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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
No standard definition for multidrug-resistant gram-negative bacteria was provided across all 12 studies included in the systematic review. Eight of the 12 studies only included information on nursing home residents, while the rest included information on nursing home residents and other patients.
Among the reviewed studies, colonization prevalence of multidrug-resistant gram-negative bacteria “ranged from 11.2% to 59.1%,” with Escherichia coli “account[ing] for the highest proportion of isolates.”
Nine of the studies identified risk factors that were “previously shown to be associated with increased [multidrug-resistant gram-negative bacteria] colonization.” These included the following: 
  • Age and Gender
  • Comorbid chronic diseases
  • Advanced dementia
  • History of recurrent hospitalization
  • Frequent exposure to antimicrobials
  • Delayed initiation of effective antibiotic therapy
  • Residency in long-term-care facility
A total of 8 studies included in the systematic review were “eligible for meta-analysis… [which] represented data from 2720 [nursing home] residents.” The researchers found colonization prevalence to be 27% among all nursing home residents included in the meta-analysis. In addition, the researchers found a greater prevalence of colonization among those studies conducted within the United States as opposed to those conducted in Germany and Korea.
“Although study duration, study location, and sample size varied considerably among studies and might have contributed to differences between groups, the review provides important insights and meaningful themes [on the prevalence of multidrug-resistant organisms in US nursing homes],” the authors concluded.
Because of the high prevalence of colonization, the researchers believe that this “emphasizes the need to enhance policies for infection control and prevention in [nursing homes].” By identifying the prevalence of multidrug-resistant gram-negative bacteria in US nursing homes, these researchers are giving infection preventionists the means to “tailor efforts and stem future contaminations.”
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