title: Multidrug-resistant organism infections in US nursing homes: a national study of prevalence, onset, and transmission across care settings, October 1, 2010-December 31, 2011.
abstract: OBJECTIVE
  To understand the prevalence of multidrug-resistant organism (MDRO) infections among nursing home (NH) residents and the potential for their spread between NHs and acute care hospitals (ACHs).
  
  
  METHODS
  Descriptive analyses of MDRO infections among NH residents using all NH residents in the Long-Term Care Minimum Data Set (MDS) 3.0 between October 1, 2010 and December 31, 2011.
  
  
  RESULTS
  Analysis of MDS data revealed a very high volume of bidirectional patient flow between NHs and ACHs, indicating the need to study MDRO infections in NHs as well as in hospitals. A total of 4.24% of NH residents had an active MDRO diagnosis on at least 1 MDS assessment during the study period. This rate significantly varied by sex, age, urban/rural status, and state. Approximately 2% of NH discharges to ACHs involved a resident with an active diagnosis of infection due to MDROs. Conversely, 1.8% of NH admissions from an ACH involved a patient with an active diagnosis of infection due to MDROs. Among residents who acquired an MDRO infection during the study period, 57% became positive in the NH, 41% in the ACH, and 2% in other settings (eg, at a private home or apartment).
  
  
  CONCLUSIONS
  Even though NHs are the most likely setting where residents would acquire MDROs after admission to an NH (accounting for 57% of cases), a significant fraction of NH residents acquire MDRO infection at ACHs (41%). Thus, effective MDRO infection control for NH residents requires simultaneous, cooperative interventions among NHs and ACHs in the same community.
authors.affiliation: Fannie Mae, Washington, DC.
authors.forename: Daver
authors.initials: D
authors.lastname: Kahvecioglu
authors.forename: Kalpana
authors.initials: K
authors.lastname: Ramiah
authors.forename: Darcy
authors.initials: D
authors.lastname: McMaughan
authors.forename: Steven
authors.initials: S
authors.lastname: Garfinkel
authors.forename: Veronica E
authors.initials: VE
authors.lastname: McSorley
authors.forename: Quy Nhi
authors.initials: QN
authors.lastname: Nguyen
authors.forename: Manshu
authors.initials: M
authors.lastname: Yang
authors.forename: Christopher
authors.initials: C
authors.lastname: Pugliese
authors.forename: David
authors.initials: D
authors.lastname: Mehr
authors.forename: Charles D
authors.initials: CD
authors.lastname: Phillips
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001424:Bacterial Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000209:etiology / Q000635:transmission; D003428:Cross Infection / Q000453:epidemiology* / Q000209:etiology / Q000382:microbiology / Q000635:transmission; D024901:Drug Resistance, Multiple, Bacterial; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000706:statistics & numerical data*; D015995:Prevalence; D014481:United States / Q000453:epidemiology; D055815:Young Adult