Multidrug-resistant organism infections in US nursing homes: a national study of prevalence, onset, and transmission across care settings, October 1, 2010-December 31, 2011.

Kahvecioglu D1, Ramiah K, McMaughan D, Garfinkel S, McSorley VE, Nguyen QN, Yang M, Pugliese C, Mehr D, Phillips CD.

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Abstract

OBJECTIVE:

To understand the prevalence of multidrug-resistant organism (MDRO) infections among nursing home (NH) residents and the potential for their spread between NHs and acute care hospitals (ACHs).

METHODS:

Descriptive analyses of MDRO infections among NH residents using all NH residents in the Long-Term Care Minimum Data Set (MDS) 3.0 between October 1, 2010 and December 31, 2011.

RESULTS:

Analysis of MDS data revealed a very high volume of bidirectional patient flow between NHs and ACHs, indicating the need to study MDRO infections in NHs as well as in hospitals. A total of 4.24% of NH residents had an active MDRO diagnosis on at least 1 MDS assessment during the study period. This rate significantly varied by sex, age, urban/rural status, and state. Approximately 2% of NH discharges to ACHs involved a resident with an active diagnosis of infection due to MDROs. Conversely, 1.8% of NH admissions from an ACH involved a patient with an active diagnosis of infection due to MDROs. Among residents who acquired an MDRO infection during the study period, 57% became positive in the NH, 41% in the ACH, and 2% in other settings (eg, at a private home or apartment).

CONCLUSION:

Even though NHs are the most likely setting where residents would acquire MDROs after admission to an NH (accounting for 57% of cases), a significant fraction of NH residents acquire MDRO infection at ACHs (41%). Thus, effective MDRO infection control for NH residents requires simultaneous, cooperative interventions among NHs and ACHs in the same community.