The burden of multidrug-resistant organisms on tertiary hospitals posed by patients with recent stays in long-term acute care facilities

Background Long-term acute care (LTAC) facilities admit patients with complex, advanced disease states. Study aims were to determine the burden posed on hospitals associated with LTAC exposure and analyze the differences between “present on admission” (POA) multidrug-resistant (MDR), gram-negative o...

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Bibliographic Details
Published in:American journal of infection control 2012-10, Vol.40 (8), p.760-765
Main Authors: Marchaim, Dror, MD, Chopra, Teena, MD, Bogan, Christopher, BS, Bheemreddy, Suchitha, MD, Sengstock, David, MD, MS, Jagarlamudi, Rajasekhar, MD, Malani, Anurag, MD, Lemanek, Leslie, BS, Moshos, Judy, BS-MT, Lephart, Paul R., PhD, Ku, Kimberley, BS, Hasan, Asma, BS, Lee, Jiha, MD, Khandker, Namir, BS, Blunden, Christopher, BS, Geffert, Sara F., MS, Moody, Megan, BS, Hiro, Rahbar, BS, Wang, Yujing, BS, Ahmad, Farah, MD, Mohammadi, Tarana, BS, Faruque, Omar, BS, Patel, Diixa, MD, Pogue, Jason M., PharmD, Hayakawa, Kayoko, MD, PhD, Dhar, Sorabh, MD, Kaye, Keith S., MD, MPH
Format: Article
Language:English
Subjects:
Acinetobacter baumannii
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - pharmacology
Antibacterial agents
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antimicrobial resistance
Bacteria
Biological and medical sciences
Cell culture
Cohort Studies
CRE
Cross Infection - epidemiology
Cross Infection - microbiology
Cross Infection - prevention & control
Disease control
Drug resistance
Drug Resistance, Multiple, Bacterial
Gram-Negative Bacteria - drug effects
Gram-Negative Bacteria - isolation & purification
Gram-Negative Bacterial Infections - drug therapy
Gram-Negative Bacterial Infections - epidemiology
Gram-Negative Bacterial Infections - microbiology
Gram-Positive Bacteria - drug effects
Gram-Positive Bacteria - isolation & purification
Gram-Positive Bacterial Infections - drug therapy
Gram-Positive Bacterial Infections - epidemiology
Gram-Positive Bacterial Infections - microbiology
Hospitals
Humans
Infection Control
Infections upon admission
Infectious Disease
Long term health care
Long-Term Care
LTAC
MDR
Medical sciences
Michigan - epidemiology
Middle Aged
Multidrug resistant organisms
Patient admissions
Pharmacology. Drug treatments
Renal Dialysis
Retrospective Studies
Tertiary Care Centers
Young Adult
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Summary:Background Long-term acute care (LTAC) facilities admit patients with complex, advanced disease states. Study aims were to determine the burden posed on hospitals associated with LTAC exposure and analyze the differences between “present on admission” (POA) multidrug-resistant (MDR), gram-negative organisms (GNO) and POA MDR gram-positive organisms (GPO). Methods A multicenter retrospective study was conducted in 13 hospitals from southeast Michigan, from September 1, 2008, to August 31, 2009. Cultures obtained in the first 72 hours of hospitalization (ie, POA) of MDR-GPO and MDR-GNO were reviewed. LTAC exposures in the previous 6 months and direct admission from a LTAC were recorded. Results Overall, 5,297 patients with 7,147 MDR POA cultures were analyzed: 2,619 (36.6%) were MDR-GNO, and 4,528 (63.4%) were MDR-GPO. LTAC exposure in the past 6 months was present in 251 (5.2%) infectious episodes and was significantly more common among POA MDR-GNO than MDR-GPO (158 [8.6%] and 94 [3.1%], respectively, odds ratio, 2.87; P < .001). Recent LTAC exposure was strongly associated with both carbapenem-resistant Enterobacteriaceae (CRE) (31.6% of all CRE cases, P < .001) and Acinetobacter baumannii (14.9% of all A baumannii cases, P < .001). Conclusion Nearly 10% of MDR-GNO POA had recent LTAC exposure. Hospital efforts to control the spread of MDR-GNO should focus on collaborations and communications with referring LTACs and interventions targeted towards patients with recent LTAC exposure.
ISSN:0196-6553
1527-3296
DOI:10.1016/j.ajic.2011.09.011