Multidrug-Resistant, Gram-Negative Bacteria in Hospitalized Elderly Patients from Non-Hospital Long-Term Care Facilities

Abstract

Background/Aims: We investigated the risk of multidrug-resistant, gram-negative bacteria (MDRGNB) in hospitalized elderly patients from non-hospital long-term care facilities (LTCFs) and the antibiotic prescription pattern. Methods: All clinical cultures obtained within 48 hours of hospitalization from elderly patients of at least 55 years of age arriving at a 623-bed, public teaching hospital in Seoul, Republic of Korea from LTCFs between April 1, 2011 and April 1, 2012 were collected retrospectively. Results: During this period, 365 elderly persons from 13 LTCFs were hospitalized. This study enrolled 135 patients who had cultures performed. In this group, 27.4% harbored MDRGNB at hospitalization. The presence of MDRGNB during prior hospitalization was the only risk factor that predicted harboring it (p = 0.043, odds ratio = 5.00, confidence interval = 1.049-23.834). Combinations of antibiotics or carbapenems were used initially in 35.6% of the patients, and this did not affect the mortality rate in this population. Conclusions: Hospitalized elderly patients from non-hospital LTCFs need more attention. Judicious antibiotic selection is needed according to the risk factor of harboring MDRGNB for antibiotics stewardship.

Prevalence of Multidrug-Resistant Organisms and Risk Factors for Carriage among Patients Transferred from Long-Term Care Facilities

“…Studies carried out at ACHs also found that patients admitted from LTCFs had higher odds of colonization [14]. Exposure to antibiotics was found to be a risk factor for colonization of VRE in the rectum [18], and previous colonization of multidrug-resistant Gram-negative bacteria was the single risk factor [19] among patients transferred from LTCFs. Interestingly, a stay in an LTCF for longer than one year was revealed to be a protective factor for the carriage of VRE (subgroup 1, Supplementary Table 1), since residency in long-term care facilities may provide an opportunity for the person to person transmission of microorganisms.…”

“…Studies carried out at ACHs also found that patients admitted from LTCFs had higher odds of colonization [ 14 ]. Exposure to antibiotics was found to be a risk factor for colonization of VRE in the rectum [ 18 ], and previous colonization of multidrug-resistant Gram-negative bacteria was the single risk factor [ 19 ] among patients transferred from LTCFs.…”

“…The point prevalence of MDROs and risk factors of carriage among patients, environmental surfaces, and hands and clothing of healthcare workers in various LTCFs were evaluated [3,5,7,8,10,[15][16][17]. However, studies are limited in Korea, and the actual prevalence remains unclear [18][19][20].…”

Shocking Levels of Antimicrobial Resistance in Burn Infections in Bestian Hospital, Seoul, South Korea

“…For grampositive organisms, the antimicrobial susceptibility test profile included penicillin (10U), ampicillin (10 μg), gentamicin (10 μg), teicoplanin (30 μg), vancomycin, ciprofloxacin (5 μg), clindamycin (2 μg), erythromycin (15 μg), and tetracycline (30 μg). The organism was classified as multidrug-resistant if it was resistant to the three major classes of antimicrobials (10). The organism was classified as pandrug-resistant when it was resistant to all classes of antimicrobial drugs except colistin.…”