Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2016 Nov;26(11):810-815.
doi: 10.1016/j.annepidem.2016.09.007. Epub 2016 Sep 23.

Examining the relationship between multidrug-resistant organism acquisition and exposure to antimicrobials in long-term care populations: a review

Michele L Shaffer  1 , Erika M C D'Agata  2 , Daniel Habtemariam  3 , Susan L Mitchell  4
Affiliations
Review

Examining the relationship between multidrug-resistant organism acquisition and exposure to antimicrobials in long-term care populations: a review

Michele L Shaffer et al. Ann Epidemiol. 2016 Nov.

Abstract

Purpose: Methodological approaches to examine the association between antimicrobial exposure and multidrug-resistant organism (MDRO) acquisition are complex. This report's objectives are to review approaches used in and findings of prior studies in the long-term care setting, illustrate how these challenges were addressed in a recently completed large prospective study, and discuss strategies for future studies.

Methods: Key design and analytic approaches used in studies conducted since 2000 examining the association between antimicrobial exposure and MDRO acquisition in the long-term care setting were reviewed. The Study of Pathogen Resistance and Exposure to Antimicrobials in Dementia (SPREAD) in nursing home residents in Boston from 2009 to 2014 is used to illustrate how to approach these challenges.

Results: Prior investigations reporting the association between antimicrobial exposure and MDRO acquisition vary considerably in their approaches. In SPREAD, grouped-time hazard models with complementary log-log link function were used to model acquisition accounting for clustering within facilities using generalized estimating equations and including all days of exposure before acquisition.

Conclusions: Future studies in these populations should make use of all available acquisition status data, incorporate the timing of antimicrobial exposure relative to acquisition, and collect detailed covariate information that facilitates examining confounding by indication.

Keywords: Antimicrobial drug resistance; Antimicrobial exposure; Hazard models; Long-term care.

PubMed Disclaimer

References

    1. van Buul LW, van der Steen JT, Veenhuizen RB, et al. Antibiotic use and resistance in long term care facilities. J Am Med Dir Assoc. 2012;13(6):568.e1–568.13. - PubMed
    1. Centers for Disease Control and Prevention. [November 8, 2015];Prevention tools. Nursing Homes and Assisted Living (Long-term Care Facilities [LTCFs]) Web site. http://www.cdc.gov/longtermcare/prevention/index.html. Updated 2015.
    1. Vasquez JE, Walker ES, Franzus BW, et al. The epidemiology of mupirocin resistance among methicillin-resistant Staphylococcus aureus at a veterans’ affairs hospital. Infect Control Hosp Epidemiol. 2000;21(7):459–464. - PubMed
    1. Nazir J, Urban C, Mariano N, et al. Quinolone-resistant haemophilus influenzae in a long-term care facility: Clinical and molecular epidemiology. Clin Infect Dis. 2004;38(11):1564–1569. - PubMed
    1. Maslow JN, Lee B, Lautenbach E. Fluoroquinolone-resistant Escherichia coli carriage in long-term care facility. Emerg Infect Dis. 2005;11(6):889–894. - PMC - PubMed

Publication types

Substances