Feeding Tubes Linked To Resistant Organisms In Nursing Home Patients

MedicalResearch.com Interview with:

Leonard Mermel, DO, ScM, AM (Hon), FSHEA, FIDSA, FACP Professor of Medicine, Warren Alpert Medical School of Brown University Medical Director, Dept. of Epidemiology & Infection Control, Rhode Island Hospital

Dr. Leonard Mermel

Leonard Mermel, DO, ScM, AM (Hon), FSHEA, FIDSA, FACP 
Professor of Medicine, Warren Alpert Medical School of Brown University
Medical Director, Dept. of Epidemiology & Infection Control, Rhode Island Hospital
Adjunct Clinical Professor, University of Rhode Island College of Pharmacy 

Medical Research: What is the background for this study? What are the main findings?

Dr. Mermel:  There is increasing concern in the US and abroad regarding multi-drug resistant organisms (MDROs), particularly bacteria resistant to carbapenem antibiotics.  Concern has been raised about MDRO colonization in high-risk populations, such as nursing home patients and transmission between nursing home and acute care hospitals.  Little data exists concerning the incidence of GI tract colonization of such pathogens in nursing home patients at the time of acute care hospitalization.  We used rectal swabs on 500 hospital admissions from nursing homes to assess carriage of bacteria resistant to carbapenem antibiotics.  We found carbapenem-resistant or carbapenemase-producing gram-negative bacteria in 23 of the 500 (4.6%) hospital admissions from nursing homes, which included 7 carbapenemase-producing CRE bacteria (1.4%).  The latter bacteria produce an enzyme that breaks down the carbapenem antibiotic and the resistance genes are located on mobile genetic elements.  We also found that use of gastrostomy tubes was associated with fecal carriage of gram-negative bacteria with detectable carbapenem resistance.

Medical Research: What should clinicians and patients take away from your report?

Dr. Mermel: Patients may be silently colonized with multi-drug resistant bacteria which have the potential for transmission in healthcare settings and if such bacteria get into sterile body sites, may cause difficult to treat infections associated with high morbidity and mortality.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Mermel: We need to do point prevalence surveys over time to determine if such carriage is increasing and to determine risk factors for such carriage. 

Medical Research: Is there anything else you would like to add?

Dr. Mermel: Infection control and prevention programs along with antimicrobial stewardship programs in acute and chronic care facilities are needed to prevent spread of MDROs in those settings and thereby mitigate risk of serious, difficult to treat infections.

Citation:

Am J Infect Control. 2016 Feb 1;44(2):126-30. doi: 10.1016/j.ajic.2015.09.019. Epub 2015 Nov 26.

Screening of nursing home residents for colonization with carbapenem-resistant Enterobacteriaceae admitted to acute care hospitals: Incidence and risk factors.

Cunha CB1, Kassakian SZ2, Chan R3, Tenover FC3, Ziakas P1, Chapin KC4, Mermel LA5.

 


Dr. Leonard Mermel (2016). Feeding Tubes Linked To Resistant Organisms In Nursing Home Patients 

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