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Risk factors for colonization with MRSA and ESBLE among a random sample of residents screened within 29 Belgian nursing homes, 2015: Results from univariate analysis
Source publication
Objectives
Following two studies conducted in 2005 and 2011, a third prevalence survey of multidrug-resistant microorganisms (MDRO) was organised in Belgian nursing homes (NHs) using a similar methodology. The aim was to measure the prevalence of carriage of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE),...
Similar publications
Carbapenem-Resistant Enterobacteriaceae (CRE) is a worldwide urgent public health problem. Similar to other countries, Saudi Arabia is facing the challenge of increasingly reported cases of CRE. The aim of this review is to bring and update on the prevalence, epidemiology and microbiological characteristics of CRE reported from Saudi Arabia.
Citations
... Although no direct transmission was observed due to the lack of bacterial or plasmid linkage between residents and environment, the predominance of bla NDM Klebsiella pneumoniae in CPE-positive environmental samples (with only one exception), combined with the fact that five of the six known CPE carriers were known to carry NDM, suggests a potential indirect role of the environment in CPE transmission. Compared to previous studies in Europe, where CPE prevalence in nursing homes was found to be low at less than 0.1%, [15,16] the prevalence of known CPE carriers in the study site was 4.1% (7 residents out of a total of 172 residents) (Fig. 1). However, only one of the seven known CPE carriers remained positive during this study. ...
Background
In 2018, Singapore’s National Infection Prevention & Control Committee (NIPC) recommended standard precautions and unrestricted movements for CPE carriers in nursing homes.
Objective
This study investigates the short-term impact of this intervention on CPE transmission in a nursing home in Singapore.
Methods
We conducted a prospective cohort study between 1st April and 11th July 2019 in a 255-bedded nursing home in Singapore. Stool samples from residents and environmental samples from sink strainers in the residents’ bedrooms, bathrooms, and lavatories, and shower drain traps in bathrooms were collected at baseline, week 2, week 8, and week 12 and tested for CPE. We performed whole genomic sequencing (WGS) to find out if there was any bacterial or plasmid linkage among the residents and between the residents and environment.
Results
A total of 32 residents, including six known CPE carriers, were recruited and completed the three-month follow-up visits. Of the six known CPE carriers, five tested negative for CPE, while one consistently tested positive for CPE throughout the study. Of the 28 sink strainers, six (21.43%) were positive for CPE. CPE was not detected in any shower drain trap throughout the study. Only one resident acquired CPE at week 12. WGS analysis of available CPE isolates showed no bacterial or plasmid linkage between residents or between residents and the environment.
Conclusions
Standard precautions and unrestricted movement of CPE carriers may be sufficient to control CPE transmission in the nursing home setting. Larger studies with more extensive environmental sampling and longer follow-up periods are needed to confirm this.
... Enterobacteriaceae are recognized as one of the most basic public health problems globally due to the unexpected resistance character of these strains, even to the last classes of antibiotics [12]. Most of the ESBLs break down antibiotics such as penicillin and cephalosporin and alter their activity, which causes infections caused by ESBL-PE and carbapenemaseproducing Enterobacteriaceae (CPE) are more challenging to manage (2,13).Carriage has become more common over the previous ten years. of ESBL and infection with multidrugresistant organisms (MDROs) such as ESBL-PE and CPE (14,15). ESBL-PE and CPE pose a serious antibiotic management problem, as these genes are easily transferred from one organism to the other via plasmids. ...
... Data were collected retrospectively by analysing patient records. Data on the site of carriage and factors influencing the risk of MRSA carriage were collected [12,13,18,19]. To identify MRSA carrier status, data for combined nasopharyngeal and perineal swabs and an additional swab of clinical site (i.e. ...
... Compared with studies conducted in geriatric care units alone (4.6e14.6%), the prevalence observed in this study was also low overall [20,22,23]. According to Belgian national data, a substantial decrease has been noted in MRSA carriage in acute hospitals (1.1 in 2007 to 0.4 per 100 admissions) and nursing homes (19.0% in 2005 to 9.0% in 2015) in recent years, and this decrease also seems to be reflected in the present study sample [19,24,25]. However, even in this sample from a single province in Belgium, there was significant variation in the prevalence of MRSA on admission depending on the hospital (1.1e6.9%). ...
Summary
Objectives
Universal screening for MRSA entails additional costs and there is no consensus for targeted screening for high-risk units. The aims of this study were to determine the prevalence of MRSA in geriatric care units and to identify the factors associated with this colonisation on admission.
Methods
This was a retrospective case-control study (1:1) in the geriatric care unit of six Belgian hospitals from 1 January, 2021 to 31 December, 2022. Cases were patients with a positive MRSA screening result within 48 hours of admission to the geriatric care unit and controls were patients with a negative screening result.
Results
A total of 556 patients were included, 278 in each group. Prevalence per 100 admissions for the total sample was 2.3 (95%CI: 2.2-2.6). Significant multivariate factors associated with MRSA carriage on admission were history of MRSA, nursing home origin, and chronic skin lesions. Applying these three factors would give an area under the ROC curve of 0.73 (0.71-0.77) and would allow screening to be carried out in only 55.4% of cases (51.2%-59.6%).
Conclusions
Using these factors as screening criteria in geriatric care units could significantly reduce the number of patients screened for MRSA while maintaining satisfactory sensitivity and specificity.
... as a similar study carried out by our research group in 2014 [14]. In the literature, the prevalence of MRSA in LTCFs exhibits significant variability worldwide, showing large geographical differences [2,[15][16][17][18][19][20][21][22][23]. The highest prevalence has been reported in studies from Asia, some of them reaching a rate of 65% [24,25]. ...
Methicillin-resistant Staphylococcus aureus (MRSA) colonization has been considered a risk factor for the development of infection, however, there are no studies that have compared the colonizing and infecting strains using whole-genome sequencing (WGS). The aim of this study is to determine the prevalence of and risk factors for MRSA colonization among long-term care facilities (LTCF) residents of Tenerife (Spain), and to analyze the epidemiological relationship between the colonizing and infecting strains using WGS. A point-prevalence study was carried out at 14 LTCFs in Tenerife from October 2020 to May 2021. Nasal swabs were cultured for MRSA. Colonized residents were followed up for two years. A phylogenetic comparison between colonization and infection strains was performed using WGS. A total of 764 residents were included. The prevalence of colonization by MRSA was 28.1% (n = 215), of which 12 (5.6%) subsequently developed infection. A close genetic relationship between colonization and infection isolates was found in three of the four (75%) residents studied. Our study confirms that colonized residents can develop serious MRSA infections from the same nasal colonization strain. Given the high prevalence of MRSA colonization in these centers, it is necessary to implement strategies with preventive measures to avoid the development of infection and the transmission of MRSA.
... The prevalence of ESBL-E was found to be 11.4% in participating hospitals and 14.0% in NHs. Notably, the NH data indicates a rising trend in ESBL-E carriage, with rates increasing from 6.2% in 2011 to 11.3% in 2015 [4]. This upward trajectory may also be observed in Belgian hospitals, as evidenced by a noteworthy increase in the occurrence of ESBL-E. ...
... Unlike ESBL-E, CPE's were not detected in the studied NHs, which is in line with previous Belgian studies conducted in NHs in 2011 [8] and 2015 [4]. In contrast to NHs, CPE could be detected in the hospitals with a mean prevalence of 1% and predominance of K. pneumoniae harbouring bla OXA-48 in line with previous findings [9]. ...
... In total, 18 VRE isolates were detected with MIC values ranging from 12 to 256 mg/l. The detection of only two VRE in two different NHs is in accordance with the low prevalence described before [4], [11]. ...
This study aimed to map MDRO carriage and potential transmission within and between three Flemish tertiary care hospitals and their neighbouring nursing homes. A cross-sectional MDRO prevalence survey was organized between October 2017 and February 2019. Perianal swabs were cultured for detection of MDRO. Determination of clonal relatedness based on wgMLST allelic profiles was performed. The prevalence of MDRO in Belgian hospitals and NHs is on the rise, compared to previous studies, and transmission in and between institutions is observed. These results re-emphasize the need for a healthcare network-wide infection prevention strategy in which WGS of MDRO strains can be supportive.
... In French nursing homes (2017-2018), 19.8% of the patients were colonized with ESBL-Ent, whereas CPE were not detected; use of a shared bathroom, previous antibiotic use and recent history of hospitalization were risk factors for colonization [76]. Similarly, in Belgium (2015) and California (2016-2017), 11.3% and 16% of the nursing home residents were gut carriers of ESBL-Ent, respectively [77,78]. In Japan (2015-2017), this prevalence was instead as high as 36% [79]. ...
The clinical impact of infections due to extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacterales ( Ent ) has reached dramatic levels worldwide. Infections due to these multidrug-resistant (MDR) pathogens—especially Escherichia coli and Klebsiella pneumoniae —may originate from a prior asymptomatic intestinal colonization that could also favor transmission to other subjects. It is therefore desirable that gut carriers are rapidly identified to try preventing both the occurrence of serious endogenous infections and potential transmission. Together with the infection prevention and control countermeasures, any strategy capable of effectively eradicating the MDR- Ent from the intestinal tract would be desirable. In this narrative review, we present a summary of the different aspects linked to the intestinal colonization due to MDR- Ent . In particular, culture- and molecular-based screening techniques to identify carriers, data on prevalence and risk factors in different populations, clinical impact, length of colonization, and contribution to transmission in various settings will be overviewed. We will also discuss the standard strategies (selective digestive decontamination, fecal microbiota transplant) and those still in development (bacteriophages, probiotics, microcins, and CRISPR-Cas-based) that might be used to decolonize MDR- Ent carriers.
... MALDI-TOF is low in cost, and analysis can be conducted within a short time, allowing rapid microbial resistance to be detected. Latour and colleagues employed MALDI BioTyper database for bacterial identification of suspected colonies (20). A study by Chen and colleagues has shown that MLST has been used for the past decades for MRSA epidemiological typing (43). ...
Introduction: Detection and diagnosis of MRSA are important in ensuring a correct and effective treatment, further reducing its spread. There are a wide range of molecular approaches for the diagnosis of AMR in MRSA, including PCR, MLST and SCCmec. This review aims to study and appraise current molecular diagnostic methods used for the detection of MRSA. Method: This narrative review was performed by searching the PubMed using the following search terms: (molecular diagnosis) AND (antimicrobial resistance) NOT (review [publication type)) NOT (systematic review [publication type)) NOT (meta-analysis[publication type)) AND (methicillin-resistant staphylococcus aureus). Studies using molecular diagnostic techniques for the detection of MRSA were included, while non-English language, duplicates, and non-article studies were excluded. After reviewing the libraries and a further manual search, 20 studies were included in this paper. RAMESES publication standard for narrative reviews was used for this synthesis. Results: Of the 20 studies included, 11 studies employed PCR for diagnosing MRSA , 2 studies on DNA Microarray, Xpert MRSA/SA BC assay (n=1), MALDI-TOF (n=2), MLST (n=5) and SCCMec typing (n=1). Discussion: Different diagnostic methods used for the diagnosis of MRSA have been studied in this review. Each diagnostic technique have its benefits and drawbacks, however, this study concludes that PCR has been extensively used due to its increased sensitivity and cost-effectiveness.
... LTCFs are recognized as an important reservoir of methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase Enterobacterales (ESBL) [6]. Recently there has been growing interest in knowing the prevalence of colonization by other MDROs such as carbapenemase-producing Enterobacterales (CPE), vancomycin-resistant Enterococcus spp (VRE), MDR Acinetobacter baumannii (MDR-Ab) and MDR Pseudomonas aeruginosa (MDR-Pa) [7][8][9][10][11][12][13][14][15]. Specifically, the increasing prevalence of infections by MDR gram negative bacteria (MDR-GNB) have become a real threat in recent years. ...
... In the literature, there are few recent studies about CPB in Europe showing a high geographical variation [8,12]. Most studies reported low CPB prevalence rates (0.06-1.7%) among residents of LTCFs [11,13,[24][25][26]. However, some studies in Israel (12%), Spain (4.1%) and Italy (28.4%) determined a high prevalence [4,17,27]. ...
Background
The emergence of carbapenemase-producing bacteria (CPB) has become a major public health concern. Long-term care facilities (LTCF) are potential reservoirs for multidrug-resistant micro-organisms (MDRO). However, data on CPB is limited. The study aims to determine the prevalence of MDRO and risk factors for CPB colonization among residents of LTCFs.
Methods
A point-prevalence study was conducted at 14 LTCFs in Tenerife (Spain) between October 2020 and May 2021. Nasal and rectal swabs were cultured for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), carbapenemase-producing Enterobacterales, MDR Acinetobacter baumannii (MDR-Ab) and MDR Pseudomonas aeruginosa . Antimicrobial susceptibility testing and molecular detection of resistance genes were performed. Risk factors for colonization by carbapenemase-producing bacteria (CPB) were determined by univariate and multivariate analysis.
Results
A total of 760 LTCF residents were recruited. The prevalence of colonization by CPB was 9.3% (n = 71) with the following distribution: 35 (49.3%) K. pneumoniae , 26 (36.6%) MDR-Ab, 17 (23.9%) E. coli , and 1 (1.4%) C. koseri . In addition, the prevalence of colonization by MRSA was 28.1% (n = 215) and only one case of VRE was isolated. Multivariate analysis identified male sex (odds ratio [OR], 1.86; 95% confidence interval [CI], 1.86–3.11; P = 0.01), having a high health requirement (OR, 6.32; 95% CI, 1.91–20.92; P = 0.003) and previous hospitalization (OR, 3.60; 95% CI, 1.59–8.15 P = 0.002) as independent risk factors for CPB rectal carriage.
Conclusions
LTCFs are an important reservoir for MDRO, including CPB. We have identified some predictors of colonization by CPB, which enable a more targeted management of high-risk residents. Antimicrobial stewardship programmes and infection control preventive measures are needed to stop acquisition and transmission of MDRO.
... Similar to the nationwide evolution in acute care hospitals, national cross-sectional surveys found a substantial decrease in the prevalence of methicillin resistant Staphylococcus aureus (MRSA) carriage in Belgian NHs (from 19.0% to 2005 to 9.0% in 2015), but at the same time an increase in the carriage of extended-spectrum β-lactamases-producing Enterobacteriaceae (from 6.2% to 2011 to 11.3% in 2015) [4][5][6][7]. ...
Background
Belgium monitors the burden of healthcare-associated infections (HAIs) and antimicrobial use in nursing homes (NHs) by participating in the European point prevalence surveys (PPSs) organised in long-term care facilities (HALT surveys). We present the main findings of the three national PPSs conducted in NHs participating in at least one of these surveys, and in a cohort that participated in all three consecutive surveys.
Methods
All NHs were invited to voluntarily participate and conduct the survey on one single day in May-September 2010 (HALT-1), in April-May 2013 (HALT-2) or in September-November 2016 (HALT-3). Data were collected at institutional, ward and resident level. A detailed questionnaire had to be completed for all eligible (i.e. living full time in the facility since at least 24 h, present at 8:00 am and willing to participate) residents receiving at least one systemic antimicrobial agent and/or presenting at least one active HAI on the PPS day. The onset of signs/symptoms had to occur more than 48 h after the resident was (re-)admitted to the NH.
Results
A total of 107, 87 and 158 NHs conducted the HALT-1, HALT-2 and HALT-3 survey, respectively. The median prevalence of residents with antimicrobial agent(s) increased from 4.3% (95% confidence interval (CI): 3.5-4.8%) in HALT-1 to 4.7% (95% CI: 3.5-6.5%) in HALT-2 and 5.0% (95% CI: 4.2-5.9%) in HALT-3. The median prevalence of residents with HAI(s) varied from 1.8% (95% CI: 1.4-2.7%) in HALT-1 to 3.2% (95% CI: 2.2-4.2%) in HALT-2 and 2.7% (95% CI: 2.1-3.4%) in HALT-3. Our post-hoc analysis on the cohort (n = 25 NHs) found similar trends. In all three surveys, respiratory tract infections were most frequently reported, followed by skin/wound infections in HALT-1 and urinary tract infections in HALT-2 and HALT-3. Antimicrobials were most commonly prescribed for the therapeutic treatment of an infection: 66.4% in HALT-1, 60.9% in HALT-2 and 64.1% in HALT-3. Uroprophylaxis accounted for 28.7%, 35.6% and 28.4% of all prescriptions, respectively.
Conclusions
None withstanding the limitations peculiar to the study design, the PPSs enabled us to assess the occurrence of and to increase awareness for HAIs and rational antimicrobial use in NHs at both local and national level.
... Eradication of MRSA is theoretically possible through elimination of MRSA-positive nursing home admissions over several years [14]; however, this is unlikely to be achieved in practice, in part because there is currently no consensus for MRSA screening at nursing home admission. Movement of residents and physicians between hospitals and nursing homes may facilitate MRSA spread within the nursing home environment [26,27], and admission of MRSA-colonized residents can cause outbreaks without strict infection control protocols [28]. ...
Inadequate infection control, wound care, and oral hygiene protocols in nursing homes provide challenges to residents’ quality of life. Based on the outcomes from a focus group meeting and a literature search, this narrative review evaluates the current and potential roles of antiseptics within nursing home infection management procedures. We examine contemporary strategies and concerns within the management of meticillin-resistant Staphylococcus aureus (MRSA; including decolonization regimes), chronic wound care, and oral hygiene, and review the available data for the use of antiseptics, with a focus on povidone-iodine.
Compared with chlorhexidine, polyhexanide, and silver, povidone-iodine has a broader spectrum of antimicrobial activity, with rapid and potent activity against MRSA and other microbes found in chronic wounds, including biofilms. As no reports of bacterial resistance or cross-resistance following exposure to povidone-iodine exist, it may be preferable for MRSA decolonization compared with mupirocin and chlorhexidine, which can cause resistant MRSA strains. Povidone-iodine oral products have greater efficacy against oral pathogens compared with other antiseptics such as chlorhexidine mouthwash, highlighting the clinical benefit of povidone-iodine in oral care. Additionally, povidone-iodine-based products, including mouthwash, have demonstrated rapid in vitro virucidal activity against SARS-CoV-2 and may help reduce its transmission if incorporated into nursing home coronavirus 2019 control protocols. Importantly, povidone-iodine activity is not adversely affected by organic material, such as that found in chronic wounds and the oral cavity.
Povidone-iodine is a promising antiseptic agent for the management of infections in the nursing home setting, including MRSA decolonization procedures, chronic wound management, and oral care.
