Chun-Ming Lee1, Chih-Cheng Lai2, Hsiu-Tzy Chiang3, Min-Chi Lu4, Ling-Fang Wang5, Tsai-Ling Tsai6, Mei-Yu Kang7, Yi-Ni Jan8, Yi-Ting Lo9, Wen-Chien Ko10, Shu-Hui Tseng11, Po-Ren Hsueh12. 1. 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. 2. Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan. 3. Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan. 4. Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan. 5. Yongen Nursing Home, Taichung, Taiwan. 6. Lukang Christian Nursing Home, Changhua, Taiwan. 7. Changhua Christian Hospital Erlin Nursing Home, Changhua, Taiwan. 8. Thanksgiving Nursing Home, Taichung, Taiwan. 9. Feng-Fung Nursing Home, Taichung, Taiwan. 10. Department of Internal Medicine, National Cheng Kung University Hospital and Medical College, Tainan, Taiwan. 11. Centers for Disease Control, Ministry of Health and Welfare, Taipei, Taiwan. 12. 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.
Abstract
OBJECTIVES: 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.
OBJECTIVES: 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.