P03. Prevalence and risk factors for multidrug resistant Enterobacterales in long-term care facilities in the province of Pavia, Italy

Abstract Introduction multidrug resistant microorganisms(MDROs), once nearly exclusive of hospitalized patients, can now be found in the community. Few studies exist on their prevalence in long term care facilities (LTCFs), despite the fact that they likely are important reservoirs, given the residents' need for continuous assistance, medical devices, hospitalisation, and antibiotics. This study establishes the prevalence of MDROs in LTCFs in the province of Pavia, an area in Northern Italy of nearly 3000 km2 and more than 500 000 inhabitant. Risk factors for MDROs were also investigated. Methods we prospectively collected a stool sample from LTCFs’ residents. Each sample was screened for MDROs by immunochromatographic testing. Epidemiological and clinical data were obtained from the patients' medical records, and analysed by counts and frequencies, t-tests and contingency tables. Results we collected 581 samples from 14 LTCFs (male/female 24/76%, median age 87, median Charlson Comorbidity Index 6). Previous hospitalisation was detected in 53.7% of the patients, and 1.4% had a known colonisation. Regarding the use of devices, 2.2% had a vascular catheter, 5.3% a bladder catheter, 1.9% nasogastric tube/gastrostomy, 0.2% tracheostomy. We found a MDRO in 49.4% of patients, mainly E. coli and K. pneumoniae, 88% were ESBL and 4.4% were carbapenem-resistant (Figure 1). Fungal colonization was present in 4.1%, mainly by C.glabrata. Colonisation was independent from age, Charlson Comorbidity Index, number of doctors, and use of devices other than urinary catheter. It was, instead, associated with number of nurses and auxiliaries, previous hospitalisation, known colonisation, use of urinary catheter, and antibiotics in the past 90 days (P < 0.05). Figure 1.Relative frequencies of (a) patients colonised by MDROs versus patients not colonised by MDROs; (b) number of MDROs in each colonised patients; (c) species of MDROs, (d) resistance mechanisms of MDROs; (e) resistance mechanisms of carbapenemases; (f) resistance mechanisms of metallo-beta-lactamases; (g) patients colonised by fungi versus patients not colonised by fungi; (h) species of fungal colonisers. Conclusions almost half of LTCFs patients are unknowingly colonized by MDROs, including carpabenem-resistant ones. The main factors associated with colonisation are: a higher number of nurses and auxiliaries, recent use of antibiotics, previous hospitalisation. These data are in agreement with the sparse literature specific to LTCFs. Our findings encourage the establishment of antimicrobial stewardship programs and education of the healthcare personnel, and conscientious use of antibiotics.

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