infections in the acute care setting. Am J Infect Control 2008;36:309332.Google Scholar
21. Kallen, A, Hildron, A, Patel, J, Srinivasan, A. Multidrug resistance among gram negative pathogens that caused heathcare-associ-ated infections reported to the National Healthcare Safety Network, 2006-2008. Infect Control Hosp Epidemiol 2010;31:528531.Google Scholar
22. Clinical Laboratory Standards Institute (CLSI). Performance Standards for Antimicrobial Disk Susceptibility Tests. Wayne, PA: CLSI, 2009. CLSI document M02-A10.Google Scholar
23. Gilbert, DN, Moellering, RC, Eliopoulos, GM, et al. The Sanford Guide to Antimicrobial Therapy 2008. 38th ed. Sperryville, VA: Antimicrobial Therapy, 2008.Google Scholar
24. Charlson, M, Pompei, P, Ales, KL, MacKenzie, CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 1987;40:373383.CrossRefGoogle ScholarPubMed
25. Centers for Disease Control and Prevention. Guidance for control of infections with carbapenem-resistant or carbapenemase-producing Enterobacteriaceae in acute care facilities. MMWR Morb Mortal Wkly Rep 2009;58:256260.Google Scholar
26. Grundman, H, Livermore, DM, Giske, CG, et al. Carbapenem-non-susceptible Enterobacteriaceae in Europe: conclusions from a meeting of national experts. Euro Surveill 2010;15:pii:19711.Google Scholar
27. Akova, M, Daikos, GL, Tzouvelekis, L, Carmeli, Y. Interventional strategies and current clinical experience with carbapenemase-producing gram-negative bacteria. Clin Microbiol Infect 2012;18:439448.Google Scholar
28. Pop-Vicas, A, Tacconelli, E, Gravenstein, S, Lu, B, D'Agata, EM. 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;30:325331.CrossRefGoogle ScholarPubMed
29. Carmeli, Y, Troillet, N, Karchmer, AW, Samore, MH. Health and economic outcomes of antibiotic resistance in Pseudomonas aeruginosa . Arch Intern Med 1999;159:11271132.Google Scholar
30. de Kraker, MEA, Davey, PG, Grundmann, H. Mortality and hospital stay associated with resistant Staphylococcus aureus and Escherichia coli bacteremia: estimating the burden of antibiotic resistance in Europe. PLOS MED 2011;8 10:e1001104.Google Scholar
31. Sunenshine, FH, Wright, MO, Maragakis, LL, et al. Multidrug-resistant Acinetobacter infection mortality rate and length of hospitalization. Emerg Infect Dis 2007;13(1)97103.Google Scholar
32. Choi, JP, Cho, EH, Lee, SJ, Lee, ST, Koo, MS, Song, YG. Influx of multidrug resistant, gram-negative bacteria (MDRGNB) in a public hospital among elderly from long-term care facilities: a single-center pilot study. Arch Gerontol Geriatr 2012;54(2):e19e22.Google Scholar
33. Gudiol, C, Tubau, F, Calatayud, L, et al. Bacteremia due to multidrug-resistant bram-negative bacilli in cancer patients: risk factors, antibiotic therapy and outcomes. J Antimicrob Chemother 2011;66:657663.Google Scholar