Physically Independent Residents May Contribute to Spread of Multidrug-Resistant Organisms in Nursing Homes

Functionally independent residents may be an underappreciated driver of the spread of multidrug-resistant organisms (MDROs) in nursing homes, according to study findings published in The Lancet Healthy Longevity.

“This study highlights that, although antibiotic-mediated gut dysbiosis can lead to colonization with vancomycin-resistant enterococcus, resident functional independence probably drives the spread of vancomycin-resistant enterococci (VRE) from resident body sites to their proximal environment via hand contamination,” wrote corresponding author Evan S. Snitkin, PhD, and study coauthors from the University of Michigan, Ann Arbor, Michigan.

The retrospective observational study included 245 residents from 6 US nursing homes. Researchers analyzed data from swabs of residents’ hands and other body sites as well as various room surfaces, such as doorknobs and wheelchairs. They also considered residents’ demographic and clinical data.

VRE colonization was present in 20% of participants, according to the study. In nearly three-quarters of patients with VRE colonization, environmental surfaces were contaminated with VRE. Rates of hand contamination were 51% among participants with environmental contamination compared with 13% among those with no environmental contamination.

Exposure to microbiota-disruptive antibiotics in the past 30 days, increased physical independence, and hand contamination were associated with environmental contamination with VRE among participants with VRE colonization, the study found.

“Our results suggest adding improved patient hand hygiene education and antibiotic stewardship to existing practices to reduce MDRO burden and risk of transmission,” researchers wrote. “Although our study used VRE as a marker of potential transmission, the results are likely to translate to the prevention and control of other infectious agents transmitted via direct and indirect contact.”

Reference

Wang J, Foxman B, Rao K, et al. Association of patient clinical and gut microbiota features with vancomycin-resistant enterococci environmental contamination in nursing homes: a retrospective observational study. Lancet Healthy Longev. 2023;4(11):e600-e607. doi:10.1016/S2666-7568(23)00188-5