TY - JOUR
T1 - Cohort profile: GRACE – a residential aged care cohort examining factors influencing antimicrobial resistance carriage
AU - Carpenter, Lucy
AU - Shoubridge, Andrew P.
AU - Flynn, Erin
AU - Lang, Catherine
AU - Taylor, Steven L.
AU - Papanicolas, Lito E.
AU - Collins, Josephine
AU - Gordon, David
AU - Lynn, David J.
AU - Crotty, Maria
AU - Whitehead, Craig
AU - Leong, Lex E.X.
AU - Wesselingh, Steve L.
AU - Ivey, Kerry
AU - Inacio, Maria C.
AU - Rogers, Geraint B.
N1 - Funding Information:
This research was supported by an Australian Medical Research Future Fund (MRFF) grant from the Australian Department of Health (GNT1152268). The Australian Department of Health reviewed the study proposal, but did not play a role in study design, data collection, analysis, interpretation, or manuscript writing. LC is supported by an Australian Government Research Training Program Scholarship (no applicable award number). SLT is supported by an NHMRC Emerging Leadership grant (GNT2008625). DJL is supported by an EMBL Australia Group Leader Award. MCI is supported by The Hospital Research Foundation Mid-Career Fellowship (MCF-27-2019) and National Health and Medical Research Council (NHMRC) Investigator Grant (APP119378). GBR is supported by a Matthew Flinders Research Fellowship (no applicable award number) and a National Health and Medical Research Council Senior Research Fellowship (GNT1155179).
Funding Information:
The authors are grateful to the participants and their families, and staff of the residential aged care facilities who participated in the GRACE study. We would like to acknowledge Registry of Senior Australians’ (ROSA) Steering Committee and the ROSA South Australian Health and Medical Research Institute (SAHMRI) Research Team for ensuring the success of the ROSA and support with this study. We also acknowledge the South Australian Government Department for Innovation and Skills (2017–2021) who provided support to establish ROSA, the Australian Government Medical Research Future Fund (2021–2024, PHRDI000009), and ROSA collaborating partners (SAHMRI, ECH Inc, Silver Chain, Life Care) for its ongoing support, and the Australian Institute of Health and Welfare for the linkage and construction of input data, SA Health, NSW Ministry of Health, Victorian Department of Health and QLD Health for the provision of the state-based data used in the ROSA with linkage via the AIHW, Centre for Health Record Linkage (CHeReL), the Centre for Victorian Data Linkage (CVDL), SA NT DataLink and Queensland Health’s Statistical Services Branch.
Publisher Copyright:
© 2023, BioMed Central Ltd., part of Springer Nature.
PY - 2023/8/28
Y1 - 2023/8/28
N2 - Background: The emergence of antimicrobial-resistant bacteria represents a considerable threat to human health, particularly for vulnerable populations such as those living in residential aged care. However, antimicrobial resistance carriage and modes of transmission remain incompletely understood. The Generating evidence on antimicrobial Resistance in the Aged Care Environment (GRACE) study was established to determine principal risk factors of antimicrobial resistance carriage and transmission in residential aged care facilities (RACFs). This article describes the cohort characteristics, national representation, and planned analyses for this study. Methods: Between March 2019 and March 2020, 279 participants were recruited from five South Australian RACFs. The median age was 88.6 years, the median period in residence was 681 days, and 71.7% were female. A dementia diagnosis was recorded in 54.5% and more than two thirds had moderate to severe cognitive impairment (68.8%). 61% had received at least one course of antibiotics in the 12 months prior to enrolment. Results: To investigate the representation of the GRACE cohort to Australians in residential aged care, its characteristics were compared to a subset of the historical cohort of the Registry of Senior Australians (ROSA). This included 142,923 individuals who were permanent residents of RACFs on June 30th, 2017. GRACE and ROSA cohorts were similar in age, sex, and duration of residential care, prevalence of health conditions, and recorded dementia diagnoses. Differences were observed in care requirements and antibiotic exposure (both higher for GRACE participants). GRACE participants had fewer hospital visits compared to the ROSA cohort, and a smaller proportion were prescribed psycholeptic medications. Conclusions: We have assembled a cohort of aged care residents that is representative of the Australian aged care population, and which provides a basis for future analyses. Metagenomic data isolated from participants and built environments will be used to determine microbiome and resistome characteristics of an individual and the facility. Individual and facility risk exposures will be aligned with metagenomic data to identify principal determinants for antimicrobial resistance carriage. Ultimately, this analysis will inform measures aimed at reducing the emergence and spread of antimicrobial resistant pathogens in this high-risk population.
AB - Background: The emergence of antimicrobial-resistant bacteria represents a considerable threat to human health, particularly for vulnerable populations such as those living in residential aged care. However, antimicrobial resistance carriage and modes of transmission remain incompletely understood. The Generating evidence on antimicrobial Resistance in the Aged Care Environment (GRACE) study was established to determine principal risk factors of antimicrobial resistance carriage and transmission in residential aged care facilities (RACFs). This article describes the cohort characteristics, national representation, and planned analyses for this study. Methods: Between March 2019 and March 2020, 279 participants were recruited from five South Australian RACFs. The median age was 88.6 years, the median period in residence was 681 days, and 71.7% were female. A dementia diagnosis was recorded in 54.5% and more than two thirds had moderate to severe cognitive impairment (68.8%). 61% had received at least one course of antibiotics in the 12 months prior to enrolment. Results: To investigate the representation of the GRACE cohort to Australians in residential aged care, its characteristics were compared to a subset of the historical cohort of the Registry of Senior Australians (ROSA). This included 142,923 individuals who were permanent residents of RACFs on June 30th, 2017. GRACE and ROSA cohorts were similar in age, sex, and duration of residential care, prevalence of health conditions, and recorded dementia diagnoses. Differences were observed in care requirements and antibiotic exposure (both higher for GRACE participants). GRACE participants had fewer hospital visits compared to the ROSA cohort, and a smaller proportion were prescribed psycholeptic medications. Conclusions: We have assembled a cohort of aged care residents that is representative of the Australian aged care population, and which provides a basis for future analyses. Metagenomic data isolated from participants and built environments will be used to determine microbiome and resistome characteristics of an individual and the facility. Individual and facility risk exposures will be aligned with metagenomic data to identify principal determinants for antimicrobial resistance carriage. Ultimately, this analysis will inform measures aimed at reducing the emergence and spread of antimicrobial resistant pathogens in this high-risk population.
KW - Geriatric medicine
KW - Infection control
KW - Microbiology
UR - http://www.scopus.com/inward/record.url?scp=85168975422&partnerID=8YFLogxK
U2 - 10.1186/s12877-023-04215-3
DO - 10.1186/s12877-023-04215-3
M3 - Article
C2 - 37641010
AN - SCOPUS:85168975422
SN - 1471-2318
VL - 23
JO - BMC Geriatrics
JF - BMC Geriatrics
IS - 1
M1 - 521
ER -