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Clin Infect Dis. 2019 Feb 11. doi: 10.1093/cid/ciz119. [Epub ahead of print]

The SHIELD Orange County Project -Multi Drug-Resistant Organism (MDRO) Prevalence in 21 Nursing Homes and Long Term Acute Care Facilities in Southern California.

Author information

1
Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, California.
2
Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, California.
3
University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, Massachusetts.
4
University of California Irvine Health, Orange, California.
5
Division of Geriatrics, Department of Medicine, University of California Irvine, Orange, California.
6
Hoag Hospital, Newport, CA.
7
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
8
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia.
9
Epidemiology and Assessment, Orange County Health Care Agency, Santa Ana, California.
10
Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, RI.
11
Center of Innovation in Long-Term Services and Supports, Veterans Affairs Medical Center, Providence VA Medical Center, Providence, RI.
12
Center for Long-Term Care Quality and Innovation, Brown University School of Public Health, Providence, RI.
13
Healthcare-Associated Infections Program, Center for Healthcare Quality, California Department of Public Health, Richmond, California.
14
Cook County Health and Hospitals System, Chicago, Illinois.
15
Department of Medicine, Rush University Medical Center, Chicago, Illinois.
16
Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts.
17
Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, California.

Abstract

Background:

Multidrug-resistant organisms (MDROs) spread between hospitals, nursing homes (NH), and long-term acute care facilities (LTACs) via patient transfers. SHIELD OC is a regional public health collaborative involving decolonization at 38 healthcare facilities selected based upon their high degree of patient sharing. We report baseline MDRO prevalence in 21 NH/LTACs.

Methods:

A random sample of 50 adults for 21 NH/LTACs (18 NHs, 3 LTACs) were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum beta-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<0.001). 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 [OR=1.7 C.I. (1.2, 2.4),p=0.004], VRE [OR=2.1 C.I.(1.2, 3.8),p=0.01], ESBL [OR=1.6 C.I.(1.1, 2.3),p=0.03] and diabetes [OR=1.3 C.I.(1.0, 1.7),p=0.03] were associated with any MDRO carriage.

Conclusions:

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

PMID:
30753383
DOI:
10.1093/cid/ciz119

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