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American journal of infection control
04, 2019;47 (4): 415-420.

Predictors of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci co-colonization among nursing facility patients.

Kevin Heinze, Mohammed Kabeto, Emily Toth Martin, Marco Cassone, Liam Hicks, Lona Mody
Author Information
  1. Kevin Heinze: University of Michigan Medical School, Ann Arbor, MI. Electronic address: kheinze@umich.edu.
  2. Mohammed Kabeto: Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI.
  3. Emily Toth Martin: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.
  4. Marco Cassone: Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI.
  5. Liam Hicks: Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI.
  6. Lona Mody: Department of Internal Medicine, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, MI; Geriatrics Research Education and Clinical Center, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, MI.
PMID: 30502107 DOI: 10.1016/j.ajic.2018.09.026

Abstract

BACKGROUND: The emergence of vancomycin-resistant Staphylococcus aureus (VRSA) poses significant challenges for antibiotic therapy. We characterized the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) co-colonization that may facilitate resistance transfer and vancomycin-resistant S aureus emergence among nursing facility patients.
METHODS: We cultured newly admitted patient hands, nares, oropharynx, groin, and perianal region plus wounds and device insertion sites, if applicable, upon enrollment at day 14, day 30, and monthly follow-up up to 6 months. Demographic, comorbidity, and antimicrobial use data were collected. Functional status was assessed at each visit using the Physical Self-Maintenance Scale. Multinomial logistic regression was performed to determine factors predictive of co-colonization.
RESULTS: Five hundred eight patients were enrolled, with an average follow-up time of 28.5days. Prevalence of MRSA/VRE co-colonization, MRSA alone, and VRE alone was 8.7%, 8.9%, and 23.4%, respectively. Independent predictors of co-colonization included indwelling device use (odds ratio [OR] = 5.5 [2.2-13.7]), recent antibiotic use (OR = 2.5 [1.4-4.2]), diabetes (OR = 1.9 [1.0-3.8]), and the presence of open wounds (OR = 1.9 [1.0-3.6]).
CONCLUSIONS: High rates of VRE are driving co-colonization with MRSA in nursing facilities. Indwelling device use, recent antibiotic use, diabetes, and open wounds predicted patient co-colonization.

Keywords

Antibiotic Resistance Infection control MDRO Nursing homes

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Grants

  1. K24 AG050685/NIA NIH HHS
  2. P30 AG024824/NIA NIH HHS
  3. R01 AG041780/NIA NIH HHS

MeSH Term

Aged
Aged, 80 and over
Carrier State
Clinical Decision Rules
Coinfection
Cross Infection
Follow-Up Studies
Gram-Positive Bacterial Infections
Humans
Male
Methicillin-Resistant Staphylococcus aureus
Middle Aged
Nursing Homes
Prevalence
Prospective Studies
Risk Factors
Vancomycin-Resistant Enterococci
Journal Article Research Support, N.I.H., Extramural
Article has an altmetric score of 10

Word Cloud

Created with Highcharts 10.0.0co-colonizationusevancomycin-resistantaureusStaphylococcusantibioticMRSAVREnursingpatientswoundsdevice[1emergencemethicillin-resistantenterococciamongfacilitypatientdayfollow-upalone85recentdiabetesOR = 190-3openBACKGROUND:VRSAposessignificantchallengestherapycharacterizedepidemiologymayfacilitateresistancetransferSMETHODS:culturednewlyadmittedhandsnaresoropharynxgroinperianalregionplusinsertionsitesapplicableuponenrollment1430monthly6monthsDemographiccomorbidityantimicrobialdatacollectedFunctionalstatusassessedvisitusingPhysicalSelf-MaintenanceScaleMultinomiallogisticregressionperformeddeterminefactorspredictiveRESULTS:Fivehundredeightenrolledaveragetime285daysPrevalenceMRSA/VRE7%9%234%respectivelyIndependentpredictorsincludedindwellingoddsratio[OR] = 5[22-137]OR = 24-42]8]presence6]CONCLUSIONS:HighratesdrivingfacilitiesIndwellingpredictedPredictorsAntibioticResistanceInfectioncontrolMDRONursinghomes

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