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Multidrug-resistant gram-negative bacteria in a long-term care facility: prevalence and risk factors
Aurora Pop-Vicas1, Susan L Mitchell, Ruth Kandel
1Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts02215, USA.
Objectives:
To quantify the prevalence, risk factors, and mode of transmission associated with colonization by multidrug-resistant gram-negative bacteria (MDRGN) in the long-term care (LTC) setting.
Design:
Cross-sectional.
Setting:
Four nursing units in a 648-bed LTC facility in Boston, Massachusetts.
Participants:
Eighty-four long-term care residents.
Measurements:
Nasal and rectal swabs were obtained to determine colonization with MDRGN; if present, molecular typing was performed. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) was also determined. Demographic and clinical characteristics were obtained from the medical record. Multivariable analysis was used to identify factors independently associated with MDRGN colonization.
Results:
A total of 51%, 28%, and 4% subjects were colonized with MDRGN, MRSA, and VRE, respectively. After multivariable adjustment, advanced dementia (adjusted odds ratio (AOR)=2.9, 95% confidence interval (CI)=1.2-7.35, P=.02) and nonambulatory status (AOR=5.7, 95% CI=1.1-28.9, P=.04) were the only independent risk factors for harboring MDRGN. Molecular typing indicated person-to-person transmission.
Conclusion:
Colonization with MDRGN is common in the LTC setting. A diagnosis of advanced dementia is a major risk factor for harboring MDRGN.
Insights
Multidrug-resistant gram-negative bacteria (MDRGN) colonization is common in long-term care facilities. Advanced dementia and nonambulatory status are key risk factors, with transmission occurring person-to-person.
Area of Science:
- Infectious Diseases
- Epidemiology
- Geriatric Medicine
Background:
- Long-term care (LTC) facilities harbor a significant burden of multidrug-resistant organisms (MDROs).
- Understanding colonization dynamics is crucial for infection control in vulnerable populations.
Purpose of the Study:
- To determine the prevalence, risk factors, and transmission of multidrug-resistant gram-negative bacteria (MDRGN) in LTC residents.
- To identify independent predictors of MDRGN colonization.
Main Methods:
- Cross-sectional study of 84 residents in a Boston LTC facility.
- Nasal and rectal swabs analyzed for MDRGN, MRSA, and VRE.
- Multivariable logistic regression identified risk factors for MDRGN colonization.
Main Results:
- 51% of residents were colonized with MDRGN; MRSA and VRE prevalence were 28% and 4%, respectively.
- Advanced dementia (AOR=2.9) and nonambulatory status (AOR=5.7) were independent risk factors for MDRGN colonization.
- Molecular typing confirmed person-to-person transmission of MDRGN.
Conclusions:
- MDRGN colonization is highly prevalent in LTC settings.
- Advanced dementia is a significant risk factor for MDRGN colonization.
- Interventions targeting transmission are needed in LTC facilities.
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