Predominance of methicillin-resistant Staphylococcus aureus in the residents and environments of long-term care facilities in Taiwan |
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| Authors: | Chia-Ying Liu Chih-Cheng Lai Hsiu-Tzy Chiang Min-Chi Lu Ling-Fang Wang Tsai-Ling Tsai Mei-Yu Kang Yi-Ni Jan Yi-Ting Lo Wen-Chien Ko Shu-Hui Tseng Chun-Ming Lee Po-Ren Hsueh |
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| Institution: | 1. Department of Internal Medicine, Far Eastern Memorial Hospital, New Taipei City, Taiwan;2. Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying, Tainan, Taiwan;3. Infection Control Center, MacKay Memorial Hospital, Taipei, Taiwan;4. Department of Internal Medicine, Chung Shan Medical University, Taichung, Taiwan;5. Yongen Nursing Home, Taichung, Taiwan;6. Lukang Christian Nursing Home, Lukang, Taiwan;7. Changhua Christian Hospital Erlin Nursing Home, Changhua, Taiwan;8. Thanksgiving Nursing Home, Taichung, Taiwan;9. Feng-Fung Nursing Home, Taichung, Taiwan;10. Department of Internal Medicine, National Cheng Kung University Hospital, Medical College, Tainan, Taiwan;11. Centers for Disease Control, Ministry of Health and Welfare, Taiwan;12. Department of Internal Medicine, St. Joseph''s Hospital, Yunlin County, Taiwan;13. MacKay Junior College of Medicine, Nursing, and Management, Taipei, Taiwan;14. Department of Laboratory Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan;15. Department of Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan |
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| Abstract: | Background/purposeThis study investigated the distribution and persistence of multidrug resistant organisms (MDROs) including methicillin-resistant Staphylococcus aureus (MRSA), carbapenem-resistant Enterobacteriaceae (CRE), carbapenem-resistant Pseudomonas aeruginosa (CRPA), and multidrug-resistant Acinetobacter baumannii (MDRAB) in six long-term care facilities (LTCFs).MethodsWe investigated the distribution of MDROs in residents of six LTCFs and their environments from January to December 2016 (intervention period). Active surveillance of colonization of MDROs was performed by culturing rectal and nasal swab samples from the residents every three months. Multilocus sequence typing (MLST) was conducted, and genes for panton-valentine leukocidin (PVL) from MRSA isolates were determined.ResultsA total of 521 samples were positive for MDROs, and MRSA was the most common organism (65.1%), followed by MDRAB (11.3%), carbapenem-resistant Klebsiella pneumoniae (11.1%), carbapenem-resistant Escherichia coli (4.6%), and carbapenem-resistant P. aeruginosa (2.1%, n = 11). By a linear regression model, positive MRSA isolates from the environment were found to be statistically significant and associated with the number of colonized LTCF residents (p = 0.01), while the timing of the surveillance culture was not (p = 0.227). The main MLST types associated with PVL-production were sequence type (ST) 59, (40.0%, 24/60), ST30 (21.4%, 3/14), ST8 (87.5%, 14/16), and ST45 (3.6%, 1/28). The susceptibility rates of tetracycline (96.7%), trimethoprim-sulfamethoxazole (96.7%), and ciprofloxacin (81.7%) were statistically significant and higher in MRSA ST59, compared to the rates in MRSA ST45 isolates.ConclusionsMRSA was the most commonly colonized MDRO, both in the LTCF residents and in the environment, followed by MDRAB and carbapenem-resistant K. pneumoniae. |
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| Keywords: | Multidrug-resistant organisms Long-term care facility Sequence type |
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