Prevalence of multidrug-resistant gram-negative bacteria among nursing home residents: A systematic review and meta-analysis


      • 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%).


      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.


      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.


      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%.


      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.

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