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Published on: August 30, 2018
Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the
Ángel Rodríguez-Villodres1, Cecilia Martín-Gandul1, Germán Peñalva1
1Clinical Unit of Infectious Diseases, Microbiology and Preventive Medicine, Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocío, 41013 Seville, Spain.
Abstract:
Elderly people confined to chronic care facilities face an increased risk of acquiring infections by multidrug-resistant organisms (MDROs). This review presents the current knowledge of the prevalence and risk factors for colonization by MDROs in long-term care facilities (LTCF), thereby providing a useful reference to establish objectives for implementing successful antimicrobial stewardship programs (ASPs). We searched in PubMed and Scopus for studies examining the prevalence of MDROs and/or risk factors for the acquisition of MDROs in LTCF. One hundred and thirty-four studies published from 1987 to 2020 were included. The prevalence of MDROs in LTCF varies between the different continents, where Asia reported the highest prevalence of extended-spectrum ß-lactamase (ESBL) Enterobacterales (71.6%), carbapenem resistant (CR) Enterobacterales (6.9%) and methicillin-resistant Staphylococcus aureus (MRSA) (25.6%) and North America the highest prevalence to MDR Pseudomonas aeruginosa (5.4%), MDR Acinetobacter baumannii (15.0%), vancomycin-resistant Enterococcus spp. (VRE) (4.0%), and Clostridioides difficile (26.1%). Furthermore, MDRO prevalence has experienced changes over time, with increases in MDR P. aeruginosa and extended spectrum ß-lactamase producing Enterobacterales observed starting in 2015 and decreases of CR Enterobacterales, MDR A. baumannii, VRE, MRSA and C. difficile. Several risk factors have been found, such as male sex, chronic wounds, the use of medical devices, and previous antibiotic use. The last of these aspects represents one of the most important modifiable factors for reducing colonization with MDROs through implementing ASPs in LTCF.
Insights
Multidrug-resistant organism (MDRO) infections are a significant risk for elderly individuals in long-term care facilities (LTCFs). Previous antibiotic use is a key modifiable factor for reducing MDRO colonization, highlighting the importance of antimicrobial stewardship programs (ASPs).
Area of Science:
- Infectious Diseases
- Public Health
- Geriatrics
Background:
- Elderly residents in long-term care facilities (LTCFs) are highly susceptible to multidrug-resistant organism (MDRO) infections.
- Understanding MDRO prevalence and risk factors in LTCFs is crucial for effective infection control and antimicrobial stewardship.
Purpose of the Study:
- To review the current knowledge on MDRO prevalence and associated risk factors in LTCFs.
- To provide a reference for developing successful antimicrobial stewardship programs (ASPs) in LTCFs.
Main Methods:
- A systematic literature search was conducted in PubMed and Scopus for studies on MDRO prevalence and risk factors in LTCFs.
- One hundred thirty-four studies published between 1987 and 2020 were included in the review.
Main Results:
- MDRO prevalence varies geographically, with Asia reporting high rates of ESBL Enterobacterales, CR Enterobacterales, and MRSA, and North America high rates of MDR Pseudomonas aeruginosa, MDR Acinetobacter baumannii, VRE, and C. difficile.
- Temporal trends show increasing MDR P. aeruginosa and ESBL Enterobacterales since 2015, alongside decreasing CR Enterobacterales, MDR A. baumannii, VRE, MRSA, and C. difficile.
- Identified risk factors include male sex, chronic wounds, medical device use, and prior antibiotic exposure, with antibiotic use being a critical modifiable factor.
Conclusions:
- Antimicrobial stewardship programs (ASPs) in LTCFs are essential for mitigating MDRO colonization, particularly by addressing modifiable risk factors like previous antibiotic use.
- Continued surveillance and targeted interventions are necessary to combat the evolving threat of MDROs in long-term care settings.
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