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Multidrug-Resistant Gram-Negative Bacteria in a Long-Term Care Facility: Prevalence and Risk Factors

Authors

  • Aurora Pop-Vicas MD, MPH,

    1. From the *Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsHebrew Senior Life Institute for Aging Research, Boston, Massachusetts.
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  • Susan L. Mitchell MD, MPH,

    1. From the *Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsHebrew Senior Life Institute for Aging Research, Boston, Massachusetts.
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  • Ruth Kandel MD,

    1. From the *Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsHebrew Senior Life Institute for Aging Research, Boston, Massachusetts.
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  • Robert Schreiber MD,

    1. From the *Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsHebrew Senior Life Institute for Aging Research, Boston, Massachusetts.
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  • Erika M. C. D'Agata MD, MPH

    1. From the *Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MassachusettsHebrew Senior Life Institute for Aging Research, Boston, Massachusetts.
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Address correspondence to Erika D'Agata, MD MPH, Beth Israel Deaconess Medical Center, Division Infectious Diseases, 330 Brookline Ave, East Campus Mailstop SL-435G, Boston, MA 02215. E-mail: edagata@bidmc.harvard.edu

Abstract

OBJECTIVES: To quantify the prevalence, risk factors, and mode of transmission associated with colonization by multidrug-resistant gram-negative bacteria (MDRGN) in the long-term care (LTC) setting.

DESIGN: Cross-sectional.

SETTING: Four nursing units in a 648-bed LTC facility in Boston, Massachusetts.

PARTICIPANTS: Eighty-four long-term care residents.

MEASUREMENTS: Nasal and rectal swabs were obtained to determine colonization with MDRGN; if present, molecular typing was performed. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) was also determined. Demographic and clinical characteristics were obtained from the medical record. Multivariable analysis was used to identify factors independently associated with MDRGN colonization.

RESULTS: A total of 51%, 28%, and 4% subjects were colonized with MDRGN, MRSA, and VRE, respectively. After multivariable adjustment, advanced dementia (adjusted odds ratio (AOR)=2.9, 95% confidence interval (CI)=1.2–7.35, P=.02) and nonambulatory status (AOR=5.7, 95% CI=1.1–28.9, P=.04) were the only independent risk factors for harboring MDRGN. Molecular typing indicated person-to-person transmission.

CONCLUSION: Colonization with MDRGN is common in the LTC setting. A diagnosis of advanced dementia is a major risk factor for harboring MDRGN.

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