Since 2003, rates of MRSA colonization have “steadily decreased,” whereas rates of vancomycin-resistant Enterococcus, or VRE, almost tripled in nursing facilities in southeastern Michigan, according to findings published in Infection Control & Hospital Epidemiology.
Julia Mantey, MPH, a data analyst with the University of Michigan Medical School, and colleagues explained that nursing facilities serve as temporary care for acutely ill patients, providing a safe transition back home. However, these patients have a high prevalence of colonization with multidrug-resistant organisms (MDROs).
“Infection prevention and control efforts have focused mostly on acute care, successfully reducing incidence of MRSA colonization in hospitals by 31% from 2005 to 2011” in the United States, Mantey and colleagues wrote. “Meanwhile, enterococcal infections and colonization with VRE have arisen, often with serious clinical implications, including a doubling in VRE-related hospital discharges.”
The researchers wanted to assess if these national trends were also true for nursing facilities in their region. They collected data from four multisite nursing facility studies conducted sequentially in southeastern Michigan between 2003 and 2016.
In each study, MRSA prevalence decreased, but VRE prevalence increased over time. In the earliest study the researchers reviewed, 37.1% of patients were colonized with MRSA and 9.9% were colonized with VRE. However, in the most recent study, 13.4% of patients were colonized with MRSA, whereas 28.9% were colonized with VRE.
Among a subgroup of high-risk patients with medical devices, Mantey and colleagues noted that the same trends held true — MRSA decreased, whereas VRE increased — but the findings were even more “pronounced.”
Based on these results, the researchers underscored three action items to improve colonization rates and infection control.
“First, more studies are needed to confirm these trends in post-acute care and other alternative care settings from other geographic settings,” they wrote. “Second, future infection prevention measures should focus on clinical consequences of increasing VRE, particularly in older adults. Third, health care facilities must develop cost-effective, efficient MDRO surveillance strategies to characterize and understand long-term trends.” – by Marley Ghizzone
Disclosures: The authors report no relevant financial disclosures.