Multidrug‐Resistant Gram‐Negative Bacteria in a Long‐Term Care Facility: Prevalence and Risk Factors

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Abstract
OBJECTIVES: To quantify the prevalence, risk factors, and mode of transmission associated with colonization by multidrug‐resistant gram‐negative bacteria (MDRGN) in the long‐term care (LTC) setting. DESIGN: Cross‐sectional. SETTING: Four nursing units in a 648‐bed LTC facility in Boston, Massachusetts. PARTICIPANTS: Eighty‐four long‐term care residents. MEASUREMENTS: Nasal and rectal swabs were obtained to determine colonization with MDRGN; if present, molecular typing was performed. The prevalence of methicillin‐resistant Staphylococcus aureus (MRSA) and vancomycin‐resistant enterococci (VRE) was also determined. Demographic and clinical characteristics were obtained from the medical record. Multivariable analysis was used to identify factors independently associated with MDRGN colonization. RESULTS: A total of 51%, 28%, and 4% subjects were colonized with MDRGN, MRSA, and VRE, respectively. After multivariable adjustment, advanced dementia (adjusted odds ratio (AOR)=2.9, 95% confidence interval (CI)=1.2–7.35, P=.02) and nonambulatory status (AOR=5.7, 95% CI=1.1–28.9, P=.04) were the only independent risk factors for harboring MDRGN. Molecular typing indicated person‐to‐person transmission. CONCLUSION: Colonization with MDRGN is common in the LTC setting. A diagnosis of advanced dementia is a major risk factor for harboring MDRGN.

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