Risk factors associated with antimicrobial resistant organism carriage in residents of residential aged care facilities: a systematic review protocol

Review question/objective This review will aim to answer the following questions: 1. What are the resident risk factors associated with antimicrobial resistant organism carriage in the residential aged care setting? 2. What are the institutional risk factors associated with antimicrobial resistant organism carriage in the residential aged care setting? 3. What are the environmental risk factors associated with antimicrobial resistant organism carriage in the residential aged care setting? The objective of this systematic review is to synthesize the best available evidence of the risk factors associated with antimicrobial resistant organism carriage in residents of residential aged care facilities. More specifically, the objective is to identify the factors that make some residents more at risk than others to either colonization or infection with an antimicrobial resistant organism. These may include patient/resident factors (predisposing medical conditions, immune status, functional capacity), institutional factors (staffing ratios, clinical policies and procedures, antibiotic use, indwelling devices) or environmental factors (cleaning of environment, cleaning of equipment, ward layout, hand hygiene facilities, shared and community living). Inclusion criteria Types of participants This review will consider studies that include permanent residents of residential aged care Facilities, both male and female. Carriage of an antimicrobial resistant organism will be defined as the presence of such an organism confirmed via a culture positive result from any site on the body. The carrier status must be clearly defined in included studies. Studies that report either antimicrobial resistant organism colonization or infection will be included. Studies that only look at a specific disease sub-population of residents who are under 65 years of age will be excluded. Studies that focus exclusively on residents under the age of 65 will also be excluded. Residents under the age of 65 included within studies that are not stratified by age will be included. Types of intervention(s)/phenomena of interest All risk factors associated with carriage of any antimicrobial resistant organism in residents of residential aged care facilities will be considered in this review. A risk factor is a condition that is associated with the presence of an antimicrobial resistant organism in a resident. Examples of risk factors include, but are not limited to predisposing medical conditions, immune status, functional capacity (resident factors); staffing ratios, clinical policies and procedures, antibiotic use, indwelling devices (institutional factors); and cleaning of environment, cleaning of equipment, ward layout, hand hygiene facilities, shared and community living (environmental factors). Types of outcomes Outcomes of interest include the characteristics of residents with antimicrobial resistant organism carriage. These will be associated with the resident, the facility, and/or the environment (i.e. immune status, clinical policies, ward layout etc.). The measurement of these outcomes may include a risk ratio (RR),likelihood ratio (LR), or odds ratio (OR) of risk factors in comparison to residents who do not have an antimicrobial resistant organism.