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Volume 50, Number 2, April 2017

Presence of multidrug-resistant organisms in the residents and environments of long-term care facilities in Taiwan 

Chun-Ming Lee, Chih-Cheng Lai, Hsiu-Tzy Chiang, Min-Chi Lu, Ling-Fang Wang, Tsai-Ling Tsai, Mei-Yu Kang, Yi-Ni Jan, Yi-Ting Lo, Wen-Chien Ko, Shu-Hui Tseng, Po-Ren Hsueh


Corresponding author:

Po-Ren Hsueh, Corresponding author. Departments of Laboratory Medicine and Internal Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No.7, Chung-Shan South Rd., Taipei 100, Taiwan. 


Background and purpose: 

This study investigated the prevalence of multidrug-resistant organisms (MDROs) in the residents and environments of long-term care facilities (LTCFs) in Taiwan.




We prospectively investigated the distribution of MDROs in residents of six LTCFs and their environments from January 2015 to December 2015 (intervention period). Active surveillance of colonization of MDROs was performed by culturing rectal and nasal swab samples every 3 months for the residents: 63, 79, and 73 in the first, second, and third surveillance investigations, respectively. If MDROs, including methicillin-resistant Staphylococcus aureus, carbapenem-resistant Enterobacteriaceae, carbapenem-resistant Pseudomonas aeruginosa, and MDR Acinetobacter baumannii were identified, then swab specimens from environmental sources were also collected and cultured. During the study period, several infection control measures were also implemented. 



The overall infection density decreased significantly from 2.69 per 1000 patient–days in the preintervention (January 2014 to December 2014) to 2.39 per 1000 patient–days during the intervention period (p < 0.001). A total of 154 samples from residents and environmental sources were positive for MDROs. Methicillin-resistant S. aureus (n = 83, 53.9%) was the predominant organism, followed by carbapenem-resistant Enterobacteriaceae (n = 35, 22.7%), MDR A. baumannii (n = 30, 19.5%), and carbapenem-resistant P. aeruginosa (n = 6, 3.9%). The rates of detection of MDROs were 27.9% (60/215) in nasal swabs, 15.8% (34/215) in rectal swabs, and 11.1% (60/542) in the environmental sources. 



The distribution and persistence of MDROs varied among the different LTCFs and time periods. 


Key words:

environment, infection control, long-term care facility, multidrug-resistant organisms, residents