Prevalence of multidrug-resistant organisms and risk factors for carriage in long-term care facilities: A nested case-control study

Lim, Ching Jou, Cheng, Allen C., Kennon, Jacqueline, Spelman, Denis, Hale, Dayna, Melican, Gabrielle, Sidjabat, Hanna E., Paterson, David L., Kong, David C. M. and Peleg, Anton Y. (2014) Prevalence of multidrug-resistant organisms and risk factors for carriage in long-term care facilities: A nested case-control study. Journal of Antimicrobial Chemotherapy, 69 7: 1972-1980. doi:10.1093/jac/dku077


Author Lim, Ching Jou
Cheng, Allen C.
Kennon, Jacqueline
Spelman, Denis
Hale, Dayna
Melican, Gabrielle
Sidjabat, Hanna E.
Paterson, David L.
Kong, David C. M.
Peleg, Anton Y.
Title Prevalence of multidrug-resistant organisms and risk factors for carriage in long-term care facilities: A nested case-control study
Journal name Journal of Antimicrobial Chemotherapy   Check publisher's open access policy
ISSN 0305-7453
1460-2091
Publication date 2014-04
Year available 2014
Sub-type Article (original research)
DOI 10.1093/jac/dku077
Open Access Status
Volume 69
Issue 7
Start page 1972
End page 1980
Total pages 9
Place of publication Oxford, United Kingdom
Publisher Oxford University Press
Collection year 2015
Language eng
Abstract Background: Long-term care facilities (LTCFs) are a potentially important reservoir of multidrug-resistant (MDR) organisms; however, limited data exist. Methods: A point-prevalence study was conducted in four co-located LTCFs in Australia. Nasal and rectal swabs were cultured for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and MDR Gram-negative bacilli (GNB). Molecular typing and resistance detection were performed. Risk factors for colonization with an MDR organism were determined using a nested case-control study. Results: Consent was obtained from 115 (85%) of 136 eligible participants. Forty-one (36%) residents carried at least one type of MDR organism. The prevalence was 16% MRSA (n=18), 6% VRE (n=7) and 21% MDR GNB [n=24; including extended-spectrum b-lactamase (ESBL)-producing Escherichia coli (n=12) and Acinetobacter baumannii (n=6)]. The majority of ESBL-producing E. coli and A. baumannii were clonal. Current wound management [adjusted OR (AOR) 8.81 (95% CI 2.78-27.94), P < 0.001], medical device in situ [AOR 5.58 (95% CI 1.34-23.32), P=0.018] and pressure ulcer [AOR 3.69 (95% CI 1.06-12.86), P=0.04] were independent risk factors for MDR organism colonization. Advanced dementia [AOR 3.54 (95% CI 1.23-10.23), P=0.02] and prolonged antibiotic use [AOR 2.95 (95% CI 1.01-8.60), P=0.047] were independently associated with MRSA colonization, whilst current wound management [AOR 15.59 (95% CI 4.85-50.10), P < 0.001] and fluoroquinolone use [AOR 4.27 (95% CI 1.20-15.25), P=0.025] were risk factors for MDR GNB colonization. Conclusions: LTCFs are an important reservoir of MDR organisms, with person-to-person transmissions being a potential issue. We have identified several predictors of colonization with MDR organisms, allowing a more targeted management of high-risk residents.
Keyword Acinetobacter baumannii
Antibiotic resistance
Gram negative bacteria
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: UQ Centre for Clinical Research Publications
Official 2015 Collection
 
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