title: Presence of multidrug-resistant organisms in the residents and environments of long-term care facilities in Taiwan.
abstract: OBJECTIVE
  This study investigated the prevalence of multidrug-resistant organisms (MDROs) in the residents and environments of long-term care facilities (LTCFs) in Taiwan.
  
  
  METHODS
  We prospectively investigated the distribution of MDROs in residents of six LTCFs and their environments from January 2015 to December 2015 (intervention period). Active surveillance of colonization of MDROs was performed by culturing rectal and nasal swab samples every 3 months for the residents: 63, 79, and 73 in the first, second, and third surveillance investigations, respectively. If MDROs, including methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa, and MDR Acinetobacter baumannii were identified, then swab specimens from environmental sources were also collected and cultured. During the study period, several infection control measures were also implemented.
  
  
  RESULTS
  The overall infection density decreased significantly from 2.69 per 1000 patient-days in the preintervention (January 2014 to December 2014) to 2.39 per 1000 patient-days during the intervention period (p < 0.001). A total of 154 samples from residents and environmental sources were positive for MDROs. Methicillin-resistant S. aureus (n = 83, 53.9%) was the predominant organism, followed by carbapenem-resistant Enterobacteriaceae (n = 35, 22.7%), MDR A. baumannii (n = 30, 19.5%), and carbapenem-resistant P. aeruginosa (n = 6, 3.9%). The rates of detection of MDROs were 27.9% (60/215) in nasal swabs, 15.8% (34/215) in rectal swabs, and 11.1% (60/542) in the environmental sources.
  
  
  CONCLUSIONS
  The distribution and persistence of MDROs varied among the different LTCFs and time periods.
authors.affiliation: Department of Internal Medicine, St. Joseph's Hospital, Yunlin County, Taiwan; Division of Infectious Disease, Department of Internal Medicine, MacKay Memorial Hospital, Taipei, Taiwan; MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan; MacKay Medical College, New Taipei City, Taiwan.
authors.forename: Chun-Ming
authors.initials: CM
authors.lastname: Lee
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Lai
authors.affiliation: Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan.
authors.forename: Hsiu-Tzy
authors.initials: HT
authors.lastname: Chiang
authors.affiliation: Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan.
authors.forename: Min-Chi
authors.initials: MC
authors.lastname: Lu
authors.affiliation: Yongen Nursing Home, Taichung, Taiwan.
authors.forename: Ling-Fang
authors.initials: LF
authors.lastname: Wang
authors.affiliation: Lukang Christian Nursing Home, Changhua, Taiwan.
authors.forename: Tsai-Ling
authors.initials: TL
authors.lastname: Tsai
authors.affiliation: Changhua Christian Hospital Erlin Nursing Home, Changhua, Taiwan.
authors.forename: Mei-Yu
authors.initials: MY
authors.lastname: Kang
authors.affiliation: Thanksgiving Nursing Home, Taichung, Taiwan.
authors.forename: Yi-Ni
authors.initials: YN
authors.lastname: Jan
authors.affiliation: Feng-Fung Nursing Home, Taichung, Taiwan.
authors.forename: Yi-Ting
authors.initials: YT
authors.lastname: Lo
authors.affiliation: Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan.
authors.forename: Wen-Chien
authors.initials: WC
authors.lastname: Ko
authors.affiliation: Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan.
authors.forename: Shu-Hui
authors.initials: SH
authors.lastname: Tseng
authors.affiliation: Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan. Electronic address: hsporen@ntu.edu.tw.
authors.forename: Po-Ren
authors.initials: PR
authors.lastname: Hsueh
mesh_terms: D040981:Acinetobacter baumannii / Q000187:drug effects / Q000472:pathogenicity; D000368:Aged; D000369:Aged, 80 and over; D001419:Bacteria / Q000302:isolation & purification; D001424:Bacterial Infections / Q000175:diagnosis / Q000453:epidemiology / Q000382:microbiology*; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology; D024901:Drug Resistance, Multiple, Bacterial; D004755:Enterobacteriaceae / Q000187:drug effects / Q000472:pathogenicity; D004783:Environmental Microbiology; D005260:Female; D006268:Health Facilities; D006801:Humans; D017053:Infection Control; D008134:Long-Term Care / Q000706:statistics & numerical data*; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000472:pathogenicity; D008826:Microbial Sensitivity Tests; D058889:Molecular Typing; D009297:Nasal Mucosa / Q000382:microbiology; D015995:Prevalence; D011446:Prospective Studies; D011550:Pseudomonas aeruginosa / Q000187:drug effects / Q000472:pathogenicity; D012007:Rectum / Q000382:microbiology; D013624:Taiwan / Q000453:epidemiology
keywords: environment; infection control; long-term care facility; multidrug-resistant organisms; residents