scholarly journals Transmission of Resistant Gram-Negative Bacteria to Health Care Worker Gowns and Gloves during Care of Nursing Home Residents in Veterans Affairs Community Living Centers

2017 ◽  
Vol 61 (10) ◽  
Author(s):  
Natalia Blanco ◽  
Lisa Pineles ◽  
Alison D. Lydecker ◽  
J. Kristie Johnson ◽  
John D. Sorkin ◽  
...  
Keyword(s):  
Health Care ◽  
Nursing Home ◽  
High Risk ◽  
Glucose Monitoring ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Veterans Affairs ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Multicenter Prospective Observational Study

ABSTRACT The objectives of the study were to estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves (G&G) worn by health care workers (HCWs) when providing care to nursing home residents and to identify the types of care and resident characteristics associated with transmission. A multicenter, prospective observational study was conducted with residents and HCWs from Veterans Affairs (VA) nursing homes. Perianal swabs to detect RGNB were collected from residents. HCWs wore G&G during usual care activities, and the G&G were swabbed at the end of the interaction in a standardized manner. Transmission of RGNB from a colonized resident to G&G by type of care was measured. Odds ratios (ORs) associated with type of care or resident characteristics were estimated. Fifty-seven (31%) of 185 enrolled residents were colonized with ≥1 RGNB. RGNB transmission to HCW gloves or gowns occurred during 9% of the interactions (n = 905): 7% to only gloves and 2% to only gowns. Bathing the resident and providing hygiene and toilet assistance were associated with a high risk of transmission. Glucose monitoring and assistance with feeding or medication were associated with a low risk of transmission. In addition, antibiotic use by the resident was strongly associated with greater transmission (OR, 2.51; P < 0.01). RGNB were transferred to HCWs during ∼9% of visits. High-risk types of care were identified for which use of G&G may be prioritized. Antibiotic use was associated with 2.5 times greater risk of transmission, emphasizing the importance of antibiotic stewardship. (This study has been registered at ClinicalTrials.gov under registration no. NCT01350479.)

scholarly journals Transmission of resistant Gram-negative bacteria to healthcare personnel gowns and gloves during care of residents in community-based nursing facilities

2018 ◽  
Vol 39 (12) ◽  
pp. 1425-1430 ◽  
Author(s):  
Natalia Blanco ◽  
J. Kristie Johnson ◽  
John D. Sorkin ◽  
Alison D. Lydecker ◽  
Lauren Levy ◽  
...  
Keyword(s):  
High Risk ◽  
Prospective Observational Study ◽  
Glucose Monitoring ◽  
Healthcare Personnel ◽  
Gram Negative Bacteria ◽  
Nursing Facilities ◽  
Community Based ◽  
Antibiotic Resistant ◽  
Gram Negative ◽  
Resident Characteristic

AbstractObjectiveTo estimate the risk of transmission of antibiotic-resistant Gram-negative bacteria (RGNB) to gowns and gloves worn by healthcare personnel (HCP) when providing care to residents of community-based nursing facilities to identify the types of care and resident characteristics associated with transmission.DesignProspective observational study.Settings and participantsResidents and HCP from 13 community-based nursing facilities in Maryland and Michigan.MethodsPerianal swabs were collected from residents and cultured to detect RGNB. HCP wore gowns and gloves during usual care activities, and at the end of each interaction, these were swabbed in a standardized manner. Transmission of RGNB from a colonized resident to gowns and gloves was estimated. Odds ratios (ORs) of transmission associated with type of care or resident characteristic were calculated.ResultsWe enrolled 403 residents and their HCP in this study. Overall, 19% of enrolled residents with a perianal swab (n=399) were colonized with at least 1 RGNB. RGNB transmission to either gloves or gowns occurred during 11% of the 584 interactions. Showering the resident, hygiene or toilet assistance, and wound dressing changes were associated with a high risk of transmission. Glucose monitoring and assistance with feeding or medication were associated with a low risk of transmission. Residents with a pressure ulcer were 3 times more likely to transmit RGNB than residents without one (OR, 3.3; 95% confidence interval [CI], 1.0–11.1).ConclusionsGown and glove use in community nursing facilities should be prioritized for certain residents and care interactions that are deemed a high risk for transmission.

scholarly journals Patterns of Ciprofloxacin-Resistant Gram-Negative Bacteria Colonization in Nursing Home Residents

2011 ◽  
Vol 32 (2) ◽  
pp. 177-180 ◽  
Author(s):  
Parimala Dommeti ◽  
Linda Wang ◽  
Erika L. Flannery ◽  
Kathleen Symons ◽  
Lona Mody
Keyword(s):  
Nursing Home ◽  
Functional Status ◽  
Nursing Home Residents ◽  
Gram Negative Bacteria ◽  
Gram Negative

We evaluated the prevalence of colonization with all gram-negative bacilli (GNB) and with ciprofloxacin-resistant GNB among nursing home residents with and without indwelling devices. We found that device presence increases the risk of colonization with all GNB and with ciprofloxacin-resistant GNB. Colonization with ciprofloxacin-resistant GNB increases with decreasing functional status.

Association between level of care and colonization with resistant gram-negative bacteria among nursing-home residents

2021 ◽  
pp. 1-3
Author(s):  
Timileyin Y Adediran ◽  
Kinjal N Sethuraman ◽  
Surbhi Leekha ◽  
Mary-Claire Roghmann
Keyword(s):  
Nursing Home ◽  
Odds Ratio ◽  
Nursing Home Residents ◽  
Cross Sectional Study ◽  
Level Of Care ◽  
Gram Negative Bacteria ◽  
Sectional Study ◽  
Cross Sectional ◽  
Gram Negative ◽  
The Relationship

Abstract In this cross-sectional study, we examined the relationship between resident level of care in the nursing home and colonization with resistant gram-negative bacteria. Residential-care residents were more likely to be colonized with resistant gram-negative bacteria than were postacute care residents (odds ratio, 2.3; 95% confidence interval, 1.40–3.80; P < .001).

scholarly journals Multidrug-Resistant Gram-Negative Bacteria: Inter- and Intradissemination Among Nursing Homes of Residents With Advanced Dementia

2015 ◽  
Vol 36 (8) ◽  
pp. 930-935 ◽  
Author(s):  
Erika M. C. D’Agata ◽  
Daniel Habtemariam ◽  
Susan Mitchell
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Risk Group ◽  
Nursing Home Residents ◽  
Multidrug Resistant ◽  
High Risk Group ◽  
Pulsed Field Gel Electrophoresis ◽  
Gram Negative Bacteria ◽  
Advanced Dementia ◽  
Gram Negative

OBJECTIVETo quantify the extent of inter– and intra–nursing home transmission of multidrug-resistant gram-negative bacteria (MDRGN) among residents with advanced dementia and characterize MDRGN colonization among these residents.DESIGNProspective cohort study.SETTINGTwenty-two nursing homes in the greater Boston, Massachusetts, area.PATIENTSResidents with advanced dementia.METHODSSerial rectal surveillance cultures for MDRGN and resident characteristics were obtained every 3 months for 12 months or until death. Molecular typing of MDRGN isolates was performed by pulsed-field gel electrophoresis.RESULTSA total of 190 MDRGN isolates from 152 residents with advanced dementia were included in the analyses. Both intra– and inter–nursing home transmission were identified. Genetically related MDRGN strains, recovered from different residents, were detected in 18 (82%) of the 22 nursing homes. The percent of clonally related strains in these nursing homes ranged from 0% to 86% (average, 35%). More than 50% of strains were clonally related in 3 nursing homes. Co-colonization with more than 1 different MDRGN species occurred among 28 residents (18.4%). A total of 168 (88.4%), 20 (10.5%), and 2 (1.0%) of MDRGN isolates were resistant to 3, 4, and 5 different antimicrobials or antimicrobial classes, respectively.CONCLUSIONSMDRGN are spread both within and between nursing homes among residents with advanced dementia. Infection control interventions should begin to target this high-risk group of nursing home residents.Infect Control Hosp Epidemiol2015;36(8):930–935

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.

#43: Monotherapy Experience in Pediatric Patients with High-risk Febrile Neutropenia

2021 ◽  
Vol 10 (Supplement_1) ◽  
pp. S19-S19
Author(s):  
Valentina Gutiérrez ◽  
Ximena Claverie
Keyword(s):  
High Risk ◽  
Febrile Neutropenia ◽  
Fungal Infections ◽  
Clinical Signs ◽  
Empiric Therapy ◽  
Fourth Generation ◽  
Gram Negative Bacteria ◽  
Gram Negative ◽  
Third Line ◽  
Clinical Worsening

Abstract Background Fever during neutropenia is a common occurrence in children with cancer. In a systematic review of RCTs of pediatric febrile neutropenia, compared monotherapy with aminoglycoside-containing combination therapy found no significant differences in failure rates, infection-related mortality, or overall mortality. The updated pediatric-specific guidelines recommend initiation of empirical antibiotic monotherapy using an antipseudomonal β-lactam, a fourth-generation cephalosporin, or a carbapenem for pediatric high-risk febrile neutropenia. However, local epidemiology and resistance patterns should be evaluated regularly. Our local hospital epidemiology does not have Pseudomonas aeruginosa isolates, therefore, we used ceftriaxone as monotherapy in patients with high-risk febrile neutropenia without other risk factors. The goal of our investigation is to describe the experience of using third-generation cephalosporins in these patients. Methods Descriptive study of high-risk febrile neutropenia episodes in patients admitted to the Pediatric Oncology Unit of Hospital Dr. Sótero del Río, Santiago, Chile. We included patients ≤15 years from June 2016 until November 2019. Results We found a total of 133 high-risk febrile neutropenia episodes corresponding to 50 patients, 78% were leukemia and 22% were solid tumor patients. Of the 133 episodes, 92 (69%) had clinical signs at admission, mostly respiratory in 46 (50%) of the cases, 18 (29%) had mucositis and 13 (14%) had diarrhea. Of 133 episodes, 41 (31%) did not have any source at clinical examination. Eighty-six (65%) cases started ceftriaxone at admission, 28 (33%) maintained ceftriaxone for 7 days of treatment with good clinical response. Of this group 58 (67%) patients changed treatment: 32 (37%) cases started second-line antibiotics for clinical worsening, 19 (22%) cases required second- and third-line antibiotics for persistent fever and clinical worsening, and 7 (8%) received third-line antibiotics from the start for past microbiological history. Sixteen (12%) cases of total evolved with sepsis requiring intensive care unit management. We had 30 (23%) episodes with positive blood culture, 11 (37%) due to gram-positive bacteria, 16 (53%) gram-negative bacteria, and 3 (10%) cases of fungal infections. Of the gram-negative bacteria, 7 (44%) were ESBL producers, without P. aeruginosa isolates. One case died (0.7%) for refractory sepsis due to gram-negative bacteria. Conclusion Although we did not have P. aeruginosa isolates, due to the spread of ESBL strains, monotherapy with ceftriaxone is not a good option as initial therapy for high-risk febrile neutropenia patients. The empiric therapy has to be evaluated regularly and should always be based on local epidemiology.

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