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Synergistic effects of length of stay and prior MDRO carriage on the colonization and co-colonization of methicillin-resistant Staphylococcus aureus, vancomycin-resistant Enterococcus, and carbapenemase-producing Enterobacterales across healthcare settings

Published online by Cambridge University Press:  30 March 2022

Htet Lin Htun Open the ORCID record for Htet Lin Htun [Opens in a new window] ,
Pei-Yun Hon ,
Rei Tan ,
Brenda Ang Open the ORCID record for Brenda Ang [Opens in a new window]  and
Angela Chow Open the ORCID record for Angela Chow [Opens in a new window]
Htet Lin Htun
Affiliation:
Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore
Pei-Yun Hon
Affiliation:
Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore
Rei Tan
Affiliation:
Yong Loo Lin School of Medicine, National University of Singapore, Singapore
Brenda Ang
Affiliation:
Yong Loo Lin School of Medicine, National University of Singapore, Singapore Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore
Angela Chow*
Affiliation:
Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics and Knowledge (OCEAN), Tan Tock Seng Hospital, Singapore Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore Saw Swee Hock School of Public Health, National University of Singapore, Singapore
*
Author for correspondence: Angela Chow, E-mail: angela_chow@ttsh.com.sg
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Abstract

Objective:

To characterize the epidemiology of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and carbapenemase-producing Enterobacterales (CPE) co-colonization and to compare risk factors between healthcare facility types.

Design, setting, and participants:

We conducted a 3-year cross-sectional study among patients admitted to an acute-care hospital (ACH) and its 6 closely affiliated intermediate- and long-term care facilities (ILTCFs) in Singapore in June and July of 2014–2016.

Methods:

Specimens were concurrently collected from nares, axillae, and groins for MRSA detection, and from rectum or stool for VRE and CPE detection. Co-colonization was defined as having >1 positive culture of MRSA/VRE/CPE. Multinomial logistic regression was performed to determine predictors of co-colonization.

Results:

Of 5,456 patients recruited, 176 (3.2%) were co-colonized, with higher prevalence among patients in ITCFs (53 of 1,255, 4.2%) and the ACH (120 of 3,044, 3.9%) than LTCFs (3 of 1,157, 0.3%). MRSA/VRE was the most common type of co-colonization (162 of 5,456, 3.0%). Independent risk factors for co-colonization included male sex (odds ratio [OR], 1.96; 95% confidence interval [CI], 1.37–2.80), prior antibiotic therapy of 1–3 days (OR, 10.39; 95% CI, 2.08–51.96), 4–7 days (OR, 4.89; 95% CI, 1.01–23.68), >7 days (OR, 11.72; 95% CI, 2.81–48.85), and having an open wound (OR, 2.34; 95% CI, 1.66–3.29). Additionally, we detected the synergistic interaction of length of stay >14 days and prior multidrug-resistant organism (MDRO) carriage on co-colonization. Having an emergency surgery was a significant predictor of co-colonization in ACH patients, and we detected a dose–response association between duration of antibiotic therapy and co-colonization in ILTCF patients.

Conclusions:

We observed common and differential risk factors for MDRO co-colonization across healthcare settings. This study has identified at-risk groups that merit intensive interventions, particularly patients with prior MDRO carriage and longer length of stay.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 44 , Issue 1 , January 2023 , pp. 31 - 39
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Copyright
© The Author(s), 2022. Published by Cambridge University Press on behalf of The Society for Healthcare Epidemiology of America

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