Major articleThe burden of multidrug-resistant organisms on tertiary hospitals posed by patients with recent stays in long-term acute care facilities
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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Epidemiology and molecular characterization of fecal carriage of third-generation cephalosporin-resistant Enterobacterales among elderly residents in Japan
2022, Journal of Infection and ChemotherapyCitation Excerpt :The fecal carriage rate was comparable with those of previous reports in nursing homes in Japan (19.6% and 53.0%) [14,15], but higher than those in hospitalized patients (12.5%) or in community dwellers (8.5%) [16]. For ESBL-PE as well as CRE, post-acute care settings, including nursing homes or long-term acute care hospitals, can be the reservoir for not only amplifying CRE in the facilities, but also for propagating them in acute-care settings [29–33]. In our study population, most of the resistant bacteria were ESBL-PE, and CRE appeared not to be detected.
Multidrug-Resistant Gram-Negative Bacteria: Infection Prevention and Control Update
2021, Infectious Disease Clinics of North AmericaThe Continuing Plague of Extended-Spectrum β-Lactamase Producing Enterbacterales Infections: An Update
2020, Infectious Disease Clinics of North AmericaCitation Excerpt :Therefore, LTCFs soon became an important pathway between the hospital and the community settings, contributing to the exponential increase in the prevalence of multidrug-resistant organisms (MDROs),68 including ESBL-producing Enterobacteriaceae.69,70 These patients with complicated medical conditions were continually transmitted back and forth between acute and chronic health care facilities, serving as “Trojan horses” of MDROs.69,71 Multiple case-control analyses conducted in various locations worldwide showed that an LTCF stay was an independent predictor for acquisition of various MDROs, including ESBLs.31,72–75
How to: molecular investigation of a hospital outbreak
2019, Clinical Microbiology and InfectionPrevalence of multidrug-resistant gram-negative bacteria among nursing home residents: A systematic review and meta-analysis
2017, American Journal of Infection ControlCitation Excerpt :Two studies reported MDR-GNB infection rates of 10.9%15 and 62.7%.31 The proportion of MDR-GNB isolates by species is summarized in Figure 3, with the exception of the study in which species were not reported.19 Escherichia coli accounted for the largest proportion of isolates.
Conflicts of interest: None to report.