Highlights
- •Multidrug resistant-gram negative bacteria colonization ranged from 11.2%-59.1%.
- •E coli accounted for the largest proportion of isolates.
- •The most common site of colonization was rectal, followed by nasal, sputum, urinary tract and wound.
- •Colonization was significantly higher in studies conducted in United States (38%) compared to other countries (14%).
Background
Multidrug-resistant gram-negative bacteria (MDR-GNB) are associated with an increasing
proportion of infections among nursing home (NH) residents. The objective of this
systematic review and meta-analysis was to critically review evidence of the prevalence
of MDR-GNB among NH residents.
Methods
Following Meta-Analysis of Observational Studies in Epidemiology guidelines, a systematic
review of literature for the years 2005-2016 using multiple databases was conducted.
Study quality, appraised by 2 reviewers, used Downs and Black risk of bias criteria.
Studies reporting prevalence of MDR-GNB colonization were pooled using a random effects
meta-analysis model. Heterogeneity was assessed using Cochran Q and I2 statistics.
Results
Of 327 articles, 12 met the criteria for review; of these, 8 met the criteria for
meta-analysis. Escherichia coli accounted for the largest proportion of isolates. Reported MDR-GNB colonization prevalence
ranged from 11.2%-59.1%. Pooled prevalence for MDR-GNB colonization, representing
data from 2,720 NH residents, was 27% (95% confidence interval, 15.2%-44.1%) with
heterogeneity (Q = 405.6; P = .01; I2 = 98.3). Two studies reported MDR-GNB infection rates of 10.9% and 62.7%.
Conclusion
Our findings suggest a high prevalence of MDR-GNB colonization among NH residents,
emphasizing the need to enhance policies for infection control and prevention (ICP)
in NHs.
Key Word
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Article info
Footnotes
SA is supported by an award from the Robert Wood Johnson Foundation and the UnitedHealth Group Foundation. The sponsors had no role in the design, methods, data collection, analysis, and writing of this manuscript.
Conflicts of interest: None to report.
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© 2017 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
