Te-Din Huang: National Reference Centre for antibiotic resistant Gram-negative bacilli, Laboratory of Clinical Microbiology, Centre hospitalier universitaire de Namur, Université catholique de Louvain, Yvoir, Belgium.
Catherine Berhin: National Reference Centre for antibiotic resistant Gram-negative bacilli, Laboratory of Clinical Microbiology, Centre hospitalier universitaire de Namur, Université catholique de Louvain, Yvoir, Belgium.
Pierre Bogaerts: National Reference Centre for antibiotic resistant Gram-negative bacilli, Laboratory of Clinical Microbiology, Centre hospitalier universitaire de Namur, Université catholique de Louvain, Yvoir, Belgium.
Audrey Noel: National Reference Centre for antibiotic resistant Gram-negative bacilli, Laboratory of Clinical Microbiology, Centre hospitalier universitaire de Namur, Université catholique de Louvain, Yvoir, Belgium.
Claire Nonhoff: National Reference Centre for methicillin-resistant Staphylococcus aureus and staphylococci, Department of Clinical Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Magali Dodémont: National Reference Centre for methicillin-resistant Staphylococcus aureus and staphylococci, Department of Clinical Microbiology, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium.
Olivier Denis: Ecole de Santé Publique, Université Libre de Bruxelles, Brussels, Belgium.
Margareta Ieven: National Reference Centre for vancomycin-resistant enterococci, Department of Clinical Microbiology, University Hospital of Antwerp, Edegem, Belgium.
Katherine Loens: National Reference Centre for vancomycin-resistant enterococci, Department of Clinical Microbiology, University Hospital of Antwerp, Edegem, Belgium.
Didier Schoevaerdts: Department of Geriatric Medicine, Centre hospitalier universitaire de Namur, Université catholique de Louvain, Mont-Godinne, Belgium.
Youri Glupczynski: National Reference Centre for antibiotic resistant Gram-negative bacilli, Laboratory of Clinical Microbiology, Centre hospitalier universitaire de Namur, Université catholique de Louvain, Yvoir, Belgium.
OBJECTIVES: Following two studies conducted in 2005 and 2011, a third prevalence survey of multidrug-resistant microorganisms (MDRO) was organised in Belgian nursing homes (NHs) using a similar methodology. The aim was to measure the prevalence of carriage of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum β-lactamase producing Enterobacteriaceae (ESBLE) and carbapenemase-producing Enterobacteriaceae (CPE) in NH residents. Risk factors for MDRO carriage were also explored. METHODS: Up to 51 randomly selected residents per NH were screened for MDRO carriage by trained local nurses between June and October 2015. Rectal swabs were cultured for ESBLE, CPE and VRE, while pooled samples of nose, throat and perineum and chronic wound swabs were obtained for culture of MRSA. Antimicrobial susceptibility testing, molecular detection of resistance genes and strain genotyping were performed. Significant risk factors for MDRO colonization MDRO was determined by univariate and multivariable analysis. RESULTS: Overall, 1447 residents from 29 NHs were enrolled. The mean weighted prevalence of ESBLE and MRSA colonization was 11.3% and 9.0%, respectively. Co-colonization occurred in 1.8% of the residents. VRE and CPE carriage were identified in only one resident each. Impaired mobility and recent treatment with fluoroquinolones or with combinations of sulphonamides and trimethoprim were identified as risk factors for ESBLE carriage, while for MRSA these were previous MRSA carriage/infection, a stay in several different hospital wards during the past year, and a recent treatment with nitrofuran derivatives. Current antacid use was a predictor for both ESBL and MRSA carriage. CONCLUSIONS: In line with the evolution of MRSA and ESBL colonization/infection in hospitals, a decline in MRSA carriage and an increase in ESBLE prevalence was seen in Belgian NHs between 2005 and 2015. These results show that a systemic approach, including surveillance and enhancement of infection control and antimicrobial stewardship programs is needed in both acute and chronic care facilities.
