Hostname: page-component-586b7cd67f-dsjbd Total loading time: 0 Render date: 2024-11-24T23:07:33.471Z Has data issue: false hasContentIssue false
  • English
  • Français

Multidrug-Resistant Gram-Negative Bacteria: Inter- and Intradissemination Among Nursing Homes of Residents With Advanced Dementia

Published online by Cambridge University Press:  29 April 2015

Erika M. C. D’Agata ,
Daniel Habtemariam  and
Susan Mitchell
Erika M. C. D’Agata*
Affiliation:
Division of Infectious Diseases, Rhode Island Hospital, Providence, Rhode Island
Daniel Habtemariam
Affiliation:
Hebrew SeniorLife, Department of Medicine, Boston, Massachusetts
Susan Mitchell
Affiliation:
Hebrew SeniorLife, Department of Medicine, Boston, Massachusetts
*
Address correspondence to Erika D’Agata, MD, MPH, Division of Infectious Diseases, Rhode Island Hospital, Aldrich 720, 593 Eddy St, Providence, RI 02903-4923 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

To quantify the extent of inter– and intra–nursing home transmission of multidrug-resistant gram-negative bacteria (MDRGN) among residents with advanced dementia and characterize MDRGN colonization among these residents.

DESIGN

Prospective cohort study.

SETTING

Twenty-two nursing homes in the greater Boston, Massachusetts, area.

PATIENTS

Residents with advanced dementia.

METHODS

Serial rectal surveillance cultures for MDRGN and resident characteristics were obtained every 3 months for 12 months or until death. Molecular typing of MDRGN isolates was performed by pulsed-field gel electrophoresis.

RESULTS

A total of 190 MDRGN isolates from 152 residents with advanced dementia were included in the analyses. Both intra– and inter–nursing home transmission were identified. Genetically related MDRGN strains, recovered from different residents, were detected in 18 (82%) of the 22 nursing homes. The percent of clonally related strains in these nursing homes ranged from 0% to 86% (average, 35%). More than 50% of strains were clonally related in 3 nursing homes. Co-colonization with more than 1 different MDRGN species occurred among 28 residents (18.4%). A total of 168 (88.4%), 20 (10.5%), and 2 (1.0%) of MDRGN isolates were resistant to 3, 4, and 5 different antimicrobials or antimicrobial classes, respectively.

CONCLUSIONS

MDRGN are spread both within and between nursing homes among residents with advanced dementia. Infection control interventions should begin to target this high-risk group of nursing home residents.

Infect Control Hosp Epidemiol 2015;36(8):930–935

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 36 , Issue 8 , August 2015 , pp. 930 - 935
Copyright
© 2015 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Lautenbach, E, Perencevich, EN. Addressing the emergence and impact of multidrug-resistant gram-negative organisms: a critical focus for the next decade. Infect Control Hosp Epidemiol 2014;35:333–335.Google Scholar
2. O’Fallon, E, Kandel, R, Schreiber, R, D’Agata, EM. Acquisition of multidrug-resistant gram-negative bacteria: incidence and risk factors within a long-term care population. Infect Control Hosp Epidemiol 2010;31:1148–1153.Google Scholar
3. O’Fallon, E, Pop-Vicas, A, D’Agata, E. The emerging threat of multidrug-resistant gram-negative organisms in long-term care facilities. J Gerontol A Biol Sci Med Sci 2009;64:138–141.Google Scholar
4. Pop-Vicas, A, Tacconelli, E, Gravenstein, S, Lu, B, D’Agata, EM. Influx of multidrug-resistant, gram-negative bacteria in the hospital setting and the role of elderly patients with bacterial bloodstream infection. Infect Control Hosp Epidemiol 2009;30:325–331.Google Scholar
5. Pop-Vicas, A, Mitchell, SL, Kandel, R, Schreiber, R, D’Agata, EM. Multidrug-resistant gram-negative bacteria in a long-term care facility: prevalence and risk factors. J Am Geriatr Soc 2008;56:1276–1280.Google Scholar
6. D’Agata, E, Mitchell, SL. Patterns of antimicrobial use among nursing home residents with advanced dementia. Arch Intern Med 2008;168:357–362.CrossRefGoogle ScholarPubMed
7. O’Fallon, E, Schreiber, R, Kandel, R, D’Agata, EM. Multidrug-resistant gram-negative bacteria at a long-term care facility: assessment of residents, healthcare workers, and inanimate surfaces. Infect Control Hosp Epidemiol 2009;30:1172–1179.Google Scholar
8. Hughes, C, Tunney, M, Bradley, MC. Infection control strategies for preventing the transmission of meticillin-resistant Staphylococcus aureus (MRSA) in nursing homes for older people. Cochrane Database Syst Rev 2013:11 CD006354.Google Scholar
9. Lee, BY, Bartsch, SM, Wong, KF, et al. The importance of nursing homes in the spread of methicillin-resistant Staphylococcus aureus (MRSA) among hospitals. Med Care 2013;51:205–215.Google Scholar
10. Mitchell, SL, Shaffer, ML, Loeb, MB, et al. Infection management and multidrug-resistant organisms in nursing home residents with advanced dementia. JAMA Intern Med 2014;174:1660–1667.Google Scholar
11. Mitchell, SL, Shaffer, ML, Kiely, DK, Givens, JL, D’Agata, E. The study of pathogen resistance and antimicrobial use in dementia: study design and methodology. Arch Gerontol Geriatr 2013;56:16–22.Google Scholar
12. Reisberg, B, Ferris, SH, de Leon, MJ, Crook, T. The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry 1982;139:1136–1139.Google Scholar
13. Nursing home compare. Medicare.gov website. http://www.medicare.gov/nursinghomecompare/?AspxAutoDetectCookieSupport=1. Accessed October 7, 2014.Google Scholar
14. Loeb, M, Bentley, DW, Bradley, S, et al. Development of minimum criteria for the initiation of antibiotics in residents of long-term care facilities: results of a consensus conference. Infect Control Hosp Epidemiol 2001;22:120–124.Google Scholar
15. Tenover, FC, Arbeit, RD, Goering, RV, et al. Interpreting chromosomal DNA restriction patterns produced by pulsed-field gel electrophoresis: criteria for bacterial strain typing. J Clin Microbiol 1995;33:2233–2239.Google Scholar
16. Hudson, LO, Reynolds, C, Spratt, BG, et al. Diversity of methicillin-resistant Staphylococcus aureus strains isolated from residents of 26 nursing homes in Orange County, California. J Clin Microbiol 2013;51:3788–3795.Google Scholar
17. Fisch, J, Lansing, B, Wang, L, et al. New acquisition of antibiotic-resistant organisms in skilled nursing facilities. J Clin Microbiol 2012;50:1698–1703.Google Scholar
18. Mortensen, E, Trivedi, KK, Rosenberg, J, et al. Multidrug-resistant Acinetobacter baumannii infection, colonization, and transmission related to a long-term care facility providing subacute care. Infect Control Hosp Epidemiol 2014;35:406–411.Google Scholar
19. Cochard, H, Aubier, B, Quentin, R, van der Mee-Marquet, N. Extended-spectrum beta-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. Infect Control Hosp Epidemiol 2014;35:384–389.Google Scholar
20. Ben-David, D, Masarwa, S, Adler, A, Mishali, H, Carmeli, Y, Schwaber, MJ. A national intervention to prevent the spread of carbapenem-resistant Enterobacteriaceae in Israeli post-acute care hospitals. Infect Control Hosp Epidemiol 2014;35:802–809.Google Scholar
21. Snyder, GM, O’Fallon, E, D’Agata, EM. Co-colonization with multiple different species of multidrug-resistant gram-negative bacteria. Am J Infect Control 2011;39:506–510.Google Scholar
22. Doi, Y, Adams-Haduch, JM, Peleg, AY, D’Agata, EM. The role of horizontal gene transfer in the dissemination of extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae isolates in an endemic setting. Diagn Microbiol Infect Dis 2012;74:34–38.Google Scholar
23. Sengstock, DM, Thyagarajan, R, Apalara, J, Mira, A, Chopra, T, Kaye, KS. Multidrug-resistant Acinetobacter baumannii: an emerging pathogen among older adults in community hospitals and nursing homes. Clin Infect Dis 2010;50:1611–1616.Google Scholar