McKinnell James A, Miller Loren G, Singh Raveena D, Gussin Gabrielle, Kleinman Ken, Mendez Job, Laurner Bryn, Catuna Tabitha D, Heim Lauren, Saavedra Raheeb, Felix James, Torres Crystal, Chang Justin, Estevez Marlene, Mendez Joanna, Tchakalian Gregory, Bloomfield Leah, Ceja Sandra, Franco Ryan, Miner Aaron, Hurtado Aura, Hean Ratharo, Varasteh Alex, Robinson Philip A, Park Steven, Tam Steven, Tjoa Thomas, He Jiayi, Agrawal Shalini, Yamaguchi Stacey, Custodio Harold, Nguyen Jenny, Bittencourt Cassiana E, Evans Kaye D, Mor Vincent, McConeghy Kevin, Weinstein Robert A, Hayden Mary K, Stone Nimalie D, Steinberg Karl, Beecham Nancy, Montgomery Jocelyn, DeAnn Walters, Peterson Ellena M, Huang Susan S
Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA; Los Angeles County Department of Public Health, Healthcare Outreach Unit, Los Angeles, CA, USA; Expert Stewardship, Newport, CA, USA.
Department of Medicine, Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, USA.
J Am Med Dir Assoc. 2020 Dec;21(12):1937-1943.e2. doi: 10.1016/j.jamda.2020.04.007. Epub 2020 Jun 16.
Determine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum beta-lactamase producing organisms (ESBLs), and carbapenem-resistant Enterobacteriaceae (CRE) among residents and in the environment of nursing homes (NHs).
Point prevalence sampling of residents and environmental sampling of high-touch objects in resident rooms and common areas.
Twenty-eight NHs in Southern California from 2016 to 2017.
NH participants in Project PROTECT, a cluster-randomized trial of enhanced bathing and decolonization vs routine care.
Fifty residents were randomly sampled per NH. Twenty objects were sampled, including 5 common room objects plus 5 objects in each of 3 rooms (ambulatory, total care, and dementia care residents).
A total of 2797 swabs were obtained from 1400 residents in 28 NHs. Median prevalence of multidrug-resistant organism (MDRO) carriage per NH was 50% (range: 24%-70%). Median prevalence of specific MDROs were as follows: MRSA, 36% (range: 20%-54%); ESBL, 16% (range: 2%-34%); VRE, 5% (range: 0%-30%); and CRE, 0% (range: 0%-8%). A median of 45% of residents (range: 24%-67%) harbored an MDRO without a known MDRO history. Environmental MDRO contamination was found in 74% of resident rooms and 93% of common areas.
In more than half of the NHs, more than 50% of residents were colonized with MDROs of clinical and public health significance, most commonly MRSA and ESBL. Additionally, the vast majority of resident rooms and common areas were MDRO contaminated. The unknown submerged portion of the iceberg of MDRO carriers in NHs may warrant changes to infection prevention and control practices, particularly high-fidelity adoption of universal strategies such as hand hygiene, environmental cleaning, and decolonization.
确定养老院（NHs）居民以及环境中耐甲氧西林金黄色葡萄球菌（MRSA）、耐万古霉素肠球菌属（VRE）、产超广谱β-内酰胺酶菌（ESBLs）和耐碳青霉烯类肠杆菌科细菌（CRE）的流行情况。
对居民进行现患率抽样，并对居民房间和公共区域的高接触物体进行环境抽样。
2016年至2017年加利福尼亚州南部的28家养老院。
参与PROTECT项目的养老院参与者，该项目是一项关于强化沐浴和去定植与常规护理的整群随机试验。
每家养老院随机抽取50名居民。抽取20个物体，包括5个公共房间物体以及3类房间（行动自如、完全护理和失智护理居民房间）中各5个物体。
从28家养老院的1400名居民中总共获取了2797份拭子样本。每家养老院耐多药菌（MDRO）携带的现患率中位数为50%（范围：24% - 70%）。特定MDRO的现患率中位数如下：MRSA为36%（范围：20% - 54%）；ESBL为16%（范围：2% - 34%）；VRE为5%（范围：0% - 30%）；CRE为0%（范围：0% - 8%）。中位数为45%的居民（范围：24% - 67%）携带MDRO但无已知MDRO病史。在74%的居民房间和93%的公共区域发现了环境MDRO污染。
在超过半数的养老院中，超过50%的居民定植有具有临床和公共卫生意义的MDRO，最常见的是MRSA和ESBL。此外，绝大多数居民房间和公共区域都受到MDRO污染。养老院中MDRO携带者这一未知的隐匿部分可能需要改变感染预防与控制措施，尤其是要切实采用如手卫生、环境清洁和去定植等通用策略。
