Indwelling device use and antibiotic resistance in nursing homes: identifying a high-risk group.

OBJECTIVES To quantify the relationship between indwelling devices (urinary catheters, feeding tubes, and peripherally inserted central catheters) and carriage of antimicrobial-resistant pathogens in nursing home residents. DESIGN Cross-sectional. SETTING Community nursing home in Southeast Michigan. PARTICIPANTS Residents with indwelling devices (n=100) and randomly selected control residents (n=100) in 14 nursing homes. MEASUREMENTS Data on age, functional status, and Charlson comorbidity score were collected. Samples were obtained from nares, oropharynx, groin, wounds, perianal area, and enteral feeding tube site. Standard microbiological methods were used to identify methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), and ceftazidime-resistant (CTZ-R) gram-negative bacteria (GNB). RESULTS Use of indwelling devices was associated with colonization with MRSA at any site (odds ratio (OR)=2.0, P=.04), groin (OR=4.8, P=.006), and perianal area (OR=3.6, P=.01) and CTZ-R GNB at any site (OR=5.6, P=.003). Use of enteral feeding tubes was associated with MRSA colonization in the oropharynx (OR=3.3, P=.02). CONCLUSION Use of indwelling devices is associated with greater colonization with antimicrobial-resistant pathogens. This study serves as an initial step in defining a high-risk group that merits intensive infection control efforts.