BACKGROUND Multidrug-resistant organisms (MDROs) spread between hospitals, nursing homes (NHs), and long-term acute care facilities (LTACs) via patient transfers. The Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County is a regional public health collaborative involving decolonization at 38 healthcare facilities selected based on their high degree of patient sharing. We report baseline MDRO prevalence in 21 NHs/LTACs. METHODS A random sample of 50 adults for 21 NHs/LTACs (18 NHs, 3 LTACs) were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum β-lactamase-producing organisms (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE) using nares, skin (axilla/groin), and peri-rectal swabs. Facility and resident characteristics associated with MDRO carriage were assessed using multivariable models clustering by person and facility. RESULTS Prevalence of MDROs was 65% in NHs and 80% in LTACs. The most common MDROs in NHs were MRSA (42%) and ESBL (34%); in LTACs they were VRE (55%) and ESBL (38%). CRE prevalence was higher in facilities that manage ventilated LTAC patients and NH residents (8% vs <1%, P < .001). MDRO status was known for 18% of NH residents and 49% of LTAC patients. MDRO-colonized adults commonly harbored additional MDROs (54% MDRO+ NH residents and 62% MDRO+ LTACs patients). History of MRSA (odds ratio [OR] = 1.7; confidence interval [CI]: 1.2, 2.4; P = .004), VRE (OR = 2.1; CI: 1.2, 3.8; P = .01), ESBL (OR = 1.6; CI: 1.1, 2.3; P = .03), and diabetes (OR = 1.3; CI: 1.0, 1.7; P = .03) were associated with any MDRO carriage. CONCLUSIONS The majority of NH residents and LTAC patients harbor MDROs. MDRO status is frequently unknown to the facility. The high MDRO prevalence highlights the need for prevention efforts in NHs/LTACs as part of regional efforts to control MDRO spread.

中文翻译：

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SHIELD橙县项目：南加州21所疗养院和长期急性护理机构中的多药耐药生物流行率。

背景技术耐多药生物（MDRO）通过患者转移在医院，疗养院（NH）和长期急性护理机构（LTAC）之间传播。消除橙县MDRO危及生命的共享医疗干预是一项区域性公共卫生合作，涉及在38个医疗机构中根据他们的高度患者共享程度选择非殖民化。我们报告了21个NH / LTAC中的基线MDRO患病率。方法随机抽取50个成年人的21个NHs / LTAC（18个NHs，3个LTAC）作为耐甲氧西林的金黄色葡萄球菌（MRSA）和耐万古霉素的肠球菌。（VRE），产生广谱β-内酰胺酶的生物（ESBL）和耐碳青霉烯的肠杆菌科（CRE），使用鼻孔，皮肤（腋窝/腹股沟）和直肠周拭子。使用多变量模型按人员和设施进行聚类，评估与MDRO运输相关的设施和居民特征。结果NHs中MDRO的患病率为65％，LTACs中MDRO的患病率为80％。NHs中最常见的MDRO是MRSA（42％）和ESBL（34％）；在LTAC中，它们是VRE（55％）和ESBL（38％）。在管理通气性LTAC患者和NH居民的设施中，CRE患病率较高（8％对<1％，P <.001）。已知18％的NH居民和49％的LTAC患者的MDRO状态。MDRO殖民化的成年人通常携带其他MDRO（54％MDRO + NH居民和62％MDRO + LTACs患者）。MRSA的历史（赔率[OR] = 1.7;置信区间[CI]：1.2，2.4; P = .004），VRE（OR = 2.1; CI：1.2，3.8; P = 0.01），ESBL（OR = 1.6； CI：1.1、2.3； P = .03）和糖尿病（OR = 1.3； CI：1.0、1.7； P = 0。03）与任何MDRO滑架相关。结论大多数NH居民和LTAC患者携带MDRO。设备经常不知道MDRO状态。MDRO患病率很高，这表明需要在NHs / LTAC中进行预防工作，这是控制MDRO扩散的区域性努力的一部分。