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High Prevalence of Multidrug-Resistant Bacteria in Mechanically Ventilated Patients

MEEFRO October 17, 2023

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A statewide assessment of hospitals and nursing homes in Maryland discovered that colonization with two multidrug-resistant bacteria is widespread in patients undergoing mechanical ventilation, suggested a new study (1). Researchers with the Maryland Multi-Drug Resistant Organism Prevention Collaborative obtained surveillance cultures from patients receiving mechanical ventilation at 33 acute care hospitals and 18 long-term care facilities for the statewide cross-sectional point-prevalence study (2).

Assessing Multidrug-Resistant Bacteria

Their goal was to establish the frequency of Acinetobacter baumannii and Candida auris, two emerging multidrug-resistant infections with limited treatment options that the World Health Organization and the Centers for Disease Control and Prevention have flagged as urgent health issues. All qualifying facilities in the state took part, screening 482 patients for A baumannii and 470 for C auris. 148 (30.7%) of the 482 patients whose samples were taken developed A baumannii, 88 (59.5%) of which were carbapenem-resistant A baumannii (CRAB). C auris was found in 31 (6.6%) of the 470 samples. Both infections were more common in patients in nursing homes.

Patients in long-term care facilities were found to be more likely to be colonized with A baumannii (RR, 7.66; 95% CI, 5.11 to 11.50), CRAB (RR, 5.48; 95% CI, 3.38 to 8.91), and C auris (RR, 1.97; 95% CI, 0.99 to 3.92) than patients in acute-care hospitals. The Maryland Department of Health was previously unaware of nine patients (29.0%) who had cultures positive for C auris.

Health Care’s Battle Against Multidrug-Resistant Infections

“This prevalence represents a substantial burden to the health care system and suggests a large reservoir for potential transmission both to other patients within health care facilities and among different health care facilities when patients are transferred between care settings,” according to the study’s authors.

Given the prevalence of both diseases in these settings, the authors recommend that greater surveillance and preventative efforts should focus on long-term care facilities. They also suggest that the study be performed in other states with mechanical ventilation patients.

References:

Mangioni D, Chatenoud L, Colombo J, Palomba E, Guerrero FA, Bolis M, Bottino N, Breda G, Chiaruttini MV, Fior G, Marotta M, Massobrio G, Matinato C, Muscatello A, Previtali P, Santambrogio S, Tardini F, Zuglian G, Grasselli G, Fumagalli R, Gori A, Stocchetti N, Monti G, Bandera A; MDR in FIERA Study Group3. Multidrug-Resistant Bacterial Colonization and Infections in Large Retrospective Cohort of Mechanically Ventilated COVID-19 Patients1. Emerg Infect Dis. 2023 Aug;29(8):1598-1607. doi: 10.3201/eid2908.230115. PMID: 37486196; PMCID: PMC10370845.