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Antimicrobial resistance in long-term-care facilities

L J Strausbaugh1, K B Crossley, B A Nurse

  • 1Department of Medicine, Oregon Health Sciences University, Portland, USA.

Infection Control and Hospital Epidemiology
|February 1, 1996
PubMed
Summary

Antimicrobial resistance is common in long-term-care facilities (LTCFs), with resistant bacteria persisting and spreading easily. Healthcare worker hand hygiene is crucial for controlling the spread of these difficult-to-treat infections.

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Area of Science:

  • Infectious Diseases
  • Public Health
  • Microbiology

Background:

  • Antimicrobial resistance is a significant challenge in long-term-care facilities (LTCFs).
  • Commonly reported resistant pathogens include Gram-negative uropathogens and methicillin-resistant Staphylococcus aureus.
  • Multiply-resistant strains of Haemophilus influenzae and vancomycin-resistant enterococci (VRE) are also prevalent.

Purpose of the Study:

  • To review the occurrence and spread of antimicrobial resistance in LTCFs.
  • To identify patient risk factors and consequences of resistant infections.
  • To discuss control strategies and future research priorities.

Main Methods:

  • Literature review of reports on antimicrobial resistance in LTCFs over the last 25 years.

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  • Analysis of pathogen types, transmission routes, and patient characteristics.
  • Evaluation of existing control strategies and their applicability.

    • Main Results:

    • Resistant bacteria enter LTCFs via transferred patients or arise from mutation/gene transfer.
    • Resistant strains persist, become endemic, and disseminate rapidly, primarily through healthcare worker hands.
    • Patients with underlying diseases, wounds, invasive devices, and prior antibiotic use are most vulnerable.

    Conclusions:

    • Antimicrobial resistance in LTCFs poses serious risks to residents, facilities, and hospitals.
    • Hospital-based control strategies are often unsuitable for LTCFs.
    • Limited experience exists for effective control; targeted recommendations and research are needed.