Colonisation with pathogenic drug-resistant bacteria and among residents of residential care facilities in Cape Town, South Africa: a cross-sectional prevalence study.

BACKGROUND

Residential care facilities (RCFs) act as reservoirs for multidrug-resistant organisms (MDRO). There are scarce data on colonisation with MDROs in Africa. We aimed to determine the prevalence of MDROs and and risk factors for carriage amongst residents of RCFs in Cape Town, South Africa.

METHODS

We performed a cross-sectional surveillance study at three RCFs. Chromogenic agar was used to screen skin swabs for methicillin-resistant (MRSA) and stool samples for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E). Antigen testing and PCR was used to detect . Risk factors for colonisation were determined with logistic regression.

RESULTS

One hundred fifty-four residents were enrolled, providing 119 stool samples and 152 sets of skin swabs. Twenty-seven (22.7%) stool samples were positive for ESBL-E, and 13 (8.6%) residents had at least one skin swab positive for MRSA. Two (1.6%) stool samples tested positive for . Poor functional status (OR 1.3 (95% CI, 1.0-1.6)) and incontinence (OR 2.9 (95% CI, 1.2-6.9)) were significant predictors for ESBL-E colonisation. MRSA colonization appeared higher in frail care areas (8/58 v 5/94,  = 0.07).

CONCLUSIONS

There was a relatively high prevalence of colonisation with MDROs, particularly ESBL-E, but low carriage, with implications for antibiotic prescribing and infection control practice.