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BACKGROUND: Long-term care facilities (LTCFs) are a potentially important reservoir of multidrug-resistant (MDR) organisms; however, limited data exist. METHODS: A point-prevalence study was conducted in four co-located LTCFs in Australia. Nasal and rectal swabs were cultured for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and MDR Gram-negative bacilli (GNB). Molecular typing and resistance detection were performed. Risk factors for colonization with an MDR organism were determined using a nested case-control study. RESULTS: Consent was obtained from 115 (85%) of 136 eligible participants. Forty-one (36%) residents carried at least one type of MDR organism. The prevalence was 16% MRSA (n = 18), 6% VRE (n = 7) and 21% MDR GNB n = 24; including extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (n = 12) and Acinetobacter baumannii (n = 6). The majority of ESBL-producing E. coli and A. baumannii were clonal. Current wound management adjusted OR (AOR) 8.81 (95% CI 2.78-27.94), P < 0.001, medical device in situ AOR 5.58 (95% CI 1.34-23.32), P = 0.018 and pressure ulcer AOR 3.69 (95% CI 1.06-12.86), P = 0.04 were independent risk factors for MDR organism colonization. Advanced dementia AOR 3.54 (95% CI 1.23-10.23), P = 0.02 and prolonged antibiotic use AOR 2.95 (95% CI 1.01-8.60), P = 0.047 were independently associated with MRSA colonization, whilst current wound management AOR 15.59 (95% CI 4.85-50.10), P < 0.001 and fluoroquinolone use AOR 4.27 (95% CI 1.20-15.25), P = 0.025 were risk factors for MDR GNB colonization. CONCLUSIONS: LTCFs are an important reservoir of MDR organisms, with person-to-person transmissions being a potential issue. We have identified several predictors of colonization with MDR organisms, allowing a more targeted management of high-risk residents.
Lim et al. (Mon,) studied this question.