Table 4.

Diagnostic screening procedure for residents suspected for HRMO carriage in LTCF

Micro-organism/Indication	Standard Culturesa	Additional cultures (when indicated)a,b
Enterobacteriaceae (ESBL and CPE inclusive)	Rectal swab or stool sample	Wound swab, sputum sample, urine sample
Acinetobacter species	Rectal swab or stool sample and sputum sample or oropharyngeal swabc	Wound swab, urine sample
Stenotrophomonas maltophilia	Rectal swab or stool sample and sputum sample or oropharyngeal swabc	Wound swab, urine sample
Pseudomonas aeruginosa	Rectal swab, stool sample and sputum sample or oropharyngeal swabc	Wound swab, urine sample
Streptococcus pneumoniae	Sputum sample or oropharyngeal swabc	–
Enterococcus faecium	Rectal swabs or stool samples	Wound swabs, sputum samples, urine samples
When resident is transferred from health care facility outside the Netherlands	Rectal swab or stool sample and sputum sample or oropharyngeal swabc	Wound swab, sputum sample, urine sample

^aSingle swab/sample from the stated site, excepting for Enterococcus faecium. Standard and additional cultures for Enterococcus faecium: five swabs/samples on five consecutive days

^bDepending on clinical presentation of the signs and symptoms of resident: ▪ culture of sputum when resident has a persistent cough ▪ culture of wound if present ▪ urine culture when urinary tract catheter is in place

^c Preferably sputum sample. If sputum sample cannot be obtained, collect oropharyngeal swab