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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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References

    1. Centers for Disease Control and Prevention US. Antibiotic resistant threats in the United States, 2013 Available at: https://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf. Accessed 28 February 2019.
    1. Boucher HW, Talbot GH, Bradley JS, et al. . Bad bugs, no drugs: no ESKAPE! An update from the Infectious Diseases Society of America. Clin Infect Dis 2009; 48:1–12. - PubMed
    1. Society for Healthcare Epidemiology of A, Infectious Diseases Society of A, Pediatric Infectious Diseases S. Policy statement on antimicrobial stewardship by the Society for Healthcare Epidemiology of America (SHEA), the Infectious Diseases Society of America (IDSA), and the Pediatric Infectious Diseases Society (PIDS). Infect Control Hosp Epidemiol 2012; 33:322–7. - PubMed
    1. White House US. National strategy for combating antibiotic-resistant bacteria. Available at: https://obamawhitehouse.archives.gov/sites/default/files/docs/carb_natio.... Accessed 28 February 2019.
    1. Irvine PW, Van Buren N, Crossley K. Causes for hospitalization of nursing home residents: the role of infection. J Am Geriatr Soc 1984; 32:103–7. - PubMed

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