Antibiotic resistance of Enterobacteriaceae causing urinary tract infections in elderly patients living in the community and in the nursing home: a retrospective observational study

Pulcini, Céline; Clerc‐Urmès, Isabelle; Attinsounon, Cossi Angelo; Fougnot, Sébastien; Thilly, Nathalie

doi:10.1093/jac/dky488

Cited by 29 publications

(22 citation statements)

References 8 publications

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“…These results are similar to common pathogens reported from either UTI or urine cultures from nursing home residents in other studies. 4,[14][15][16][17][18] Within nursing homes, levels of antibiotic resistance, including MDR, were generally higher among the CA-SUTI events than UTIs not associated with catheters, most notably for vancomycin resistance in E. faecium and extended-spectrum cephalosporin and carbapenem resistance in Klebsiella spp. These differences observed among nursing-home UTI event types may be explained by the role that biofilm formation on indwelling devices plays in the selection and emergence of antibiotic resistance.…”

Section: Discussionmentioning

confidence: 99%

“…Large European studies have described higher levels of resistance to fluoroquinolones and cephalosporins among uropathogens isolated from nursing home residents compared to community-dwelling older adults. 4,5 However, fewer studies describe antibiotic resistance among uropathogens from residents of US nursing homes. 6,7 The Centers for Disease Control and Prevention (CDC) National Healthcare Safety Network (NHSN) provides surveillance infrastructure for tracking healthcare-associated infections and antibioticresistant pathogens in US healthcare facilities.…”

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confidence: 99%

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Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: Summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013–2017

Eure

Stone

Mungai

et al. 2020

Infect. Control Hosp. Epidemiol.

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Objective: Antibiotic resistance (AR) is a growing and highly prevalent problem in nursing homes. We describe selected AR phenotypes from pathogens causing urinary tract infections (UTIs) reported by nursing homes to the National Healthcare Safety Network (NHSN). Design: Pathogens and antibiotic susceptibility testing results for UTI events in nursing homes between January 2013 and December 2017 were analyzed. The pathogen distribution and pooled mean proportion of isolates that tested resistant to select antibiotic agents are reported. Setting and Participants: US nursing homes voluntarily participating in the Long-Term Care Facility component of the NHSN. Results: Overall, 243 nursing homes reported 1 or more UTIs: 121 (50%) were nonprofit facilities, median bed size was 91 (range: 9–801), and average occupancy was 87%. In total, 6,157 pathogens were reported for 5,485 UTI events. Moreover, 9 pathogens accounted for 90% of all reported UTIs; the 3 most frequently identified were Escherichia coli (41%), Proteus species (14%), and Klebsiella pneumoniae/oxytoca (13%). Among E. coli, fluoroquinolone, and extended-spectrum cephalosporin resistance were most prevalent (50% and 20%, respectively). Although Staphylococcus aureus and Enterococcus faecium represented <5% of pathogens reported, they had the highest rates of resistance (67% methicillin resistant and 60% vancomycin resistant, respectively). Multidrug resistance was most common in Pseudomonas aeruginosa (11%). For the resistant phenotypes we assessed, 36% of all UTIs reported were associated with a resistant pathogen. Conclusions: This is the first summary of AR among common pathogens causing UTIs reported to NHSN by nursing homes. Improved understanding of the resistance burden among common infections helps inform facility infection prevention and antibiotic stewardship efforts.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: Summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013–2017

Eure

Stone

Mungai

et al. 2020

Infect. Control Hosp. Epidemiol.

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“…Residing in an LTCF has been identified as a risk factor for infection caused by ESBL-producing Enterobacteria [8, 28, 29]. Pulcini et al showed that older people from nursing homes had a 40% risk of having an antibiotic-resistant Enterobacteriaceae isolated from the urine compared to their community peers [30]. More recently, McKinnell et al estimated a prevalence of MDRO colonization in older people from nursing homes and long-term acute care facilities of 65 and 80% respectively [31].…”

Section: Discussionmentioning

confidence: 99%

Characteristics of febrile urinary tract infections in older male adults

et al. 2019

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BackgroundUrinary tract infections (UTI) are among the most frequent bacterial infections in older adults. The aim of the study was to analyse the existence of differences in clinical features, microbiological data and risk of infection by multidrug-resistant organisms (MDRO) between older and non-older men with febrile UTI (FUTI).MethodsThis was an ambispective observational study involving older males with a FUTI attended in the Emergency Department. Variables collected included age, comorbidity, diagnostic of healthcare-associated (HCA)-FUTI, clinical manifestations, hospitalization, mortality, and microbiological data.ResultsFive hundred fifty-two males with a FUTI, 329 (59.6%) of whom were older adults, were included. Older males had a higher frequency of HCA-FUTI (p < 0.001), increased Charlson scores (p < 0.001), had received previous antimicrobial treatment more frequently (p < 0.001) and had less lower urinary tract symptoms (p < 0.001). Older patients showed a lower frequency of FUTI caused by E. coli (p < 0.001) and a higher rate of those due to Enterobacter spp. (p = 0.003) and P. aeruginosa (p = 0.033). Resistance rates to cefuroxime (p = 0.038), gentamicin (p = 0.043), and fluoroquinolones (p < 0.001) in E. coli isolates and the prevalence of extended-spectrum beta-lactamase and AmpC producing E. coli and Klebsiella spp. strains (p = 0.041) and MDRO (p < 0.001) were increased in older males. Inadequate empirical antimicrobial treatment (p = 0.004), frequency of hospitalization (p < 0.001), and all cause in-hospital mortality (p = 0.007) were higher among older patients. In the multivariate analysis, being admitted from an long term care facility (OR 2.4; 95% CI: 1.06–5.9), having a urinary tract abnormality (OR 2.2; 95% CI: 1.2–3.8) and previous antimicrobial treatment (OR 3.2; 95% CI: 1.9–5.4) were associated to FUTI caused by MDRO.ConclusionsOlder male adults with a FUTI have different clinical characteristics, present specific microbiological features, and antimicrobial resistance rates. In the multivariate analysis being an older male was not associated with an increased risk of FUTI caused by MDRO.

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“…Bloodstream infections (BSI) caused by these bacteria are associated with a high mortality rate and increased hospital costs (8). Patients with comorbidity and the institutionalized elderly are at particularly high risk of contracting a BSI as a result of ESBL-producing Enterobacteriaceae and also have a high mortality rate (5,9,10). Moreover, the number of centenarians is increasing, and several previous studies of bacteremia caused by ESBL-producing organisms have defined "elderly" as aged ≥65 years (5,9,11).…”

Section: Accepted Manuscript Introductionmentioning

confidence: 99%

Advanced Age is not a Risk Factor for Mortality in Patients with Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Organisms: a Multicenter Cohort Study

Mitsuboshi

Tsuruma

Watanabe³

et al. 2020

Jpn J Infect Dis

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A 5-year multicenter retrospective cohort study was conducted across six hospitals in Niigata, Japan. Patients (n = 179) with bacteremia due to ESBL-producing organisms were included in the study. The rate of appropriate carbapenem prescription was 41 (61%) in patients aged 65-84 years and 31 (89%) in those aged ≥85 years; patients aged ≥85 years were significantly more like to receive a carbapenem than their younger counterparts. After propensity score matching, 65 patients were assigned to two groups based on age (65-84 years or ≥85 years). Multivariate regression analysis showed that other sites of infection had a positive association with 30-day mortality (odds ratio [OR] 27.50, 95% confidence interval [CI] 2.90-260.00) and biliary tract infection tended to have a positive association with 30-day mortality (OR 8.90, 95% CI 0.88-89.90) compared with urinary tract infection. However, age ≥85 years was not associated with 30-day mortality. Elderly patients aged ≥85 years were more likely to be treated with carbapenem; however, being elderly was not associated with 30-day mortality when bacteremia was caused by ESBL-producing organisms. These results may help clinicians justify withholding carbapenem in patients over 85 years of age.

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Antibiotic resistance of Enterobacteriaceae causing urinary tract infections in elderly patients living in the community and in the nursing home: a retrospective observational study

Cited by 29 publications

References 8 publications

Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: Summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013–2017

Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: Summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013–2017

Characteristics of febrile urinary tract infections in older male adults

Advanced Age is not a Risk Factor for Mortality in Patients with Bacteremia Caused by Extended-Spectrum β-Lactamase-Producing Organisms: a Multicenter Cohort Study

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