The burden of multidrug-resistant organisms on tertiary hospitals posed by patients with recent stays in long-term acute care facilities

Dror Marchaim*, Teena Chopra, Christopher Bogan, Suchitha Bheemreddy, David Sengstock, Rajasekhar Jagarlamudi, Anurag Malani, Leslie Lemanek, Judy Moshos, Paul R. Lephart, Kimberley Ku, Asma Hasan, Jiha Lee, Namir Khandker, Christopher Blunden, Sara F. Geffert, Megan Moody, Rahbar Hiro, Yujing Wang, Farah AhmadTarana Mohammadi, Omar Faruque, Diixa Patel, Jason M. Pogue, Kayoko Hayakawa, Sorabh Dhar, Keith S. Kaye

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Background: Long-term acute care (LTAC) facilities admit patients with complex, advanced disease states. Study aims were to determine the burden posed on hospitals associated with LTAC exposure and analyze the differences between "present on admission" (POA) multidrug-resistant (MDR), gram-negative organisms (GNO) and POA MDR gram-positive organisms (GPO). Methods: A multicenter retrospective study was conducted in 13 hospitals from southeast Michigan, from September 1, 2008, to August 31, 2009. Cultures obtained in the first 72 hours of hospitalization (ie, POA) of MDR-GPO and MDR-GNO were reviewed. LTAC exposures in the previous 6 months and direct admission from a LTAC were recorded. Results: Overall, 5,297 patients with 7,147 MDR POA cultures were analyzed: 2,619 (36.6%) were MDR-GNO, and 4,528 (63.4%) were MDR-GPO. LTAC exposure in the past 6 months was present in 251 (5.2%) infectious episodes and was significantly more common among POA MDR-GNO than MDR-GPO (158 [8.6%] and 94 [3.1%], respectively, odds ratio, 2.87; P <.001). Recent LTAC exposure was strongly associated with both carbapenem-resistant Enterobacteriaceae (CRE) (31.6% of all CRE cases, P <.001) and Acinetobacter baumannii (14.9% of all A baumannii cases, P <.001). Conclusion: Nearly 10% of MDR-GNO POA had recent LTAC exposure. Hospital efforts to control the spread of MDR-GNO should focus on collaborations and communications with referring LTACs and interventions targeted towards patients with recent LTAC exposure.

Original languageEnglish
Pages (from-to)760-765
Number of pages6
JournalAmerican Journal of Infection Control
Issue number8
StatePublished - Oct 2012
Externally publishedYes


  • Acinetobacter baumannii
  • Antimicrobial resistance
  • CRE
  • Infection control
  • Infections upon admission
  • LTAC
  • MDR


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