Multi-drug-resistant Organisms (MDROs) Have Escaped the Hospital: Evidence of Community Acquisition at a Regional Hospital. (4th October 2017)

• Record Type: Journal Article
• Authors: Turner, Nicholas; Moehring, Rebekah W; Fowler, Vance; Schmader, Kenneth; Weber, David J; Sexton, Daniel J; Anderson, Deverick J
• Is Part Of: Open forum infectious diseases. Volume 4(2017)Supplement 1
• Page Start: S157
• Page End: S157
• Publication Date: 2017-10-04
• Subjects: Communicable diseases -- Periodicals; Medical microbiology -- Periodicals; Infection -- Periodicals; 616.9
• DOI: 10.1093/ofid/ofx163.266
• Languages: English
• ISSNs: 2328-8957

Abstract

Abstract: Background: MDROs pose a serious health threat. Community acquisition of MDROs is increasing, but its relative impact on the burden of MDROs in hospitals is unclear. We conducted a prospective study of patients with MDRO infections who received care at a regional hospital to examine the prevalence of community acquisition. Methods: This prospective cohort study enrolled adults with MDRO infections admitted between 2013 and 2016 at a 202-bed regional hospital. MDRO infections included MRSA, VRE, Gram-negatives resistant to more than three antimicrobial classes and C. difficile . Infections were defined as community-acquired if the patients met the following criteria: (1) the index culture was obtained either prior to or within the first 48 hours of admission and (2) the patient may not have been admitted for greater than 48 hours in the preceding 90 days. We separately examined the proportion of community acquired infections coming from nursing facilities. Results: A total of 300 patients were enrolled. C. difficile (45% of infections) and MRSA (35% of infections) were the most prevalent MDROs overall (table). Forty-five (42%) of MRSA infections, 46 (34%) of C. difficile colitis cases and 22 (50%) of MDR Gram-negatives met criteria for community acquisition. Only 10 VRE infections were enrolled - none met criteria for community acquisition. Among community acquired infections, a minority came from nursing facilities (only 13 % of community acquired infections). Conclusion: C. difficile and MRSA were the most common MDRO infections in our cohort of patients. More than one-third of MDROs were acquired in the community. These data suggest that all types of MDROs are no longer confined to healthcare settings and, in fact, are increasingly established in the community. Disclosures: V. Fowler Jr., Pfizer, Novartis, Galderma, Novadigm, Durata, Debiopharm, Genentech, Achaogen, Affinium, Medicines Co., Cerexa, Tetraphase, Trius, MedImmune, Bayer, Theravance, Cubist, Basilea, Affinergy, Janssen, xBiotech, Contrafect: Consultant, Consulting fee. NIH, MedImmune, Cerexa/Forest/Actavis/Allergan, Pfizer, Advanced Liquid Logics, Theravance, Novartis, Cubist/Merck; Medical Biosurfaces; Locus; Affinergy; Contrafect; Karius: Grant Investigator, Grant recipient. Green Cross, Cubist, Cerexa, Durata, Theravance; Debiopharm: Consultant, Consulting fee. UpToDate: Royalties, Royalties. K. Schmader, Merck: Investigator, Research grant. D. J. Weber, PDI: Consultant, Consulting fee.