Trend of multidrug-resistant pathogens in critically ill patients transferred from long-term care facilities: A single ICU study, South Korea

Background: Experience of Middle East Respiratory Syndrome leads Korean to worry about the hidden spread of infectious pathogens between hospitals. Although long-term care facilities (LTCFs) have been geometrically increased in Korea, little is known about status of multidrug-resistant (MDR) pathogens in LTCFs.

Methods: We investigated LTCFs patients who were transferred to intensive care unit (ICU) of Kangnam Sacred Heart Hospital between January 2010 and December 2014. Carriage rate of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin resistant Enterococci (VRE) and carbapenem-resistant Enterobactericeae (CRE) was calculated in all patients. Patients with infection were also explored for causative pathogens including MRSA, VRE, CRE, extended spectrum beta lactamase (ESBL)-producing Enterobactericeae, carbapenem-resistant Acinetobacter baumannii (CRAB), carbapenem-resistant Pseudomonas aeruginosa (CRPA).

Results: The MRSA carriage rate was over 20% during the study period peaking in 2011 as 39.7%. The VRE carriage rate increased steadily from 2011 to 2014 with 6.9% to 19.2%. Surveillance study of CRE was started from 2013, and the rate was maintained at approximately 10.0%. Regarding causative pathogens for infection, overall proportion of MDR pathogens was dramatically increased from 30.8% in 2010 and the highest as 61.7% in 2013. The main pathogen was ESBL-producing Enterobactericeae except in 2011 when MRSA (14.8%) was the highest. Throughout five years, overall in-hospital mortality was 29.8%. Of mortality cases, the proportion of MDR infection was 40.3%. The appropriateness of the empirical antibiotics was only 57.0%.

Conclusion: MDR pathogens seems to be already prevalent in Korean LTCFs. Considering high mortality rate in critically ill patients with MDR infection, it is needed to investigate infection control practice in LTCFs on the national level.