Multidrug-Resistant Organisms on Patients’ Hands

Cao, Jie; Min, Lillian; Lansing, Bonnie; Foxman, L. P.N.Betsy; Mody, Lona

doi:10.1001/jamainternmed.2016.0142

Cited by 40 publications

(37 citation statements)

References 7 publications

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“…The TIP study, a cluster-randomized intervention trial aiming to reduce the prevalence of drug-resistant organisms in nursing homes, was conducted in Michigan between May 2010 and April 2013 (27). Details of the trial design and outcomes have been reported previously (27,(47)(48)(49). In short, 12 community-based nursing homes (NHs) were randomly assigned as control or intervention sites, with 215 and 203 enrolled residents, respectively.…”

Section: Methodsmentioning

confidence: 99%

Network of microbial and antibiotic interactions drive colonization and infection with multidrug-resistant organisms

Wang

Foxman

Mody

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

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The emergence and spread of multidrug-resistant organisms (MDROs) across global healthcare networks poses a serious threat to hospitalized individuals. Strategies to limit the emergence and spread of MDROs include oversight to decrease selective pressure for MDROs by promoting appropriate antibiotic use via antibiotic stewardship programs. However, restricting the use of one antibiotic often requires a compensatory increase in the use of other antibiotics, which in turn selects for the emergence of different MDRO species. Further, the downstream effects of antibiotic treatment decisions may also be influenced by functional interactions among different MDRO species, with the potential clinical implications of such interactions remaining largely unexplored. Here, we attempt to decipher the influence network between antibiotic treatment, MDRO colonization, and infection by leveraging active surveillance and antibiotic treatment data for 234 nursing home residents. Our analysis revealed a complex network of interactions: antibiotic use was a risk factor for primary MDRO colonization, which in turn increased the likelihood of colonization and infection by other MDROs. When we focused on the risk of catheterassociated urinary tract infections (CAUTI) caused by Escherichia coli, Enterococcus, and Staphylococcus aureus we observed that cocolonization with specific pairs of MDROs increased the risk of CAUTI, signifying the involvement of microbial interactions in CAUTI pathogenesis. In summary, our work demonstrates the existence of an underappreciated healthcare-associated ecosystem and strongly suggests that effective control of overall MDRO burden will require stewardship interventions that take into account both primary and secondary impacts of antibiotic treatments.multidrug-resistant organisms | nursing homes | long-term care facilities | antibiotics | catheter-associated urinary tract infection T he successful treatment of bacterial infections has been significantly undermined by the emergence and spread of multidrug-resistant organisms (MDROs) (1). Antibiotic-resistant healthcare-acquired infections are of particular concern, as MDROs complicate treatment of infections, hinder effective treatment of comorbid conditions, and increase risk of morbidity and mortality (2-5). While the threats of MDROs in acute-care hospitals are well known, MDROs are not limited to those settings. In particular, residents in long-term care facilities (LTCFs) often have underlying medical conditions that make them particularly vulnerable to infections. Moreover, the high rates of MDRO colonization (6) and antibiotic use (7-9) among LTCF residents further put this population at risk for contracting infections. Furthermore, the frequent transfers between LTCFs and other healthcare facilities leads to the dissemination of MDROs throughout the healthcare network, creating a substantial economic and clinical burden that permeates healthcare systems (10, 11).Given the central role of antibiotic use in both the emergence and proliferation of...

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Section: Methodsmentioning

confidence: 99%

Network of microbial and antibiotic interactions drive colonization and infection with multidrug-resistant organisms

Wang

Foxman

Mody

et al. 2017

Proc. Natl. Acad. Sci. U.S.A.

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“…Our finding that patient‐used common areas are more likely to be contaminated with MDROs than nursing‐used common areas is particularly intriguing. Studies now show that patient hands are more likely to be contaminated than healthcare provider hands . Because patient hand contamination with MDROs is higher than healthcare provider hand contamination with MDROs, these findings point to the role of patient hands in MDRO transmission.…”

Section: Discussionmentioning

confidence: 95%

Contamination of Common Area and Rehabilitation Gym Environment with Multidrug‐Resistant Organisms

Gontjes

Gibson

Lansing

et al. 2019

J American Geriatrics Society

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OBJECTIVES To quantify the multidrug‐resistant organism (MDRO) burden of high‐touch common area and rehabilitation gym surfaces, and to assess microorganism transfer potential during rehabilitation sessions. DESIGN Prospective study of environmental contamination. SETTING Nursing home (NH). PARTICIPANTS Six Michigan NHs. MEASUREMENTS Monthly samples from common area surfaces (eg, living room), rehabilitation equipment, and rehabilitation personnel hands were screened for methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant enterococci (VRE), and resistant gram‐negative bacilli (R‐GNB). To assess microorganism transfer potential, we conducted an in‐depth assessment of microorganism transfer during 10 rehabilitation sessions. Microorganism transfer was defined as the identification of a microorganism on a destination surface that was uncontaminated before the rehabilitation session. Patient frequency of common area usage was also assessed qualitatively. RESULTS We obtained 1338 common area specimens from 180 monthly facility visits, of which 13.4% (179/1338) were MDRO positive: MRSA, 3.8%; VRE, 5.8%; and R‐GNB, 5.1%. A total of 64% (116/180) of sampling visits had at least one MDRO‐positive common area specimen. Within rehabilitation gyms, we obtained 521 equipment and 190 personnel hand specimens during 60 monthly visits. Of the equipment specimens collected, 7.7% (40/521) were MDRO positive: MRSA, 2.5%; VRE, 4.0%; and R‐GNB, 1.9%. Of the 190 rehabilitation personnel hand specimens collected, 3.7% (7/190) were MDRO positive. Overall, 55% (33/60) of rehabilitation gym visits had at least one MDRO‐positive specimen. Microorganism transfer assessment during 10 rehabilitation sessions revealed 35 opportunities for transfer during which microorganism transfer occurred in 17.1% (6/35) of opportunities. CONCLUSION NH common areas and rehabilitation gyms are MDRO reservoirs that may contribute to the transmission of healthcare‐associated pathogens. Because NHs accommodate the increasing short‐stay patient population, developing effective interventions that reduce MDRO transmission in the common area and rehabilitation gym environment should be considered an infection prevention priority. J Am Geriatr Soc 68:478–485, 2020

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“…On each visit, swabs were collected from patients’ hands, other anatomic sites, and from high-touch surfaces in the environment. 2 MRSA, VRE and RGNB were identified using standard microbiological methods. Study personnel also collected information on patient characteristics and medical history.…”

Section: Methodsmentioning

confidence: 99%

Patient Hand Colonization With MDROs Is Associated with Environmental Contamination in Post-Acute Care

Patel

Mantey

Mody

2017

Infect. Control Hosp. Epidemiol.

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Multidrug-Resistant Organisms on Patients’ Hands

Cited by 40 publications

References 7 publications

Network of microbial and antibiotic interactions drive colonization and infection with multidrug-resistant organisms

Network of microbial and antibiotic interactions drive colonization and infection with multidrug-resistant organisms

Contamination of Common Area and Rehabilitation Gym Environment with Multidrug‐Resistant Organisms

Patient Hand Colonization With MDROs Is Associated with Environmental Contamination in Post-Acute Care

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