Lillian Min1, Andrzej Galecki, Lona Mody. 1. Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan; Geriatric Research, Education and Clinical Center, Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.
Abstract
OBJECTIVES: To use a simple measure of activities of daily living, wounds, and indwelling devices (urinary catheter, feeding tube) to predict prevalent, new, and intermittent multidrug-resistant organism (MDRO) acquisition in nursing home (NH) residents. DESIGN: Secondary analysis, prospective cohort study. SETTING: Southeast Michigan NHs (n = 15). PARTICIPANTS: NH residents (N = 111, mean age 81) with two or more monthly visits (729 total). MEASUREMENTS: Monthly microbiological surveillance for MDROs from multiple anatomic sites from enrollment until discharge or 1 year. The Arling scale, previously developed as a measure of NH residents' need (time-intensity) for nursing resources, was used to predict prevalent and time to new or intermittent acquisition (months) of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and antibiotic-resistant gram-negative bacteria (R-GNB) colonization using multiple-failure accelerated time-factor survival analysis, controlling for comorbidity, hospitalization, and antibiotic use in the prior month. RESULTS: One-fifth of participants had a wound, and one-third had a device. There were 60 acquisitions of MRSA, 56 of R-GNB, and 15 of VRE. Expected time to acquisition was less than 1 year for MRSA (median 6.7 months) and R-GNB (median 4.5 months) and more than 1 year for VRE (median 40 months). Arling score was associated with earlier new MRSA and VRE acquisition. A resident with only mild functional impairment and no device or wound would be expected to acquire MRSA in 20 months, versus 5 months for someone needing the most-intense nursing contact. CONCLUSION: MDRO acquisition is common in community NHs. Need for nursing care predicts new MDRO acquisition in NHs, suggesting potential mechanisms for MDRO acquisition and strategies for future interventions for high-risk individuals (e.g., enhanced barrier precautions). Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
OBJECTIVES: To use a simple measure of activities of daily living, wounds, and indwelling devices (urinary catheter, feeding tube) to predict prevalent, new, and intermittent multidrug-resistant organism (MDRO) acquisition in nursing home (NH) residents. DESIGN: Secondary analysis, prospective cohort study. SETTING: Southeast Michigan NHs (n = 15). PARTICIPANTS: NH residents (N = 111, mean age 81) with two or more monthly visits (729 total). MEASUREMENTS: Monthly microbiological surveillance for MDROs from multiple anatomic sites from enrollment until discharge or 1 year. The Arling scale, previously developed as a measure of NH residents' need (time-intensity) for nursing resources, was used to predict prevalent and time to new or intermittent acquisition (months) of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and antibiotic-resistant gram-negative bacteria (R-GNB) colonization using multiple-failure accelerated time-factor survival analysis, controlling for comorbidity, hospitalization, and antibiotic use in the prior month. RESULTS: One-fifth of participants had a wound, and one-third had a device. There were 60 acquisitions of MRSA, 56 of R-GNB, and 15 of VRE. Expected time to acquisition was less than 1 year for MRSA (median 6.7 months) and R-GNB (median 4.5 months) and more than 1 year for VRE (median 40 months). Arling score was associated with earlier new MRSA and VRE acquisition. A resident with only mild functional impairment and no device or wound would be expected to acquire MRSA in 20 months, versus 5 months for someone needing the most-intense nursing contact. CONCLUSION: MDRO acquisition is common in community NHs. Need for nursing care predicts new MDRO acquisition in NHs, suggesting potential mechanisms for MDRO acquisition and strategies for future interventions for high-risk individuals (e.g., enhanced barrier precautions). Published 2015. This article is a U.S. Government work and is in the public domain in the USA.
Entities:
Keywords:
functional disability; multidrug-resistant organisms; nursing homes
Authors: L Wang; B Lansing; K Symons; E L Flannery; J Fisch; K Cherian; S E McNamara; L Mody Journal: Eur J Clin Microbiol Infect Dis Date: 2012-01-25 Impact factor: 3.267
Authors: Rajiv Jain; Stephen M Kralovic; Martin E Evans; Meredith Ambrose; Loretta A Simbartl; D Scott Obrosky; Marta L Render; Ron W Freyberg; John A Jernigan; Robert R Muder; LaToya J Miller; Gary A Roselle Journal: N Engl J Med Date: 2011-04-14 Impact factor: 91.245
Authors: Erika L Flannery; Linda Wang; Sebastian Zöllner; Betsy Foxman; Harry L T Mobley; Lona Mody Journal: Clin Infect Dis Date: 2011-12 Impact factor: 9.079
Authors: Glenn A Pacio; Paul Visintainer; George Maguire; Gary P Wormser; John Raffalli; Marisa A Montecalvo Journal: Infect Control Hosp Epidemiol Date: 2003-04 Impact factor: 3.254
Authors: Kepler A Davis; Justin J Stewart; Helen K Crouch; Christopher E Florez; Duane R Hospenthal Journal: Clin Infect Dis Date: 2004-08-27 Impact factor: 9.079
Authors: Kevin Heinze; Mohammed Kabeto; Emily Toth Martin; Marco Cassone; Liam Hicks; Lona Mody Journal: Am J Infect Control Date: 2018-11-28 Impact factor: 2.918
Authors: Lona Mody; Kristen E Gibson; Amanda Horcher; Katherine Prenovost; Sara E McNamara; Betsy Foxman; Keith S Kaye; Suzanne Bradley Journal: Infect Control Hosp Epidemiol Date: 2015-06-15 Impact factor: 3.254
Authors: Julia Mantey; Lillian Min; Marco Cassone; Kristen E Gibson; Lona Mody Journal: Infect Control Hosp Epidemiol Date: 2019-06-27 Impact factor: 3.254
Authors: Lona Mody; Kyle J Gontjes; Marco Cassone; Kristen E Gibson; Bonnie J Lansing; Julia Mantey; Mohammed Kabeto; Andrzej Galecki; Lillian Min Journal: JAMA Netw Open Date: 2021-07-01