The CDC SHIELD Orange County Project – Baseline Multi Drug-Resistant Organism (MDRO) Prevalence in a Southern California Region

作     者：Singh, Raveena D Jernigan, John A Slayton, Rachel B Stone, Nimalie D McKinnell, James A Miller, Loren G Kleinman, Ken Heim, Lauren Dutciuc, Tabitha D Estevez, Marlene Gussin, Gabrielle Chang, Justin Peterson, Ellena M Evans, Kaye D Lee, Bruce Y Mueller, Leslie E Bartsch, Sarah M Zahn, Matthew Janssen, Lynn Weinstein, Robert A Hayden, Mary K Gohil, Shruti K Park, Steven Tam, Steven Saavedra, Raheeb Yamaguchi, Stacey Custodio, Harold Nguyen, Jenny Tjoa, Thomas He, Jiayi O’Donnell, Kathleen Coady, Micaela H Platt, Richard Huang, Susan S CDC Safety and Healthcare Epidemiology Prevention Research Development (SHEPheRD) Program 

作者机构：Division of Infectious Diseases and Health Policy Research Institute University of California Irvine School of Medicine Irvine California Division of Healthcare Quality Promotion Centers for Disease Control and Prevention Atlanta Georgia Infectious Disease Clinical Outcomes Research (ID-CORE) LA Biomed at Harbor-UCLA Medical Center Torrance California University of Massachusetts Amherst School of Public Health and Health Sciences Amherst Massachusetts University of California Irvine Health Orange California Johns Hopkins Bloomberg School of Public Health Baltimore MD Epidemiology and Assessment Orange County Health Care Agency Santa Ana California Healthcare-Associated Infections Program Center for Healthcare Quality California Department of Public Health Richmond California Cook County Health and Hospitals System Chicago Illinois Internal Medicine (Infectious Diseases) and Pathology Rush University Medical Center Chicago Illinois Division of Geriatrics Department of Medicine University of California Irvine Orange California Department of Population Medicine Harvard Medical School and Harvard Pilgrim Health Care Institute Boston Massachusetts 

出 版 物：《Open Forum Infectious Diseases》 

年 卷 期：2017年第4卷第suppl_1期

页      面：S46-S47页

摘      要：Background MDROs can spread between hospitals, nursing homes (NH), and long-term acute care facilities (LTACs) via shared patients. SHIELD OC is a regional decolonization collaborative involving 38 of 104 countywide adult facilities identified by their high degree of direct and indirect patient sharing with one another. We report baseline MDRO prevalence in these facilities. Methods Adult patients in 38 facilities (17 hospitals, 18 NHs, 3 LTACs) underwent point-prevalence screening between September 2016–April 2017 for MRSA, VRE, ESBL, and CRE using nares, skin (axilla/groin), and peri-rectal swabs. In NHs and LTACs, residents were randomly selected until 50 sets of swabs were obtained. Swabbing in hospitals involved all patients in contact precautions. An additional set of swabs were also performed for all LTAC admissions from November 2016–February 2017. Results The overall prevalence of any MDRO among patients was 64% (44%–88%) in NHs, 80% (range 72%–86%) in LTACs, and 64% (54–84%) in hospitals (contact precaution patients) (Table 1). Only 25%, 64%, and 81% of patients were already known to harbor an MDRO in NHs, LTACs, and hospitals, respectively. Known MDRO patients also harbored another MDRO 49%, 63%, and 34% of the time for NHs, LTACs, and hospitals, respectively. In LTACs, MDRO point prevalence was 38% higher than the usual admission prevalence (65% higher for MRSA, 34% higher for VRE, 95% higher for ESBL, and 50% higher for CRE). Conclusion MDRO carriage in highly inter-connected NHs and LTACs was widespread, rivaling that found in hospitalized patients on contact precautions. MRSA, VRE, and ESBL carriage far outnumbered CRE carriage. A history of MDRO was insensitive for identifying MDRO carriers, and many patients carried multiple MDROs. The extensive MDRO burden and transmission in long-term care settings suggests that regional MDRO prevention efforts must include MDRO control in long-term care facilities. Open in a separate window Disclosures R. D. Sing