Influx of multidrug resistant, Gram-negative bacteria (MDRGNB) in a public hospital among elderly patients from long-term care facilities: a single-center pilot study

Abstract

Residence at a long-term care facility (LTCF) and older age are both recognized as significant risk factors for harboring MDRGNB. However, well designed prospective observational studies are few on the prevalence and risk factors of MDRGNB influx to hospital due to elderly patients arriving from LTCFs. Between November 1 and December 31, 2009, at a 500-bed, public teaching hospital in Seoul, Republic of Korea, all clinical cultures within 48 h of hospitalization from elderly patients at least 50 years of age arriving from LTCFs were collected prospectively. During these periods, the prevalence of MDRGNB influx among elderly patients from LTCFs was higher than that among other hospitalized patients (14.5% vs. 2.5%, odds ratio [OR] 8.1, 95% confidence interval [CI] 3.5-18.8, P<0.001). Of a total of 55 elderly hospitalized subjects from 6 LTCFs, clinical cultures were performed in 37. MDRGNB were found in 8 patients (6 of whom were infected). There was no difference between patients with and without MDRGNB regarding previously reported clinical characteristics associated with harboring MDRGNB. However, the mortality within one month of hospitalization was higher in patients with MDRGNB than without MDRGNB, regardless of the appropriateness of the antibiotics they received (OR, 15.91; 95% CI, 1.01-251.36; P=0.049). In conclusion, the prevalence of MDRGNB influx among elderly patients from LTCFs is significant in Korean public hospital. They require specific remedies in order to reduce the risk of early mortality.