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Cited by 76Infection Control in HealthcareAntimicrobial Resistance in StaphylococcusAntibiotic Resistance in Bacteria

The SHIELD Orange County Project: Multidrug-resistant Organism Prevalence in 21 Nursing Homes and Long-term Acute Care Facilities in Southern California

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McKinnell, James A, Singh, Raveena D, Miller, Loren G, Kleinman, Ken, Gussin, Gabrielle, He, Jiayi, Saavedra, Raheeb, Dutciuc, Tabitha D +31 more·2019·Clinical Infectious Diseases
DOI 10.1093/cid/ciz119PMC PMC7320073
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Abstract

Background: Multidrug-resistant organisms (MDROs) spread between hospitals, nursing homes (NHs), and long-term acute care facilities (LTACs) via patient transfers. The Shared Healthcare Intervention to Eliminate Life-threatening Dissemination of MDROs in Orange County is a regional public health collaborative involving decolonization at 38 healthcare facilities selected based on their high degree of patient sharing. We report baseline MDRO prevalence in 21 NHs/LTACs. Methods: A random sample of 50 adults for 21 NHs/LTACs (18 NHs, 3 LTACs) were screened for methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum β-lactamase–producing organisms (ESBL), and carbapenem-resistant Enterobacteriaceae (CRE) using nares, skin (axilla/groin), and peri-rectal swabs. Facility and resident characteristics associated with MDRO carriage were assessed using multivariable models clustering by person and facility. Results: Prevalence of MDROs was 65% in NHs and 80% in LTACs. The most common MDROs in NHs were MRSA (42%) and ESBL (34%); in LTACs they were VRE (55%) and ESBL (38%). CRE prevalence was higher in facilities that manage ventilated LTAC patients and NH residents (8% vs <1%, P < .001). MDRO status was known for 18% of NH residents and 49% of LTAC patients. MDRO-colonized adults commonly harbored additional MDROs (54% MDRO+ NH residents and 62% MDRO+ LTACs patients). History of MRSA (odds ratio [OR] = 1.7; confidence interval [CI]: 1.2, 2.4; P = .004), VRE (OR = 2.1; CI: 1.2, 3.8; P = .01), ESBL (OR = 1.6; CI: 1.1, 2.3; P = .03), and diabetes (OR = 1.3; CI: 1.0, 1.7; P = .03) were associated with any MDRO carriage. Conclusions: The majority of NH residents and LTAC patients harbor MDROs. MDRO status is frequently unknown to the facility. The high MDRO prevalence highlights the need for prevention efforts in NHs/LTACs as part of regional efforts to control MDRO spread.

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  • CDC recommends colonization screening for patients with high-risk healthcare exposures and those with an epidemiologic link to a patient with C. auris.

    “Because C. auris spreads easily in healthcare settings, the Centers for Disease Control and Prevention (CDC) recommends colonization screening for patients with high-risk healthcare exposures (e.g., recent stay in a long-term acute-care hospital [LTACH] or ventilator-capable skilled nursing facility [SNF]) and those with an epidemiologic link to a patient with C. auris (2,6) (https://www.cdc.gov/c”

    From Progression from <i>Candida auris</i> Colonization Screening to Clinical Case Status, United States, 2016–2023 (2025) · cites this paper as [6]

    The Methods passage describes screening nursing-home and long-term acute-care residents for MRSA, VRE, ESBL-producing organisms, and CRE. Searches for C. auris, epidemiologic links, and CDC screening recommendations found no passage addressing the claimed guidance. (LLM, conf=0.76)

    Experimental — accuracy not yet measured

  • C. auris spreads easily in healthcare settings.

    “Because C. auris spreads easily in healthcare settings, the Centers for Disease Control and Prevention (CDC) recommends colonization screening for patients with high-risk healthcare exposures (e.g., recent stay in a long-term acute-care hospital [LTACH] or ventilator-capable skilled nursing facility [SNF]) and those with an epidemiologic link to a patient with C. auris (2,6) (https://www.cdc.gov/c”

    From Progression from <i>Candida auris</i> Colonization Screening to Clinical Case Status, United States, 2016–2023 (2025) · cites this paper as [6]

    The Abstract says multidrug-resistant organisms spread between healthcare facilities through patient transfers, but it identifies the organisms studied as MRSA, VRE, ESBL-producing organisms, and CRE. A search for “C. auris” and “Candida auris” found no passage addressing whether that organism spreads easily in healthcare settings. Page numbers were not available in our copy. (LLM, conf=0.76)

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Authors
McKinnell, J. A., Singh, R. D., Miller, L. G., Kleinman, K., Gussin, G., He, J., Saavedra, R., Dutciuc, T. D., Estevez, M., Chang, J., Heim, L., Yamaguchi, S., Custodio, H., Gohil, S. K., Park, S., Tam, S., Robinson, P. A., Tjoa, T., Nguyen, J., Evans, K. D., Bittencourt, C. E., Lee, B. Y., Mueller, L. E., Bartsch, S. M., Jernigan, J. A., Slayton, R. B., Stone, N. D., Zahn, M., Mor, V., McConeghy, K., Baier, R. R., Janssen, L., O’Donnell, K., Weinstein, R. A., Hayden, M. K., Coady, M. H., Bhattarai, M., Peterson, E. M., & Huang, S. S.
Affiliations
  • University of California, Los Angeles (US)
  • University of California, Irvine (US)
  • University of Massachusetts Amherst (US)
  • Hoag Memorial Hospital Presbyterian (US)
  • Johns Hopkins University (US)
  • Centers for Disease Control and Prevention (US)
  • Orange County Healthcare Agency (US)
  • Brown University (US)
  • California Department of Public Health (US)
  • Epidemiology and Assessment, Orange County Health Care Agency, Santa Ana, California
  • Rush University Medical Center (US)
  • Harvard University (US)
Corresponding author
McKinnell, James A
ORCID
Venue
Clinical Infectious Diseases
Publisher
Oxford University Press (OUP)
Published
2019-02-11
Volume
69
Issue
9
Pages
1566-1573
ISSN
  • 1058-4838 (ISSN-L)
  • 1537-6591
DOI
10.1093/cid/ciz119
PMC
PMC7320073
OpenAlex
W2912149658
Cited by
76
References
0
Citations by year
2026: 11 · 2025: 11 · 2024: 11 · 2023: 12 · 2022: 5 · 2021: 9 · 2020: 10 · 2019: 7
FWCI
5.94
Type
journal article
Language
en
Open access
Licence
academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model (vor)
Locations
  • Clinical Infectious Diseases (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • eScholarship (California Digital Library) (submittedVersion)
Funders
  • National Institutes of Health
  • Safety and Healthcare Epidemiology Prevention Research Development
  • Agency for Healthcare Research and Quality (R01HS023317)
Topics
  • Health Sciences › Medicine › Infectious Diseases › Infection Control in Healthcare
  • Health Sciences › Medicine › Infectious Diseases › Antimicrobial Resistance in Staphylococcus
  • Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Medicine › Antibiotic Resistance in Bacteria
Keywords
multidrug-resistant organisms, nursing homes, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, extended-spectrum beta-lactamase, carbapenem-resistant Enterobacteriaceae, decolonization, patient transfer, nosocomial infections, ventilator-associated infection, Southern California
MeSH terms
Carbapenem-Resistant Enterobacteriaceae, California, Chlorhexidine, Enterobacteriaceae Infections, Humans, Long-Term Care, Nursing Homes, Public Health, Staphylococcal Infections, Prevalence, Drug Resistance, Multiple, Bacterial, Methicillin-Resistant Staphylococcus aureus, Vancomycin-Resistant Enterococci

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