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


METHODS
Point-prevalence survey and medical record review.


METHODS
The skilled-care units in one healthcare facility.


METHODS
120 skilled-care unit residents.


METHODS
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).


CONCLUSIONS
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.
Trick
W E
WE
Hospital Infectious Program, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
Weinstein
R A
RA
DeMarais
P L
PL
Kuehnert
M J
MJ
Tomaska
W
W
Nathan
C
C
Rice
T W
TW
McAllister
S K
SK
Carson
L A
LA
Jarvis
W R
WR
D000368:Aged; D001424:Bacterial Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D015169:Colony Count, Microbial; D003428:Cross Infection / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology*; D003625:Data Collection; D004352:Drug Resistance, Microbial; D018432:Drug Resistance, Multiple; D004926:Escherichia coli / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology; D005260:Female; D019538:Health Care Surveys; D006757:Hospital Units / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007710:Klebsiella Infections / Q000453:epidemiology; D007711:Klebsiella pneumoniae / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015995:Prevalence; D012866:Skilled Nursing Facilities / Q000592:standards / Q000706:statistics & numerical data*; D013203:Staphylococcal Infections / Q000453:epidemiology; D013211:Staphylococcus aureus / Q000302:isolation & purification; D019467:Subacute Care / Q000592:standards / Q000706:statistics & numerical data*