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Colonization of skilled-care facility residents with antimicrobial-resistant pathogens
W E Trick1, R A Weinstein, P L DeMarais
1Hospital Infectious Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Journal of the American Geriatrics Society
|April 13, 2001
Summary
A high rate of antimicrobial-resistant bacteria colonization was found in skilled-care residents, with many carrying multiple resistant species. Enhanced infection control strategies are needed to prevent transmission in these facilities.
Area of Science:
- Infectious Diseases
- Healthcare Epidemiology
- Microbiology
Background:
- Antimicrobial resistance is a growing global health threat.
- Skilled-care units (SCUs) harbor vulnerable populations susceptible to resistant pathogens.
- Understanding colonization prevalence and risk factors in SCUs is crucial for infection control.
Purpose of the Study:
- To determine the frequency of colonization by specific antimicrobial-resistant bacteria in SCU residents.
- To identify risk factors associated with colonization by methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), and extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae or Escherichia coli.
- To inform the development of targeted infection control strategies.
Main Methods:
- A point-prevalence survey was conducted in the SCUs of a single healthcare facility.
- 120 SCU residents participated, with cultures collected from multiple sites (rectal, nasal, wound, etc.).
- Demographic and clinical data were reviewed to identify risk factors; isolates were strain typed using pulsed-field gel electrophoresis.
Main Results:
- 43% of 117 surveyed residents were colonized with at least one target antimicrobial-resistant pathogen.
- Methicillin-resistant Staphylococcus aureus (MRSA) was most common (24%), followed by ESBL-producing K. pneumoniae (18%) and E. coli (15%), and VRE (3.5%).
- Dependence on healthcare workers for daily activities and recent antimicrobial receipt were identified as risk factors for MRSA and ESBL-producing K. pneumoniae colonization.
Conclusions:
- A significant, unrecognized reservoir of antimicrobial-resistant pathogens exists among SCU residents.
- Co-colonization with multiple resistant species was common, highlighting the need for comprehensive infection control.
- Modified infection control strategies, including enhanced precautions and targeted screening, are recommended for SCUs.
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