517. Prevalence of Multi-Drug Resistant Organisms (MDRO) in Patients Admitted From Long Term Care Facilities (LTCF)
Session: Poster Session: Hospital-acquired and Transplant Infections
Friday, October 30, 2009: 12:00 AM
Room: Poster Hall A
Background: The prevalence of infections due to MDRO in LTCF is estimated to range from 1.6 and 3.8 million per year, with even higher colonization rates. Few studies have prospectively addressed the prevalence of colonization and infection in patients from LTCF admitted to acute care hospitals, other than in outbreak settings.
Methods: A prospective study was undertaken at our 920 bed tertiary care hospital to evaluate the burden of MDRO in patients admitted from LTCF to general wards (not ICU). Admissions from LTCF from 10/08 through 12/08 screened for MDRO were evaluated; screening consisted of nasal swab for methicillin resistant S. aureus (MRSA), rectal swab for vancomycin resistant Enterococcus (VRE), respiratory specimen for carbapenem resistant Acinetobacter (MDRAB) and extended spectrum β-lactamase (ESBL) producing organisms. MDRO colonization and infection were determined according to CDC guidelines.
Results: 202 admissions (125 patients) from LTCF were screened; 104/125 (83.2%) patients had either MDRO colonization, infection, or both, upon admission. In contrast, the overall MDRO prevalence was 7% of all non-ICU admissions screened during the same period. Of LTCF patients with MDRO, 47/125 (37.6%) had MRSA, 45/125 (36%) had VRE, 2/125 (1.6%) had MDRAB, and 10/125 (8%) presented with ESBL. Infection at admission was documented in 14/125 (11.2%), 3 MRSA, 5 VRE, 1 MDRAB and 5 ESBL.
Conclusion: The value of this screening program is reflected in the fact that 94% of the study patients had no known prior history of MDRO. Despite the high prevalence of MDRO found in this descriptive epidemiological study of LTCF admissions to non-ICU wards, the subsequent effects of MDRO carriage are unclear in this setting. A second phase of the study will be undertaken over the next six months, where a cohort of LTCFs will implement specific infection control interventions according to recently published guidelines. Specific outcomes including mortality rates, length of stay, readmissions, and infection and colonization rates between the intervention group and a control group will be measured.
Rekha Murthy, MD, Tuan Ta, MD, Cedars Sinai Medical Center, Los Angeles, CA and  T. Ta, None. 
R. Murthy,
Merck Role(s): Investigator, Received: Research Grant.
Wyeth Ayerst Role(s): Speaker's Bureau, Received: Speaker Honorarium.