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Infection rate and colonization with antibiotic-resistant organisms in skilled nursing facility residents with
1Division of Geriatric Medicine, University of Michigan Medical School, Ann Arbor, MI 48105, USA.
Abstract:
The objective of this prospective surveillance study was to quantify colonization with antimicrobial-resistant organisms (AROs) and infections attributable to indwelling devices in skilled nursing facility (SNF) residents. The study was conducted in 15 SNFs in Southeast Michigan. Residents with (n=90) and without (n=88) an indwelling device were enrolled and followed for 907 resident-months. Residents were cultured monthly from multiple anatomic sites and data on infections were obtained. The device-attributable rate was calculated by subtracting the infection rate in the device group from the infection rate in the non-device group. A total of 197 new infections occurred during the study period; 87 in the device group (incidence rate [IR] =331/1,000 resident-months) and 110 infections in the non-device group (IR=171/1,000 resident-months), with a relative risk of 1.9 (95% confidence interval [CI]: 1.4-2.6). The attributable rate of excess infections among residents in the device group was 160/1,000 resident-months, with an attributable fraction of 48% (95% CI: 31-61%). Prevalence rates for all AROs were higher in the device group compared with the no-device group. The prevalence of the number of AROs per 1,000 residents cultured increased from no-device to those with only feeding tubes, followed by those with only urinary catheters and both these devices. In conclusion, the presence of indwelling devices is associated with higher incidence rates for infections and prevalence rates for AROs. Our study quantifies this risk and shows that approximately half of all infections in SNF residents with indwelling devices can be eliminated with device removal. Effective strategies to reduce infections and AROs in these residents are warranted.
Insights
Indwelling devices in skilled nursing facilities increase infection risk and antimicrobial-resistant organism (ARO) colonization. Removing devices could eliminate nearly half of all infections in these residents.
Area of Science:
- Infectious Diseases
- Gerontology
- Public Health Surveillance
Background:
- Skilled nursing facilities (SNFs) house vulnerable populations susceptible to infections.
- Indwelling devices (e.g., urinary catheters, feeding tubes) are common in SNF residents and may increase infection risk.
- Antimicrobial-resistant organisms (AROs) pose a significant threat in healthcare settings, particularly in long-term care.
Purpose of the Study:
- To quantify the colonization of antimicrobial-resistant organisms (AROs) in SNF residents.
- To determine the incidence of infections attributable to indwelling devices in this population.
- To assess the risk associated with different types of indwelling devices.
Main Methods:
- Prospective surveillance study conducted in 15 SNFs in Southeast Michigan.
- Enrollment of residents with and without indwelling devices, followed for 907 resident-months.
- Monthly cultures from multiple anatomic sites and systematic data collection on infections.
Main Results:
- Residents with indwelling devices had a 1.9 times higher risk of infection compared to those without.
- The attributable rate of excess infections in the device group was 160/1,000 resident-months, representing 48% of infections.
- Prevalence of AROs was higher in residents with indwelling devices, increasing with the number and type of devices (feeding tubes, urinary catheters).
Conclusions:
- Indwelling devices are significantly associated with increased infection incidence and ARO prevalence in SNF residents.
- Approximately 50% of infections in SNF residents with indwelling devices could be prevented by device removal.
- Development of effective strategies to reduce device-associated infections and AROs in SNF residents is crucial.
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