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. 2019 Oct 15;69(9):1566-1573.
doi: 10.1093/cid/ciz119.

The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California

James A McKinnell  1 , Raveena D Singh  2 , Loren G Miller  1 , Ken Kleinman  3 , Gabrielle Gussin  2 , Jiayi He  2 , Raheeb Saavedra  2 , Tabitha D Dutciuc  2 , Marlene Estevez  2 , Justin Chang  2 , Lauren Heim  2 , Stacey Yamaguchi  2 , Harold Custodio  2 , Shruti K Gohil  2 , Steven Park  4 , Steven Tam  5 , Philip A Robinson  6 , Thomas Tjoa  2 , Jenny Nguyen  2 , Kaye D Evans  4 , Cassiana E Bittencourt  4 , Bruce Y Lee  7 , Leslie E Mueller  7 , Sarah M Bartsch  7 , John A Jernigan  8 , Rachel B Slayton  8 , Nimalie D Stone  8 , Matthew Zahn  9 , Vincent Mor  10   11   12 , Kevin McConeghy  10   11   12 , Rosa R Baier  10   12 , Lynn Janssen  13 , Kathleen O'Donnell  9   13 , Robert A Weinstein  14   15 , Mary K Hayden  15 , Micaela H Coady  16 , Megha Bhattarai  16 , Ellena M Peterson  4 , Susan S Huang  2   17
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The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California

James A McKinnell et al. Clin Infect Dis. .

Abstract

Background: Multidrug-resistant organisms (MDROs) spread between hospitals, nursing homes (NHs), and long-term acute care facilities (LTACs) via patient transfers. The Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County is a regional public health collaborative involving decolonization at 38 healthcare facilities selected based on their high degree of patient sharing. We report baseline MDRO prevalence in 21 NHs/LTACs.

Methods: A random sample of 50 adults for 21 NHs/LTACs (18 NHs, 3 LTACs) were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum β-lactamase-producing organisms (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE) using nares, skin (axilla/groin), and peri-rectal swabs. Facility and resident characteristics associated with MDRO carriage were assessed using multivariable models clustering by person and facility.

Results: Prevalence of MDROs was 65% in NHs and 80% in LTACs. The most common MDROs in NHs were MRSA (42%) and ESBL (34%); in LTACs they were VRE (55%) and ESBL (38%). CRE prevalence was higher in facilities that manage ventilated LTAC patients and NH residents (8% vs <1%, P < .001). MDRO status was known for 18% of NH residents and 49% of LTAC patients. MDRO-colonized adults commonly harbored additional MDROs (54% MDRO+ NH residents and 62% MDRO+ LTACs patients). History of MRSA (odds ratio [OR] = 1.7; confidence interval [CI]: 1.2, 2.4; P = .004), VRE (OR = 2.1; CI: 1.2, 3.8; P = .01), ESBL (OR = 1.6; CI: 1.1, 2.3; P = .03), and diabetes (OR = 1.3; CI: 1.0, 1.7; P = .03) were associated with any MDRO carriage.

Conclusions: The majority of NH residents and LTAC patients harbor MDROs. MDRO status is frequently unknown to the facility. The high MDRO prevalence highlights the need for prevention efforts in NHs/LTACs as part of regional efforts to control MDRO spread.

Keywords: CRE; MRSA; chlorhexidine; decolonization; long term care; public health.

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