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Increased MDR Gram-Negative Bacteria Prevalence in US Nursing Homes Highlights Need to Enhance Infection Control

MAY 05, 2017 | SARAH ANWAR
Researchers from Columbia University recently conducted a systematic review and meta-analysis to investigate the prevalence of multidrug-resistant organisms in US nursing homes. Their findings were published in the American Journal of Infection Control.
According to Nimalie Stone, MD, MS, Team Lead, LTC, Division of Healthcare Quality Promotion at the Centers for Disease Control and Prevention (CDC), many infrastructure gaps exist in US nursing homes, which has affected the quality of infection prevention and control in these facilities.
Now, researchers from Columbia University School of Nursing and the Department of Epidemiology at Mailman School of Public Health at Columbia University, and led by Sainfer Aliyu, MPhil, MSEd, MHPM, BSN, RN, analyzed the prevalence of multidrug-resistant gram-negative bacteria in nursing home residents across the country. According to the researchers, “To our knowledge, this is the first systematic review and meta-analysis to estimate the prevalence of [multidrug-resistant gram-negative bacteria] colonization among [nursing home] residents.”
Aliyu and colleagues used multiple databases to extract data collected between January 1, 2005 and February 28, 2016. The researchers chose to limit the review to studies published after 2005 “given the emergence of [multidrug-resistant gram-negative bacteria] in recent years.”
A total of 12 peer-reviewed studies were included in the systematic review (3 retrospective studies, 1 case-control study, 4 cross-sectional studies, and 4 prospective studies). The studies were limited to those which reported on adult patients and which were published in English in indexed journals. Criteria for inclusion focused on outcome measures, such as colonization and infection rates with multidrug-resistant gram-negative bacteria, as well as mortality rates associated with these infections. Patients were classified as “colonized” if swab samples from rectal, nasal, skin, throat, oropharyngeal, inguinal swabs, or wounds tested positive, while “infection” was characterized by positive samples collected from sputum, blood, and urine. Of the 12 studies included in the review, 1 “reported sputum and urine [samples] as both infection and colonization.”  
The majority of the 12 studies were conducted within the United States, while the rest were from Korea, Italy, Singapore, and Germany. Eight of the reviewed studies reported on cases in more than 1 nursing home

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