Epidemiology of multidrug-resistant microorganisms among nursing home residents in Belgium

PLoS One. 2013 May 30;8(5):e64908. doi: 10.1371/journal.pone.0064908. Print 2013.


Objectives: A national survey was conducted to determine the prevalence and risk factors of methicillin-resistant Staphylococcus aureus (MRSA), extended-spectrum β-lactamases-producing Enterobacteriaceae (ESBLE) and vancomycin-resistant enterococci (VRE) among nursing home residents in Belgium.

Methods: A random stratified, national prevalence survey was conducted in nursing home residents who were screened for carriage of ESBLE, MRSA and VRE by multisite enriched culture. Characteristics of nursing homes and residents were collected by a questionnaire survey and were analysed by multilevel logistic regression analysis.

Results: Of 2791 screened residents in 60 participating nursing home, the weighted prevalence of ESBLE and MRSA carriage were 6.2% (range: 0 to 20%) and 12.2% (range: 0 to 36%), respectively. No cases of VRE were found. No relationship was found between ESBLE and MRSA prevalence rates within nursing homes and the rate of co-colonization was very low (0.8%). Geographical variations in prevalence of MRSA and ESBLE and in distribution of ESBL types in nursing home residents paralleled that of acute hospitals. Risk factors of ESBLE carriage included previously known ESBLE carriage, male gender, a low level of mobility and previous antibiotic exposure. Risk factors for MRSA colonization were: previously known MRSA carriage, skin lesions, a low functional status and antacid use.

Conclusions: A low prevalence of ESBLE carriage was found in nursing home residents in Belgium. The prevalence of MRSA carriage decreased substantially in comparison to a similar survey conducted in 2005. A low functional status appeared as a common factor for ESBLE and MRSA carriage. Previous exposure to antibiotics was a strong predictor of ESBLE colonization while increased clustering of MRSA carriage suggested the importance of cross-transmission within nursing homes for this organism. These results emphasize the need for global coordination of the surveillance of MDRO within and between nursing homes and hospitals.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Bacteria* / drug effects
  • Bacterial Physiological Phenomena*
  • Belgium
  • Drug Resistance, Bacterial*
  • Drug Resistance, Multiple*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Nursing Homes / statistics & numerical data*
  • Risk Factors
  • Surveys and Questionnaires*

Grant support

This study was supported by grants from the Belgian Antibiotic Policy Coordination Committee (BAPCOC; Ministry of Public Health, Belgium) and from the Belgian Infection Control Society (BICS). The work is a part of a PhD thesis (DS) supported by a grant of the Mont-Godinne Foundation (Catholic University of Louvain) and Chair DCF (Croix Rouge, Belgium). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.