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

Hyeongseok Jeong; Seonghui Kang; Hyun Jung Cho

doi:10.3947/ic.2020.52.2.183

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

Infect Chemother. 2020 Jun;52(2):183-193. doi: 10.3947/ic.2020.52.2.183. Epub 2020 May 29.

Authors

Hyeongseok Jeong¹, Seonghui Kang², Hyun Jung Cho³

Affiliations

¹ Division of Infectious Disease, Department of Internal Medicine, Chungnam National University School of Medicine, Daejeon, Korea. grinus@gmail.com.
² Division of Infectious Disease, Department of Internal Medicine, Konyang University College of Medicine, Daejeon, Korea.
³ Department of Laboratory Medicine, Konyang University College of Medicine, Daejeon, Korea.

Abstract

Background: Patient transport between acute care hospitals and long-term care facilities (LTCFs) plays a significant role in microbial migration. The study aimed to estimate the prevalence and risk factors associated with the colonization of multidrug-resistant organisms (MDROs) among patients transferred from LTCFs.

Materials and methods: We retrospectively reviewed medical records to examine the colonization of MDROs. All patients who were transferred from LTCFs and admitted to an acute care hospital with 800 beds in Daejeon between March 2018 and February 2019 were included in the study. We surveyed rectal cultures and nasal swabs obtained for screening vancomycin-resistant Enterococcus (VRE), carbapenem-resistant Enterobacteriaceae (CRE), and methicillin-resistant Staphylococcus aureus (MRSA) at the time of hospitalization. We conducted a multivariable logistic regression to assess the association between clinical variables and the carriage of MDROs.

Results: Four hundred and fifteen patients from 86 LTCFs were enrolled. A total of 31.1% (130/415) of participants carried MDROs; VRE colonization was detected in 17.1% (71/415) of participants, and MRSA colonization was shown in 19.5% (81/415) of participants. No CRE was isolated. Previous use of antibiotics within three months [odds ratio (OR) 2.28; (95% confidence interval (CI) 1.30 - 4.00), P = 0.004], use of antibiotics for longer than two weeks [OR 2.16; (95% CI 1.03 - 4.53), P = 0.040], and previous colonization of MDROs within one year [OR 2.01; (95% CI 1.15 - 3.54), P = 0.015] were independently associated with increased risk for carriage of MDROs.

Conclusion: Our study showed that a third of patients transferred from LTCFs carried VRE or MRSA, and prior antibiotic therapy was highly associated with the carriage of MDROs, which suggested more efficient management approaches for high-risk patients.

Keywords: Antibiotic resistance; Long-term care facilities; Risk factors.