Major article
Prevalence of methicillin-resistant Staphylococcus aureus and Acinetobacter baumannii in a long-term acute care facility

https://doi.org/10.1016/j.ajic.2008.01.003Get rights and content

Background

Patients in long-term acute care (LTAC) facilities often have many known risk factors for acquisition of antibiotic-resistant bacteria. However, the prevalence of resistance in these facilities has not been well described.

Methods

We performed a single-day, point-prevalence study of a 180-bed, university-affiliated LTAC facility in Baltimore to assess the prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and Acinetobacter baumannii in the anterior nares, perirectal area, sputum, and wounds.

Results

Among the 147 patients evaluated, we found a high prevalence of colonization by both MRSA (28%) and A baumannii (30%). Of the A baumannii isolates, 90% were susceptible to imipenem and 92% were susceptible to ampicillin-sulbactam. No isolates were resistant to both imipenem and ampicillin-sulbactam.

Conclusion

The high prevalence of resistance found in this study supports the need for increased surveillance of patients in the LTAC environment. The fact that these patients are often frequently transferred to tertiary care facilities also supports the need for coordination and collaboration among facilities within the same health care system and the broader geographic area.

Section snippets

Study population and data collection

This study was approved by the University of Maryland Baltimore's Institutional Review Board. On December 20, 2005, we completed a point prevalence study of a 180-bed, university-affiliated LTAC facility in Baltimore as part of an ongoing quality improvement and infection control initiative within the University of Maryland Medical System. During the study period, the facility did not use active surveillance for any organism. Patients with positive clinical cultures for MRSA,

Results

There were 147 patients in the facility on the study date. Characteristics of the study population are given in Table 1. The mean age was 52 years, and 61% of the population was male. The median length of stay was 91 days, and the median duration from the date of admission to the study date was 33 days. Diabetes mellitus, heart failure, and renal disease were the most prevalent comorbid conditions, at 25%, 20%, and 19%, respectively. Some 55% of the patients had been admitted to the affiliated

Discussion

Our data suggest a high prevalence of MRSA and A baumannii during a single-day point-prevalence study at an LTAC. The prevalence of MRSA far exceeded that in patients admitted to the general medical and surgical wards, medical and surgical intensive care units, and correctional health unit of the affiliated university hospital (7%, 6%, and 13%, respectively).2, 3, 6 The proportion of A baumannii isolates resistant to commonly used antibiotics was low, notwithstanding several recent reports of

References (13)

There are more references available in the full text version of this article.

Cited by (77)

  • Multidrug-Resistant Gram-Negative Bacteria: Infection Prevention and Control Update

    2021, Infectious Disease Clinics of North America
    Citation Excerpt :

    CRPA infections in this setting have been associated with intermittent urethral catheterization, chronic indwelling urinary catheters, and postsurgical drains.36,37 CRAB have been detected among ventilated patients in long-term acute-care hospitals (LTACHs) and also in LTCFs in general.38,39 Importantly, Acinetobacter spp. may persist on dry inanimate surfaces for days to months.40

  • High Prevalence of Multidrug-Resistant Organism Colonization in 28 Nursing Homes: An “Iceberg Effect”

    2020, Journal of the American Medical Directors Association
    Citation Excerpt :

    This is especially important for CRE, which was first noted in Southern California in 2009. We note, however, that our other MDRO findings are similar to previous smaller studies conducted in California, Illinois, Maryland, Massachusetts, Michigan, and Washington.3,11–14,16,17,20,21,25,27,28 In addition, our efforts to determine a history of MDRO were limited to NH medical records and transfer records.

  • Persistent nasal carriers of Acinetobacter baumannii in long-term-care facilities

    2017, American Journal of Infection Control
    Citation Excerpt :

    Our study highlights the importance of determining the nasal carriage status of LTCF residents and their health care workers in Taiwan. In this study, the 8.3% nasal carriage rate of S aureus among the elderly sick group at LTCFs was lower than previously reported.18,19 To our surprise, a 91.7% nasal carriage rate for A baumannii was found among the elderly sick group at LTCFs, which far exceeded the rate among patients admitted to acute care hospitals (6%-13%).20

  • Multidrug-Resistant Gram-Negative Bacilli: Infection Control Implications

    2016, Infectious Disease Clinics of North America
    Citation Excerpt :

    Instituting a comprehensive plan to reduce catheter-associated urinary tract infection and late surgical site infections may curb the emergence and spread of CRPA in these facilities.71,72 CRAB have been detected among ventilated patients in LTACs but also in general LTCFs.73,74 A report from Northeast Ohio illustrated the clonal expansion of a blaOXA-23–producing CRAB in outpatient settings.75

View all citing articles on Scopus

These data were presented in part at the 47th Interscience Conference on Antimicrobial Agents and Chemotherapy, Chicago, IL.

This work was supported by National Institutes of Health grants 1K12RR02350-01 (to J.P.F.), P60 AG12583 (to R.R.M), and K23 AI01752-01A1 and R01 AI60859-01A1 (to A.D.H.) and US Department of Veterans Affairs grants RCD-02-026-2 and IIR-05-123-1 (to E.N.P.).

View full text