The Investigation of Multi-Drug Resistant Bacteria Colonization in Geriatric Population in A Turkish Nursing Home

The Investigation of Multi-Drug Resistant Bacteria Colonization in Geriatric Population in a Nursing Home

Background: Nursing homes act as a reservoir for Multi drug resistant (MDR) bacteria. The aim of this study is to determine the frequency of nasal axillary and rectal colonization of MDR bacteria and risk factors for the colonization in elderly people living in a nursing home.

Methods: This is a cross-sectional prospective study. Residents (> 65 years) signed the consent form were included. Demographical data and accessible risk factors of the residents were recorded. Also instrumental activity daily scale and activities of daily living scale forms of the residents were used. Nasal and axillary swabs were examined for Methicillin resistant Staphylococcus aureus (MRSA) colonization and rectal swabs were examined for Vancomycin resistant enterococci (VRE), Extended spectrum beta-lactamases producing Enterobacteriaceae(ESBL-E) and carbapenemase-producing K. pneumoniae colonization.

Results: 247 axillary, 246 nasal and 245 rectal swabs from 247 residents were obtained. Median age was 85 ± 6.7 years and 190 (77%) of residents were female. The swab samples taken from 75 (30%) residents were isolated as S. aureus, 8 (3.2%) of them were MRSA. Perianal carriage for VRE (E. faecium MIC ≥ 4 mg/L) was found in 10 (4.1%) residents. ESBL-producing bacteria were isolated from 17 (6.9%) of the residents (14 Escherichia coli and 3 Klebsiella pneumoniae). In only one resident (0.4%) carbapenemase-producing K. pneumoniae was detected. Colonization with multiple MDR bacteria was found in 3 (1.2%) residents. The risk factors are defined in Table 1.

Conclusion: In the study, colonization with MDR bacteria rate was 32 (12.9%) and colonization rate increases as the activity of daily living scale increase (p=0.004). Therefore, risk factors should be considered and surveillance analysis should be done to manage infections caused by MDR bacteria in nursing homes.

Table 1. Presence of risk factors for MDR bacteria

Risk factors	Colonized (n=32)	Noncolonized (n=215)	P
Antibiotic use	9(28.1)	23 (10.8)	0.006
Skin lesions	2(6.3)	6(2.8)	0.619
Hospitalization in last 3 months	3 (9.4)	8(3.8)	0.323
Malignancy	5(15.6)	11(5.2)	0.024
Dementia	25 (78.1)	134 (62.9)	0.082
Ýmmobility	19(59.4)	65(30.5)	0.001
Enteral support	10(31.2)	22(10.3)	0.0009
PEG	3(9.4)	4(1.9)	0.06