Multidrug-Resistant Organisms in Long-Term Care Facilities
Summary
Long-term care facilities (LTCFs) house a vulnerable population with frequent antibiotic exposure, multiple comorbidities and prolonged stays, creating a niche for multidrug-resistant organisms (MDROs). These include Gram-negative bacilli producing extended-spectrum β-lactamases (ESBLs) or carbapenemases, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE). Colonisation often precedes infection and can persist for months, promoting intra-facility transmission via direct contact, shared equipment and hands of healthcare personnel. Device use, wound care and functional dependency further amplify risk. Surveillance and molecular typing have revealed clonal dissemination across wards and between connected healthcare settings, underscoring the role of patient transfers in regional spread. Antimicrobial stewardship and stringent infection prevention measures—hand hygiene, contact precautions, environmental decontamination and staff education—are essential to curb transmission. LTCFs also serve as reservoirs influencing hospital networks and community health, making targeted interventions in these settings a global priority.
Research from Nature Portfolio
Recent studies in high-throughput surveillance have delineated colonisation and transmission dynamics of MDROs in US nursing homes. In a prospective cohort of newly admitted residents, baseline colonisation was widespread across hands, nares and environmental surfaces. Scheduled and unscheduled interactive visits with healthcare personnel and shared equipment accounted for significant MDRO transfer events. Whole-genome sequencing of isolates uncovered hidden transmission routes not apparent from standard microbiological methods, revealing interconnected clusters spanning multiple wards. These findings highlight the need for multidisciplinary strategies combining behavioural interventions, environmental engineering and rapid genomic diagnostics to interrupt transmission pathways in real time.
Multidrug-Resistant Organisms in Long-Term Care Facilities publication trend
The graph below shows the total number of articles in multidrug-resistant organisms in long-term care facilities across all publications each year (not limited to Nature Index journals).
Technical terms
Multidrug-resistant organism (MDRO): A pathogen resistant to three or more classes of antibiotics, limiting treatment options.
Colonisation: The presence of bacteria on or within a host without causing clinical infection, serving as a reservoir for transmission.
Extended-spectrum β-lactamase (ESBL): Enzymes produced by some Gram-negative bacteria that hydrolyse penicillins and cephalosporins, conferring broad β-lactam resistance.
Carbapenem-resistant Enterobacteriaceae (CRE): A subset of Enterobacteriaceae that produce carbapenemases or possess other mechanisms leading to resistance against carbapenem antibiotics.
Antimicrobial stewardship: A coordinated set of interventions designed to optimise antibiotic use, improve patient outcomes and reduce resistance emergence.
Long-term care facility (LTCF): A residential institution providing healthcare and assistance to individuals with chronic illness or disability over extended periods.
References
- Epidemiology and transmission dynamics of multidrug-resistant organisms in nursing homes within the United States. Nature Communications (2025).
- Gut microbiology of UK care home residents: a cross-sectional analysis from a randomised controlled trial. Clinical Microbiology and Infection (2023).
- Regional spread of an atypical ESBL-producing Escherichia coli ST131H89 clone among different human and environmental reservoirs in Western Switzerland. Antimicrobial Agents and Chemotherapy (2024).
- Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review. Antibiotics (2021).
- The Role of Nursing Homes in the Spread of Antimicrobial Resistance Over the Healthcare Network. Infection Control and Hospital Epidemiology (2016).
- Challenges and Strategies for Prevention of Multidrug-Resistant Organism Transmission in Nursing Homes. Current Infectious Disease Reports (2017).
About these summaries
This Nature Research Intelligence Topic summary is created with the cited references and a large language model. We take care to ground generated text with facts, and have systems in place to gain human feedback on the overall quality of the process in line with our AI principles. We strive to create accurate and useful summaries for people unfamiliar with the research topic and that supports this goal. These pages are a beta release and will be updated as we learn how best to help people gain value from a research topic summary.
Turn complex research questions into confident strategic decisions
When you're under pressure to set direction, justify investment, or understand your competitive position, you need more than raw data — you need trusted insights you can act on.
Benchmark your performance against global peers using robust, methodologically sound analysis.
Combine quantitative metrics with qualitative expert insight to uncover strengths, gaps and emerging opportunities.
Gain tailored, decision-ready recommendations aligned to your strategic priorities.
Talk to us to learn more about our data dashboards and bespoke strategy reports.
Grow research skills, confidence and careers with training built for every stage of the research lifecycle.
Developed with Nature Portfolio journal Editors and internationally renowned experts. Discover three ways to learn:
Self-paced, online courses in convenient bite-sized units, covering key skills across scientific writing, publishing, grant writing, data analysis, and more.
Expert trainer-led workshops with hands-on exercises and real-time feedback across core research skills, delivered via interactive group sessions.
Editor-led workshops combining core principles in writing and publishing, personalised 1:1 feedback from Nature Portfolio Editors and hands-on exercises.
Explore course catalogues and workshop agendas, enquire about the options or request institutional pricing.