title: Inguinal skin colonization with multidrug-resistant bacteria among residents of elderly care facilities: frequency, persistence, molecular analysis and clinical impact.
abstract: Frequency, persistence and molecular characteristics of multidrug resistant bacteria colonizing inhabitants of long term care facilities are topics of current concern. We performed a point-prevalence survey of 402 residents in 7 elderly care facilities in Berlin, Germany. Inguinal swabs were analyzed for the presence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), and multidrug-resistant gram-negative bacteria. Three and six months following the initial investigation, all colonized residents were sampled again and the occurrence of intercurrent infections, hospital admissions and use of antimicrobials were registered. Genetic relatedness of the bacteria was investigated using multi-locus sequence typing (MLST), spa-typing and SmaI/XbaI-macrorestriction analysis. 33 (8.2%) residents were skin-colonized with multidrug-resistant bacteria. MRSA were found in 19 (4.7%) and ESBL-producing Enterobacteriaceae in 16 residents (3.98%). Independent risk factors for colonization with multidrug-resistant bacteria were a high level of care and the presence of chronic wounds. A large proportion of the observed bacteria persisted up to six months and showed a high degree of inter-individual diversity. Outcome analysis revealed that infections tend to occur slightly more often in residents colonized by multiresistant pathogens. We assume that a perceptible population of residents in nursing homes is at risk for individual colonization with multidrug-resistant bacteria as well as healthcare associated infections.
authors.affiliation: Robert Koch-Institute, Department of Infectious Diseases, Division for Applied Infection Control and Hospital Hygiene, 13353 Berlin, Germany. Electronic address: ruscherc@rki.de.
authors.forename: Claudia
authors.initials: C
authors.lastname: Ruscher
authors.affiliation: Robert Koch-Institute, Department of Infectious Diseases, Division for Nosocomial Pathogens and Antimicrobial Resistance, 38855 Wernigerode, Germany.
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Pfeifer
authors.affiliation: Robert Koch-Institute, Department of Infectious Diseases, Division for Nosocomial Pathogens and Antimicrobial Resistance, 38855 Wernigerode, Germany.
authors.forename: Franziska
authors.initials: F
authors.lastname: Layer
authors.affiliation: Robert Koch-Institute, Department of Infectious Diseases, Division for Applied Infection Control and Hospital Hygiene, 13353 Berlin, Germany.
authors.forename: Reiner
authors.initials: R
authors.lastname: Schaumann
authors.affiliation: Robert Koch-Institute, Department of Infectious Diseases, Division for Applied Infection Control and Hospital Hygiene, 13353 Berlin, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Levin
authors.affiliation: Robert Koch-Institute, Department of Infectious Diseases, Division for Applied Infection Control and Hospital Hygiene, 13353 Berlin, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Mielke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001604:Berlin / Q000453:epidemiology; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology*; D003430:Cross-Sectional Studies; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D005260:Female; D006268:Health Facilities; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D058889:Molecular Typing; D012867:Skin / Q000382:microbiology*; D065507:Vancomycin-Resistant Enterococci / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*
keywords: Antimicrobial resistance; ESBL; Healthcare-associated infections; Long term care; Meticillin-resistant Staphylococcus aureus (MRSA); Multidrug resistance