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Colonization and Infection with Antibiotic‐Resistant Bacteria in a Long‐Term Care Facility
Author(s) -
Terpenning Margaret S.,
Bradley Suzanne F.,
Wan Jim Y.,
Chenoweth Carol E.,
Jorgensen Karen A.,
Kauffman Carol A.
Publication year - 1994
Publication title -
journal of the american geriatrics society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.992
H-Index - 232
eISSN - 1532-5415
pISSN - 0002-8614
DOI - 10.1111/j.1532-5415.1994.tb06210.x
Subject(s) - medicine , colonization , mupirocin , gentamicin , antibiotics , staphylococcus aureus , methicillin resistant staphylococcus aureus , pneumonia , ceftriaxone , veterans affairs , surgery , microbiology and biotechnology , bacteria , biology , genetics
OBJECTIVE: To assess colonization and infection with methicillin‐resistant Staphylococcus aureus (MRSA), high‐level gentamicin‐resistant enterococci (R‐ENT) and gentamicin and/or ceftriaxone‐resistant Gram‐negative bacilli (R‐GNB) and the factors that are associated with colonization and infection with these organisms. DESIGN : Monthly surveillance for colonization and infection over a period of 2 years. In the second year, an intervention to decrease MRSA colonization by the use of mupirocin ointment was carried out. SETTING : Long‐term care facility attached to an acute care Veterans Affairs Medical Center. PATIENTS : A total of 551 patients in the facility were followed for a period of 2 years. MEASUREMENTS : Colonization and infection rates with MRSA, R‐ENT, and R‐GNB. Analysis of risk factors associated with colonization and infection with these three groups of organisms. MAIN RESULTS : In the first year, colonization rates were highest for MRSA (22.7 ± 1% patients colonized each month) and R‐ENT (20.2 ± 1%) and lower for R‐GNB (12.6±1%). After introduction of decolonization of nares and wounds with mupirocin, the rate of MRSA colonization fell significantly to 11.5 ± 1.8%, but rates remained unchanged for R‐ENT and R‐GNB. Risk factors for MRSA colonization included the presence of wounds and decubitus ulcers. For R‐ENT, the presence of wounds, renal failure, intermittent urethral catheterization, low serum albumin, and poor functional level were significant. For R‐GNB, intermittent urethral catheterization, chronic renal disease, inflammatory bowel disease, presence of wounds, and prior pneumonia were significantly associated with colonization. Overall, of infections caused by known organisms, 49.6% were due to MRSA, R‐ENT, or R‐GNB, and 50.4% were due to susceptible organisms. Infections were more commonly due to R‐GNB (21.1% of all infections) than to R‐ENT (8.3%) or MRSA (4.6%). The most common infections were urinary tract infections (42.9% of all infections) and skin and soft tissue infections (31.9% of all infections). Risk factors for MRSA infections were diabetes mellitus and peripheral vascular disease, for R‐GNB infections were intermittent urethral catheterization and indwelling urethral catheters, and no one factor was associated with R‐ENT infection. CONCLUSIONS : In our long‐term care facility, colonization with resistant MRSA and R‐ENT was more common than R‐GNB, but infections were more often due to R‐GNB than R‐ENT and MRSA. Several host factors, which potentially could be modified in order to prevent infections, emerged as important in colonization and infection with these antibiotic‐resistant organisms.