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Antimicrobial Resistance in Long-Term–Care Facilities

Published online by Cambridge University Press:  02 January 2015

Larry J. Strausbaugh ,
Kent B. Crossley ,
Brenda A. Nurse ,
Lauri D. Thrupp  and
SHEA Long-Term–Care Committee
Larry J. Strausbaugh*
Affiliation:
Medical Service, Veterans Affairs Medical Center and Division of Infectious Diseases, Department of Medicine, School of Medicine, Oregon Health Sciences University, Portland, Oregon
Kent B. Crossley
Affiliation:
Department of Medicine, St Paul Ramsey Medical Center, St Paul, Minnesota, and Division of Infectious Diseases, Department of Medicine, University of Minnesota Medical School, Minneapolis, Minnesota
Brenda A. Nurse
Affiliation:
Hospital for Special Care, New Britain, Connecticut, and School of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut
Lauri D. Thrupp
Affiliation:
Infectious Disease Service, Department of Medicine, University of California–Irvine Medical Center and Department of Medicine, University of California–Irvine College of Medicine, Orange, California
*
Medical Service (111F), Portland VA Medical Center, PO Box 1034, Portland, OR 97207
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Abstract

During the last quarter century, numerous reports have indicated that antimicrobial resistance commonly is encountered in long-term–care facilities (LTCFs). Gramnegative uropathogens resistant to penicillin, cephalosporin, aminoglycoside, or fluoroquinolone antibiotics and methicillin-resistant Staphylococcus aureus have received the greatest attention, but other reports have described the occurrence of multiply-resistant strains of Haemophilus influenzae and vancomycin-resistant enterococci (VRE) in this setting. Antimicrobial-resistant bacteria may enter LTCFs with colonized patients transferred from the hospital, or they may arise in the facility as a result of mutation or gene transfer. Once present, resistant strains tend to persist and become endemic. Rapid dissemination also has been documented in some facilities. Person-to-person transmission via the hands of healthcare workers appears to be the most important means of spread. The LTCF patients most commonly affected are those with serious underlying disease, poor functional status, wounds such as pressure sores, invasive devices such as urinary catheters, and prior antimicrobial therapy. The presence of antimicrobial-resistant pathogens in LTCFs has serious consequences not only for residents but also for LTCFs and hospitals. Experience with control strategies for antimicrobial-resistant pathogens in LTCFs is limited; however, strategies used in hospitals often are inapplicable. Six recommendations for controlling antimicrobial resistance in LTCFs are offered, and four priorities for future research are identified.

Type
SHEA Position Paper
Information
Infection Control & Hospital Epidemiology , Volume 17 , Issue 2 , February 1996 , pp. 129 - 140
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1996

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Footnotes

*

Other members of the SHEA Long-Term–Care Committee include David W. Bentley, MD; Richard A. Garibaldi, MD; Ellen G. Neuhaus, MD; Lindsay E. Nicolle, MD; and Philip W. Smith, MD.

References

1. O'Toole, RD, Drew, WL, Dahlgren, BJ, Beaty, HN. An outbreak of methicillin-resistant Staphylococcus aureus infection. Observations in hospital and nursing home. JAMA 1970;213:257–263.10.1001/jama.1970.03170280017003Google Scholar
2. Terpenning, MS, Bradley, SF, Wan, JY, Chenoweth, CE, Jorgensen, KA, Kauffman, CA. Colonization and infection with antibiotic-resistant bacteria in a long-term care facility. J Am Geriatr Soc 1994;42:1062–1069.10.1111/j.1532-5415.1994.tb06210.xCrossRefGoogle ScholarPubMed
3. Sherman, FT, Tucci, V, Libow, LS, Isenberg, HD. Nosocomial urinary-tract infections in a skilled nursing facility. J Am Geriatr Soc 1980;28:456–461.10.1111/j.1532-5415.1980.tb01119.xGoogle Scholar
4. Garibaldi, RA, Brodine, S, Matsumiya, S. Infections among patients in nursing homes. Policies, prevalence, and problems. N Engl J Med 1981;305:731–735.10.1056/NEJM198109243051304CrossRefGoogle ScholarPubMed
5. Farber, BF, Brennen, C, Puntereri, AJ, Brody, JP. A prospective study of nosocomial infections in a chronic care facility. J Am Geriatr Soc 1984;32:499–502.10.1111/j.1532-5415.1984.tb02234.xCrossRefGoogle Scholar
6. Muder, RR, Brennen, C, Wagener, MM, Goetz, Am. Bacteremia in a long-term care facility: a five-year prospective study of 163 consecutive episodes. Clin Infect Dis 1992;14:647–654.10.1093/clinids/14.3.647Google Scholar
7. Warren, JW, Tenney, JH, Hoopes, JM, Muncie, HL, Anthony, WC. A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 1982;146:719–723.10.1093/infdis/146.6.719Google Scholar
8. Warren, JW. Providencia stuartii: a common cause of antibioticresistant bacteriuria in patients with long-term indwelling catheters. Rev Infect Dis 1986;8:61–67.10.1093/clinids/8.1.61CrossRefGoogle ScholarPubMed
9. Standfast, SJ, Michelsen, PB, Baltch, AL, et al. A prevalence survey of infections in a combined acute- and long-term care hospital. Infect Control 1984;5:177–184.10.1017/S019594170005918XCrossRefGoogle Scholar
10. Lee, Y-L, Thrupp, LD, Friis, RH, Fine, M, Maleki, P, Cesario, TC. Nosocomial infection and antibiotic utilization in geriatric patients: a pilot prospective surveillance program in skilled nursing facilities. Gerontology 1992;38:223–232.10.1159/000213332CrossRefGoogle ScholarPubMed
11. Bjork, DT, Pelletier, LL, Tight, RR. Urinary tract infections with antibiotic resistant organisms in catheterized nursing home patients. Infect Control 1984;5:173–176.10.1017/S0195941700059178CrossRefGoogle ScholarPubMed
12. Alling, B, Brandberg, A, Seeberg, S, Svanborg, A. Aerobic and anaerobic microbial flora in the urinary tract of geriatric patients during long-term care. J Infect Dis 1973;127:34–39.10.1093/infdis/127.1.34Google Scholar
13. Gerding, DN, Buxton, AE, Hughes, RA, Cleary, PP, Arbaczawski, J, Stamm, WE. Nosocomial multiply resistant Klebsiella pneumoniae: epidemiology of an outbreak of apparent index case origin. Antimicrob Agents Chemother 1979;15:608–615.10.1128/AAC.15.4.608CrossRefGoogle ScholarPubMed
14. MacArthur, RD, Lehman, MH, Currie-McCumber, CA, Shlaes, DM. The epidemiology of gentamicin-resistant Pseudomonas aeruginosa on an intermediate care unit. Am J Epidemiol 1988;128:821–827.10.1093/oxfordjournals.aje.a115035CrossRefGoogle Scholar
15. Shlaes, DM, Lehman, M-H, Currie-McCumber, CA, Kim, CH, Floyd, R. Prevalence of colonization with antibiotic resistant gram-negative bacilli in a nursing home care unit: the importance of cross-colonization as documented by plasmid analysis. Infect Control 1986;7:538–545.10.1017/S0195941700065280CrossRefGoogle Scholar
16. Flournoy, DJ. Antimicrobial susceptibilities of bacteria from nursing home residents in Oklahoma. Gerontology 1994;40:53–56.10.1159/000213575Google Scholar
17. Wingard, E, Shlaes, JH, Mortimer, EA, Shlaes, DM. Colonization and cross-colonization of nursing home patients with trimethoprim-resistant gram-negative bacilli. Clin Infect Dis 1993;16:75–81.10.1093/clinids/16.1.75Google Scholar
18. Rice, LB, Willey, SH, Papanicolaou, GA, et al. Outbreak of ceftazidime resistance caused by extended-spectrum b-lactamases at a Massachusetts chronic-care facility. Antimicrob Agents Chemother 1990;34:2193–2199.10.1128/AAC.34.11.2193Google Scholar
19. Storch, GA, Radcliff, JL, Meyer, PL, Hinrichs, JH. Methicillin-resistant Staphylococcus aureus in a nursing home. Infect Control 1987;8:24–29.10.1017/S0195941700066947CrossRefGoogle ScholarPubMed
20. Thomas, JC, Bridge, J, Waterman, S, Vogt, J, Kilman, L, Hancock, G. Transmission and control of methicillin-resistant Staphylococcus aureus in a skilled nursing facility. Infect Control Hosp Epidemiol 1989;10:106–110.10.2307/30105108Google Scholar
21. Budnick, LD, Schaefler, S, New York MRSA Study Group. Ciprofloxacin-resistant methicillin-resistant Staphylococcus aureus in New York health care facilities, 1988. Am J Public Health 1990;80:810–813.10.2105/AJPH.80.7.810Google Scholar
22. Hsu, CCS. Serial survey of methicillin-resistant Staphylococcus aureus nasal carriage among residents in a nursing home. Infect Control Hosp Epidemiol 1991;12:416–421.10.2307/30148303Google Scholar
23. Bradley, SF, Terpenning, MS, Ramsey, MA, et al. Methicillin-resistant Staphylococcus aureus: colonization and infection in a long-term care facility. Ann Intern Med 1991;115:417–422.10.7326/0003-4819-115-6-417CrossRefGoogle ScholarPubMed
24. Muder, RR, Brennen, C, Wagener, MW, et al. Methicillin-resistant staphylococcal colonization and infection in a longterm care facility. Ann Intern Med 1991;114:107–112.10.7326/0003-4819-114-2-1-107CrossRefGoogle Scholar
25. Strausbaugh, LJ, Jacobson, C, Sewell, DL, Potter, S, Ward, TT. Methicillin-resistant Staphylococcus aureus in extended-care facilities: experiences in a Veterans' Affairs nursing home and a review of the literature. Infect Control Hosp Epidemiol 1991;12:36–45.10.1086/646236Google Scholar
26. Mylotte, JM, Karuza, J, Bentley, DW. Methicillin-resistant Staphylococcus aureus: a questionnaire survey of 75 longterm care facilities in western New York. Infect Control Hosp Epidemiol 1992;13:711–718.10.2307/30146488CrossRefGoogle ScholarPubMed
27. Ward, TT, Strausbaugh, LJ. Increasing prevalence of methicillin-resistant Staphylococcus aureus in hospitals and nursing homes: the Oregon experience. Infect Med 1992;9:46–51.Google Scholar
28. Murphy, S, Denman, S, Bennett, RG, Greenough, WB III, Lindsay, J, Zelesnick, LB. Methicillin-resistant Staphylococcus aureus colonization in a long-term care facility. J Am Geriatr Soc 1992;40:213–217.10.1111/j.1532-5415.1992.tb02070.xCrossRefGoogle ScholarPubMed
29. Stover, BH, Duff, A, Adams, G, Buck, G, Hancock, G, Rabalais, G. Emergence and control of methicillin-resistant Staphylococcus aureus in a children's hospital and pediatric long-term care facility. Am J Infect Control 1992;20:248–255.10.1016/S0196-6553(05)80198-1CrossRefGoogle Scholar
30. Aeilts, GD, Sapico, FL, Canawati, HN, Malik, GM, Montgomerie, JZ. Methicillin-resistant Staphylococcus aureus colonization and infection in a rehabilitation facility. J Clin Microbiol 1982:16:218–223.10.1128/jcm.16.2.218-223.1982CrossRefGoogle Scholar
31. Thurn, JR, Belongia, EA, Crossley, K. Methicillin-resistant Staphylococcus aureus in Minnesota nursing homes. J Am Geriatr Soc 1991;39:1105–1109.10.1111/j.1532-5415.1991.tb02877.xCrossRefGoogle ScholarPubMed
32. Zervos, MJ, Terpenning, MS, Shaberg, DR, Therasse, PM, Medendorp, SV, Kauffman, CA. High-level aminoglycoside-resistant enterococci. Colonization of nursing home and acute care hospital patients. Arch Intern Med 1987;147:1591–1594.10.1001/archinte.1987.00370090069013CrossRefGoogle ScholarPubMed
33. Smith, PF, Stricof, RL, Shayegani, M, Morse, DL. Cluster of Haemophilus influenzae type b infections in adults. JAMA 1988;260:1446–1448.10.1001/jama.1988.03410100136040Google Scholar
34. Sturm, Aw, Mostert, R, Rouing, PJE, van Klingeren, B, van Alphen, L. Outbreak of multiresistant non-encapsulated Haemophilus influenzae infections in a pulmonary rehabilitation centre. Lancet 1990;335:214–216.10.1016/0140-6736(90)90291-CCrossRefGoogle Scholar
35. Choi, M, Yoshikawa, TT, Bridge, J, et al. Salmonella outbreak in a nursing home. J Am Geriatr Soc 1990;38:531–534.10.1111/j.1532-5415.1990.tb02403.xCrossRefGoogle ScholarPubMed
36. Shlaes, DM, Currie-McCumber, CA, Lehman, M-H. Introduction of a plasmid encoding the OHIO-1 β-lactamase to an intermediate care ward by patient transfer. Infect Control Hosp Epidemiol 1988;9:317–319.Google Scholar
37. Nicolle, LE, Bentley, DW, Garibaldi, RA, Neuhaus, EG, Smith, PW. Antimicrobial use in long-term–care facilities. Infect Control Hosp Epidemiol 1996;17:119–128.10.2307/30141012Google Scholar
38. Gaynes, RP, Weinstein, RA, Chamberlin, W, Kabins, SA. Antibiotic-resistant flora in nursing home patients admitted to the hospital. Arch Intern Med 1985;145:1804–1807.10.1001/archinte.1985.00360100064009Google Scholar
39. John, JE, Ribner, BS. Antibiotic resistance in long-term care facilities. Infect Control Hosp Epidemiol 1991;12:245–250.10.2307/30146999Google Scholar
40. Crossley, KB, Irvine, P, Kaszar, DJ, Loewenson, RB. Infection control practices in Minnesota nursing homes. JAMA 1985;254:2918–2921.10.1001/jama.1985.03360200070029Google Scholar
41. Price, LE, Sarubbi, FA Jr, Rutala, WA. Infection control programs in twelve North Carolina extended care facilities. Infect Control 1985;6:437–441.10.1017/S0195941700064778Google Scholar
42. Khabbaz, RF, Tenney, JH. Infection control in Maryland nursing homes. Infect Control Hosp Epidemiol 1988;9:159–162.10.2307/30145424CrossRefGoogle ScholarPubMed
43. Campbell, B. Surveillance and control of infections in longterm care: the Canadian experience. Am J Med 1991;91(suppl 3B):3B–286S–3B-288S.10.1016/0002-9343(91)90383-9Google Scholar
44. Boyce, JM, Jackson, MM, Pugliese, G, et al. Methicillin-resistant Staphylococcus aureus (MRSA): a briefing for acute care hospitals and nursing facilities. Infect Control Hosp Epidemiol 1994;15:105–115.10.2307/30145540CrossRefGoogle ScholarPubMed
45. Strausbaugh, LJ, Jacobson, C, Sewell, DL, Potter, S, Ward, TT. Antimicrobial therapy for methicillin-resistant Staphylococcus aureus colonization in residents and staff of a Veterans' Affair nursing home care unit. Infect Control Hosp Epidemiol 1992;13:151–159.10.2307/30147118CrossRefGoogle ScholarPubMed
46. Larsen, E, Bobo, L, Bennett, R, et al. Lack of caregiver hand contamination with endemic bacterial pathogens in a nursing home. Am J Infect Control 1991;19:11–15.Google Scholar
47. Lee, YL, Cesario, T, Lee, R, et al. Colonization by Staphylococcus species resistant to methicillin or quinolone on hands of medical personnel in a skilled-nursing facility. Am J Infect Control 1994;22:346–351.10.1016/0196-6553(94)90033-7Google Scholar
48. Cederna, JE, Terpenning, MS, Ensberg, M, Bradley, SF, Kauffman, CA. Staphylococcus aureus nasal colonization in a nursing home: eradication with mupirocin. Infect Control Hosp Epidemiol 1990;11:13–16.10.2307/30144250Google Scholar
49. Goodal, B, Tompkins, DS. Nursing homes act as reservoir. BMJ 1994;308:358.Google Scholar
50. Hsu, CCS, Macaluso, CP, Special, L, Hubble, RH. High rate of methicillin resistance of Staphylococcus aureus isolated from hospitalized nursing home patients. Arch Intern Med 1988;148:569–570.10.1001/archinte.1988.00380030075016Google Scholar
51. Strausbaugh, LJ, Jacobson, C, Yost, T. Methicillin-resistant Staphylococcus aureus in a nursing home and affiliated hospital: a four year perspective. Infect Control Hosp Epidemiol 1993;14:331–336.Google Scholar
52. Kauffman, CA, Terpenning, MS, He, X, et al. Attempts to eradicate methicillin-resistant Staphylococcus aureus from a longterm care facility with the use of mupirocin ointment. Am J Med 1993;94:371–378.10.1016/0002-9343(93)90147-HGoogle Scholar
53. Smith, PW, Rusnak, PG. APIC guideline for infection prevention and control in the long-term care facility. Am J Infect Control 1991;9:198–211.10.1016/0196-6553(91)90004-VCrossRefGoogle Scholar
54. Mulligan, ME, Murray-Leisure, KA, Ribner, BS, et al. Methicillin-resistant Staphylococcus aureus: a consensus review of the microbiology, pathogenesis, and epidemiology with implications for prevention and management. Am J Med 1993;94:313–328.10.1016/0002-9343(93)90063-UGoogle Scholar
55. Pennington, GR. Multiple antibiotic-resistant Staphylococcus aureus in rehabilitation and extended-care facilities: a non-problem. Aust N Z J Surg 1982;52:534–535.10.1111/j.1445-2197.1982.tb06047.xGoogle Scholar
56. Little, RJ. Staphylococcus aureus carriage in the nursing home. JAMA 1991;266:1999. Questions and Answers.10.1001/jama.266.14.1999CrossRefGoogle ScholarPubMed
57. Kauffman, CA, Bradley, SF, Terpenning, MS. Methicillin-resistant Staphylococcus aureus in long-term care facilities. Infect Control Hosp Epidemiol 1990;11:600–603.10.2307/30148435Google Scholar
58. Mylotte, JM. Control of methicillin-resistant Staphylococcus aureus: the ambivalence persists. Infect Control Hosp Epidemiol 1994;15:73–77.10.2307/30145534Google Scholar
59. Boyce, J. Methicillin-resistant Staphylococcus aureus in hospitals and long-term care facilities: microbiology, epidemiology, and preventive measures. Infect Control Hosp Epidemiol 1992;13:725–737.10.2307/30146490Google Scholar
60. Boyce, J. Methicillin-resistant Staphylococcus aureus in nursing homes: putting the problem in perspective. Infect Control Hosp Epidemiol 1991;12:413–415.10.2307/30148302Google Scholar
61. Simor, AE, Augustin, A, Ng, J, Betschel, S, McArthur, M. Control of MRSA in a long-term care facility. Infect Control Hosp Epidemiol 1994;15:69–70.10.2307/30145531CrossRefGoogle ScholarPubMed
62. Mylotte, JM. Methicillin-resistant Staphylococcus aureus in long-term care facilties. Infect Control Hosp Epidemiol 1991;12:274–276.10.2307/30145192Google Scholar
63. Bradley, SF. MRSA in long-term care: fact, fiction, and controversy. Infect Dis Clin Pract 1994;3:321–326.10.1097/00019048-199407000-00025Google Scholar
64. Gross, PA, Barrett, TL, Dellinger, EP, et al. Purpose of quality standards for infectious diseases. Clin Infect Dis 1994;18:421.10.1093/clinids/18.3.421CrossRefGoogle ScholarPubMed
65. Spindle, SJ, Strausbaugh, LJ, Jacobson, C. Infections caused by Staphylococcus aureus in a Veterans' Affairs nursing home care unit: a five year experience. Infect Control Hosp Epidemiol 1995;16:217–223.10.2307/30140981CrossRefGoogle Scholar