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Multidrug-resistant gram-negative bloodstream infections among residents of long-term care facilities
Indumathi Venkatachalam1, Hsu Li Yang, Dale Fisher
1National University of Singapore, National University Health System, Singapore.
Objective:
Prevalence of multidrug-resistant (MDR) gram-negative (GN) bacteria is increasing globally and is complicated by patient movement between acute and long-term care facilities (LTCFs). In Asia, the contribution of LTCFs as a source of MDR GN infections is poorly described. We aimed to define the association between residence in LTCFs and MDR GN bloodstream infections (BSIs).
Design:
Secondary analysis of data from an observational cohort.
Setting:
Two tertiary referral hospitals in Singapore, including the 1,400-bed Tan Tock Seng Hospital and the 1,600-bed Singapore General Hospital.
Participants:
Adult patients with healthcare-onset (HCO) or hospital-onset (HO) GN BSI.
Methods:
Patients were identified from hospital databases using standard definitions. Risk factors for both MDR GN HCO and HO BSI were analyzed using a multivariable logistic regression model.
Results:
A total of 675 episodes of GN BSI occurred over a 31-month period. Residence in a LTCF was an independent risk factor for developing MDR GN BSI (odds ratio [OR], 5.1 [95% confidence interval (CI), 2.2-11.9]; P < .01) when antibiotics were not used within the preceding 30 days. This risk persisted beyond the first 48 hours of hospitalization (OR, 3.4 [95% CI, 1.3-9.0]; P = .01). Previous culture growing an MDR organism (OR, 1.8 [95% CI, 1.3-2.7]; P < .01), previous antibiotic use (OR, 1.8 [95% CI, 1.2-2.6]; P < .01), and intensive care unit stay (OR, 2.2 [95% CI, 1.2-3.9]; P = .01), increased the risk of MDR GN BSI.
Conclusions:
Residence in a LTCF is an independent risk factor for MDR GN BSI. Attempts to contain MDR GN bacteria in large Asian cities, where the proportion of the population that is elderly is projected to increase, should include infection prevention strategies that engage LTCFs.
Insights
Residence in long-term care facilities (LTCFs) significantly increases the risk of multidrug-resistant (MDR) gram-negative (GN) bloodstream infections (BSIs). Infection prevention strategies must include LTCFs to combat rising MDR GN bacteria.
Area of Science:
- Infectious Diseases
- Public Health
- Epidemiology
Background:
- Increasing global prevalence of multidrug-resistant (MDR) gram-negative (GN) bacteria poses a significant public health challenge.
- Patient movement between acute care and long-term care facilities (LTCFs) complicates the spread of MDR GN infections.
- The role of LTCFs as a source of MDR GN infections in Asia remains underexplored.
Purpose of the Study:
- To determine the association between residence in LTCFs and the development of MDR GN bloodstream infections (BSIs).
- To identify risk factors contributing to healthcare-onset (HCO) and hospital-onset (HO) MDR GN BSIs.
Main Methods:
- A secondary analysis of an observational cohort study was conducted.
- Data were collected from two tertiary referral hospitals in Singapore over a 31-month period.
- Adult patients with HCO or HO GN BSIs were identified, and risk factors were analyzed using multivariable logistic regression.
Main Results:
- A total of 675 GN BSI episodes were recorded.
- Residence in an LTCF was identified as an independent risk factor for MDR GN BSI (OR, 5.1; P < .01), particularly when antibiotics were not used recently.
- This increased risk persisted beyond 48 hours of hospitalization (OR, 3.4; P = .01), with previous MDR organism culture, prior antibiotic use, and ICU stay also increasing risk.
Conclusions:
- Residence in an LTCF is a significant independent risk factor for MDR GN BSIs.
- Effective containment of MDR GN bacteria requires infection prevention strategies that actively involve LTCFs.
- Given the projected increase in elderly populations in Asian cities, integrating LTCFs into infection control efforts is crucial.
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