Abstract
Previous studies indicated residents in geriatric long-term care facilities (LTCFs) had much higher prevalence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) carriage than the general population. Most ESBL-E carriers are asymptomatic. The study tested the hypothesis that residents with ESBL-E carriage may accumulate inside geriatric LTCFs through potential cross-transmission after exposure to residents with prolonged ESBL-E carriage. 260 residents from four Japanese LTCFs underwent ESBL-E testing of fecal specimens and were divided into two cohorts: Cohort 1,75 patients with ≥ 2 months residence at study onset; Cohort 2, 185 patients with < 2 months residence at study onset or new admission during the study period. Three analyses were performed: (1) ESBL-E carriage statuses in Cohort 1 and Cohort 2; (2) changes in ESBL-E carriage statuses 3–12 months after the first testing and ≥ 12 months after the second testing; and (3) lengths of positive ESBL-E carriage statuses. Compared with the residents in Cohort 1, a significantly larger proportion of residents in Cohort 2 were positive for ESBL-E carriage (28.0% in Cohort 1 vs 40.0% in Cohort 2). In the subsequent testing results, 18.3% of residents who were negative in the first testing showed positive conversion to ESBL-E carriage in the second testing, while no patients who were negative in the second testing showed positive conversion in the third testing. The maximum length of ESBL-E carriage was 17 months. The findings indicated that some residents acquired ESBL-E through potential cross-transmission inside the LTCFs after short-term residence. However, no residents showed positive conversion after long-term residence, which indicates that residents with ESBL-E carriage may not accumulate inside LTCFs. Practical infection control and prevention measures could improve the ESBL-E prevalence in geriatric LTCFs.
Highlights
Previous studies indicated residents in geriatric long-term care facilities (LTCFs) had much higher prevalence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) carriage than the general population
The prevalence of ESBL-E carriage was significantly higher in Cohort 2 than in Cohort 1 (40% vs 28%), which indicates that ESBL-E was most likely to be carried into LTCFs through admission of new residents, who provided a large contribution to the increased total prevalence of ESBL-E carriage among LTCF residents
Using the exact same LTCF settings employed in the present study, we recently reported that the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the nasal cavity of LTCF residents was approximately 10%23
Summary
Previous studies indicated residents in geriatric long-term care facilities (LTCFs) had much higher prevalence of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) carriage than the general population. No residents showed positive conversion after long-term residence, which indicates that residents with ESBL-E carriage may not accumulate inside LTCFs. Practical infection control and prevention measures could improve the ESBL-E prevalence in geriatric LTCFs. With the rapid aging of populations worldwide, the number of older adults requiring residence in geriatric longterm care facilities (LTCFs) is increasing. Multidrug-resistant Gram-negative organisms represent an ongoing threat to global public health and necessitate the implementation of practical infection prevention and control guidelines in daily practice and caregiving[7,8,9,10] Among these organisms, extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) has become widespread in hospital settings as well as geriatric LTCFs worldwide[10,11,12,13,14,15,16,17]. Several studies have indicated that asymptomatic carriers of ESBL-E may require effective surveillance and specific control programs to prevent the infection becoming w idespread[21,22]
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