Colonization by multidrug-resistant organisms in long-term care facilities in Italy

a point-prevalence study

M. Giufrè, E. Ricchizzi, M. Accogli, F. Barbanti, M. Monaco, F. Pimentel de Araujo, C. Farina, P. Fazii, R. Mattei, M. Sarti, A. Barozzi, R. Buttazzi, M. Cosentino, M. Nardone, V. Savini, P. Spigaglia, A. Pantosti, M. L. Moro, M. Cerquetti

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Objectives To determine prevalence and risk factors for colonization by multidrug-resistant organisms (MDROs) in long-term care facility (LTCF) residents in Italy. Genotypes of MDRO isolates were investigated. Methods A point-prevalence study was conducted at 12 LTCFs located in four Italian cities (2 February to 14 March 2015). Rectal swabs, faeces and nasal/auxiliary swabs were cultured for extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacteriaceae, Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) respectively. Antimicrobial susceptibility testing, detection of ESBL and/or carbapenemase genes and molecular typing of MDROs were performed. Risk factors for colonization were determined by univariate and multivariate analysis. Results A total of 489 LTCF residents aged ≥65 years were enrolled. The prevalence of colonization by ESBL-producing Enterobacteriaceae, MRSA and C. difficile was 57.3% (279/487), 17.2% (84/487) and 5.1% (21/409) respectively. Carriage rate of carbapenemase-producing Enterobacteriaceae was 1% (5/487). Being bedridden was a common independent risk factor for colonization by all MDROs, although risk factors specific for each MDRO were identified. ESBL-producing Escherichia coli carriage was associated with the sequence type (ST) 131-H30 subclone, but other minor STs predominated in individual LTCF or in LTCFs located in the same city, suggesting a role for intrafacility or local transmission. Similarly, MRSA from LTCF residents belonged to the same spa types/ST clones (t008/ST8 and t032/ST22) commonly found in Italian acute-care hospitals, but infrequent spa types were recovered in individual LTCFs. The prevalent C. difficile PCR ribotypes were 356/607 and 018, both common in Italian acute-care hospitals. Conclusions MDRO colonization is common among residents in Italian LTCFs.

Original languageEnglish
Pages (from-to)961-967
Number of pages7
JournalClinical Microbiology and Infection
Volume23
Issue number12
DOIs
Publication statusPublished - Dec 1 2017

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Long-Term Care
Italy
Clostridium difficile
Enterobacteriaceae
Methicillin-Resistant Staphylococcus aureus
Cross-Sectional Studies
Ribotyping
Molecular Typing
Nose
Feces
Multivariate Analysis
Clone Cells
Genotype
Escherichia coli
Polymerase Chain Reaction
Genes
carbapenemase

Keywords

  • Carbapenemase
  • Clostridium difficile
  • Enterobacteriaceae
  • ESBL
  • Escherichia coli
  • Klebsiella pneumoniae
  • Long-term care facilities
  • MRSA

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

Cite this

Colonization by multidrug-resistant organisms in long-term care facilities in Italy : a point-prevalence study. / Giufrè, M.; Ricchizzi, E.; Accogli, M.; Barbanti, F.; Monaco, M.; Pimentel de Araujo, F.; Farina, C.; Fazii, P.; Mattei, R.; Sarti, M.; Barozzi, A.; Buttazzi, R.; Cosentino, M.; Nardone, M.; Savini, V.; Spigaglia, P.; Pantosti, A.; Moro, M. L.; Cerquetti, M.

In: Clinical Microbiology and Infection, Vol. 23, No. 12, 01.12.2017, p. 961-967.

Research output: Contribution to journalArticle

Giufrè, M, Ricchizzi, E, Accogli, M, Barbanti, F, Monaco, M, Pimentel de Araujo, F, Farina, C, Fazii, P, Mattei, R, Sarti, M, Barozzi, A, Buttazzi, R, Cosentino, M, Nardone, M, Savini, V, Spigaglia, P, Pantosti, A, Moro, ML & Cerquetti, M 2017, 'Colonization by multidrug-resistant organisms in long-term care facilities in Italy: a point-prevalence study', Clinical Microbiology and Infection, vol. 23, no. 12, pp. 961-967. https://doi.org/10.1016/j.cmi.2017.04.006
Giufrè, M. ; Ricchizzi, E. ; Accogli, M. ; Barbanti, F. ; Monaco, M. ; Pimentel de Araujo, F. ; Farina, C. ; Fazii, P. ; Mattei, R. ; Sarti, M. ; Barozzi, A. ; Buttazzi, R. ; Cosentino, M. ; Nardone, M. ; Savini, V. ; Spigaglia, P. ; Pantosti, A. ; Moro, M. L. ; Cerquetti, M. / Colonization by multidrug-resistant organisms in long-term care facilities in Italy : a point-prevalence study. In: Clinical Microbiology and Infection. 2017 ; Vol. 23, No. 12. pp. 961-967.
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abstract = "Objectives To determine prevalence and risk factors for colonization by multidrug-resistant organisms (MDROs) in long-term care facility (LTCF) residents in Italy. Genotypes of MDRO isolates were investigated. Methods A point-prevalence study was conducted at 12 LTCFs located in four Italian cities (2 February to 14 March 2015). Rectal swabs, faeces and nasal/auxiliary swabs were cultured for extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacteriaceae, Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) respectively. Antimicrobial susceptibility testing, detection of ESBL and/or carbapenemase genes and molecular typing of MDROs were performed. Risk factors for colonization were determined by univariate and multivariate analysis. Results A total of 489 LTCF residents aged ≥65 years were enrolled. The prevalence of colonization by ESBL-producing Enterobacteriaceae, MRSA and C. difficile was 57.3{\%} (279/487), 17.2{\%} (84/487) and 5.1{\%} (21/409) respectively. Carriage rate of carbapenemase-producing Enterobacteriaceae was 1{\%} (5/487). Being bedridden was a common independent risk factor for colonization by all MDROs, although risk factors specific for each MDRO were identified. ESBL-producing Escherichia coli carriage was associated with the sequence type (ST) 131-H30 subclone, but other minor STs predominated in individual LTCF or in LTCFs located in the same city, suggesting a role for intrafacility or local transmission. Similarly, MRSA from LTCF residents belonged to the same spa types/ST clones (t008/ST8 and t032/ST22) commonly found in Italian acute-care hospitals, but infrequent spa types were recovered in individual LTCFs. The prevalent C. difficile PCR ribotypes were 356/607 and 018, both common in Italian acute-care hospitals. Conclusions MDRO colonization is common among residents in Italian LTCFs.",
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T1 - Colonization by multidrug-resistant organisms in long-term care facilities in Italy

T2 - a point-prevalence study

AU - Giufrè, M.

AU - Ricchizzi, E.

AU - Accogli, M.

AU - Barbanti, F.

AU - Monaco, M.

AU - Pimentel de Araujo, F.

AU - Farina, C.

AU - Fazii, P.

AU - Mattei, R.

AU - Sarti, M.

AU - Barozzi, A.

AU - Buttazzi, R.

AU - Cosentino, M.

AU - Nardone, M.

AU - Savini, V.

AU - Spigaglia, P.

AU - Pantosti, A.

AU - Moro, M. L.

AU - Cerquetti, M.

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Objectives To determine prevalence and risk factors for colonization by multidrug-resistant organisms (MDROs) in long-term care facility (LTCF) residents in Italy. Genotypes of MDRO isolates were investigated. Methods A point-prevalence study was conducted at 12 LTCFs located in four Italian cities (2 February to 14 March 2015). Rectal swabs, faeces and nasal/auxiliary swabs were cultured for extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacteriaceae, Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) respectively. Antimicrobial susceptibility testing, detection of ESBL and/or carbapenemase genes and molecular typing of MDROs were performed. Risk factors for colonization were determined by univariate and multivariate analysis. Results A total of 489 LTCF residents aged ≥65 years were enrolled. The prevalence of colonization by ESBL-producing Enterobacteriaceae, MRSA and C. difficile was 57.3% (279/487), 17.2% (84/487) and 5.1% (21/409) respectively. Carriage rate of carbapenemase-producing Enterobacteriaceae was 1% (5/487). Being bedridden was a common independent risk factor for colonization by all MDROs, although risk factors specific for each MDRO were identified. ESBL-producing Escherichia coli carriage was associated with the sequence type (ST) 131-H30 subclone, but other minor STs predominated in individual LTCF or in LTCFs located in the same city, suggesting a role for intrafacility or local transmission. Similarly, MRSA from LTCF residents belonged to the same spa types/ST clones (t008/ST8 and t032/ST22) commonly found in Italian acute-care hospitals, but infrequent spa types were recovered in individual LTCFs. The prevalent C. difficile PCR ribotypes were 356/607 and 018, both common in Italian acute-care hospitals. Conclusions MDRO colonization is common among residents in Italian LTCFs.

AB - Objectives To determine prevalence and risk factors for colonization by multidrug-resistant organisms (MDROs) in long-term care facility (LTCF) residents in Italy. Genotypes of MDRO isolates were investigated. Methods A point-prevalence study was conducted at 12 LTCFs located in four Italian cities (2 February to 14 March 2015). Rectal swabs, faeces and nasal/auxiliary swabs were cultured for extended-spectrum β-lactamase (ESBL)- and/or carbapenemase-producing Enterobacteriaceae, Clostridium difficile and methicillin-resistant Staphylococcus aureus (MRSA) respectively. Antimicrobial susceptibility testing, detection of ESBL and/or carbapenemase genes and molecular typing of MDROs were performed. Risk factors for colonization were determined by univariate and multivariate analysis. Results A total of 489 LTCF residents aged ≥65 years were enrolled. The prevalence of colonization by ESBL-producing Enterobacteriaceae, MRSA and C. difficile was 57.3% (279/487), 17.2% (84/487) and 5.1% (21/409) respectively. Carriage rate of carbapenemase-producing Enterobacteriaceae was 1% (5/487). Being bedridden was a common independent risk factor for colonization by all MDROs, although risk factors specific for each MDRO were identified. ESBL-producing Escherichia coli carriage was associated with the sequence type (ST) 131-H30 subclone, but other minor STs predominated in individual LTCF or in LTCFs located in the same city, suggesting a role for intrafacility or local transmission. Similarly, MRSA from LTCF residents belonged to the same spa types/ST clones (t008/ST8 and t032/ST22) commonly found in Italian acute-care hospitals, but infrequent spa types were recovered in individual LTCFs. The prevalent C. difficile PCR ribotypes were 356/607 and 018, both common in Italian acute-care hospitals. Conclusions MDRO colonization is common among residents in Italian LTCFs.

KW - Carbapenemase

KW - Clostridium difficile

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KW - ESBL

KW - Escherichia coli

KW - Klebsiella pneumoniae

KW - Long-term care facilities

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