Lona Mody1,2, Betsy Foxman3, Suzanne Bradley4,5, Sara McNamara1, Bonnie Lansing1, Kristen Gibson1, Marco Cassone1, Chelsie Armbruster6, Julia Mantey1, Lillian Min1,2. 1. Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School. 2. Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System. 3. Department of Epidemiology, University of Michigan School of Public Health. 4. Infectious Diseases Section, Veterans Affairs Ann Arbor Healthcare System. 5. Internal Medicine, Division of Infectious Diseases, University of Michigan Medical School, Ann Arbor. 6. Department of Microbiology and Immunology, University of Michigan Medical School, Ann Arbor.
Abstract
Background: The spread of multidrug-resistant organisms (MDROs) is a global concern, and much about transmission in healthcare systems remains unknown. To reduce hospital stays, nursing facilities (NFs) have increasingly assumed care of post-acute populations. We estimate the prevalence of MDRO colonization in NF patients on enrollment and discharge to community settings, risk factors for colonization, and rates of acquiring MDROs during the stay. Methods: We conducted a prospective, longitudinal cohort study of newly admitted patients in 6 NFs in southeast Michigan using active microbial surveillance of multiple anatomic sites sampled at enrollment, days 14 and 30, and monthly thereafter for up to 6 months. Results: We enrolled 651 patients and collected 7526 samples over 1629 visits, with an average of 29 days of follow-up per participant. Nearly all participants were admitted for post-acute care (95%). More than half (56.8%) were colonized with MDROs at enrollment: methicillin-resistant Staphylococcus aureus (MRSA), 16.1%; vancomycin-resistant enterococci (VRE), 33.2%; and resistant gram-negative bacilli (R-GNB), 32.0%. Risk factors for colonization at enrollment included prolonged hospitalization (>14 days), functional disability, antibiotic use, or device use. Rates per 1000 patient-days of acquiring a new MDRO were MRSA, 3.4; VRE, 8.2; and R-GNB, 13.6. MDRO colonization at discharge was similar to that at enrollment (56.4%): MRSA, 18.4%; VRE, 30.3%; and R-GNB, 33.6%. Conclusions: Short-stay NF patients exhibit a high prevalence of MDROs near the time of admission, as well as at discharge, and may serve as a reservoir for spread in other healthcare settings. Future interventions to reduce MDROs should specifically target this population.
Background: The spread of multidrug-resistant organisms (MDROs) is a global concern, and much about transmission in healthcare systems remains unknown. To reduce hospital stays, nursing facilities (NFs) have increasingly assumed care of post-acute populations. We estimate the prevalence of MDRO colonization in NF patients on enrollment and discharge to community settings, risk factors for colonization, and rates of acquiring MDROs during the stay. Methods: We conducted a prospective, longitudinal cohort study of newly admitted patients in 6 NFs in southeast Michigan using active microbial surveillance of multiple anatomic sites sampled at enrollment, days 14 and 30, and monthly thereafter for up to 6 months. Results: We enrolled 651 patients and collected 7526 samples over 1629 visits, with an average of 29 days of follow-up per participant. Nearly all participants were admitted for post-acute care (95%). More than half (56.8%) were colonized with MDROs at enrollment: methicillin-resistant Staphylococcus aureus (MRSA), 16.1%; vancomycin-resistant enterococci (VRE), 33.2%; and resistant gram-negative bacilli (R-GNB), 32.0%. Risk factors for colonization at enrollment included prolonged hospitalization (>14 days), functional disability, antibiotic use, or device use. Rates per 1000 patient-days of acquiring a new MDRO were MRSA, 3.4; VRE, 8.2; and R-GNB, 13.6. MDRO colonization at discharge was similar to that at enrollment (56.4%): MRSA, 18.4%; VRE, 30.3%; and R-GNB, 33.6%. Conclusions: Short-stay NF patients exhibit a high prevalence of MDROs near the time of admission, as well as at discharge, and may serve as a reservoir for spread in other healthcare settings. Future interventions to reduce MDROs should specifically target this population.
Authors: Martin E Evans; Stephen M Kralovic; Loretta A Simbartl; Ron W Freyberg; D Scott Obrosky; Gary A Roselle; Rajiv Jain Journal: Am J Infect Control Date: 2014-01 Impact factor: 2.918
Authors: Dale Fisher; Long Pang; Sharon Salmon; Raymond T P Lin; Cathrine Teo; Paul Tambyah; Roland Jureen; Alex R Cook; Jonathan A Otter Journal: Infect Control Hosp Epidemiol Date: 2015-10-21 Impact factor: 3.254
Authors: L Silvia Munoz-Price; Philip Carling; Timothy Cleary; Yovanit Fajardo-Aquino; Dennise DePascale; Adriana Jimenez; Michael Hughes; Nicholas Namias; Louis Pizano; Daniel H Kett; Kristopher Arheart Journal: Am J Infect Control Date: 2014-05 Impact factor: 2.918
Authors: Susan L Mitchell; Michele L Shaffer; Mark B Loeb; Jane L Givens; Daniel Habtemariam; Dan K Kiely; Erika D'Agata Journal: JAMA Intern Med Date: 2014-10 Impact factor: 21.873
Authors: Michael Y Lin; Rosie D Lyles-Banks; Karen Lolans; David W Hines; Joel B Spear; Russell Petrak; William E Trick; Robert A Weinstein; Mary K Hayden Journal: Clin Infect Dis Date: 2013-08-14 Impact factor: 9.079
Authors: Courtney R Murphy; Victor Quan; Diane Kim; Ellena Peterson; Matthew Whealon; Grace Tan; Kaye Evans; Hildy Meyers; Michele Cheung; Bruce Y Lee; Dana B Mukamel; Susan S Huang Journal: BMC Infect Dis Date: 2012-10-24 Impact factor: 3.090
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: 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