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Extended-Spectrum β-Lactamase–Producing Enterobacteriaceae in French Nursing Homes: An Association between High Carriage Rate among Residents, Environmental Contamination, Poor Conformity with Good Hygiene Practice, and Putative Resident-to-Resident Transmission

Published online by Cambridge University Press:  10 May 2016

Hélène Cochard
Affiliation:
Réseau des Hygiénistes du Centre, Centre Hospitalier Universitaire, Tours, France
Benjamin Aubier
Affiliation:
Réseau des Hygiénistes du Centre, Centre Hospitalier Universitaire, Tours, France
Roland Quentin
Affiliation:
Service de Bactériologie et Hygiène, Centre Hospitalier Universitaire, Tours, France
Nathalie van der Mee-Marquet*
Affiliation:
Réseau des Hygiénistes du Centre, Centre Hospitalier Universitaire, Tours, France Service de Bactériologie et Hygiène, Centre Hospitalier Universitaire, Tours, France
*
Centre Hospitalier Universitaire Service de Bactériologie et Hygiène Réseau des Hygiénistes du Centre Hôpital Trousseau Université de Tours, UMR 1282, 37044 Tours Cedex, France ([email protected])

Abstract

Objective.

We evaluated the spread of multidrug-resistant Enterobacteriaceae in 38 nursing homes (NHs) in the Centre region of France.

Methods.

We conducted a multicenter prevalence study and evaluated extended-spectrum β-lactamase- and carbapenemase-producing Enterobacteriaceae (ESBLE and CPE, respectively) colonization of 1,155 residents. The colonizing isolates were studied by randomly amplified polymorphic DNA typing. We observed hygiene practices and studied the contamination of the environment in 8 NHs.

Results.

A total of 114 residents were ESBLE carriers (9.9%); none were CPE carriers. A total of 82.6% of the ESBLE were Escherichia coli. ESBLE colonization was associated with poor health status (P = .002), malignancy (P = .006), urinary incontinence (P = .007), fecal incontinence (P = .002), previous hospitalization (P = .033), and carbapenem treatment (P = .040). The clonal relationship between isolates within NHs suggested resident-to-resident ESBLE transmission in 15 NHs. ESBLE isolates were recovered from 6 of 232 bedrooms studied. A total of 1,533 observations revealed low rates of conformity for hand hygiene (25.7%), the use of gloves (45.9%) and protective clothing (13.3%), and waste management (46.7%). Conformity rates correlated inversely with ESBLE carriage rates.

Conclusions.

In most of the participating NHs, improved application of standard precautions during incontinence care is needed, and greater efforts to clean the environment of residents are required.

Type
Original Article
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2014

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Footnotes

a

Participating physicians and nurses are listed at the end of the text

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