Review on colonization of residents and staff in Italian long-term care facilities by multidrug-resistant bacteria compared with other European countriesReport as inadecuate

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Antimicrobial Resistance and Infection Control

, 5:33

First Online: 11 October 2016Received: 20 August 2016Accepted: 27 September 2016


BackgroundRates of colonization and infection with multidrug-resistant MDR bacteria are increasing worldwide, in both acute care hospitals and long-term care facilities LTCFs. Italy has one of the highest prevalence of MDR bacteria in European countries, especially with regard to methicillin-resistant Staphylococcus aureus MRSA and extended-spectrum β-lactamase ESBL or carbapenemase producing Enterobacteriaceae CPE.

MethodReview of studies on colonization by MDR bacteria from Italian LTCFs, risk factors for colonization and molecular characteristics of surveillance and clinical isolates, compared with other European countries.

ResultsHigh variability of MDR colonization has been reported within and especially between European countries. Only a few surveillance studies have been performed in Italian LTCFs; these show MRSA colonization prevalence of 7.8–38.7 % for residents and 5.2–7.0 % for staff members, ESBL prevalence of 49.0–64.0 % for residents and 5.2–14.5 % for staff and prevalence of CPE of 1.0–6.3 % for residents and 0.0–1.5 % for staff. In Italian LTCFs, as well as in other European countries, the most prevalent ESBLs from surveillance or clinical Escherichia coli isolates were found to be CTX-M-type enzymes, particularly CTX-M-15, expressed by the pandemic ST131 clonal group; this lineage also expresses carbapenemase genes of the blaVIM and blaKPC types. Various risk factors for colonization of residents by MDR bacteria were identified.

ConclusionsThe limited data from Italian LTCFs confirms these settings as important reservoirs for MDR organisms, allowing important considerations regarding the infection risk by these organisms. Nevertheless, more extended and countrywide screening studies for MDR colonization in Italian LTCFs are required. To promote further studies of various microbiological aspects related to LTCFs, the Association of Italian Clinical Microbiologists Associazione Microbiologi Clinici Italiani; AMCLI in 2016 has set up a new Working Group for the Study of Infections in LTCFs Gruppo di Lavoro per lo Studio delle Infezioni nelle Residenze Sanitarie Assistite e Strutture Territoriali assimilabili; GLISTer, consisting of Clinical Microbiologists represented by the authors of this review article.

KeywordsLTCF ESBL MRSA Carbapenemase Colonization AbbreviationsAMCLIAssociazione Microbiologi Clinici Italiani

AmpCGroup of cephalosporinases


CCClonal complex

CMYCephalosporinase type

CPECarbapenemase-producing Enterobacteriaceae

CTX-MCefotaximase-Munich, ESBL type

ESBLExtended-spectrum β-lactamase

GLISTerGruppo di Lavoro per lo studio delle Infezioni nelle Residenze Sanitarie Assistite e Strutture Territoriali assimilabili


KPCKlebsiella pneumoniae carbapenemase

LTCFLong-term care facility

mcrColistin resistance determinant

MDRMulti-drug resistant

MRSAMethicillin-resistant Staphylococcus aureus

NDM-1New Delhi metallo-β-lactamase

OXA-48Type of carbapenemase, OXA stays for oxacillinase

PVLPanton-Valentine leukocidin

SCCmecStaphylococcal chromosome cassette mec

SHVβ-lactamase type, SHV stays for sulfhydryl-variable

spaStaphylococcal protein A type

STSequence type

TEMβ-lactamase type, TEM stays for the Greek patient name -Temoneira-

VIMIntegron-encoded metallo-β-lactamase

VREVancomycin-resistant enterococci

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Author: Richard Aschbacher - Elisabetta Pagani - Massimo Confalonieri - Claudio Farina - Paolo Fazii - Francesco Luzzaro - Pier Gior


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