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J Am Geriatr Soc. 2015 Apr;63(4):659-66. doi: 10.1111/jgs.13353. Epub 2015 Apr 8.

Functional disability and nursing resource use are predictive of antimicrobial resistance in nursing homes.

Author information

1
Division of Geriatric and Palliative Medicine, University of Michigan, Ann Arbor, Michigan; Geriatric Research, Education and Clinical Center, Veteran Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan.

Abstract

OBJECTIVES:

To use a simple measure of activities of daily living, wounds, and indwelling devices (urinary catheter, feeding tube) to predict prevalent, new, and intermittent multidrug-resistant organism (MDRO) acquisition in nursing home (NH) residents.

DESIGN:

Secondary analysis, prospective cohort study.

SETTING:

Southeast Michigan NHs (n = 15).

PARTICIPANTS:

NH residents (N = 111, mean age 81) with two or more monthly visits (729 total).

MEASUREMENTS:

Monthly microbiological surveillance for MDROs from multiple anatomic sites from enrollment until discharge or 1 year. The Arling scale, previously developed as a measure of NH residents' need (time-intensity) for nursing resources, was used to predict prevalent and time to new or intermittent acquisition (months) of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and antibiotic-resistant gram-negative bacteria (R-GNB) colonization using multiple-failure accelerated time-factor survival analysis, controlling for comorbidity, hospitalization, and antibiotic use in the prior month.

RESULTS:

One-fifth of participants had a wound, and one-third had a device. There were 60 acquisitions of MRSA, 56 of R-GNB, and 15 of VRE. Expected time to acquisition was less than 1 year for MRSA (median 6.7 months) and R-GNB (median 4.5 months) and more than 1 year for VRE (median 40 months). Arling score was associated with earlier new MRSA and VRE acquisition. A resident with only mild functional impairment and no device or wound would be expected to acquire MRSA in 20 months, versus 5 months for someone needing the most-intense nursing contact.

CONCLUSION:

MDRO acquisition is common in community NHs. Need for nursing care predicts new MDRO acquisition in NHs, suggesting potential mechanisms for MDRO acquisition and strategies for future interventions for high-risk individuals (e.g., enhanced barrier precautions).

KEYWORDS:

functional disability; multidrug-resistant organisms; nursing homes

PMID:
25857440
PMCID:
PMC4406786
DOI:
10.1111/jgs.13353
[Indexed for MEDLINE]
Free PMC Article

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