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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
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.
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.
- 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.