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Longitudinal Assessment of Multidrug-Resistant Organisms in Newly Admitted Nursing Facility Patients: Implications
Lona Mody1,2, Betsy Foxman3, Suzanne Bradley4,5
1Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School.
Background:
The spread of multidrug-resistant organisms (MDROs) is a global concern, and much about transmission in healthcare systems remains unknown. To reduce hospital stays, nursing facilities (NFs) have increasingly assumed care of post-acute populations. We estimate the prevalence of MDRO colonization in NF patients on enrollment and discharge to community settings, risk factors for colonization, and rates of acquiring MDROs during the stay.
Methods:
We conducted a prospective, longitudinal cohort study of newly admitted patients in 6 NFs in southeast Michigan using active microbial surveillance of multiple anatomic sites sampled at enrollment, days 14 and 30, and monthly thereafter for up to 6 months.
Results:
We enrolled 651 patients and collected 7526 samples over 1629 visits, with an average of 29 days of follow-up per participant. Nearly all participants were admitted for post-acute care (95%). More than half (56.8%) were colonized with MDROs at enrollment: methicillin-resistant Staphylococcus aureus (MRSA), 16.1%; vancomycin-resistant enterococci (VRE), 33.2%; and resistant gram-negative bacilli (R-GNB), 32.0%. Risk factors for colonization at enrollment included prolonged hospitalization (>14 days), functional disability, antibiotic use, or device use. Rates per 1000 patient-days of acquiring a new MDRO were MRSA, 3.4; VRE, 8.2; and R-GNB, 13.6. MDRO colonization at discharge was similar to that at enrollment (56.4%): MRSA, 18.4%; VRE, 30.3%; and R-GNB, 33.6%.
Conclusions:
Short-stay NF patients exhibit a high prevalence of MDROs near the time of admission, as well as at discharge, and may serve as a reservoir for spread in other healthcare settings. Future interventions to reduce MDROs should specifically target this population.
Insights
Multidrug-resistant organisms (MDROs) are common in nursing facility patients upon admission and discharge, posing a risk for wider healthcare spread. Targeted interventions are needed for this vulnerable population to reduce MDRO transmission.
Area of Science:
- Infectious Diseases
- Healthcare Epidemiology
- Microbiology
Background:
- Multidrug-resistant organisms (MDROs) pose a significant global health threat.
- Nursing facilities (NFs) increasingly manage post-acute care populations, leading to unknown transmission dynamics.
- Understanding MDRO prevalence and acquisition in NFs is crucial for infection control.
Purpose of the Study:
- To determine the prevalence of MDRO colonization in nursing facility patients at admission and discharge.
- To identify risk factors associated with MDRO colonization in this population.
- To calculate the incidence rates of acquiring new MDROs during a nursing facility stay.
Main Methods:
- A prospective, longitudinal cohort study was conducted in six NFs in southeast Michigan.
- Active microbial surveillance of multiple anatomic sites was performed on newly admitted patients.
- Sampling occurred at enrollment, days 14 and 30, and monthly for up to six months.
Main Results:
- Over 651 patients were enrolled, with 56.8% colonized with MDROs at enrollment.
- Common MDROs included vancomycin-resistant enterococci (VRE) and resistant gram-negative bacilli (R-GNB).
- High rates of MDRO acquisition were observed, and colonization remained high at discharge (56.4%).
Conclusions:
- Short-stay nursing facility patients have a high prevalence of MDROs at admission and discharge.
- These patients may act as reservoirs for MDRO transmission to other healthcare settings.
- Interventions targeting MDRO reduction should focus on this specific patient population.
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