1543. Burden of Antibiotic Resistance in Long-Term Care Settings: A Systematic Review of the Literature
Session: Poster Abstract Session: Infections in Non-Acute Healthcare Settings
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • Poster_IDWeek_LTC.pdf (704.4 kB)
  • Background: Elderly residents of long-term care (LTC) are at increased risk of colonization with multi-drug resistant organisms (MDRO). However, there is paucity of data on the overall burden of MDRO colonization in this setting. The purpose of this review is to estimate the prevalence and/or incidence of colonization with MDRO in LTC.

    Methods: Relevant studies were identified through a systematic search in MEDLINE and review of reference lists of identified articles. To establish clarity and standardized reporting of findings, the Preferred Reporting Items for Systematic Reviews and Meta-Analysis checklist was used. Data extracted included design, setting, study period and size, sampling method, organism studied, screening procedure, sampling sites, and prevalence or incidence of colonization.

    Results: 41 articles met criteria for inclusion; of these, 24 (59%) were conducted in Europe and 8 (20%) in the U.S.  Ten (24%) were single site (42 to 270 participants) and 31 (76%) were multisite ranging from 2 to 69 facilities (79 to 3236 participants). Studies focusing on single organisms examined methicillin-resistant Staphylococcus aureus (MRSA) (25), multi-drug resistant gram negative bacteria (MDR GNBs) (5), vancomycin-resistant enterococcus (VRE) (2), C. difficile (3), H. influenzae (1); 5 examined multiple organisms (4 MRSA and C. diff,  5 MDR GNBs and VRE). All estimated prevalence; in addition, 3 examined new colonization/incidence. The majority were cross-sectional (85%) and included all eligible residents (78%).  Reported prevalence of MRSA colonization varied from 11-63% in the U.S. and 0-34% in Europe. In 12 (41%) studies only nasal cultures were collected. The prevalence of VRE and C. diff colonization ranged from <1% to 18% and 1% to 17% respectively. Studies of MDR GNBs examined different organisms: MDR GNBs overall, MDR E. coli, extended spectrum β lactamase-producing organisms, and GNB resistant to ciprofloxacin or ceftazidime.

    Conclusion: Prevalence of colonization varied greatly which may be due to differences in prevalence across geographic regions as well as methodological differences between studies. Standardization of surveillance methods and outcomes is needed to allow for comparisons between different settings.

    Monika Pogorzelska-Maziarz, PhD, MPH, Columbia University School of Nursing, New York, NY, Kimberly Alvarez, MPH, Columbia University Mailman School of Public Health, New York, NY and Elaine Larson, PhD, RN, FIDSA, FSHEA, School of Nursing, Columbia University Medical Center, New York, NY


    M. Pogorzelska-Maziarz, None

    K. Alvarez, None

    E. Larson, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.