Skip to main content

Advertisement

SpringerLink
Log in

Infection rate and colonization with antibiotic-resistant organisms in skilled nursing facility residents with indwelling devices

  • Article
  • Published:
European Journal of Clinical Microbiology & Infectious Diseases Aims and scope Submit manuscript

Abstract

The objective of this prospective surveillance study was to quantify colonization with antimicrobial-resistant organisms (AROs) and infections attributable to indwelling devices in skilled nursing facility (SNF) residents. The study was conducted in 15 SNFs in Southeast Michigan. Residents with (n = 90) and without (n = 88) an indwelling device were enrolled and followed for 907 resident-months. Residents were cultured monthly from multiple anatomic sites and data on infections were obtained. The device-attributable rate was calculated by subtracting the infection rate in the device group from the infection rate in the non-device group. A total of 197 new infections occurred during the study period; 87 in the device group (incidence rate [IR] = 331/1,000 resident-months) and 110 infections in the non-device group (IR = 171/1,000 resident-months), with a relative risk of 1.9 (95% confidence interval [CI]: 1.4–2.6). The attributable rate of excess infections among residents in the device group was 160/1,000 resident-months, with an attributable fraction of 48% (95% CI: 31–61%). Prevalence rates for all AROs were higher in the device group compared with the no-device group. The prevalence of the number of AROs per 1,000 residents cultured increased from no-device to those with only feeding tubes, followed by those with only urinary catheters and both these devices. In conclusion, the presence of indwelling devices is associated with higher incidence rates for infections and prevalence rates for AROs. Our study quantifies this risk and shows that approximately half of all infections in SNF residents with indwelling devices can be eliminated with device removal. Effective strategies to reduce infections and AROs in these residents are warranted.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Warren JW, Tenney JH, Hoopes JM et al (1982) A prospective microbiologic study of bacteriuria in patients with chronic indwelling urethral catheters. J Infect Dis 146:719–723. doi:10.1093/infdis/146.6.719

    Article  PubMed  CAS  Google Scholar 

  2. Kunin CM, Douthitt S, Dancing J et al (1992) The association between the use of urinary catheters and morbidity and mortality among elderly patients in nursing homes. Am J Epidemiol 135:291–301

    PubMed  CAS  Google Scholar 

  3. Ahronheim JC, Mulvihill M, Sieger C et al (2001) State practice variations in the use of tube feeding for nursing home residents with severe cognitive impairment. J Am Geriatr Soc 49:148–152

    Article  PubMed  CAS  Google Scholar 

  4. Mitchell SL, Teno JM, Roy J et al (2003) Clinical and organizational factors associated with feeding tube use among nursing home residents with advanced cognitive impairment. JAMA 290:73–80

    Article  PubMed  Google Scholar 

  5. Teno JM, Mor V, DeSilva D et al (2002) Use of feeding tubes in nursing home residents with severe cognitive impairment. JAMA 287:3211–3212

    Article  PubMed  Google Scholar 

  6. Teno JM, Feng Z, Mitchell SL et al (2008) Do financial incentives of introducing case mix reimbursement increase feeding tube use in nursing home residents? J Am Geriatr Soc 56:887–890

    Article  PubMed  Google Scholar 

  7. Tsan L, Davis C, Langberg R et al (2008) Prevalence of nursing home-associated infections in the Department of Veterans Affairs nursing home care units. Am J Infect Control 36:173–179

    Article  PubMed  Google Scholar 

  8. Safdar N, Maki DG (2002) The commonality of risk factors for nosocomial colonization and infection with antimicrobial-resistant Staphylococcus aureus, Enterococcus, gram-negative bacilli, Clostridium difficile, and Candida. Ann Intern Med 136:834–844

    PubMed  Google Scholar 

  9. Mody L, Maheshwari S, Galecki A et al (2007) Indwelling device use and antibiotic resistance in nursing homes: identifying a high-risk group. J Am Geriatr Soc 55:1921–1926

    Article  PubMed  Google Scholar 

  10. Mody L, Kauffman CA, Donabedian S et al (2008) Epidemiology of Staphylococcus aureus colonization in nursing home residents. Clin Infect Dis 46:1368–1373

    Article  PubMed  Google Scholar 

  11. Dommeti P, Wang L, Flannery EL et al (2011) Patterns of ciprofloxacin-resistant gram-negative bacteria colonization in nursing home residents. Infect Control Hosp Epidemiol 32:177–180

    Article  PubMed  Google Scholar 

  12. Platt R, Polk BF, Murdock B et al (1982) Mortality associated with nosocomial urinary-tract infection. N Engl J Med 307:637–642

    Article  PubMed  CAS  Google Scholar 

  13. Kunin CM, Chin QF, Chambers S (1987) Morbidity and mortality associated with indwelling urinary catheters in elderly patients in a nursing home—confounding due to the presence of associated diseases. J Am Geriatr Soc 35:1001–1006

    PubMed  CAS  Google Scholar 

  14. Mamun K, Lim J (2005) Role of nasogastric tube in preventing aspiration pneumonia in patients with dysphagia. Singapore Med J 46:627–631

    PubMed  CAS  Google Scholar 

  15. Donskey CJ (2004) The role of the intestinal tract as a reservoir and source for transmission of nosocomial pathogens. Clin Infect Dis 39:219–226

    Article  PubMed  Google Scholar 

  16. Pacio GA, Visintainer P, Maguire G et al (2003) Natural history of colonization with vancomycin-resistant enterococci, methicillin-resistant Staphylococcus aureus, and resistant gram-negative bacilli among long-term-care facility residents. Infect Control Hosp Epidemiol 24:246–250

    Article  PubMed  Google Scholar 

  17. Ben-Ami R, Schwaber MJ, Navon-Venezia S et al (2006) Influx of extended-spectrum β-lactamase-producing enterobacteriaceae into the hospital. Clin Infect Dis 42:925–934

    Article  PubMed  CAS  Google Scholar 

  18. Eun SH, Lee YS, Cha JO et al (2006) The point prevalence and associated factors of nasal methicillin-resistant Staphylococcus aureus colonisation in eight geriatric hospitals in Korea. Clin Microbiol Infect 12:81–83

    Article  PubMed  CAS  Google Scholar 

  19. Pop-Vicas A, Mitchell SL, Kandel R et al (2008) Multidrug-resistant gram-negative bacteria in a long-term care facility: prevalence and risk factors. J Am Geriatr Soc 56:1276–1280

    Article  PubMed  Google Scholar 

  20. Benenson S, Cohen MJ, Block C et al (2009) Vancomycin-resistant enterococci in long-term care facilities. Infect Control Hosp Epidemiol 30:786–789

    Article  PubMed  Google Scholar 

  21. Nicolle LE, Mubareka S, Simor A et al (2008) Variation in mortality rates among long-term care facilities for residents with lower respiratory tract infection. Infect Control Hosp Epidemiol 29:754–759

    Article  PubMed  CAS  Google Scholar 

  22. McGeer A, Campbell B, Emori TG et al (1991) Definitions of infection for surveillance in long-term care facilities. Am J Infect Control 19:1–7

    Article  PubMed  CAS  Google Scholar 

  23. Loeb M, Bentley DW, Bradley S et al (2001) Development of minimum criteria for the initiation of antibiotics in residents of long-term-care facilities: results of a consensus conference. Infect Control Hosp Epidemiol 22:120–124

    Article  PubMed  CAS  Google Scholar 

  24. Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  25. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    Article  PubMed  CAS  Google Scholar 

  26. Flannery EL, Wang L, Zöllner S et al (2011) Wounds, functional disability, and indwelling devices are associated with cocolonization by methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in southeast Michigan. Clin Infect Dis 53:1215–1222

    Article  PubMed  Google Scholar 

  27. Juthani-Mehta M, Quagliarello V, Perrelli E et al (2009) Clinical features to identify urinary tract infection in nursing home residents: a cohort study. J Am Geriatr Soc 57:963–970

    Article  PubMed  Google Scholar 

  28. Trick WE, Weinstein RA, DeMarais PL et al (2001) Colonization of skilled-care facility residents with antimicrobial-resistant pathogens. J Am Geriatr Soc 49:270–276

    Article  PubMed  CAS  Google Scholar 

  29. Pop-Vicas A, Strom J, Stanley K et al (2008) Multidrug-resistant gram-negative bacteria among patients who require chronic hemodialysis. Clin J Am Soc Nephrol 3:752–758

    Article  PubMed  CAS  Google Scholar 

  30. O’Fallon E, Pop-Vicas A, D’Agata E (2009) The emerging threat of multidrug-resistant gram-negative organisms in long-term care facilities. J Gerontol A Biol Sci Med Sci 64:138–141

    Article  PubMed  Google Scholar 

  31. Mody L, Saint S, Galecki A et al (2010) Knowledge of evidence-based urinary catheter care practice recommendations among healthcare workers in nursing homes. J Am Geriatr Soc 58:1532–1537

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

The authors would like to thank all the participating facilities, staff, and residents for their continued support of this research.

Funding source

Funding source for the study was provided by NIA K23 AG028943, ASP/AGS T. Franklin Williams Research Scholarship, NIA R01AG032298, and Claude D. Pepper Older Americans Independence Center and Michigan Institute for Clinical & Health Research, University of Michigan Pilot Grant Program.

Author information

Authors and Affiliations

  1. Division of Geriatric Medicine, University of Michigan Medical School, Ann Arbor, MI, USA

    L. Wang, B. Lansing, J. Fisch, K. Cherian, S. E. McNamara & L. Mody

  2. Infectious Diseases Section, University of Michigan School of Public Health, Ann Arbor, MI, USA

    K. Symons

  3. Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI, USA

    E. L. Flannery

  4. Geriatrics Research Education and Clinical Center (GRECC), Veteran Affairs Ann Arbor Healthcare System, 11-G GRECC, 2215 Fuller Rd., Ann Arbor, MI, 48105, USA

    L. Mody

Authors
  1. L. Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. B. Lansing
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. K. Symons
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. E. L. Flannery
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. J. Fisch
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. K. Cherian
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. S. E. McNamara
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. L. Mody
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to L. Mody.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wang, L., Lansing, B., Symons, K. et al. Infection rate and colonization with antibiotic-resistant organisms in skilled nursing facility residents with indwelling devices. Eur J Clin Microbiol Infect Dis 31, 1797–1804 (2012). https://doi.org/10.1007/s10096-011-1504-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10096-011-1504-7

Keywords

Search

Navigation