Table 1.
Review of prior studies that have examined the relationship between antimicrobial exposure and MDRO acquisition in the long-term care setting
| Reference No. |
First Author, Year |
Location | Population | No. of Sites |
No. of Participants |
Defining Antimicrobial Exposure |
Timing of Swabs | Definition of MDRO Acquisition |
Study Design |
Findings |
|---|---|---|---|---|---|---|---|---|---|---|
| 15 | Min, 2015 | United States | Nursing home residents | 15 | 111 | Dichotomous 30 days prior during follow-up | Monthly until discharge or 12 months | First positive culture; any of Methicillin-resistant Staphylococcus aureus , antibiotic-resistant gram negative bacteria, or Vancomycin-resistant enterococci | Prospective cohort | In unadjusted analysis, antibiotic use in the past 30 days significantly associated with time to initial Vancomycin-resistant enterococci acquisition; no significant association in multivariable analysis |
| 13 | Couderc, 2014 | France | Neurologic patients | 4 | 76 cases; 207 controls; 112 sensitive controls | Dichotomous before admission and after admission | Weekly for 13 weeks | First positive culture; Methicillin-resistant Staphylococcus aureus | Nested case-case-control | Fluoroquinolone use significantly associated with Methicillin-resistant Staphylococcus aureus acquisition |
| 12 | Han, 2014 | United States | Long-term care facility residents | 3 | 120 | Dichotomous 30 days prior to enrollment and during follow-up (time-varying) | Approximately every two weeks until recovery or up to 12 months or discharge or death | First positive culture; Fluoroquinolone-resistant E. coli | Prospective cohort | Amoxicillin-clavulanate use during follow-up significantly associated with Fluoroquinolone-resistant E. coli acquisition |
| 11 | Olofsson, 2013 | Sweden | Nursing home residents | 11 | 268 | In the 180 days preceding sampling | Study entry | Positive culture; E. coli | Cross-sectional | Antimicrobial use significantly associated with antimicrobial-resistant E. coli |
| 10 | Stone, 2012 | United States | Long-term care facility residents | 3 | 254 | Dichotomous in the 3 months before study and during study | Weekly 3 times during first month followed by monthly for 5 months | >1 positive culture and no subsequent negative cultures; Methicillin-resistant Staphylococcus aureus | Prospective cohort | Systemic antimicrobial use during study significantly associated with Methicillin-resistant Staphylococcus aureus acquisition |
| 9 | Fisch, 2012 | United States | Skilled nursing facility patients | 15 | 82 | Dichotomous any use prior to colonization | Monthly swabs for up to 3 months | Any positive culture; Any new of Methicillin-resistant Staphylococcus aureus, Vancomycin-resistant enterococci, Ciprofloxacin-resistant, or Ceftazidime-resistant | Prospective cohort | Antimicrobial use prior to colonization not significantly associated with acquisition |
| 8 | Ray, 2010 | United States | Long-term acute care hospital patients | 1 | 13 cases; 27 controls | Dichotomous intravenous antibiotics on admission | Routine clinical care and point prevalence surveillance cultures | Any positive culture; Acinetobacter baumannii | Case-control | Intravenous antibiotics on admission significantly associated with Acinetobacter baumannii acquisition |
| 7 | O’Fallon, 2010 | United States | Long-term care facility residents | 1 | 29 cases; 29 controls | Dichotomous during interval between baseline culture and follow-up culture | Baseline and every 4 months for up to 12 months of follow-up | Any positive culture; multi-drug resistant gram negative bacteria | Nested case-control | Antimicrobial use during the study significantly associated with multi-drug resistant gram negative bacteria acquisition |
| 6 | Manzur, 2010 | Spain | Long-term care facility residents | 9 | 196 | Dichotomous any exposure during follow-up | Every 6 months for up to 18 months | Any positive culture; Methicillin-resistant Staphylococcus aureus | Prospective cohort | Antimicrobial use during follow-up significantly associated with Methicillin-resistant Staphylococcus aureus acquisition |
| 5 | Maslow, 2005 | United States | Long-term care facility residents | 1 | 49 | Dichotomous use in the 3, 6, 9, and 12 months before study entry | At study entry | Positive culture; Fluoroquinolone-resistant E. coli | Cross-sectional | Fluoroquinolone use within the past 12 months significantly associated with Fluoroquinolone-resistant E. coli acquisition |
| 4 | Nazir, 2004 | United States | Long-term care facility residents | 1 | 28 cases matched 4:1 controls to cases | Dichotomous any antimicrobial use and approximate annual days of therapy derived from no. of prescriptions | Routine clinical cultures | Any positive culture; Levofloxacin-resistant H. influenzae | Case-control | Any Levofloxacin use significantly associated with Levofloxacin-resistant H. influenza acquisition |
| 3 | Vasquez, 2000 | United States | Acute care patients, long-term care facility residents, and nursing home residents | 1 | 96 cases; 96 controls | Systemic exposure within the previous 30 days | Routine clinical cultures | Any positive culture; Mupirocin-resistant Methicillin-resistant Staphylococcus aureus | Case-control | Mupirocin use not significantly associated with Mupirocin-resistant Methicillin-resistant Staphylococcus aureus acquisition |