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Natural History of Colonization With Vancomycin-Resistant Enterococci, Methicillin-Resistant Staphylococcus Aureus, And Resistant Gram-Negative Bacilli Among Long-Term–Care Facility Residents

Published online by Cambridge University Press:  02 January 2015

Glenn A. Pacio ,
Paul Visintainer ,
George Maguire ,
Gary P. Wormser ,
John Raffalli  and
Marisa A. Montecalvo
Glenn A. Pacio
Affiliation:
Division of Infectious Diseases, New York Medical College, Valhalla, New York
Paul Visintainer
Affiliation:
Graduate School of Health Sciences, New York Medical College, Valhalla, New York
George Maguire
Affiliation:
Division of Pulmonary Medicine, Department of Medicine, New York Medical College, Valhalla, New York
Gary P. Wormser
Affiliation:
Division of Infectious Diseases, New York Medical College, Valhalla, New York
John Raffalli
Affiliation:
Division of Infectious Diseases, New York Medical College, Valhalla, New York
Marisa A. Montecalvo*
Affiliation:
Division of Infectious Diseases, New York Medical College, Valhalla, New York
*
Division of Infectious Diseases, New York Medical College, Munger Pavilion 320, Valhalla, NY 10595
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Abstract

Objective:

To determine the natural history of colonization with vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and resistant gram-negative bacilli among long-term–care facility (LTCF) residents.

Design:

Observational cohort study.

Setting:

A 355-bed LTCF with a ventilator unit and a subacute unit.

Participants:

Residents with colonization or infection with VRE, MRSA or resistant gram-negative bacilli housed at the LTCF between December 1,1999, and February 29, 2000.

Methods:

Cultures of clinical and surveillance sites were performed at regular intervals. Charts were reviewed for clinical characteristics associated with clearance of colonization. Kaplan–Meier curves were constructed to analyze the number of days to clearance of colonization.

Results:

Forty-nine residents had 65 episodes of colonization (27 VRE, 30 MRSA and 8 resistant gram-negative bacilli). Eighteen (28%) of the episodes cleared. The clearance rate was 2.7 episodes per 1,000 person-days. Clearance occurred significantly more often with resistant gram-negative bacilli colonization compared with VRE or MRSA colonization (6 [75%] vs 12 [21%]; P = .007; relative risk, 4.17; 95% confidence interval, 1.26 to 11.8). There was a trend toward longer use of antimicrobial agents among residents with persistent colonization. Infections occurred most frequently with MRSA The urinary tract was the most common site of infection.

Conclusion:

Among LTCF residents, colonization with resistant gram-negative bacilli is four times more likely to clear than colonization with VRE or MRSA. Performance of surveillance cultures at regular intervals may reduce the need for contact precautions for LTCF residents with resistant gram-negative bacilli colonization.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 24 , Issue 4 , April 2003 , pp. 246 - 250
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2003

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References

1.Hospital Infections Program, National Center for Infectious Diseases, Centers for Disease Control and Prevention, U.S. Department of Health and Human Services. National Nosocomial Infections Surveillance (NNIS) System report data summary from January 1990-May 1999, issued June 1999. Am J Infect Control 1999;27:520–532.Google Scholar
2.Trick, WE, Kuehnert, MJ, Quirk, SB, et al. Regional dissemination of vancomycin-resistant enterococci resulting from interfacility transfer of colonized patients. J Infect Dis 1999;180:391–396.CrossRefGoogle ScholarPubMed
3.Monnet, DL, Biddle, JW, Edwards, JR, et al. Evidence of interhospital transmission of extended-spectrum beta-lactam-resistant Klebsiella pneumoniae in the US, 1986-1993: The National Nosocomial Infections Surveillance System. Infect Control Hosp Epidemiol 1997;18:492–498.CrossRefGoogle Scholar
4.Montecalvo, MA, Raffalli, JT, Trick, WE, et al. Epidemiology of vancomycin-resistant enterococci in nursing home residents in Westchester County, NY. Presented at the 39th Interscience Conference on Antimicrobial Agents and Chemotherapy; 1999; San Francisco, CA. Abstract 1718.Google Scholar
5.Terpenning, MS, Bradley, SF, Wan, JY, Chenoweth, CE, Jorgensen, KA, Kauffman, CA. Colonization and infection with antibiotic-resistant bacteria in a long-term care facility. J Am Geriatr Soc 1994;42:1062–1069.Google Scholar
6.Mulhausen, PL, Harrell, IJ, Weinberger, M, Kochersberger, GG, Feussner, JR. Contrasting methicillin-resistant Staphylococcus aureus colonization in Veterans Affairs and community nursing homes. Am J Med 1996;100:24–31.Google Scholar
7.Gaynes, RP, Weinstein, RA, Chamberlin, W, Kabins, SA. Antibiotic-resistant flora in nursing home patients admitted to the hospital. Arch Intern Med 1985;145:1804–1807.CrossRefGoogle ScholarPubMed
8.Garner, JS, Jarvis, WR, Emori, TG, Horan, TC, Hughes, JM. CDC definitions for nosocomial infections, 1988. Am J Infect Control 1988;16:128–140.Google Scholar
9.Knaus, WA, Draper, EA, Wagner, DP, Zimmerman, JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13:818–829.Google Scholar
10.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Disk Susceptibility Tests, 5th ed. Villanova, PA: National Committee for Clinical Laboratory Standards; 1993. Approved standard M2-A5.Google Scholar
11.Trick, WE, Demarais, PL, Jarvis, WR, et al. Risk factors for acquisition of multi-resistant organisms in long-term care facility (LTCF) residents. Presented at the 37th Annual Meeting of the Infectious Diseases Society of America; 1999; Philadelphia, PA.Google Scholar
12.Muder, RR, Brennen, C, Wagener, MM, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.Google Scholar
13.Brennen, C, Wagener, MM, Muder, RR. Vancomycin-resistant Enterococcus faecium in a long-term care facility. J Am Geriatr Soc 1998;46:157–160.Google Scholar
14.Muder, RR, Brennen, C, Drenning, SD, Stout, JE, Wagener, MM. Multiply antibiotic-resistant gram-negative bacilli in a long-term-care facility: a case-control study of patient risk factors and prior antibiotic use. Infect Control Hosp Epidemiol 1997;18:809–813.Google Scholar
15.Bradley, SF, Terpenning, MS, Ramsey, MA, et al. Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417–422.Google Scholar
16.Strausbaugh, LS, Crossley, KB, Nurse, BA, Thrupp, LD. Antimicrobial resistance in long-term-care facilities. Infect Control Hosp Epidemiol 1996;17:129–140.Google Scholar
17.Crossley, K. Vancomycin-resistant enterococci in long-term-care facilities. Infect Control Hosp Epidemiol 1998;19:521–525.Google Scholar