Abstract
Long-term care facilities (LTCFs) are an important reservoir of multidrug-resistant organisms (MDROs). Colonization of LTCF residents by MDROs is generally higher in Italy compared to other European countries. The present review by the working group for the study of infections in LTCFs (GLISTer) of the Italian Association of Clinical Microbiologists (AMCLI) aims to propose criteria for a laboratory-based surveillance of MDROs in Italian LTCFs.We recommend the adhesion to three levels of laboratory-based MDROs surveillance in LTCFs: i) mandatory MDRO surveillance by cumulative retrospective analysis of antimicrobial susceptibility data, obtained as part of routine care of clinical specimens. ii) strongly recommended surveillance by active rectal swab cultures or molecular screening to determine colonization with carbapenemase-producing Enterobacterales, should a resident be proven infected. iii) voluntary surveillance by prospective MDRO surveys, mainly based on point prevalence colonization studies, allowing to determine the MDROs baseline prevalence in the facility.Laboratory-based surveillance of MDROs in LTCFs is aimed at providing useful epidemiological information to healthcare providers operating in the facility, but it is only effective if the collected data are used for infection prevention and control purposes, targeting the peculiar aspects of LTCFs.
Highlights
Long-term care facilities (LTCFs) are institutions that provide skilled nursing care to residents in need of assistance with activities of daily living
LTCFs are an important reservoir for Multidrug-resistant organism (MDRO), such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Pseudomonas aeruginosa or Acinetobacter baumannii with MDR phenotypes and Enterobacterales producing extended-spectrum β-lactamases (ESBLs), high-level cephalosporinases (AmpCs) and/or carbapenemases [3, 4]; these MDROs have been included in the present surveillance recommendations
Surveillance by active surveillance cultures Active surveillance of LTCF residents for carriage of MDROs can be defined as obtaining isolates from cultures of specimens that are collected for determining if a patient is harboring a particular organism, and are not from cultures that are obtained as part of the clinical evaluation of a resident’s illness
Summary
Recommendations for the surveillance of multidrug-resistant bacteria in Italian longterm care facilities by the GLISTer working group of the Italian Association of Clinical Microbiologists (AMCLI).
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