scholarly journals Prevalence of and Risk Factors for Multidrug-ResistantAcinetobacter baumanniiColonization Among High-Risk Nursing Home Residents

2015 ◽  
Vol 36 (10) ◽  
pp. 1155-1162 ◽  
Author(s):  
Lona Mody ◽  
Kristen E. Gibson ◽  
Amanda Horcher ◽  
Katherine Prenovost ◽  
Sara E. McNamara ◽  
...  
Keyword(s):  
Risk Factors ◽  
Nursing Home ◽  
High Risk ◽  
Functional Disability ◽  
Insertion Site ◽  
Nursing Home Residents ◽  
Feeding Tube ◽  
Multidrug Resistant ◽  
Antibiotic Resistant ◽  
Nested Case Control

OBJECTIVETo characterize the epidemiology of multidrug-resistant (MDR)Acinetobacter baumanniicolonization in high-risk nursing home (NH) residents.DESIGNNested case-control study within a multicenter prospective intervention trial.SETTINGFour NHs in Southeast Michigan.PARTICIPANTSCase patients and control subjects were NH residents with an indwelling device (urinary catheter and/or feeding tube) selected from the control arm of the Targeted Infection Prevention study. Cases were residents colonized with MDR (resistant to ≥3 classes of antibiotics)A. baumannii; controls were never colonized with MDRA. baumannii.METHODSFor active surveillance cultures, specimens from the nares, oropharynx, groin, perianal area, wounds, and device insertion site(s) were collected upon study enrollment, day 14, and monthly thereafter.A. baumanniistrains and their susceptibilities were identified using standard microbiologic methods.RESULTSOf 168 NH residents, 25 (15%) were colonized with MDRA. baumannii. Compared with the 143 controls, cases were more functionally disabled (Physical Self-Maintenance Score >24; odds ratio, 5.1 [95% CI, 1.8–14.9];P<.004), colonized withProteus mirabilis(5.8 [1.9–17.9];P<.003), and diabetic (3.4 [1.2–9.9];P<.03). Most cases (22 [88%]) were colonized with multiple antibiotic-resistant organisms and 16 (64%) exhibited co-colonization with at least one other resistant gram-negative bacteria.CONCLUSIONFunctional disability,P. mirabiliscolonization, and diabetes mellitus are important risk factors for colonization with MDRA. baumanniiin high-risk NH residents.A. baumanniiexhibits widespread antibiotic resistance and a preference to colonize with other antibiotic-resistant organisms, meriting enhanced attention and improved infection control practices in these residents.Infect Control Hosp Epidemiol 2015;36(10):1155–1162

scholarly journals Methicillin-ResistantStaphylococcus aureus:Site of Acquisition and Strain Variation in High-Risk Nursing Home Residents with Indwelling Devices

2014 ◽  
Vol 35 (12) ◽  
pp. 1458-1465 ◽  
Author(s):  
Kristen E. Gibson ◽  
Sara E. McNamara ◽  
Marco Cassone ◽  
Mary Beth Perri ◽  
Marcus Zervos ◽  
...  
Keyword(s):  
Nursing Home ◽  
High Risk ◽  
Urinary Catheter ◽  
Insertion Site ◽  
Nursing Home Residents ◽  
Feeding Tube ◽  
Perianal Area ◽  
Multicenter Prospective Observational Study ◽  
Healthcare Associated ◽  
Mrsa Colonization

Objective.Characterize the clinical and molecular epidemiology of new methicillin-resistantStaphylococcus aureus(MRSA) acquisitions at nasal and extranasal sites among high-risk nursing home (NH) residents.Design.Multicenter prospective observational study.Setting.Six NHs in southeast Michigan.Participants.A total of 120 NH residents with an indwelling device (feeding tube and/or urinary catheter).Methods.Active surveillance cultures from the nares, oropharynx, groin, perianal area, wounds (if present), and device insertion site(s) were collected upon enrollment, at day 14, and monthly thereafter. Pulsed-field gel electrophoresis and polymerase chain reaction for SCCmec, agr, and Panton-Valentine leukocidin were performed.Results.Of 120 participants observed for 16,290 device-days, 50 acquired MRSA (78% transiently, 22% persistently). New MRSA acquisitions were common in extranasal sites, particularly at device insertion, groin, and perianal areas (27%, 23%, and 17.6% of all acquisitions, respectively). Screening extranasal sites greatly increases the detection of MRSA colonization (100% of persistent carriers and 97.4% of transient carriers detected with nares, groin, perianal, and device site sampling vs 54.5% and 25.6%, respectively, for nares samples alone). Colonization at suprapubic urinary catheter sites generally persisted. Healthcare-associated MRSA (USA100 and USA100 variants) were the dominant strains (79.3% of all new acquisition isolates). Strain diversity was more common in transient carriers, including acquisition of USA500 and USA300 strains.Conclusion.Indwelling device insertion sites as well as the groin and perianal area are important sites of new MRSA acquisitions in NH residents and play a role in the persistency of MRSA carriage. Clonal types differ among persistent and transient colonizers.

scholarly journals Prevalence of Multidrug-Resistant Bacterial Colonization and Risk Factors in Geriatric Nursing Home Residents

2018 ◽  
Vol 21 (1) ◽  
pp. 41-48
Author(s):  
Oya Özlem EREN KUTSOYLU ◽  
Vildan AVKAN OĞUZ ◽  
Madina ABDULLAYEVA ◽  
Nil TEKİN ◽  
Nur YAPAR
Keyword(s):  
Risk Factors ◽  
Nursing Home ◽  
Bacterial Colonization ◽  
Nursing Home Residents ◽  
Multidrug Resistant ◽  
Geriatric Nursing

scholarly journals Impact of Roommates on MDRO Spread in Nursing Homes

2020 ◽  
Vol 41 (S1) ◽  
pp. s66-s67
Author(s):  
Gabrielle M. Gussin ◽  
Ken Kleinman ◽  
Raveena D. Singh ◽  
Raheeb Saavedra ◽  
Lauren Heim ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Secondary Analysis ◽  
Nursing Home Residents ◽  
Multidrug Resistant ◽  
Healthcare Intervention ◽  
Odds Ratios ◽  
Care Needs ◽  
Environmental Cleaning ◽  
The Impact

Background: Addressing the high burden of multidrug-resistant organisms (MDROs) in nursing homes is a public health priority. High interfacility transmission may be attributed to inadequate infection prevention practices, shared living spaces, and frequent care needs. We assessed the contribution of roommates to the likelihood of MDRO carriage in nursing homes. Methods: We performed a secondary analysis of the SHIELD OC (Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County, CA) Project, a CDC-funded regional decolonization intervention to reduce MDROs among 38 regional facilities (18 nursing homes, 3 long-term acute-care hospitals, and 17 hospitals). Decolonization in participating nursing homes involved routine chlorhexidine bathing plus nasal iodophor (Monday through Friday, twice daily every other week) from April 2017 through July 2019. MDRO point-prevalence assessments involving all residents at 16 nursing homes conducted at the end of the intervention period were used to determine whether having a roommate was associated with MDRO carriage. Nares, bilateral axilla/groin, and perirectal swabs were processed for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococcus (VRE), extended-spectrum β-lactamase (ESBL)–producing Enterobacteriaceae, and carbapenem-resistant Enterobacteriaceae (CRE). Generalized linear mixed models assessed the impact of maximum room occupancy on MDRO prevalence when clustering by room and hallway, and adjusting for the following factors: nursing home facility, age, gender, length-of-stay at time of swabbing, bedbound status, known MDRO history, and presence of urinary or gastrointestinal devices. CRE models were not run due to low counts. Results: During the intervention phase, 1,451 residents were sampled across 16 nursing homes. Overall MDRO prevalence was 49%. In multivariable models, we detected a significant increasing association of maximum room occupants and MDRO carriage for MRSA but not other MDROs. For MRSA, the adjusted odds ratios for quadruple-, triple-, and double-occupancy rooms were 3.5, 3.6, and 2.8, respectively, compared to residents in single rooms (P = .013). For VRE, these adjusted odds ratios were 0.3, 0.3, and 0.4, respectively, compared to residents in single rooms (P = NS). For ESBL, the adjusted odds ratios were 0.9, 1.1, and 1.5, respectively, compared to residents in single rooms (P = nonsignificant). Conclusions: Nursing home residents in shared rooms were more likely to harbor MRSA, suggesting MRSA transmission between roommates. Although decolonization was previously shown to reduce MDRO prevalence by 22% in SHIELD nursing homes, this strategy did not appear to prevent all MRSA transmission between roommates. Additional efforts involving high adherence hand hygiene, environmental cleaning, and judicious use of contact precautions are likely needed to reduce transmission between roommates in nursing homes.Funding: NoneDisclosures: Gabrielle M. Gussin, Stryker (Sage Products): Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Clorox: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Medline: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes. Xttrium: Conducting studies in which contributed antiseptic product is provided to participating hospitals and nursing homes.

scholarly journals Advanced cognitive impairment among older nursing home residents

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tadeja Gracner ◽  
Patricia W. Stone ◽  
Mansi Agarwal ◽  
Mark Sorbero ◽  
Susan L Mitchell ◽  
...  
Keyword(s):  
Risk Factors ◽  
Alzheimer’S Disease ◽  
Alzheimer's Disease ◽  
Nursing Home ◽  
Cognitive Impairment ◽  
Mortality Risk ◽  
Advanced Disease ◽  
Nursing Home Residents ◽  
Functional Score ◽  
Data Set

Abstract Background Though work has been done studying nursing home (NH) residents with either advanced Alzheimer’s disease (AD) or Alzheimer’s disease related dementia (ADRD), none have distinguished between them; even though their clinical features affecting survival are different. In this study, we compared mortality risk factors and survival between NH residents with advanced AD and those with advanced ADRD. Methods This is a retrospective observational study, in which we examined a sample of 34,493 U.S. NH residents aged 65 and over in the Minimum Data Set (2011–2013). Incident assessment of advanced disease was defined as the first MDS assessment with severe cognitive impairment (Cognitive Functional Score equals to 4) and diagnoses of AD or ADRD. Demographics, functional limitations, and comorbidities were evaluated as mortality risk factors using Cox models. Survival was characterized with Kaplan-Maier functions. Results Of those with advanced cognitive impairment, 35 % had AD and 65 % ADRD. At the incident assessment of advanced disease, those with AD had better health compared to those with ADRD. Mortality risk factors were similar between groups (shortness of breath, difficulties eating, substantial weight-loss, diabetes mellitus, heart failure, chronic obstructive pulmonary disease, and pneumonia; all p < 0.01). However, stroke and difficulty with transfer (for women) were significant mortality risk factors only for those with advanced AD. Urinary tract infection, and hypertension (for women) only were mortality risk factors for those with advanced ADRD. Median survival was significantly shorter for the advanced ADRD group (194 days) compared to the advanced AD group (300 days). Conclusions There were distinct mortality and survival patterns of NH residents with advanced AD and ADRD. This may help with care planning decisions regarding therapeutic and palliative care.

1035-P: HbA1c Does Not Identify Nursing Home Residents at High Risk of Hypoglycemia and Hyperglycemia

Diabetes ◽  
2021 ◽  
Vol 70 (Supplement 1) ◽  
pp. 1035-P
Author(s):  
ALEXANDRA K. LEE ◽  
SEI J. LEE ◽  
BOCHENG JING ◽  
MEDHA MUNSHI ◽  
ANDREW J. KARTER
Keyword(s):  
Nursing Home ◽  
High Risk ◽  
Nursing Home Residents
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