Low prevalence of colonization with multidrug-resistant gram-negative bacteria in long-term care facilities in Graz, Austria

Leitner, Eva; Zechner, Elisabeth; Ullrich, Elisabeth; Zarfel, Gernot; Luxner, Josefa; Pux, Christian; Pichler, Gerhard; Schippinger, Walter; Krause, Robert; Zollner‐Schwetz, Ines

doi:10.1016/j.ajic.2017.07.004

Cited by 7 publications

(11 citation statements)

References 15 publications

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“…Thus, we had a balanced number of publications on both groups, for each MDRO (Table 2). The ESBL Enterobacterales prevalence increased from 10.5% [14,18,22,23,25,31,33,39,57,75,76,82,85,89,99,101,102,104,106,107,111,112,116,119,[121][122][123][124][125]143] to 15.1% [1,16,[19][20][21]34,62,73,83,97,100,103,105,[108][109][110][113][114][115]117,…”

Section: Changes In Mdro Prevalence Over Timementioning

confidence: 99%

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Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review

et al. 2021

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Elderly people confined to chronic care facilities face an increased risk of acquiring infections by multidrug-resistant organisms (MDROs). This review presents the current knowledge of the prevalence and risk factors for colonization by MDROs in long-term care facilities (LTCF), thereby providing a useful reference to establish objectives for implementing successful antimicrobial stewardship programs (ASPs). We searched in PubMed and Scopus for studies examining the prevalence of MDROs and/or risk factors for the acquisition of MDROs in LTCF. One hundred and thirty-four studies published from 1987 to 2020 were included. The prevalence of MDROs in LTCF varies between the different continents, where Asia reported the highest prevalence of extended-spectrum ß-lactamase (ESBL) Enterobacterales (71.6%), carbapenem resistant (CR) Enterobacterales (6.9%) and methicillin-resistant Staphylococcus aureus (MRSA) (25.6%) and North America the highest prevalence to MDR Pseudomonas aeruginosa (5.4%), MDR Acinetobacter baumannii (15.0%), vancomycin-resistant Enterococcus spp. (VRE) (4.0%), and Clostridioides difficile (26.1%). Furthermore, MDRO prevalence has experienced changes over time, with increases in MDR P. aeruginosa and extended spectrum ß-lactamase producing Enterobacterales observed starting in 2015 and decreases of CR Enterobacterales, MDR A. baumannii, VRE, MRSA and C. difficile. Several risk factors have been found, such as male sex, chronic wounds, the use of medical devices, and previous antibiotic use. The last of these aspects represents one of the most important modifiable factors for reducing colonization with MDROs through implementing ASPs in LTCF.

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Section: Changes In Mdro Prevalence Over Timementioning

confidence: 99%

“…Apart from the index, dependence categories among studies include autonomous mobility vs. non-autonomous vs. bedridden [19]; ambulant (with or without help) vs. bedridden [31,83,105]; and ranking the dependence level as low, medium, or high [91].…”

Section: Dependence or Disabilitymentioning

confidence: 99%

Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review

et al. 2021

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“…A retrospective chart review was performed to collect the following data for all infected residents: age, gender, comorbidities, level of care as defined by national standards and described before [5] , immunosuppressive therapy, symptoms during 7 days before and after rt-PCR test, need for treatment at the hospital and for supplemental oxygen and outcome. In May 2020, health care personnel who had been positive for SARS-CoV-2 were asked to complete a structured questionnaire to collect information on symptoms including onset, severity, need for treatment at the hospital and presumed origin of infection (work or private contact).…”

Section: Methodsmentioning

confidence: 99%

Analysis of COVID-19 outbreaks in 3 long-term care facilities in Graz, Austria

Zollner‐Schwetz

König

Krause

et al. 2021

American Journal of Infection Control

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Background: Nursing homes and long-term care facilities (LTCF) caring for elderly and chronically ill residents are at high risk to experience SARS-CoV-2 outbreaks. We report an outbreak of COVID-19 in three LTCFs of the Geriatric Health Centres of Graz, Austria lasting from 22nd March to 14th April, 2020. Aim: The objectives of our study were: (1) to elucidate contributing factors and transmission pathways of SARS-CoV-2, (2) to analyse symptoms of COVID-19 in the residents and health care workers. Methods: We carried out a retrospective outbreak analysis. Findings: 36/277 residents of 3 LTCFs were infected with SARS-CoV-2. Only a quarter of COVID-19 cases among residents had fever ≥ 38.1°C and 19% suffered from cough. 6/36 residents remained asymptomatic. Hospitalization rate was 58% in residents. Overall, 33% (12/36) residents infected with SARS-CoV-2 died. 19/214 health care workers were tested positive for SARS-CoV-2. Universal rt-PCR testing for SARS-CoV-2 of all residents and health care workers as well as infection control measures contributed to ending the outbreaks. Conclusion: Delayed recognition of possible COVID-19 cases due to either mild symptoms or symptoms that were perceived as atypical early in the pandemic contributed to the transmission of SARS-CoV-2 in LTCFs. This emphasizes the importance of low-threshold testing in LTCF residents.

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“…Residents in nursing homes are favorable carriers of microbes [ 1 ] and spread antibiotic-resistant microbes, leading to antimicrobial resistance (AMR) [ 2 ]. Previous studies have shown that 4.7–64% of the residents of nursing homes had multidrug-resistant Gram-negative bacteria [ 3 , 4 , 5 , 6 ] that were subsequently transmitted to and infected [ 7 ] other patients or healthcare workers [ 8 ]. Although nursing homes provide limited healthcare services and have fewer beds than healthcare facilities, the probability of transmission of antimicrobial-resistant pathogens remains high [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Mortality in Thai Nursing Homes Based on Antimicrobial-Resistant Enterobacterales Carriage and COVID-19 Lockdown Timing: A Prospective Cohort Study

et al. 2022

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Antimicrobial-resistant Enterobacterales carriage and the coronavirus disease 2019 (COVID-19) lockdown measures may impact the incidence all-cause mortality rate among nursing home residents. To determine the all-cause mortality rate in the presence/absence of antimicrobial-resistant Enterobacterales carriage and the incidence all-cause mortality rate before and during COVID-19 pandemic lockdown, this prospective closed-cohort study was conducted at various types of nursing homes in Bangkok, Thailand, from June 2020 to December 2021. The elderly residents included 142 participants (aged ≥60 years) living in nursing homes ≥3 months, who did not have terminal illnesses. Time-to-event analyses with Cox proportional hazards models and stratified log-rank tests were used. The all-cause mortality rate was 18%, and the incidence all-cause mortality rate was 0.59/1000 person-days in residents who had antimicrobial-resistant Enterobacterales carriage at baseline. Meanwhile, the incidence all-cause mortality rate among noncarriage was 0.17/1000 person-days. The mortality incidence rate of carriage was three times higher than residents who were noncarriage without statistical significance (HR 3.2; 95% CI 0.74, 13.83). Residents in nonprofit nursing homes had a higher mortality rate than those in for-profit nursing homes (OR 9.24; 95% CI 2.14, 39.86). The incidence mortality rate during and before lockdown were 0.62 and 0.30, respectively. Effective infection-control policies akin to hospital-based systems should be endorsed in all types of nursing homes. To limit the interruption of long-term chronic care, COVID-19 prevention should be individualized to nursing homes.

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Low prevalence of colonization with multidrug-resistant gram-negative bacteria in long-term care facilities in Graz, Austria

Cited by 7 publications

References 15 publications

Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review

Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review

Analysis of COVID-19 outbreaks in 3 long-term care facilities in Graz, Austria

Mortality in Thai Nursing Homes Based on Antimicrobial-Resistant Enterobacterales Carriage and COVID-19 Lockdown Timing: A Prospective Cohort Study

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