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Background  This study examined colonisation with and characteristics of antimicrobial-resistant organisms among residents of a long-term care facility (LTCF) over one year, including strain persistence and molecular diversity among isolates of extended-spectrum beta-lactamase (ESBL)-producing  Enterobacteriaceae .    Methods  Sixty-four residents of a LTCF were recruited (51 at baseline, 13 during the year). Data on dependency levels, hospitalisations, and antimicrobial prescribing were collected. Nasal and rectal swabs and catheter urine specimens were examined quarterly, using chromogenic agars, for ESBL-producing  Enterobacteriaceae , carbapenemase-producing  Enterobacteriaceae  (CPE), vancomycin-resistant enterococci (VRE), and meticillin-resistant  S. aureus  (MRSA). All ESBL-producing  E. coli  (ESBL-EC) were characterised by pulsed-field gel electrophoresis (PFGE) and PCR to assess for sequence type (ST) ST131, its resistance-associated  H 30 and  H 30-Rx subclones, and  bla  CTX-M,  bla  TEM,  bla  SHV,  and  bla  OXA-1 .    Results  The overall number of residents colonised, by organism, was as follows: ESBL-EC, 35 (55%); MRSA, 17 (27%); ESBL-producing  K. pneumoniae  (ESBL-KP), 5 (8%); VRE, 2 (3%) and CPE, 0 (0%). All 98 ESBL-EC isolates were  H 30-Rx ST131, with  bla  CTX-M-group 1.  By PFGE, a group of 91 ESBL-EC (from 33 participants) had ≥ 85% similar profiles and resembled UK epidemic strain A/ international pulsotype PFGE812. Sequential ESBL-EC from individual residents were closely related. Six ESBL-KP isolates, from five participants, had  bla  CTX-M-group 1  and by PFGE were closely related. Colonisation with ESBL and MRSA was associated with location within the LTCF and previous exposure to antimicrobials.    Conclusions  Among LTCF residents, colonisation with ESBL-EC and MRSA was common. All ESBL-EC were  H 30-Rx ST131, consistent with clonal dissemination.

bmc infectious diseases

Colonisation with ESBL-producing and carbapenemase-producing Enterobacteriaceae, vancomycin-resistant enterococci, and meticillin-resistant Staphylococcus aureus in a long-term care facility over one year