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Colonization of long-term care facility residents in three Italian Provinces by multidrug-resistant bacteria
BACKGROUND: Rationale and aims of the study were to compare colonization frequencies with MDR bacteria isolated from LTCF residents in three different Northern Italian regions, to investigate risk factors for colonization and the genotypic characteristics of isolates. The screening included Enteroba...
Autores principales: | , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2018
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839059/ https://www.ncbi.nlm.nih.gov/pubmed/29527303 http://dx.doi.org/10.1186/s13756-018-0326-0 |
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author | Nucleo, Elisabetta Caltagirone, Mariasofia Marchetti, Vittoria Mattioni D’Angelo, Roberto Fogato, Elena Confalonieri, Massimo Reboli, Camilla March, Albert Sleghel, Ferisa Soelva, Gertrud Pagani, Elisabetta Aschbacher, Richard Migliavacca, Roberta Pagani, Laura |
author_facet | Nucleo, Elisabetta Caltagirone, Mariasofia Marchetti, Vittoria Mattioni D’Angelo, Roberto Fogato, Elena Confalonieri, Massimo Reboli, Camilla March, Albert Sleghel, Ferisa Soelva, Gertrud Pagani, Elisabetta Aschbacher, Richard Migliavacca, Roberta Pagani, Laura |
author_sort | Nucleo, Elisabetta |
collection | PubMed |
description | BACKGROUND: Rationale and aims of the study were to compare colonization frequencies with MDR bacteria isolated from LTCF residents in three different Northern Italian regions, to investigate risk factors for colonization and the genotypic characteristics of isolates. The screening included Enterobacteriaceae expressing extended-spectrum β-lactamases (ESβLs) and high-level AmpC cephalosporinases, carbapenemase-producing Enterobacteriaceae, Pseudomonas aeruginosa or Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). METHODS: Urine samples and rectal, inguinal, oropharyngeal and nasal swabs were plated on selective agar; resistance genes were sought by PCR and sequencing. Demographic and clinical data were collected. RESULTS: Among the LTCF residents, 75.0% (78/104), 69.4% (84/121) and 66.1% (76/115) were colonized with at least one of the target organisms in LTCFs located in Milan, Piacenza and Bolzano, respectively. ESβL producers (60.5, 66.1 and 53.0%) were highly predominant, mainly belonging to Escherichia coli expressing CTX-M group-1 enzymes. Carbapenemase-producing enterobacteria were found in 7.6, 0.0 and 1.6% of residents; carbapemenase-producing P. aeruginosa and A. baumannii were also detected. Colonization by MRSA (24.0, 5.7 and 14.8%) and VRE (20.2, 0.8 and 0.8%) was highly variable. Several risk factors for colonization by ESβL-producing Enterobacteriaceae and MRSA were found and compared among LTCFs in the three Provinces. Colonization differences among the enrolled LTCFs can be partially explained by variation in risk factors, resident populations and staff/resident ratios, applied hygiene measures and especially the local antibiotic resistance epidemiology. CONCLUSIONS: The widespread diffusion of MDR bacteria in LTCFs within three Italian Provinces confirms that LTCFs are an important reservoir of MDR organisms in Italy and suggests that future efforts should focus on MDR screening, improved implementation of infection control strategies and antibiotic stewardship programs targeting the complex aspects of LTCFs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13756-018-0326-0) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-5839059 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-58390592018-03-09 Colonization of long-term care facility residents in three Italian Provinces by multidrug-resistant bacteria Nucleo, Elisabetta Caltagirone, Mariasofia Marchetti, Vittoria Mattioni D’Angelo, Roberto Fogato, Elena Confalonieri, Massimo Reboli, Camilla March, Albert Sleghel, Ferisa Soelva, Gertrud Pagani, Elisabetta Aschbacher, Richard Migliavacca, Roberta Pagani, Laura Antimicrob Resist Infect Control Research BACKGROUND: Rationale and aims of the study were to compare colonization frequencies with MDR bacteria isolated from LTCF residents in three different Northern Italian regions, to investigate risk factors for colonization and the genotypic characteristics of isolates. The screening included Enterobacteriaceae expressing extended-spectrum β-lactamases (ESβLs) and high-level AmpC cephalosporinases, carbapenemase-producing Enterobacteriaceae, Pseudomonas aeruginosa or Acinetobacter baumannii, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). METHODS: Urine samples and rectal, inguinal, oropharyngeal and nasal swabs were plated on selective agar; resistance genes were sought by PCR and sequencing. Demographic and clinical data were collected. RESULTS: Among the LTCF residents, 75.0% (78/104), 69.4% (84/121) and 66.1% (76/115) were colonized with at least one of the target organisms in LTCFs located in Milan, Piacenza and Bolzano, respectively. ESβL producers (60.5, 66.1 and 53.0%) were highly predominant, mainly belonging to Escherichia coli expressing CTX-M group-1 enzymes. Carbapenemase-producing enterobacteria were found in 7.6, 0.0 and 1.6% of residents; carbapemenase-producing P. aeruginosa and A. baumannii were also detected. Colonization by MRSA (24.0, 5.7 and 14.8%) and VRE (20.2, 0.8 and 0.8%) was highly variable. Several risk factors for colonization by ESβL-producing Enterobacteriaceae and MRSA were found and compared among LTCFs in the three Provinces. Colonization differences among the enrolled LTCFs can be partially explained by variation in risk factors, resident populations and staff/resident ratios, applied hygiene measures and especially the local antibiotic resistance epidemiology. CONCLUSIONS: The widespread diffusion of MDR bacteria in LTCFs within three Italian Provinces confirms that LTCFs are an important reservoir of MDR organisms in Italy and suggests that future efforts should focus on MDR screening, improved implementation of infection control strategies and antibiotic stewardship programs targeting the complex aspects of LTCFs. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1186/s13756-018-0326-0) contains supplementary material, which is available to authorized users. BioMed Central 2018-03-06 /pmc/articles/PMC5839059/ /pubmed/29527303 http://dx.doi.org/10.1186/s13756-018-0326-0 Text en © The Author(s). 2018 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Research Nucleo, Elisabetta Caltagirone, Mariasofia Marchetti, Vittoria Mattioni D’Angelo, Roberto Fogato, Elena Confalonieri, Massimo Reboli, Camilla March, Albert Sleghel, Ferisa Soelva, Gertrud Pagani, Elisabetta Aschbacher, Richard Migliavacca, Roberta Pagani, Laura Colonization of long-term care facility residents in three Italian Provinces by multidrug-resistant bacteria |
title | Colonization of long-term care facility residents in three Italian Provinces by multidrug-resistant bacteria |
title_full | Colonization of long-term care facility residents in three Italian Provinces by multidrug-resistant bacteria |
title_fullStr | Colonization of long-term care facility residents in three Italian Provinces by multidrug-resistant bacteria |
title_full_unstemmed | Colonization of long-term care facility residents in three Italian Provinces by multidrug-resistant bacteria |
title_short | Colonization of long-term care facility residents in three Italian Provinces by multidrug-resistant bacteria |
title_sort | colonization of long-term care facility residents in three italian provinces by multidrug-resistant bacteria |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5839059/ https://www.ncbi.nlm.nih.gov/pubmed/29527303 http://dx.doi.org/10.1186/s13756-018-0326-0 |
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