Microbiome and Host Health Programme, South Australian Health and Medical Research Institute, 5D332, Flinders Medical Centre, Flinders Drive, Bedford Park, Adelaide, SA, 5042, Australia.
College of Medicine and Public Health, Flinders University, Adelaide, SA, Australia.
BMC Geriatr. 2023 Aug 28;23(1):521. doi: 10.1186/s12877-023-04215-3.
The emergence of antimicrobial-resistant bacteria represents a considerable threat to human health, particularly for vulnerable populations such as those living in residential aged care. However, antimicrobial resistance carriage and modes of transmission remain incompletely understood. The Generating evidence on antimicrobial Resistance in the Aged Care Environment (GRACE) study was established to determine principal risk factors of antimicrobial resistance carriage and transmission in residential aged care facilities (RACFs). This article describes the cohort characteristics, national representation, and planned analyses for this study.
Between March 2019 and March 2020, 279 participants were recruited from five South Australian RACFs. The median age was 88.6 years, the median period in residence was 681 days, and 71.7% were female. A dementia diagnosis was recorded in 54.5% and more than two thirds had moderate to severe cognitive impairment (68.8%). 61% had received at least one course of antibiotics in the 12 months prior to enrolment.
To investigate the representation of the GRACE cohort to Australians in residential aged care, its characteristics were compared to a subset of the historical cohort of the Registry of Senior Australians (ROSA). This included 142,923 individuals who were permanent residents of RACFs on June 30th, 2017. GRACE and ROSA cohorts were similar in age, sex, and duration of residential care, prevalence of health conditions, and recorded dementia diagnoses. Differences were observed in care requirements and antibiotic exposure (both higher for GRACE participants). GRACE participants had fewer hospital visits compared to the ROSA cohort, and a smaller proportion were prescribed psycholeptic medications.
We have assembled a cohort of aged care residents that is representative of the Australian aged care population, and which provides a basis for future analyses. Metagenomic data isolated from participants and built environments will be used to determine microbiome and resistome characteristics of an individual and the facility. Individual and facility risk exposures will be aligned with metagenomic data to identify principal determinants for antimicrobial resistance carriage. Ultimately, this analysis will inform measures aimed at reducing the emergence and spread of antimicrobial resistant pathogens in this high-risk population.
抗菌药物耐药菌的出现对人类健康构成了重大威胁，尤其是对那些生活在养老院的弱势群体。然而，抗菌药物耐药性的携带和传播方式仍不完全清楚。“在老年护理环境中产生抗菌药物耐药性证据（GRACE）”研究旨在确定养老院中抗菌药物耐药性携带和传播的主要危险因素。本文介绍了该研究的队列特征、全国代表性和计划分析。
2019 年 3 月至 2020 年 3 月，从南澳大利亚的 5 家养老院招募了 279 名参与者。中位年龄为 88.6 岁，中位居住时间为 681 天，71.7%为女性。54.5%有痴呆诊断，超过三分之二有中度至重度认知障碍（68.8%）。61%在入组前 12 个月内至少接受过 1 个疗程的抗生素。
为了研究 GRACE 队列对澳大利亚养老院居民的代表性，将其特征与澳大利亚老年人登记处（ROSA）历史队列的一个子集进行了比较。该子集包括 2017 年 6 月 30 日居住在养老院的 142923 名常住居民。GRACE 和 ROSA 队列在年龄、性别和居住时间、健康状况患病率以及记录的痴呆诊断方面相似。在护理需求和抗生素暴露方面存在差异（GRACE 参与者更高）。与 ROSA 队列相比，GRACE 参与者的住院次数更少，开处精神药物的比例也更小。
我们已经组建了一个养老院居民队列，该队列代表了澳大利亚养老院的人口，为未来的分析提供了基础。从参与者和建筑环境中分离出的宏基因组数据将用于确定个体和设施的微生物组和抗基因组特征。个体和设施的风险暴露将与宏基因组数据对齐，以确定抗菌药物耐药性携带的主要决定因素。最终，这项分析将为旨在减少高危人群中抗菌药物耐药病原体的出现和传播的措施提供信息。
