Major article
The burden of multidrug-resistant organisms on tertiary hospitals posed by patients with recent stays in long-term acute care facilities

https://doi.org/10.1016/j.ajic.2011.09.011Get rights and content

Background

Long-term acute care (LTAC) facilities admit patients with complex, advanced disease states. Study aims were to determine the burden posed on hospitals associated with LTAC exposure and analyze the differences between “present on admission” (POA) multidrug-resistant (MDR), gram-negative organisms (GNO) and POA MDR gram-positive organisms (GPO).

Methods

A multicenter retrospective study was conducted in 13 hospitals from southeast Michigan, from September 1, 2008, to August 31, 2009. Cultures obtained in the first 72 hours of hospitalization (ie, POA) of MDR-GPO and MDR-GNO were reviewed. LTAC exposures in the previous 6 months and direct admission from a LTAC were recorded.

Results

Overall, 5,297 patients with 7,147 MDR POA cultures were analyzed: 2,619 (36.6%) were MDR-GNO, and 4,528 (63.4%) were MDR-GPO. LTAC exposure in the past 6 months was present in 251 (5.2%) infectious episodes and was significantly more common among POA MDR-GNO than MDR-GPO (158 [8.6%] and 94 [3.1%], respectively, odds ratio, 2.87; P < .001). Recent LTAC exposure was strongly associated with both carbapenem-resistant Enterobacteriaceae (CRE) (31.6% of all CRE cases, P < .001) and Acinetobacter baumannii (14.9% of all A baumannii cases, P < .001).

Conclusion

Nearly 10% of MDR-GNO POA had recent LTAC exposure. Hospital efforts to control the spread of MDR-GNO should focus on collaborations and communications with referring LTACs and interventions targeted towards patients with recent LTAC exposure.

Section snippets

Study design and setting

A multicenter retrospective study was conducted at 3 different health care systems from southeast Michigan, constituting 13 different hospitals. Eight institutions were from Detroit Medical Center (DMC); 4 from Oakwood Healthcare System; and 1 from Saint Joseph Mercy Health System (SJMHS). The total number of inpatient beds of all participating centers was 4,150. The study was approved by the institutional review boards of all participating centers.

During the study period (September 1, 2008, to

Results

There were 7,147 unique POA MDRO cultures that were obtained from 5,792 patients from all 13 participating hospitals that were included in the final analyses. Characteristics of the study population are depicted in Table 1. The mean age for the entire cohort of patients was 58.7 ± 19.6 years (median, 59 [range, 18-104]). Overall, there were 2,096 isolations from wounds (29.3%), 1,697 from urine (23.7%), 1,397 from sputum (19.5%), 815 from blood (11.4%), and 1,142 (16%) from other sites.

There

Discussion

This large multicenter study, with over 7,000 unique cultures analyzed during a 1-year period, aimed to quantify the actual “burden” posed by LTACs on ACHs in terms of MDROs. In the past few years, there has been an increased awareness of the role that LTAC facilities play in the modern continuum of medical care.1, 14 In this study, LTAC exposure was independently associated with isolation of MDR-GNOs present at the time of hospital admission (POA) to a much greater degree than isolation of

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    Conflicts of interest: None to report.

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