title: The burden of multidrug-resistant organisms on tertiary hospitals posed by patients with recent stays in long-term acute care facilities.
abstract: BACKGROUND
  Long-term acute care (LTAC) facilities admit patients with complex, advanced disease states. Study aims were to determine the burden posed on hospitals associated with LTAC exposure and analyze the differences between "present on admission" (POA) multidrug-resistant (MDR), gram-negative organisms (GNO) and POA MDR gram-positive organisms (GPO).
  
  
  METHODS
  A multicenter retrospective study was conducted in 13 hospitals from southeast Michigan, from September 1, 2008, to August 31, 2009. Cultures obtained in the first 72 hours of hospitalization (ie, POA) of MDR-GPO and MDR-GNO were reviewed. LTAC exposures in the previous 6 months and direct admission from a LTAC were recorded.
  
  
  RESULTS
  Overall, 5,297 patients with 7,147 MDR POA cultures were analyzed: 2,619 (36.6%) were MDR-GNO, and 4,528 (63.4%) were MDR-GPO. LTAC exposure in the past 6 months was present in 251 (5.2%) infectious episodes and was significantly more common among POA MDR-GNO than MDR-GPO (158 [8.6%] and 94 [3.1%], respectively, odds ratio, 2.87; P < .001). Recent LTAC exposure was strongly associated with both carbapenem-resistant Enterobacteriaceae (CRE) (31.6% of all CRE cases, P < .001) and Acinetobacter baumannii (14.9% of all A baumannii cases, P < .001).
  
  
  CONCLUSIONS
  Nearly 10% of MDR-GNO POA had recent LTAC exposure. Hospital efforts to control the spread of MDR-GNO should focus on collaborations and communications with referring LTACs and interventions targeted towards patients with recent LTAC exposure.
authors.affiliation: Division of Infectious Diseases, Detroit Medical Center, Wayne State University, Detroit, MI, USA. drormc@hotmail.com
authors.forename: Dror
authors.initials: D
authors.lastname: Marchaim
authors.forename: Teena
authors.initials: T
authors.lastname: Chopra
authors.forename: Christopher
authors.initials: C
authors.lastname: Bogan
authors.forename: Suchitha
authors.initials: S
authors.lastname: Bheemreddy
authors.forename: David
authors.initials: D
authors.lastname: Sengstock
authors.forename: Rajasekhar
authors.initials: R
authors.lastname: Jagarlamudi
authors.forename: Anurag
authors.initials: A
authors.lastname: Malani
authors.forename: Leslie
authors.initials: L
authors.lastname: Lemanek
authors.forename: Judy
authors.initials: J
authors.lastname: Moshos
authors.forename: Paul R
authors.initials: PR
authors.lastname: Lephart
authors.forename: Kimberley
authors.initials: K
authors.lastname: Ku
authors.forename: Asma
authors.initials: A
authors.lastname: Hasan
authors.forename: Jiha
authors.initials: J
authors.lastname: Lee
authors.forename: Namir
authors.initials: N
authors.lastname: Khandker
authors.forename: Christopher
authors.initials: C
authors.lastname: Blunden
authors.forename: Sara F
authors.initials: SF
authors.lastname: Geffert
authors.forename: Megan
authors.initials: M
authors.lastname: Moody
authors.forename: Rahbar
authors.initials: R
authors.lastname: Hiro
authors.forename: Yujing
authors.initials: Y
authors.lastname: Wang
authors.forename: Farah
authors.initials: F
authors.lastname: Ahmad
authors.forename: Tarana
authors.initials: T
authors.lastname: Mohammadi
authors.forename: Omar
authors.initials: O
authors.lastname: Faruque
authors.forename: Diixa
authors.initials: D
authors.lastname: Patel
authors.forename: Jason M
authors.initials: JM
authors.lastname: Pogue
authors.forename: Kayoko
authors.initials: K
authors.lastname: Hayakawa
authors.forename: Sorabh
authors.initials: S
authors.lastname: Dhar
authors.forename: Keith S
authors.initials: KS
authors.lastname: Kaye
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D015331:Cohort Studies; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control; D024901:Drug Resistance, Multiple, Bacterial; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016905:Gram-Negative Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D006094:Gram-Positive Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D016908:Gram-Positive Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology / Q000382:microbiology*; D006801:Humans; D008134:Long-Term Care; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies; D062606:Tertiary Care Centers; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents