Acquisition of Multidrug-resistant Organisms in the Absence of Antimicrobials.

A nested case-control study among 137 nursing home residents who did not receive antimicrobials, of whom 44 acquired a multidrug-resistant organism, was performed. Risk factors for acquisition included gastrointestinal medications that affect the gut microbiome, number of visits from healthcare workers, pressure ulcers, and not residing in a dementia unit.

Cryptococcus albidus Fungemia in an Immunosuppressed Child: Case Report and Systematic Literature Review.

Cryptococcus albidus, synonymous with Naganishia albida, rarely causes opportunistic infection in immunocompromised individuals. Its clinical features, particularly in children, are not well defined. Here, we report a case of C albidus fungemia in an immunosuppressed child; we also present results of a systematic review, for which we searched PubMed, Embase, and Web of Science using the keywords "cryptococcus" and "albidus." Our goal was to describe the spectrum of disease, diagnostic approaches, therapies, and outcomes. We identified 20 cases of invasive infection, only 2 of which involved children, and 7 cases of noninvasive infection. The reports originated in the Americas, Europe, and Asia. Of those with invasive infection, 16 (80%) patients had an underlying chronic disorder or had received immunosuppressive therapy, 8 (40%) had fungemia, and 6 (30%) had a central nervous system infection. The attributable case fatality rate was 40%. C albidus is an opportunistic yeast that can rarely cause life-threatening fungemia and central nervous system infection in individuals of any age, especially those who are immunocompromised.

Acquisition of antimicrobial-resistant bacteria in the absence of antimicrobial exposure: A systematic review and meta-analysis.

OBJECTIVE: The main risk factor for acquisition of antimicrobial-resistant bacteria (ARB) is antimicrobial exposure, although acquisition can occur in their absence. The aim of this study was to quantify the proportion of patients who acquire ARB without antimicrobial exposure. STUDY DESIGN: We searched Medline, Embase, and the Cochrane library for publications between January 1, 2000, and July 24, 2017, to identify studies of ARB acquisition in endemic settings. Studies required collection of serial surveillance cultures with acquisition defined as a negative baseline culture and a subsequent positive culture for an ARB, including either multidrug-resistant gram-negative bacteria or antimicrobial-resistant enterococci. Intervention studies were excluded. For each study, the proportion of patients who acquired an ARB but were not exposed to antimicrobials during the study period was quantified. RESULTS: A total of 4,233 citations were identified; 147 underwent full-text review. Of these, 10 studies met inclusion criteria; 7 studies were considered to be at low risk of bias; and 6 studies were conducted in the intensive care unit (ICU) setting. The overall summary estimate for the proportion of patients who were not exposed to antimicrobials among those who acquired an ARB was 16.6% (95% CI, 7.8%-31.8%; P < .001), ranging from 0% to 57.1%. We observed no heterogeneity in the ICU studies but high heterogeneity among the non-ICU studies. CONCLUSION: In most included studies, a subset of patients acquired an ARB but were not exposed to antimicrobials. Future studies need to address transmission dynamics of ARB acquisition in the absence of antimicrobials.

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

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.