The neighboring effect of long-term care (LTC) facility residents to the distribution of multi-drug resistant (MDR) bacteria of one teaching hospital

Background: Chunghua Hospital is a 700-bed public hospital at Mid-Taiwan. Besides the business of Out-patient Department (OPD) and In-Patient Department (IPD), we play the characters of public health system and medical institutions. There are 4 LTC facilities signed with our hospital, one is in-hospital and the others are from outside the hospital. We send staffs and afford medical service for them regularly since September, 2016. MDR bacteria (including MRSA, CRE, CRPA/MDRAB, CRAB, VRE) are progressive increasing from the inspection report of Laboratory Department in recent 2 years. So, we want to investigate the relationship of LTC facility residents and MDR bacteria from clinical practice. Methods: By way of Tamis system, we collect the MDR bacteria isolated from different specimens weekly between 2016 and 2017. The same bacteria of the same specimen in one month, we certify it as one episode of MDR bacteria. The different MDR bacteria are doing statistical analysis and comparing the trend on the timeline. At last, we divide the MDR bacteria from hospital-acquired or LTC facility-acquired individually. The student-t test for the relationship of LTC facility residents and MDR bacteria will be completed later. Results: 1.From the database of 2017, we make the following conclusions: (1) The total number of MDR bacteria is decreasing from 1st quarter to 4th quarter in the year of 2017. (2) The percentage of each MDR bacteria are MRSA (30%), CRE (32%), MDRAB / CRAB (23%), CRPA (9%), and VRE (6%). (3) Of all the specimens, MDR bacteria most come from urine and then are sputum, wound, blood and others. 2. Three different time (A:Sep, 2016; B:Mar, 2017; C: Sep, 2017) between Sep, 2016 and Dec,2017 are selected and analyzed. Then we make brief summaries: (1) The MDR bacteria are more present at period B (38), and then period C (25), period A (16) (2) LTC facilities-acquired MDR bacteria are more and more between period A (2), B (10) and C (12). (3) The percentage of LTC facilities-acquired MDR bacteria are increasing from period A to C (A- 12%, B- 26%, C- 48%). Conclusion: 1.LTC-acquired MDR bacteria are more and more present from the clinical practice (including OPD and IPD) and their percentage are also increasing. 2.Well education (MDR bacteria) and multimodal approach of infection control (hand hygiene, contact precaution, active surveillance, anamnesis shift and antibiotic stewardship) are worth to contain the trend.