title: Colonization of residents and staff of a long-term-care facility and adjacent acute-care hospital geriatric unit by multiresistant bacteria.
abstract: Long-term-care facilities (LTCFs) are reservoirs of resistant bacteria. We undertook a point-prevalence survey and risk factor analysis for specific resistance types among residents and staff of a Bolzano LTCF and among geriatric unit patients in the associated acute-care hospital. Urine samples and rectal, inguinal, oropharyngeal and nasal swabs were plated on chromogenic agar; isolates were typed by pulsed-field gel electrophoresis; resistance genes and links to insertion sequences were sought by PCR; plasmids were analysed by PCR, restriction fragment length polymorphism and incompatibility grouping. Demographic data were collected. Of the LTCF residents, 74.8% were colonized with ≥1 resistant organism, 64% with extended-spectrum β-lactamase (ESBL) producers, 38.7% with methicillin-resistant Staphylococcus aureus (MRSA), 6.3% with metallo-β-lactamase (MBL) producers, and 2.7% with vancomycin-resistant enterococci. Corresponding rates for LTCF staff were 27.5%, 14.5%, 14.5%, 1.5% and 0%, respectively. Colonization frequencies for geriatric unit patients were lower than for those in the LTCF. Both clonal spread and plasmid transfer were implicated in the dissemination of MBL producers that harboured IncN plasmids bearing bla(VIM-1), qnrS, and bla(SHV-12). Most (44/45) ESBL-producing Escherichia coli isolates had bla(CTX-M) genes of group 1; a few had bla(CTX-M) genes of group 9 or bla(SHV-5); those with bla(CTX-M-15) or bla(SHV-5) were clonal. Risk factors for colonization of LTCF residents with resistant bacteria included age ≥86 years, antibiotic treatment in the previous 3 months, indwelling devices, chronic obstructive pulmonary disease, physical disability, and the particular LTCF unit; those for geriatric unit patients were age and dementia. In conclusion, ESBL-producing and MBL-producing Enterobacteriaceae and MRSA were prevalent among the LTCF residents and staff, but less so in the hospital geriatric unit. Education of LTCF employees and better infection control are proposed to minimize the spread of resistant bacteria in the facility.
authors.affiliation: Reparto di Geriatria, Comprensorio Sanitario di Bolzano, Bolzano, Italy.
authors.forename: A
authors.initials: A
authors.lastname: March
authors.forename: R
authors.initials: R
authors.lastname: Aschbacher
authors.forename: H
authors.initials: H
authors.lastname: Dhanji
authors.forename: D M
authors.initials: DM
authors.lastname: Livermore
authors.forename: A
authors.initials: A
authors.lastname: Böttcher
authors.forename: F
authors.initials: F
authors.lastname: Sleghel
authors.forename: S
authors.initials: S
authors.lastname: Maggi
authors.forename: M
authors.initials: M
authors.lastname: Noale
authors.forename: C
authors.initials: C
authors.lastname: Larcher
authors.forename: N
authors.initials: N
authors.lastname: Woodford
mesh_terms: D001419:Bacteria / Q000187:drug effects / Q000302:isolation & purification*; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D016521:Electrophoresis, Gel, Pulsed-Field; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification; D006299:Health Services for the Aged; D006757:Hospital Units; D006761:Hospitals; D006801:Humans; D007264:Inguinal Canal / Q000382:microbiology; D007558:Italy; D008134:Long-Term Care; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification; D009666:Nose / Q000382:microbiology; D009960:Oropharynx / Q000382:microbiology; D010361:Patients; D010564:Personnel, Hospital; D010957:Plasmids; D016133:Polymerase Chain Reaction; D012150:Polymorphism, Restriction Fragment Length; D012007:Rectum / Q000382:microbiology; D012307:Risk Factors; D014556:Urine / Q000382:microbiology; D020713:Vancomycin Resistance