ArticleJournal of the American Medical Directors Association2020
High Prevalence of Multidrug-Resistant Organism Colonization in 28 Nursing Homes: An "Iceberg Effect".
Article in Journal of the American Medical Directors Association, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 22 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
22 citing papers in PubMed, 49 citations in OpenAlex.
- Decolonization in Nursing Homes to Prevent Infection and Hospitalization.The New England journal of medicine · 2023Trial
- Effectiveness of a Multicomponent Intervention to Reduce Multidrug-Resistant Organisms in Nursing Homes: A Cluster Randomized Clinical Trial.JAMA network open · 2021Trial
- Methicillin-resistant Staphylococcus aureus.Nature reviews. Disease primers · 2026Review
- Decolonization vs Enhanced Cleaning for Multidrug-Resistant Organism Reduction in Nursing Homes.JAMA network open · 2026Article
- A Public Health Approach to Antimicrobial Stewardship in Long-term Care Facilities: A Multifaceted Program in Massachusetts.Clinical infectious diseases : an official publication of the Infectious Diseases Society of America · 2026Article
- Genome sequencing for prevention of health-care-associated bacterial infections.Nature reviews. Microbiology · 2026Review
- Trends of Microorganisms and Antibiotic Resistance Isolated from Patients with Bacterial Keratitis from a Tertiary Hospital in Southeastern Korea: A 26-Year Retrospective Medical Record Review.Antibiotics (Basel, Switzerland) · 2026Article
- Projected impact of a pathogen reduction intervention on carbapenem-resistant Enterobacterales bloodstream infections and deaths in the United States.Infection control and hospital epidemiology · 2026Article
- Environmental contamination and cleaning practices in long-term care: a transdisciplinary mixed-methods study.Antimicrobial stewardship & healthcare epidemiology : ASHE · 2026Article
- Impact of routine chlorhexidine bathing and nasal iodophor on MDRO colonization and environmental contamination in nursing homes.Infection control and hospital epidemiology · 2025Article
- Rising Threats of MRSA and Carbapenem-ResistantMicroorganisms · 2025Article
- Identification of Long-Term Care Facility Residence From Admission Notes Using Large Language Models.JAMA network open · 2025Observational
- Epidemiology and transmission dynamics of multidrug-resistant organisms in nursing homes within the United States.Nature communications · 2025Article
- A multi-center validation of the electronic health record admission source and discharge location fields against the clinical notes for identifying inpatients with long-term care facility exposure.Infection control and hospital epidemiology · 2024Article
- Decolonization and Pathogen Reduction Approaches to Prevent Antimicrobial Resistance and Healthcare-Associated Infections.Emerging infectious diseases · 2024Review
- Phage-specific immunity impairs efficacy of bacteriophage targeting Vancomycin Resistant Enterococcus in a murine model.Nature communications · 2024Article
- Not as simple as it seems: extensive facility and training gaps in nursing home bathing.Infection control and hospital epidemiology · 2023Article
- Risk factors for colonization with multidrug-resistant Gram-negative bacteria andFrontiers in cellular and infection microbiology · 2023Article
- Clinical epidemiology of carbapenem-resistant Enterobacterales in the Greater Houston region of Texas: a 6-year trend and surveillance analysis.Journal of global antimicrobial resistance · 2022Observational
- Distribution of Extended-Spectrum β-Lactamase Genes and Antimicrobial Susceptibility among Residents in Geriatric Long-Term Care Facilities in Japan.Antibiotics (Basel, Switzerland) · 2021Article
Corrections and comments
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Authors and funding
45 authors at 9 institutions in 1 country.
Funding
Abstract
objectiveDetermine the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), extended-spectrum beta-lactamase producing organisms (ESBLs), and carbapenem-resistant Enterobacteriaceae (CRE) among residents and in the environment of nursing homes (NHs).
designPoint prevalence sampling of residents and environmental sampling of high-touch objects in resident rooms and common areas.
settingTwenty-eight NHs in Southern California from 2016 to 2017.
participantsNH participants in Project PROTECT, a cluster-randomized trial of enhanced bathing and decolonization vs routine care.
methodsFifty residents were randomly sampled per NH. Twenty objects were sampled, including 5 common room objects plus 5 objects in each of 3 rooms (ambulatory, total care, and dementia care residents).
resultsA total of 2797 swabs were obtained from 1400 residents in 28 NHs. Median prevalence of multidrug-resistant organism (MDRO) carriage per NH was 50% (range: 24%-70%). Median prevalence of specific MDROs were as follows: MRSA, 36% (range: 20%-54%); ESBL, 16% (range: 2%-34%); VRE, 5% (range: 0%-30%); and CRE, 0% (range: 0%-8%). A median of 45% of residents (range: 24%-67%) harbored an MDRO without a known MDRO history. Environmental MDRO contamination was found in 74% of resident rooms and 93% of common areas. CONCLUSIONS AND IMPLICATIONS: In more than half of the NHs, more than 50% of residents were colonized with MDROs of clinical and public health significance, most commonly MRSA and ESBL. Additionally, the vast majority of resident rooms and common areas were MDRO contaminated. The unknown submerged portion of the iceberg of MDRO carriers in NHs may warrant changes to infection prevention and control practices, particularly high-fidelity adoption of universal strategies such as hand hygiene, environmental cleaning, and decolonization.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.