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Environmental contamination with meticillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) in skilled nursing facilities (SNFs) may contribute to patient acquisition. This study assessed diversity and association of MRSA and VRE isolates in an SNF wing, and developed a mathematical index to define the tendency of each strain to persist in rooms and spread horizontally. This was a longitudinal study of MRSA and VRE colonization and contamination among successive patient occupancies in a cluster of nine SNF private rooms over 8 months, characterized by microbiological testing and whole-genome isolate typing. The 'dispersion index' of a strain was defined as the number of rooms in which it was found (including if it was found in the patient), divided by the average number of times it was found consecutively in the same room. MRSA (10 strain types) and VRE (seven types) were recovered from the room or patient in 16.4% and 35.6% of the occupancies, respectively. MRSA showed moderate horizontal spread and several episodes of same-room persistence (three distinct strain types) (overall dispersion index 1.08). VRE showed a high tendency towards horizontal spread/new introductions (overall dispersion index 3.25) and only one confirmed episode of persistence. The emerging picture of high diversity among contaminating strains and high likelihood of room persistence despite terminal cleaning (MRSA) and horizontal spread between rooms (VRE) in this setting calls for improved cleaning practices, heightened contact precautions and, most of all, establishment of individually tailored facility screening programmes to enable informed choices based on local, measurable and actionable epidemiologic parameters. [ABSTRACT FROM AUTHOR]

Background: The incidence of infectious complications has not been previously compared for two types of common urinary catheters used in the long-term care setting: indwelling urethral catheters and suprapubic catheters.Aim: To compare catheter-associated urinary tract infection (CAUTI) rates and multidrug-resistant organism (MDRO) colonization between nursing home residents with indwelling urethral and suprapubic catheters.Methods: Participants included 418 nursing home residents with an indwelling device enrolled in a previously published prospective targeted infection prevention study conducted between 2010 and 2013. Resident age, gender, function, comorbidities, and information on infections, antibiotic use, and recent hospitalizations were obtained at study enrolment, day 14, and every 30 days thereafter for up to one year. Microbiological samples were obtained from several anatomic sites at each visit. Cox proportional hazard models were adjusted for facility-level clustering and other covariates.Findings: In all, 208 study participants had an indwelling urinary catheter, contributing 21,700 device-days; 173 (83%) with a urethral catheter, 35 (17%) with a suprapubic catheter. After covariate adjustment, the suprapubic group had a lower incidence of CAUTI (6.6 vs 8.8 per 1000 device-days; P = 0.05), were half as likely to be hospitalized (hazard ratio (HR) = 0.46; P < 0.01) and were 23% less likely to have had antibiotics in the past 30 days (HR = 0.77; P = 0.02). Among residents catheterized ≥90 days, the mean number of MDROs isolated in the suprapubic group was significantly higher than in the urethral group (0.57 vs 0.44; P = 0.01). Ciprofloxacin-resistant Gram-negative bacilli were frequent in both groups.Conclusion: Residents with a suprapubic catheter may have fewer CAUTIs, less hospitalization and less antibiotic use, but are more likely colonized with MDROs. [ABSTRACT FROM AUTHOR]