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Published on: September 14, 2013
Risk factors for colonization with multidrug-resistant Gram-negative bacteria and Clostridioides difficile in Long
Anna Maria Azzini1, Giorgia Be1,2, Laura Naso3
1Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy.
Introduction:
Residency in LTCFs increases the likelihood of colonization with multidrug resistant Gram-negative bacteria (MDR-GNB). We assessed the prevalence and risk factors for enteric colonization by III-generation cephalosporins-resistant and carbapenem-resistant (CR) GNB in a large group of LTCFs in a high endemic setting. We also assessed the prevalence and risk factors for C. difficile colonization.
Methods:
A point prevalence survey with rectal screening (RS) was conducted in 27 LTCFs in north Italy. Epidemiological and clinical variables on the survey day, history of hospitalization and surgery within one year, and antibiotics within three months, were collected. The presence of III-generation cephalosporin resistant and CR GNB was assessed using a selective culture on chromogenic medium and PCR for carbapenemase detection. The presence of C. difficile was assessed using ELISA for GDH and RT-PCR to identify toxigenic strains. Multi-variable analyses were performed using two-level logistic regression models.
Results:
In the study period 1947 RSs were performed. The prevalence of colonization by at least one GNB resistant to III-generation cephalosporin was 51% (E. coli 65%, K. pneumoniae 14% of isolates). The prevalence of colonization by CR GNB was 6%. 6% of all isolates (1150 strains) resulted in a carbapenem-resistant K. pneumoniae, and 3% in a carbapenem-resistant E. coli. KPC was the most frequent carbapenemase (73%) identified by PCR, followed by VIM (23%). The prevalence of colonization by C. difficile was 11.7%. The presence of a medical device (OR 2.67) and previous antibiotic use (OR 1.48) were significantly associated with III-generation cephalosporin resistant GNB colonization. The presence of a medical device (OR 2.67) and previous hospitalization (OR 1.80) were significantly associated with CR GNB. The presence of a medical device (OR 2.30) was significantly associated with C. difficile colonization. Main previously used antibiotic classes were fluoroquinolones (32% of previously treated subjects), III-generation cephalosporins (21%), and penicillins (19%).
Conclusion:
Antimicrobial stewardship in LTCFs is a critical issue, being previous antibiotic treatment a risk factor for colonization by MDR-GNB. The prevalence of colonization by III-generation cephalosporin and CR GNB among LTCF residents also underlines the importance to adhere to hand hygiene indications, infection prevention and control measures, and environmental hygiene protocols, more achievable than rigorous contact precautions in this type of social setting.
Insights
Long-term care facility residents have high rates of colonization with multidrug-resistant Gram-negative bacteria (MDR-GNB), including cephalosporin-resistant and carbapenem-resistant GNB. Medical devices and prior antibiotic use are key risk factors, highlighting the need for antimicrobial stewardship and infection control.
Area of Science:
- Infectious Diseases
- Microbiology
- Public Health
Background:
- Long-term care facilities (LTCFs) are hotspots for multidrug-resistant Gram-negative bacteria (MDR-GNB) colonization.
- Understanding colonization prevalence and risk factors in LTCF residents is crucial for infection control.
Purpose of the Study:
- To determine the prevalence and risk factors for colonization with third-generation cephalosporin-resistant (GNB-3CR) and carbapenem-resistant (CR-GNB) Gram-negative bacteria in LTCF residents.
- To assess the prevalence and risk factors for Clostridioides difficile colonization in the same population.
Main Methods:
- A point prevalence survey was conducted in 27 LTCFs in North Italy.
- Rectal screening (RS) was used to assess colonization by GNB-3CR, CR-GNB, and C. difficile.
- Logistic regression models identified risk factors, including medical device use, prior hospitalization, and antibiotic exposure.
Main Results:
- Colonization with GNB-3CR was prevalent in 51% of residents, while CR-GNB colonization was found in 6%.
- Carbapenem-resistant Klebsiella pneumoniae and Escherichia coli were the most common CR-GNB strains.
- Clostridioides difficile colonization was observed in 11.7% of residents.
- Medical device presence, previous antibiotic use, and prior hospitalization were significant risk factors for GNB and C. difficile colonization.
Conclusions:
- High rates of GNB-3CR and CR-GNB colonization in LTCF residents necessitate robust antimicrobial stewardship programs.
- Implementing infection prevention and control measures, including hand hygiene and environmental hygiene, is essential.
- Addressing antibiotic use and medical device management can mitigate colonization risks in LTCFs.
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