Active surveillance for carbapenem-resistant Enterobacteriaceae, vancomycin-resistant enterococci and toxigenic Clostridium difficile among patients transferred from long-term care facilities in Korea

Objective.To establish a statewide network to detect, control, and prevent the spread of carbapenem-resistant Enterobacteriaceae (CRE) in a region with a low incidence of CRE infection.Design.Implementation of the Drug Resistant Organism Prevention and Coordinated Regional Epidemiology (DROP-CRE) Network.Setting and Participants.Oregon infection prevention and microbiology laboratory personnel, including 48 microbiology laboratories, 62 acute care facilities, and 140 long-term care facilities.Methods.The DROP-CRE working group, comprising representatives from academic institutions and public health, convened an interdisciplinary advisory committee to assist with planning and implementation of CRE epidemiology and control efforts. The working group established a statewide CRE definition and surveillance plan; increased the state laboratory capacity to perform the modified Hodge test and polymerase chain reaction for carbapenemases in real time; and administered surveys that assessed the needs and capabilities of Oregon infection prevention and laboratory personnel. Results of these inquiries informed CRE education and the response plan.Results.Of 60 CRE reported from November 2010 through April 2013, only 3 were identified as carbapenemase producers; the cases were not linked, and no secondary transmission was found. Microbiology laboratories, acute care facilities, and long-term care facilities reported lacking carbapenemase testing capability, reliable interfacility communication, and CRE awareness, respectively. Survey findings informed the creation of the Oregon CRE Toolkit, a state-specific CRE guide booklet.Conclusions.A regional epidemiology surveillance and response network has been implemented in Oregon in advance of widespread CRE transmission. Prospective surveillance will determine whether this collaborative approach will be successful at forestalling the emergence of this important healthcare-associated pathogen.

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Lack of Transmission of Vancomycin-Resistant Enterococci in Three Long-Term–Care Facilities

Infection Control and Hospital Epidemiology ◽

10.1086/501628 ◽

1999 ◽

Vol 20 (05) ◽

pp. 341-343 ◽

Cited By ~ 15

Author(s):

Christina A. Greenaway ◽

Mark A. Miller

Keyword(s):

Infection Control ◽

Long Term Care ◽

Point Prevalence ◽

Control Measures ◽

Term Care ◽

Infection Control Measures ◽

Vancomycin Resistant Enterococci ◽

Care Facilities ◽

Vancomycin Resistant

Abstract Three patients colonized with vancomycin-resistant Enterococcus were admitted to one or more of three long-term-care facilities. Six point-prevalence surveys revealed no transmission of vancomycin-resistant Enterococcus after a total of 234 days of exposure during which moderately strict infection control measures were implemented. Four of 116 environmental cultures were positive.

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Survey of Long-Term-Care Facilities in Iowa for Policies and Practices Regarding Residents With Methicillin-Resistant Staphylococcus aureus or Vancomycin-Resistant Enterococci

Infection Control and Hospital Epidemiology ◽

10.1086/502498 ◽

2005 ◽

Vol 26 (10) ◽

pp. 811-815 ◽

Cited By ~ 38

Author(s):

Trisha Kreman ◽

Jianfang Hu ◽

Jean Pottinger ◽

Loreen A. Herwaldt

Keyword(s):

Staphylococcus Aureus ◽

Infection Control ◽

Long Term Care ◽

Term Care ◽

Methicillin Resistant ◽

Vancomycin Resistant Enterococci ◽

Care Facilities ◽

Vancomycin Resistant ◽

Policies And Practices

AbstractObjectives:To identify infection control policies and practices used by long-term-care facilities (LTCFs) in Iowa for residents with methicillin-resistant Staphylococcus aureus (MRSA) or vancomycin-resistant enterococci (VRE), and to estimate the prevalence of residents known to have these organisms.Design:Survey.Setting:LTCFs in Iowa from December 2002 through March 2003.Results:Of the 429 LTCFs in Iowa, 331 (77%) responded to the survey. The estimated prevalence of residents known to have MRSA was 13.4 per 1,000 and that of residents known to have VRE was 2.3 per 1,000. Facilities owned by the government or those with an average of more than 86 occupied beds were more likely to have residents known to have MRSA and VRE (P = .002 and .007, respectively). Of the responding facilities, 7.3% acknowledged that they refused to accept individuals known to have MRSA and 16.9% acknowledged that they refused to accept those known to have VRE. Facilities in large communities (population, > 100,000) were least likely to deny admission to an individual known to have either MRSA or VRE (P = .05). Most facilities reported adhering to the national guidelines, but fewer than half (44.7%) of the respondents had heard of the Iowa Antibiotic Resistance Task Force's guidelines regarding residents with MRSA or VRE.Conclusions:Many LTCFs in Iowa care for residents known to have MRSA or VRE, but some refuse to admit these individuals. Infection control personnel and public health officials should work together to educate LTCF staff so that residents receive proper care and resistant organisms do not spread within this setting.

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Success of a National Intervention in Controlling Carbapenem-resistant Enterobacteriaceae in Israel’s Long-term Care Facilities

Clinical Infectious Diseases ◽

10.1093/cid/ciy572 ◽

2018 ◽

Vol 68 (6) ◽

pp. 964-971 ◽

Cited By ~ 10

Author(s):

Debby Ben-David ◽

Samira Masarwa ◽

Noga Fallach ◽

Elizabeth Temkin ◽

Ester Solter ◽

...

Keyword(s):

Long Term Care ◽

Term Care ◽

Carbapenem Resistant ◽

Care Facilities ◽

Carbapenem Resistant Enterobacteriaceae

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Comparative Epidemiology of Vancomycin-Resistant Enterococci Colonization in an Acute-Care Hospital and Its Affiliated Intermediate- and Long-Term Care Facilities in Singapore

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.01507-18 ◽

2018 ◽

Vol 62 (12) ◽

Cited By ~ 5

Author(s):

Damon Tan ◽

Htet Lin Htun ◽

Jocelyn Koh ◽

Kala Kanagasabai ◽

Jia-Wei Lim ◽

...

Keyword(s):

Risk Factors ◽

Health Care ◽

Length Of Stay ◽

Long Term Care ◽

Term Care ◽

Vancomycin Resistant Enterococci ◽

Care Facilities ◽

Independent Risk Factors ◽

Vancomycin Resistant

ABSTRACTVancomycin-resistant enterococci (VRE) are an important cause of nosocomial infections in acute-care hospitals (ACHs), intermediate-care facilities (ITCFs), and long-term care facilities (LTCFs). This study contemporaneously compared the epidemiology and risk factors for VRE colonization in different care settings in a health care network. We conducted a serial cross-sectional study in a 1,700-bed ACH and its six closely affiliated ITCFs and LTCFs in June and July of 2014 to 2016. Rectal swab or stool specimens were cultured for VRE. Multivariable logistic regression was used to assess for independent risk factors associated with VRE colonization. Of 5,357 participants, 523 (9.8%) were VRE colonized. VRE prevalence was higher in ACHs (14.2%) than in ITCFs (7.6%) and LTCFs (0.8%). Common risk factors between ACHs and ITCFs included prior VRE carriage, a longer duration of antibiotic therapy, surgery in the preceding 90 days, and the presence of a skin ulcer. Independent risk factors specific to ACH-admitted patients were prior methicillin-resistantStaphylococcus aureuscarriage, a higher number of beds per room, prior proton pump inhibitor use, and a length of stay of >14 days. For ITCFs, a length of stay of >14 days was inversely associated with VRE colonization. Similarities and differences in risk factors for VRE colonization were observed between health care settings. VRE prevention efforts should target the respective high-risk patients.

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