Publications
Risk
Factors for Colonization during an outbreak of Multi-Drug Resistant
(MDR), Extended Spectrum Beta-lactamase (ESBL) Producing E.coli
in Long Term Care Facilities (LTCF) in Ontario, Canada. E. CHAN1,
K. MORAN2, D. REYNOLDS2, A. MCGEER3,
M. OFNER-AGOSTINI1; 1Health Canada, Ottawa, ON,
Canada, 2Durham Region Health Department, Whitby, ON, Canada,
3Mount Sinai Hospital, Toronto, ON, Canada.
Background:
An outbreak of a MDR ESBL E.coli has to date affected more
than 300 patients/residents in hospitals and LTCF in southern Ontario.
Within involved LTCF, we looked at risk factors for colonization with
the outbreak strain.
Methods:
Residents of LTCF with at least 1 positive clinical/screening isolate
between August 2000 and July 2001were considered cases and were matched
by facility to residents with at least 4 negative screens and no clinical
isolates. Data on demographics, underlying illness, functional status,
and care requirements were collected by chart review. Antibiotic use
and exposure to case roommates/bathroommates were collected for the
6 months and 4 weeks, respectively, prior to the first positive test
for cases, and the first test for controls.
Results:
127 eligible cases and 127 controls were identified in 7 LTCF. There
were no differences between cases and controls in demographics, underlying
illnesses, medication use other than antibiotics, diet, or functional
status. Cases were more likely to have had a case roommate (mean 0.53
for cases vs. 0.22 for controls, P=0.001), or bathroommate (mean 0.44
for cases vs. 0.08 for controls, P=0.006). Cases were more likely
to have been exposed to any antibiotic in the previous 6 months (OR=
3.04 CI 1.7-5.4 P<0.000), particularly fluoroquinolones (OR= 4.7,
CI 2.1-11.5 P<0.000). A history of hospitalization in the previous
6 months was also more common in cases (OR= 2.2, CI 1.09-4.9 P=0.01).
Conclusions:
In these LTCF, neither underlying illness nor functional status was
associated with colonization with MDR ESBL E. coli. Antibiotic
use and exposure to other colonized residents increased the risk of
colonization. Control of dissemination within LTCF will likely require
interventions to alter both antibiotic use and person to person transmission.
42nd INTERSCIENCE CONFERENCE ON ANTIMICROBIAL AGENTS AND CHEMOTHERAPY
(ICAAC), San Diego, California, USA, September 29, 2002. 3:30pm-3:45pm
©Copyright 2002 Last Modified
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