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Issue: November 2017
October 09, 2017
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MDRO carriage ‘extensive’ in interconnected facilities

Issue: November 2017
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Susan huang
Susan S. Huang

SAN DIEGO — Carriage of multidrug-resistant organisms, or MDROs, is widespread in nursing homes and long-term acute care facilities that are part of an interconnected network in Orange County, California — even rivaling carriage rates found among hospitalized patients on contact precautions, according to new research.

Susan S. Huang, MD, MPH, medical director of epidemiology and infection prevention at the University of California, Irvine, presented the findings during the SHEA featured oral abstract at IDWeek.

Huang and colleagues are part of a CDC-initiated program called SHIELD Orange County, a regional collaborative that will conduct decolonization interventions at 38 countywide adult health care facilities that share a significant number of patients. These include 17 hospitals, 18 nursing homes and three long-term acute care hospitals (LTACHs). Supported by state and county health officials, the collaborative will also measure the prevalence of MDROs identified by microbiology laboratories that serve hospitals, nursing homes and LTACHs throughout the county.

“Our goal, ultimately, is to reduce MDROs not only in participating facilities, but across the county,” Huang said. “We are going to evaluate this by looking at point prevalence assessments.”

To get an estimate of the prevalence of MDROs at these interconnected facilities, researchers collected nares, skin and peri-rectal swabs from patients between September 2016 and April 2017. Patients in nursing homes and LTACHs were randomly selected for screening until 50 samples had been collected, and 50 adult patients on contact precautions in the county’s 17 hospitals were also screened for MDROs. The researchers conducted additional screening of LTACH admissions from November 2016 to February 2017 to study the importation of MDROs into those facilities.

Huang and colleagues looked for several types of resistant pathogens, including MRSA, vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamases (ESBLs)-producing bacteria and carbapenem-resistant Enterobacteriaceae (CRE) — which both the CDC and WHO consider an urgent public health priority.

The overall prevalence of any MDRO, Huang said, was 64% in nursing homes, 80% in LTACHs and 64% in hospitals.

According to the researchers, the point prevalence of MDROs in LTACHs was 38% higher than the usual admission prevalence — specifically, 65% higher for MRSA, 34% higher for VRE, 95% higher for ESBL and 50% higher for CRE.

Huang said six of 10 nursing home residents and seven of 10 LTACH patients were found to harbor an MDRO that was unknown to the facilities. She added that if patients have one MDRO, they are likely to have more.

“What we found was extensive multidrug-resistant carriage throughout facilities in a very large county,” Huang said. “We have to think about how we can work together. We share a lot of patients. Regional cooperation is going to be critical in answering this question about how you can really to contain [the spread of MDROs].” – by John Schoen

Reference:

Huang SS, et al. Abstract 1712. Presented at: IDWeek; Oct. 4-8, 2017; San Diego.

Disclosure: Huang reports that SHIELD Orange County hospitals, nursing homes and LTACHs are receiving contributed antiseptic products from a variety of companies, similar to her other projects, but these companies have no role in the design, conduct or analysis of these studies.