Persistence of fluoroquinolone-resistant, multidrug-resistant Streptococcus pneumoniae in a long-term-care facility: efforts to reduce intrafacility transmission.
OBJECTIVE
We describe an effort to reduce transmission of a multidrug-resistant Streptococcus pneumoniae (MDRSP) in a long-term-care facility (LTCF).


METHODS
Longitudinal cross-sectional study.


METHODS
An LTCF in New York City with ongoing disease due to an MDRSP strain among residents with AIDS since a 1995 outbreak. The MDRSP outbreak strain was susceptible to vancomycin but not to other antimicrobials tested, including fluoroquinolones.


METHODS
Residents and staff members of the LTCF during 1999 through 2001.


METHODS
Implementing standard infection control measures, and developing and implementing "enhanced standard" infection control measures, modified respiratory droplet prevention measures to reduce inter-resident transmission.


RESULTS
Before the intervention, nasopharyngeal carriage of the MDRSP outbreak strain was detected in residents with AIDS and residents with tracheostomies who were not dependent on mechanical ventilation. The prevalence of nasopharyngeal carriage of the MDRSP outbreak strain was 7.8% among residents who had AIDS and 14.6% among residents with tracheostomies. After training sessions on standard and enhanced standard infection control measures, the staff appeared to have good knowledge and practice of the infection control measures. After the intervention, new transmission among residents with tracheostomies was prevented; however, these residents were prone to persistent tracheal carriage and needed ongoing enhanced standard infection control measures. Ongoing transmission among residents with AIDS, a socially active group, was documented, although fewer cases of disease due to the outbreak strain occurred.


CONCLUSIONS
Infection control contributed to less transmission of MDRSP in the LTCE Additional strategies are needed to reduce transmission and carriage among certain resident populations.
Fry
Alicia M
AM
espiratory Diseases Branch, Division of Bacterial and Mycotic Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia 30333, USA.
Udeagu
Chi Chi N
CC
Soriano-Gabarro
Montse
M
Fridkin
Scott
S
Musinski
Diana
D
LaClaire
Leslie
L
Elliott
John
J
Cook
Debra J P
DJ
Kornblum
John
J
Layton
Marcelle
M
Whitney
Cynthia G
CG
D019072:Antibiotic Prophylaxis; D000904:Antibiotics, Antitubercular / Q000494:pharmacology; D001428:Bacterial Vaccines / Q000276:immunology; D002353:Carrier State / Q000382:microbiology*; D003428:Cross Infection / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission; D003430:Cross-Sectional Studies; D024881:Drug Resistance, Bacterial / Q000187:drug effects / Q000276:immunology; D018432:Drug Resistance, Multiple / Q000187:drug effects / Q000276:immunology; D024841:Fluoroquinolones / Q000494:pharmacology; D006268:Health Facilities; D006801:Humans; D008134:Long-Term Care; D008137:Longitudinal Studies; D009302:Nasopharyngeal Diseases / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control; D009518:New York / Q000453:epidemiology; D011008:Pneumococcal Infections / Q000382:microbiology* / Q000517:prevention & control / Q000635:transmission; D015995:Prevalence; D012293:Rifampin / Q000494:pharmacology; D012307:Risk Factors; D012703:Serotyping; D013296:Streptococcus pneumoniae / Q000145:classification / Q000276:immunology / Q000302:isolation & purification*; D016896:Treatment Outcome
D000904:Antibiotics, Antitubercular; D001428:Bacterial Vaccines; D024841:Fluoroquinolones; D012293:Rifampin