Antimicrobial resistance among people with intellectual disabilities in long-term care facilities: an exploratory, isolate-based surveillance study based on routine diagnostics between 2018 and 2023 in the Netherlands

Background
Little is known about the presence of resistant micro-organisms in people with intellectual disabilities (ID) residing in long-term care facilities (LTCFs). We explored the resistant percentages of six highly resistant micro-organisms (HRMOs) among people with ID in ID-LTCFs: ESBL-producing Enterobacterales (ESBL-E), carbapenemase-producing Enterobacterales (CPE), Acinetobacter spp. (CPA) and Pseudomonas aeruginosa (CPPA), MRSA and VRE.

Methods
We included data on the first isolate per species, per patient, per year ordered by ID physicians, as delivered by 11 clinical microbiology laboratories, participating in the Dutch National Infectious Diseases Surveillance Information System-Antimicrobial Resistance (ISIS-AR) between 2018 and 2023. Resistance was classified based on phenotypic and genotypic test results. The resistance percentage for each HRMO was calculated as the percentage of resistant isolates among the total number of isolates for each corresponding species.

Results
The percentage of resistant ESBL-E isolates among Enterobacterales isolates was 3.2% (95% CI: 2.5%–4.0%), CPPA among P. aeruginosa isolates was 1.3% (0.4%–3.8%) and MRSA among Staphylococcus aureus isolates 0.4% (0.01%–2.35%). No CPE (ntested = 2242), CPA (ntested = 25) and VRE (ntested = 6) were found.

Conclusions
The resistance percentages for six HRMOs among positive diagnostic isolates ordered by ID physicians for people with ID in the Netherlands are low. The majority of HRMOs detected were isolated from older adults with ID. To estimate the burden of AMR and associated risk factors in the whole ID population, more extensive studies, including data from other medical specialties serving people with ID, such as general practitioners, are needed.