Prevalence of multidrug resistant organisms (MDRO) in nursing homes in Ireland and the Netherlands

The Netherlands has a lower prevalence of Clostridioides difficile and other multidrug resistant organisms (MDRO) in hospital and community settings when compared to Ireland. We hypothesized that the nursing home setting would reflect this. We compared C. difficile and MDRO colonization in an Irish and Dutch nursing home. Stool specimens, demographic and MDRO risk factor data were collected on consenting residents in February 2017. Specimens were evaluated for the presence of C. difficile, vancomycin-resistant enterococci (VRE), extended spectrum beta-lactamase (ESBL) and carbapenemase – producing (CPE) Enterobacteriaceae. Of the 37 (62%) Dutch and 67 (78%) Irish residents, four (11%) Dutch and six (9%) Irish residents were colonized with eleven ESBL-producing Escherichia coli of which ten contained CTX-M-15. Four Dutch isolates, from three residents of the same ward belonged to E.coli O25:H4, sequence type (ST) 131 and were part of the same cluster type by whole genome sequencing. Four Irish residents on three different wards were colonized with an identical E. coli O89:H9, ST131. One Irish resident was VRE colonized. No residents were colonized with CPE or C. difficile. A high abundance of risk factors, with significant differences between the two countries was observed. On multivariate analysis, only pressure sores were associated with MDRO colonization (OR 11.41, CI 1.21 – 107.58). Though MDRO prevalence was low, small-scale MDRO spread was detected. This may reflect differences in nursing home infrastructure specifically communal areas and multi-bedded resident rooms in the Irish nursing home.