Endemic and Emerging Multidrug Resistant Organisms in Nursing Homes: A Neglected Clinical Setting

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Project Summary/Abstract Individuals receiving care in nursing homes disproportionally experience adverse outcomes due to multidrug-resistant organisms. This investigation will focus on an endemic and virulent pathogen common to nursing homes – methicillin-resistant Staphylococcus aureus (MRSA), and a highly emerging antibiotic resistant fungus – Candida auris, both of which have been linked to substantial morbidity and mortality in U.S. nursing homes. While MRSA has been a major prevention target in hospitals, little has been done to address this pathogen in nursing homes despite the fact that nursing homes have a 3-fold higher MRSA prevalence than hospitals and MRSA carriers in nursing homes have a 40% risk of infection per year. Risk in nursing homes due to MRSA is now compounded by C. auris, which has been termed the “fungal MRSA” due to similar transmission characteristics, including a remarkable propensity to colonize the body and persist on surfaces for prolonged periods. C. auris has been associated with intractable outbreaks in nursing homes with high attributable mortality; 5-10% of known carriers develop invasive infections and 30- 60% of those with invasive infection die as a result. Thus, determining which nursing home residents are at greatest risk for MRSA and C. auris carriage is crucial for effective response and control. The overall goal of this proposal is to generate novel data on MRSA and C. auris carriage and contamination in nursing homes to inform interventions to control these important pathogens. The first objective is to identify nursing home facility characteristics and resident risk factors associated with MRSA and C. auris carriage. Results from this objective could target high-risk residents for screening and prevention activities. The second objective is to determine if high-contact care activities (e.g., dressing, bathing) for MRSA and C. auris carriers cause contamination of high-touch objects in their immediate environment. If so, focused post-activity cleaning could be important to reduce MRSA and C. auris contamination and mitigate spread. I (Gabrielle Gussin, MS) am pursuing a Ph.D. in Public Health at the University of California, Irvine. This F31 fellowship will enable me to bridge my previous Master’s training in Systems Biology with skills in epidemiology, clinical research, and population health. I will be mentored by a multidisciplinary team with expertise in clinical infectious diseases, epidemiology, multidrug-resistant organisms, public health, nursing home operations, and biostatistics to support my proposed aims and career goals.