Colonization of skilled-care facility residents with antimicrobial-resistant pathogens.

Colonization of skilled-care facility residents with antimicrobial-resistant pathogens. Research Abstract Details 

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Colonization of skilled-care facility residents with antimicrobial-resistant pathogens. Abstract Text:

OBJECTIVES: To determine the frequency of and risk factors for colonization of skilled-care unit residents by several antimicrobial-resistant bacterial species, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), or extended-spectrum-beta-lactamase-producing (ESBL-producing) (ceftazidime resistant) Klebsiella pneumoniae or Escherichia coli. DESIGN: Point-prevalence survey and medical record review. SETTING: The skilled-care units in one healthcare facility. PARTICIPANTS: 120 skilled-care unit residents. MEASUREMENTS: Colonization by each of the four antimicrobial-resistant pathogens during a point-prevalence survey, using rectal, nasal, gastrostomy-tube site, wound, and axillary cultures, June 1-3, 1998; 117 (98%) had at least one swab collected and 114 (95%) had a rectal swab collected. Demographic and clinical characteristics were evaluated as risk factors for colonization. All isolates were strain typed by pulsed-field gel electrophoresis of total genomic deoxyribonucleic acid. RESULTS: Of 117 participants, 50 (43%) were culture positive for > or =1 antimicrobial-resistant pathogen: MRSA (24%), ESBL-producing K. pneumoniae (18%) or E. coli (15%), and VRE (3.5%). Of 50 residents culture positive for any of these four antimicrobial-resistant species, 13 (26%) were colonized by more than one resistant species; only three (6%) were on contact-isolation precautions at the time of the prevalence survey. Risk factors for colonization varied by pathogen: total dependence on healthcare workers (HCWs) for activities of daily living (ADLs) and antimicrobial receipt for MRSA, total dependence on HCWs for ADLs for ESBL-producing K. pneumoniae, and antimicrobial receipt for VRE. No significant risk factors were identified for colonization by ESBL-producing E. coli. Among colonized patients, there was a limited number of strain types for MRSA (24 patients, 4 strain types) and ESBL-producing K. pneumoniae (21 patients, 3 strain types), and a high proportion of unique strain types for VRE (4 patients, 4 strain types) and FSBL-producing E. coli (17 patients, 10 strain types). CONCLUSION: A large unrecognized reservoir of skilled-care-unit residents was colonized by antimicrobial-resistant pathogens, and co-colonization by more than one target species was common. To prevent transmission of antimicrobial-resistant pathogens in long-term care facilities in which residents have high rates of colonization, infection-control strategies may need to be modified. Potential modifications include enhanced infection-control strategies, such as universal gloving for all or high-risk residents, or screening of high-risk residents, such as those with total dependence on HCWs for ADLs or recent antimicrobial receipt, and initiation of contact-isolation precautions for colonized residents.

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For similar therapeutics: patient care: subacute care research abstracts see: therapeutics: patient care: subacute care research

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Colonization of skilled-care facility residents with antimicrobial-resistant pathogens. Journal Published:

PUBLICATION TYPE: Journal Article

Journal: Journal of the American Geriatrics Society

VOLUME: 49

Page Numbers: 270-6

Journal Abbreviation: J Am Geriatr Soc

ISSN: 0002-8614

DAY: 10

MONTH: Mar

YEAR: 2001

Colonization of skilled-care facility residents with antimicrobial-resistant pathogens. Information

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LANGUAGE: eng

NlmUniqueID: 7503062

Colonization of skilled-care facility residents with antimicrobial-resistant pathogens. Keywords Mesh Terms:

KEYWORDS: Subacute Care

MESH TERMS: statistics & numerical data

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Grant and Affiliation Information for Colonization of skilled-care facility residents with antimicrobial-resistant pathogens.

AFFILIATION: Hospital Infectious Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.

Country: United States

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MEDLINETA: J Am Geriatr Soc

REFSOURCE: J Am Geriatr Soc. 2002 Dec;50(12):2105

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