Antibiotic-Resistant Organisms Affect Majority of Long-Term Care Patients Interview with:
Susan S. Huang, MD
Professor, Infectious Disease
School of Medicine
Medical Director, Epidemiology and Infection Prevention
UCI What is the background for this study? What are the main findings?

Response:  The SHIELD Orange County Project is a CDC-initiated public health collaborative among nursing homes, long-term acute care (LTAC) facilities, and hospitals in the 6th largest U.S. County (Orange County, California). The 38 facilities (18 nursing homes, 3 LTACs, 17 hospitals) received targeted invitations based upon their high degree of shared patients with one another. The goal of the collaborative is to reduce multi-drug resistant organisms throughout the county using a decolonization strategy.

As part of the baseline assessment, we swabbed 50 adult patients in each facility to assess the frequency that patients had multi-drug resistant organisms (MDRO) on their body. Nursing home and LTAC patients were sampled from the entire population while hospital sampling involved only adults in contact precautions. We found that an alarmingly high percent of patients had an MDRO, including methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), extended-spectrum beta-lactamase producers (ESBLs), and carbapenem-resistant enterobacteriaceae (CRE).

  • For nursing homes, 64% of residents have an antibiotic resistant bacteria on their body. Almost all of these are not known to the nursing home.
  • For LTACs, 80% of patients have an antibiotic resistant bacteria on their body. 7 in 10 patients have an MDRO that is not known to the LTAC.
  • For hospitalized patients on contact precautions, 64% have an antibiotic-resistant bacteria on their body. One third have an antibiotic-resistant bacteria that is not known to the hospital.
  • Having one MDRO is highly associated with having another one/ What should readers take away from your report?

Response:    These results are alarming. Antibiotic-resistant organisms affect the vast majority of patients in long term care settings such as nursing homes and  long-term acute care hospitals (LTACs) . These organisms increase the risk for serious infections and efforts are urgently needed to protect these patients from acquiring, spreading, and becoming infected with these pathogens. What recommendations do you have for future research as a result of this study?

Response:            The SHIELD Orange County project will be evaluating the ability of antiseptic soaps and nasal products to reduce these levels of antibiotic resistant bacteria across the county. We will be evaluating whether that type of intervention benefits not only facilities who participate in the intervention, but also facilities who simply share patients with them. Studies of other strategies are also needed. Is there anything else you would like to add?

Response:            This collaborative is funded by the Centers for Disease Control and Prevention. Nursing homes, LTACs, and hospitals participating in the SHIELD Orange County Project are receiving contributed antiseptic products from Sage Products/Stryker, Clorox, Medline, and Xttrium. These companies have no role in the design, conduct, analyses, or publication of this project. Thank you for your contribution to the community.

Citation: upcoming ID week abstract:

The CDC SHIELD Orange County Project – Baseline Multi Drug-Resistant Organism (MDRO) Prevalence in a Southern California Region.

Raveena D. Singh, MA1, John A. Jernigan, MD, MS2, Rachel Slayton, PhD, MPH2, Nimalie D. Stone, MD, MS2, James A. McKinnell, MD3, Loren Miller, MD, MPH, FIDSA3, Ken Kleinman, ScD4, Lauren Heim, MPH1, Tabitha D. Dutciuc, MPH1, Marlene Estevez, BA1, Gabrielle Gussin, MS1, Justin Chang, BS1, Ellena M. Peterson, PhD5, Kaye D. Evans, BA/MT5, Bruce Y. Lee, MD, MBA6, Leslie E. Mueller, MPH6, Sarah M. Bartsch, MPH6, Matthew Zahn, MD, FIDSA7, Lynn Janssen, MS, CIC, CPHQ8, Robert A. Weinstein, MD, FIDSA, FSHEA, FACP9, Mary K. Hayden, MD, FIDSA, FSHEA10, Shruti K. Gohil, MD, MPH1, Steven Park, MD, PhD5, Steven Tam, MD11, Raheeb Saavedra, AS1, Stacey Yamaguchi, BA1, Harold Custodio, MPH1, Jenny Nguyen, BA1, Thomas Tjoa, MPH, MS1, Jiayi He, MS1, Kathleen O’Donnell, MPH7, Micaela H. Coady, MS12, Richard Platt, MD, MS, FIDSA, FSHEA12Susan S. Huang, MD, MPH, FIDSA, FSHEA1 and CDC Safety and Healthcare Epidemiology Prevention Research Development (SHEPheRD) Program, (1)Division of Infectious Diseases and Health Policy Research Institute, University of California Irvine School of Medicine, Irvine, CA, (2)Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, Atlanta, GA, (3)Infectious Disease Clinical Outcomes Research (ID-CORE), LA Biomed at Harbor-UCLA Medical Center, Torrance, CA, (4)University of Massachusetts Amherst School of Public Health and Health Sciences, Amherst, MA, (5)University of California Irvine Health, Orange, CA, (6)Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, (7)Epidemiology and Assessment, Orange County Health Care Agency, Santa Ana, CA, (8)Healthcare-Associated Infections Program, Center for Healthcare Quality, California Department of Public Health, Richmond, CA, (9)Cook County Health and Hospitals System, Chicago, IL, (10)Internal Medicine (Infectious Diseases) and Pathology, Rush University Medical Center, Chicago, IL, (11)Division of Geriatrics, Department of Medicine, University of California Irvine, Orange, CA, (12)Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA

Note: Content is Not intended as medical advice. Please consult your health care provider regarding your specific medical condition and questions.


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