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Acquisition of multidrug-resistant gram-negative bacteria: incidence and risk factors within a long-term care
Erin O'Fallon1, Ruth Kandel, Ruth Kandell
1Department of Medicine, Hebrew Senior Life, Boston, Massachusetts 02131, USA. erinofallon@hrca.harvard.edu
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 1 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.
Insights
Multidrug-resistant (MDR) gram-negative bacteria frequently spread among residents in long-term care facilities (LTCFs). Antibiotic exposure was a significant risk factor for acquiring these resistant organisms.
Area of Science:
- Infectious Diseases
- Epidemiology
- Microbiology
Background:
- Understanding transmission dynamics of multidrug-resistant (MDR) gram-negative bacteria in long-term care facilities (LTCFs) is crucial for developing targeted prevention strategies.
- LTCFs present unique challenges for infection control due to resident vulnerability and close proximity.
Purpose of the Study:
- To investigate the incidence of MDR gram-negative bacteria acquisition among LTCF residents.
- To identify risk factors associated with the acquisition of these pathogens within an LTCF setting.
Main Methods:
- A prospective cohort study was conducted over one year in a 600-bed LTCF in Boston, Massachusetts.
- Rectal samples from 172 residents were cultured to track the acquisition of MDR gram-negative bacteria.
- A nested case-control study identified risk factors, with antibiotic exposure being a key variable.
Main Results:
- During the study period, 39% of residents acquired at least one MDR gram-negative organism.
- Genetically related strains were identified among residents, indicating transmission.
- Antibiotic exposure was significantly associated with MDR gram-negative bacteria acquisition (OR, 5.6; P = .04).
Conclusions:
- Acquisition of MDR gram-negative bacteria is frequent in LTCFs, primarily through resident-to-resident transmission.
- Current infection control interventions require reevaluation to address the high rate of MDR gram-negative bacteria acquisition.
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