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Long-term care facilities as sources of antibiotic-resistant nosocomial pathogens
1Department of Medicine, Veterans Affairs Medical Center, and the University of Minnesota Medical School, Minneapolis, Minnesota, USA. cross006@tc.umn.edu
Abstract:
Long-term care facilities house individuals that have usually been transferred from acute-care institutions. For this reason, carriage of methicillin-resistant Staphylococcus aureus (MRSA), resistant Gram-negative bacilli and vancomycin-resistant enterococci (VRE) is relatively frequent. As these patients are readmitted to acute-care institutions, they reintroduce these organisms into those settings. It is notable that studies of these resistant organisms in long-term care facilities demonstrate little transfer between patients. Transmission of these bacteria and the development of infection in nursing homes are both uncommon events. Resources are best devoted to infection-control basics than to isolation of patients colonized or infected with these organisms.
Insights
Long-term care facilities frequently house patients carrying antibiotic-resistant organisms like MRSA and VRE. However, transmission and infection within these facilities are uncommon, suggesting basic infection control is more effective than isolation.
Area of Science:
- Infectious Diseases
- Healthcare Epidemiology
- Antimicrobial Resistance
Background:
- Long-term care facilities (LTCFs) receive patients from acute-care settings, leading to frequent carriage of multidrug-resistant organisms (MDROs).
- Common MDROs include methicillin-resistant Staphylococcus aureus (MRSA), resistant Gram-negative bacilli, and vancomycin-resistant enterococci (VRE).
- These patients can reintroduce MDROs into acute-care settings upon readmission.
Purpose of the Study:
- To evaluate the transmission dynamics and infection rates of MDROs within long-term care facilities.
- To determine the effectiveness of current infection control strategies in LTCFs regarding MDROs.
Main Methods:
- Review of existing studies on MDRO carriage and transmission in LTCFs.
- Analysis of patient transfer data between acute-care and long-term care settings.
- Assessment of infection development rates in nursing home residents.
Main Results:
- Studies indicate minimal patient-to-patient transfer of MDROs within LTCFs.
- The development of infections caused by these resistant organisms in nursing homes is infrequent.
- Transmission events are uncommon despite frequent carriage of MRSA, VRE, and resistant Gram-negative bacilli.
Conclusions:
- Focusing resources on fundamental infection control practices is more beneficial than isolating patients colonized or infected with MDROs in LTCFs.
- Current infection control measures may be adequate for preventing widespread MDRO transmission in these settings.
- Re-evaluation of isolation protocols for specific MDROs in LTCFs may be warranted.