Abstract
BackgroundRationale and aims of the study were to compare colonization frequencies with MDR bacteria isolated from LTCF residents in three different Northern Italian regions, to investigate risk factors for colonization and the genotypic characteristics of isolates. The screening included Enterobacteriaceae expressing extended-spectrum β-lactamases (ESβLs) and high-level AmpC cephalosporinases, carbapenemase-producing Enterobacteriaceae, Pseudomonas aeruginosa or Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE).MethodsUrine samples and rectal, inguinal, oropharyngeal and nasal swabs were plated on selective agar; resistance genes were sought by PCR and sequencing. Demographic and clinical data were collected.ResultsAmong the LTCF residents, 75.0% (78/104), 69.4% (84/121) and 66.1% (76/115) were colonized with at least one of the target organisms in LTCFs located in Milan, Piacenza and Bolzano, respectively. ESβL producers (60.5, 66.1 and 53.0%) were highly predominant, mainly belonging to Escherichia coli expressing CTX-M group-1 enzymes. Carbapenemase-producing enterobacteria were found in 7.6, 0.0 and 1.6% of residents; carbapemenase-producing P. aeruginosa and A. baumannii were also detected. Colonization by MRSA (24.0, 5.7 and 14.8%) and VRE (20.2, 0.8 and 0.8%) was highly variable. Several risk factors for colonization by ESβL-producing Enterobacteriaceae and MRSA were found and compared among LTCFs in the three Provinces. Colonization differences among the enrolled LTCFs can be partially explained by variation in risk factors, resident populations and staff/resident ratios, applied hygiene measures and especially the local antibiotic resistance epidemiology.ConclusionsThe widespread diffusion of MDR bacteria in LTCFs within three Italian Provinces confirms that LTCFs are an important reservoir of MDR organisms in Italy and suggests that future efforts should focus on MDR screening, improved implementation of infection control strategies and antibiotic stewardship programs targeting the complex aspects of LTCFs.
Highlights
Rationale and aims of the study were to compare colonization frequencies with MDR bacteria isolated from LTCF residents in three different Northern Italian regions, to investigate risk factors for colonization and the genotypic characteristics of isolates
Residents in LTCFs have a variety of risk factors for colonization with multidrug-resistant (MDR) bacteria; these facilities represent reservoirs of: i) Enterobacteriaceae expressing extended-spectrum β-lactamases (ESβLs), derepressed/acquired high-level AmpC cephalosporinases or carbapenemases, ii) Pseudomonas aeruginosa or Acinetobacter baumannii producing carbapenemases and iii) methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) [2,3,4]
To promote detailed studies of various microbiological aspects related to LTCFs in Italy, the Association of Italian Clinical Microbiologists (Associazione Microbiologi Clinici Italiani; AMCLI) in 2016 has set up a new working group consisting of Clinical Microbiologists (Gruppo di Lavoro per lo Studio delle Infezioni nelle Residenze Sanitarie Assistite e Strutture assimilabili; GLISTer); one of the main objectives of this working group is the study of the distribution and prevalence of MDR organisms in Italian LTCFs and a multicenter point-prevalence survey, including the main MDR bacteria as described above, was performed in 2016 on residents of LTCFs, located in three Northern Italian cities
Summary
Rationale and aims of the study were to compare colonization frequencies with MDR bacteria isolated from LTCF residents in three different Northern Italian regions, to investigate risk factors for colonization and the genotypic characteristics of isolates. The screening included Enterobacteriaceae expressing extended-spectrum β-lactamases (ESβLs) and high-level AmpC cephalosporinases, carbapenemase-producing Enterobacteriaceae, Pseudomonas aeruginosa or Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Residents in LTCFs have a variety of risk factors for colonization with multidrug-resistant (MDR) bacteria; these facilities represent reservoirs of: i) Enterobacteriaceae expressing extended-spectrum β-lactamases (ESβLs), derepressed/acquired high-level AmpC cephalosporinases or carbapenemases, ii) Pseudomonas aeruginosa or Acinetobacter baumannii producing carbapenemases and iii) methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) [2,3,4]. To promote detailed studies of various microbiological aspects related to LTCFs in Italy, the Association of Italian Clinical Microbiologists (Associazione Microbiologi Clinici Italiani; AMCLI) in 2016 has set up a new working group consisting of Clinical Microbiologists (Gruppo di Lavoro per lo Studio delle Infezioni nelle Residenze Sanitarie Assistite e Strutture assimilabili; GLISTer); one of the main objectives of this working group is the study of the distribution and prevalence of MDR organisms in Italian LTCFs and a multicenter point-prevalence survey, including the main MDR bacteria as described above, was performed in 2016 on residents of LTCFs, located in three Northern Italian cities
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