Antimicrobial Stewardship, Resistance and Emerging Pathogens
Concurrent Education Session - 60 minutes
Lona Mody, MD, MSc
Amanda Sanford Hickey Professor of Internal Medicine
University of Michigan and VA Ann Arbor Healthcare System
University of Michigan and VA Ann Arbor Healthcare System
Ann Arbor, Michigan
AHRQ and NIH: Research Grant
Salah Qutaishat, PhD, CIC, FSHEA, FAPIC
System Director, Infection Prevention
Munson Healthcare
Multidrug-resistant organisms (MDROs) are now ubiquitous. Frail older adults are susceptible to MDROs such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and cephalosporin- and quinolone-resistant Gram-negative organisms (R-GNB).The ecology of MDROs in healthcare settings is continuously changing, with prevalence rates of VRE and R-GNB now surpassing MRSA rates. Prospective studies, albeit limited, show that the transmission of MDROs in nursing homes (NHs) is common and increasing.
Several recent studies exemplify this trend. Stone et al. (2008) showed that 29% of patients were colonized with MRSA on admission and an estimated 20% acquired MRSA after admission. Datta et al (2014) showed MRSA prevalence on admission at 16% with an estimated 11% acquiring new MRSA while at the facility. Several MRSA Prevention Initiatives (2007 onwards) have produced a reduction in MRSA healthcare-associated infections. However, there are dynamic changes in the overall epidemiology of MDROs. In a small study evaluating VRE colonization conducted in Madison and Milwaukee, investigators performed perirectal cultures on admission to an intensive care unit (ICU) and found that VRE prevalence exceeded MRSA prevalence and that VRE prevalence varied with severity of illness. Over 50% of recently hospitalized patients enter community-based NHs colonized with an MDRO, VRE and R-GNB now surpass MRSA and even more alarming, a similar number are discharged in a colonized state with a dynamic interplay of new acquisition and loss while at the facility as shown by our recent study (2018).
With a burgeoning short-stay population and an emphasis on early functional recovery during and right after hospitalizations, NH residents spend a substantial amount of time outside of their rooms for visits that include medical appointments for diagnostic and therapeutic purposes as well as other activities including recreational therapy and dining creating a clinical dilemma – how common and important is the transmission as a result of these visits? Can we identify high-risk visits and areas? What are some of the effective prevention strategies? In this presentation, we will discuss MDRO epidemiology and MDRO transmission during these out-of-room visits by our older adults and reflect on interventions that have been effective in disrupting this transmission.