Colonization by multidrug-resistant organisms in long-term care facilities in Italy: a point-prevalence study. (December 2017)

• Record Type: Journal Article
• Authors: Giufrè, M.; Ricchizzi, E.; Accogli, M.; Barbanti, F.; Monaco, M.; Pimentel de Araujo, F.; Farina, C.; Fazii, P.; Mattei, R.; Sarti, M.; Barozzi, A.; Buttazzi, R.; Cosentino, M.; Nardone, M.; Savini, V.; Spigaglia, P.; Pantosti, A.; Moro, M.L.; Cerquetti, M.
• Is Part Of: Clinical microbiology and infection. Volume 23:Number 12(2017)
• Page Start: 961
• Page End: 967
• Publication Date: 2017-12
• Subjects: Carbapenemase -- Clostridium difficile -- Enterobacteriaceae -- ESBL -- Escherichia coli -- Klebsiella pneumoniae -- Long-term care facilities -- MRSA; Medical microbiology -- Periodicals; Diagnostic microbiology -- Periodicals; Communicable diseases -- Periodicals; Infection -- Periodicals; 616.01
• DOI: 10.1016/j.cmi.2017.04.006
• Languages: English
• ISSNs: 1198-743X

Abstract

Abstract: Objectives: To determine prevalence and risk factors for colonization by multidrug-resistant organisms (MDROs) in long-term care facility (LTCF) residents in Italy. Genotypes of MDRO isolates were investigated. Methods: A point-prevalence study was conducted at 12 LTCFs located in four Italian cities (2 February to 14 March 2015). Rectal swabs, faeces and nasal/auxiliary swabs were cultured for extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacteriaceae, Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) respectively. Antimicrobial susceptibility testing, detection of ESBL and/or carbapenemase genes and molecular typing of MDROs were performed. Risk factors for colonization were determined by univariate and multivariate analysis. Results: A total of 489 LTCF residents aged ≥65 years were enrolled. The prevalence of colonization by ESBL-producing Enterobacteriaceae, MRSA and C. difficile was 57.3% (279/487), 17.2% (84/487) and 5.1% (21/409) respectively. Carriage rate of carbapenemase-producing Enterobacteriaceae was 1% (5/487). Being bedridden was a common independent risk factor for colonization by all MDROs, although risk factors specific for each MDRO were identified. ESBL-producing Escherichia coli carriage was associated with the sequence type (ST) 131-H30 subclone, but other minor STs predominated in individual LTCF or in LTCFs located in the same city, suggesting a role for intrafacility or local transmission. Similarly, MRSA from LTCF residents belonged to the same spa types/ST clones (t008/ST8 and t032/ST22) commonly found in Italian acute-care hospitals, but infrequent spa types were recovered in individual LTCFs. The prevalent C. difficile PCR ribotypes were 356/607 and 018, both common in Italian acute-care hospitals. Conclusions: MDRO colonization is common among residents in Italian LTCFs.