title: Asymptomatic rectal colonization with carbapenem-resistant Enterobacteriaceae and Clostridium difficile among residents of a long-term care facility in New York City.
abstract: Residents of long-term care facilities (LTCFs) are at increased risk for colonization and development of infections with multidrug-resistant organisms. This study was undertaken to determine prevalence of asymptomatic rectal colonization with Clostridium difficile (and proportion of 027/NAP1/BI ribotype) or carbapenem-resistant Enterobacteriaceae (CRE) in an LTCF population.
  
  
  
  Active surveillance was performed for C difficile and CRE rectal colonization of 301 residents in a 320-bed (80-bed ventilator unit), hospital-affiliated LTCF with retrospective chart review for patient demographics and potential risk factors.
  
  
  
  Over 40% of patients had airway ventilation and received enteral feeding. One-third of these patients had prior C difficile-associated infection (CDI). Asymptomatic rectal colonization with C difficile occurred in 58 patients (19.3%, one-half with NAP1+), CRE occurred in 57 patients (18.9%), and both occurred in 17 patients (5.7%). Recent CDI was significantly associated with increased risk of C difficile ± CRE colonization. Multivariate logistic regression analysis revealed presence of tracheostomy collar to be significant for C difficile colonization, mechanical ventilation to be significant for CRE colonization, and prior CDI to be significant for both C difficile and CRE colonization.
  
  
  
  The strong association of C difficile or CRE colonization with disruption of normal flora by mechanical ventilation, enteral feeds, and prior CDI carries important implications for infection control intervention in this population.
authors.affiliation: Department of Medicine, NewYork-Presbyterian/Queens, Flushing, NY; The Dr. James J. Rahal Jr. Division of Infectious Diseases, NewYork-Presbyterian/Queens, Flushing, NY; Silvercrest Center for Nursing and Rehabilitation, Flushing, NY.
authors.forename: Nishant
authors.initials: N
authors.lastname: Prasad
authors.affiliation: Department of Medicine, NewYork-Presbyterian/Queens, Flushing, NY; Division of Geriatrics and Palliative Medicine, NewYork-Presbyterian/Queens, Flushing, NY.
authors.forename: Georges
authors.initials: G
authors.lastname: Labaze
authors.affiliation: Department of Medicine, NewYork-Presbyterian/Queens, Flushing, NY; The Dr. James J. Rahal Jr. Division of Infectious Diseases, NewYork-Presbyterian/Queens, Flushing, NY; Silvercrest Center for Nursing and Rehabilitation, Flushing, NY.
authors.forename: Joanna
authors.initials: J
authors.lastname: Kopacz
authors.affiliation: Department of Medicine, NewYork-Presbyterian/Queens, Flushing, NY; Division of Geriatrics and Palliative Medicine, NewYork-Presbyterian/Queens, Flushing, NY.
authors.forename: Sophie
authors.initials: S
authors.lastname: Chwa
authors.affiliation: Department of Medicine, NewYork-Presbyterian/Queens, Flushing, NY; Division of Geriatrics and Palliative Medicine, NewYork-Presbyterian/Queens, Flushing, NY.
authors.forename: Dimitris
authors.initials: D
authors.lastname: Platis
authors.affiliation: Department of Medicine, NewYork-Presbyterian/Queens, Flushing, NY; Division of Geriatrics and Palliative Medicine, NewYork-Presbyterian/Queens, Flushing, NY.
authors.forename: Cynthia X
authors.initials: CX
authors.lastname: Pan
authors.affiliation: Silvercrest Center for Nursing and Rehabilitation, Flushing, NY.
authors.forename: Daniel
authors.initials: D
authors.lastname: Russo
authors.affiliation: Department of Pathology, NewYork-Presbyterian/Queens, Flushing, NY.
authors.forename: Vincent J
authors.initials: VJ
authors.lastname: LaBombardi
authors.affiliation: Department of Pathology, NewYork-Presbyterian/Queens, Flushing, NY.
authors.forename: Giuliana
authors.initials: G
authors.lastname: Osorio
authors.affiliation: Computer Information Systems and Decision Sciences, St. John's University, Queens, NY.
authors.forename: Simcha
authors.initials: S
authors.lastname: Pollack
authors.affiliation: Public Health Research Institute, New Jersey Medical School, Rutgers University, Newark, NJ.
authors.forename: Barry N
authors.initials: BN
authors.lastname: Kreiswirth
authors.affiliation: Public Health Research Institute, New Jersey Medical School, Rutgers University, Newark, NJ.
authors.forename: Liang
authors.initials: L
authors.lastname: Chen
authors.affiliation: Department of Medicine, NewYork-Presbyterian/Queens, Flushing, NY; The Dr. James J. Rahal Jr. Division of Infectious Diseases, NewYork-Presbyterian/Queens, Flushing, NY.
authors.forename: Carl
authors.initials: C
authors.lastname: Urban
authors.affiliation: Department of Medicine, NewYork-Presbyterian/Queens, Flushing, NY; The Dr. James J. Rahal Jr. Division of Infectious Diseases, NewYork-Presbyterian/Queens, Flushing, NY. Electronic address: sxsegalm@nyp.org.
authors.forename: Sorana
authors.initials: S
authors.lastname: Segal-Maurer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D058070:Asymptomatic Diseases; D015780:Carbapenems / Q000494:pharmacology; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D016360:Clostridioides difficile / Q000187:drug effects / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology; D004755:Enterobacteriaceae / Q000187:drug effects / Q000302:isolation & purification*; D004756:Enterobacteriaceae Infections / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D015995:Prevalence; D012007:Rectum / Q000382:microbiology*; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult; D018440:beta-Lactam Resistance
chemical_list: D000900:Anti-Bacterial Agents; D015780:Carbapenems
keywords: Clostridium difficile; carbapenem-resistant Enterobacteriaceae; long-term care facility; rectal colonization