Abstract
ObjectivesA national survey was conducted to determine the prevalence and risk factors of methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBLE) and vancomycin-resistant enterococci (VRE) among nursing home residents in Belgium.MethodsA random stratified, national prevalence survey was conducted in nursing home residents who were screened for carriage of ESBLE, MRSA and VRE by multisite enriched culture. Characteristics of nursing homes and residents were collected by a questionnaire survey and were analysed by multilevel logistic regression analysis.ResultsOf 2791 screened residents in 60 participating nursing home, the weighted prevalence of ESBLE and MRSA carriage were 6.2% (range: 0 to 20%) and 12.2% (range: 0 to 36%), respectively. No cases of VRE were found. No relationship was found between ESBLE and MRSA prevalence rates within nursing homes and the rate of co-colonization was very low (0.8%). Geographical variations in prevalence of MRSA and ESBLE and in distribution of ESBL types in nursing home residents paralleled that of acute hospitals. Risk factors of ESBLE carriage included previously known ESBLE carriage, male gender, a low level of mobility and previous antibiotic exposure. Risk factors for MRSA colonization were: previously known MRSA carriage, skin lesions, a low functional status and antacid use.ConclusionsA low prevalence of ESBLE carriage was found in nursing home residents in Belgium. The prevalence of MRSA carriage decreased substantially in comparison to a similar survey conducted in 2005. A low functional status appeared as a common factor for ESBLE and MRSA carriage. Previous exposure to antibiotics was a strong predictor of ESBLE colonization while increased clustering of MRSA carriage suggested the importance of cross-transmission within nursing homes for this organism. These results emphasize the need for global coordination of the surveillance of MDRO within and between nursing homes and hospitals.
Highlights
Infections due to multidrug-resistant bacteria are a major health concern worldwide [1]
The rate of co-colonization with both extended-spectrum b-lactamase producing Enterobacteriaceae (ESBLE) and methicillinresistant Staphylococcus aureus (MRSA) among the 2609 patients was low (25 cases; weighted prevalence 0.8% [95% confidence intervals (95%CI): 0.6–1.1]) and no relationship was found between the prevalence of ESBLE and of MRSA in the Nursing homes (NHs)
Risk factors of co-colonization by both MRSA and ESBLE were bladder catheter (OR: 6.29 [95%CI: 2.61–15.14]; P,0.001) and decubitus ulcers (OR: 9.04 [95%CI: 3.15–25.91]; P,0.001). This represents the first large scale study in Europe that included the screening of ESBLE, MRSA and vancomycin-resistant enterococci (VRE) concomitantly in a large sample size of NH residents using standardized microbiological methods
Summary
Infections due to multidrug-resistant bacteria are a major health concern worldwide [1]. Asymptomatic colonization by multidrugresistant microorganisms (MDRO) has been recognized as the first step before subsequent infection [2,3,4]. Infections due to MDRO have been associated with a delay in initiating effective therapy, a higher mortality, and an increase of the length of hospital stay with subsequent increases of medical costs [5,6]. Nursing homes (NHs) may represent a large reservoir of MDRO since these institutions do admit old frail residents who frequently require a higher degree of medical care and often need to be hospitalized. Studies in various countries have reported, among NH residents, high rates of asymptomatic colonization by other MDROs like extended-spectrum b-lactamase producing Enterobacteriaceae (ESBLE) and vancomycin-resistant enterococci (VRE) [8,9]
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