Surveillance Screening for Extended-Spectrum β-Lactamases in Skilled Nursing Facility Admissions

The spread of multidrug-resistant organisms (MDROs) continues to be major concern within the healthcare community. A subset of Gram-negative MDROs that has been on the rise is extended-spectrum β-lactamases (ESBL). These organisms account for approximately 26,000 infections per year. One of the areas affected the most by these organisms are skilled nursing facilities (SNFs). While many SNFs have programs in place to decrease the spread of ESBLs, they typically lack the resources for dedicated infection control personnel. The objective of this study was to determine whether surveillance screening would provide a healthcare system with information regarding SNFs at high risk for ESBL admissions. A retrospective review of patients who had a positive surveillance screening of an MDRO admitted to four separate hospital intensive care units (ICU) within a single healthcare system over the period of February 2016 to October 2016. A patient was considered positive for an MDRO if they had an organism that was susceptible to <2 classes of antibiotics and were classified as an ESBL based on each organism’s antibiotic resistance profile. The patients’ locations prior to admission were identified using the hospital electronic medical record. Over 6 months, there were 110 patients with unique organisms fitting the criteria for an MDRO. Of these 110, only 103 had a recorded species. Out of 103, 86(84%) were admitted from SNFs and 61(71%) of SNF admissions were classified as an ESBL. Of the 28 SNFs, 6 SNFs encompassed 51(59%) of all MDRO SNF admissions. Of these 51, 31(61%) were classified as an ESBL. The most prevalent ESBLs in SNFs were E. coli, K. pneumonia, and P. mirabilis with 44(72%), 11(18%), and 5(8%), respectively. Directed surveillance screening in the ICU could be a useful tool in determining which patients are at risk to carry ESBLs. Infection control personnel could use this information to create a database to help determine which SNF patients should be screened on admission to ensure proper isolation precautions. In the future, healthcare systems could use this data to work with local SNFs to improve and assist with the implementation of infectious control protocols further decreasing the spread of certain organisms. All authors: No reported disclosures.