title: Multidrug-resistant bacteria in geriatric clinics, nursing homes, and ambulant care--prevalence and risk factors.
abstract: Colonization/infection with multidrug-resistant bacteria (MDRB) such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae, is an increasing problem not only in hospitals but also in long-term care facilities. The aim of this study was to determine the prevalence as well as the risk factors of colonization/infection with MRSA, VRE, and ESBL producing Enterobacteriaceae in geriatric clinics, nursing homes, and ambulant care in Frankfurt am Main, Germany. 288 patients from 2 geriatric clinics (n=46), 8 nursing homes (n=178), and 2 ambulant care facilities (n=64) as well as 64 staff members were screened for MDRB in the time period from October 2006 to May 2007. 58 patients (20.1%) and 4 staff members (6.2%) were colonized with MDRB. Among patients, 27 (9.4%) were colonized with MRSA, 11 (3.8%) were screened positive for VRE, and 25 (8.7%) were found to be colonized with ESBL producing Enterobacteriaceae. Prevalence of MDRB in geriatric clinics, nursing homes, and ambulant care facilities were 32.6%, 18.5%, and 15.6%, respectively. Significant risk factors for MDRB were immobility (OR: 2.7, 95% CI: 1.5-4.9; p=0.002), urinary catheter (OR: 3.1, 95% CI: 1.7-5.9; p<0.001), former hospitalization (OR: 2.1, 95% CI: 1.1-4.0; p=0.033), and wounds/decubiti (OR: 2.3, 95% CI: 1.5-4.9; p=0.03). Finally, the high level of MDRB in geriatric clinics, nursing homes, and ambulant care points to the importance of these institutions as a reservoir for dissemination.
authors.affiliation: Institute of Medical Microbiology and Infection Control, Hospital of Goethe-University, Frankfurt am Main, Germany.
authors.forename: Isabella
authors.initials: I
authors.lastname: Gruber
authors.forename: Ursel
authors.initials: U
authors.lastname: Heudorf
authors.forename: Guido
authors.initials: G
authors.lastname: Werner
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Pfeifer
authors.forename: Can
authors.initials: C
authors.lastname: Imirzalioglu
authors.forename: Hanns
authors.initials: H
authors.lastname: Ackermann
authors.forename: Christian
authors.initials: C
authors.lastname: Brandt
authors.forename: Silke
authors.initials: S
authors.lastname: Besier
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Wichelhaus
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000453:epidemiology* / Q000382:microbiology; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification*; D016983:Enterococcus / Q000187:drug effects / Q000302:isolation & purification*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006268:Health Facilities; D006801:Humans; D008297:Male; D015995:Prevalence; D012307:Risk Factors; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification*
keywords: Ambulant care; ESBL; Geriatric clinics; MRSA; Nursing homes; VRE