Comparison of a Hospital‐Wide Antibiogram with That of an Associated Long‐Term Care Facility

Kindschuh, William F.; Russo, Daniel; Kariolis, Ioannis; Wehbeh, Wehbeh; Urban, Carl

doi:10.1111/j.1532-5415.2011.03881.x

Cited by 8 publications

(5 citation statements)

References 9 publications

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“…Prior hospitalization is a general risk factor, as is current residence in a NH, again attesting to the changing epidemiology of MDROs and the important role of NHs [44, 48•]. In a study of an acute-care hospital in NYC and its associated long-term care facility, isolates from residents undergoing rehabilitation at the long-term care facility after being discharged from the hospital had a higher percentage of antimicrobial resistance than those from patients in the hospital [45]. The most relevant increases in resistance among isolates from long-term facility residents, were observed in enterococci (vancomycin resistance), staphylococci (methicillin resistance) and also in many Gram-negative species (especially resistance to new-generation fluoroquinolones, carbapenems, and antipseudomonal penicillins).…”

Section: Nursing Homes and The Changing Epidemiology Of Antimicrobialmentioning

confidence: 99%

Colonization with Multidrug-Resistant Organisms in Nursing Homes: Scope, Importance, and Management

Cassone

Mody

2015

Curr Geri Rep

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Bacterial infections are among the most common causes of morbidity and mortality in Nursing Homes (NH) and other long term care facilities. Multi-drug resistant organisms (MDROs) represent an ever-increasing share of causative agents of infection, and their prevalence in NHs is now just as high as in acute-care facilities, or even higher. Indeed, NHs are now considered a major reservoir of MDROs for the community at large. Asymptomatic colonization is usually a prerequisite to development of symptomatic infection. While progress has been made in defining epidemiology of MDROs in NHs, few studies have evaluated the role of changing healthcare delivery in introducing and further transmitting MDROs in this setting. Furthermore, the factors influencing the spread of colonization and the key prognostic indicators leading to symptomatic infections in the burgeoning short stay population need to be explored further. The difficulty of this task lies in the heterogeneity of NHs in terms of focus of care, organization and resources, and on the diversity among the many MDRO species encountered, which harbor different resistance genes and with a different prevalence depending on the geographic location, local antimicrobial pressure and residents risk factors such as use of indwelling devices, functional disability, wounds and other comorbidities. We present literature findings on the scope and importance of colonization as a pathway to infection with MDROs in NHs, underline important open questions that need further research, and discuss the strength of the evidence for current and proposed screening, prevention, and management interventions.

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Section: Nursing Homes and The Changing Epidemiology Of Antimicrobialmentioning

confidence: 99%

Colonization with Multidrug-Resistant Organisms in Nursing Homes: Scope, Importance, and Management

Cassone

Mody

2015

Curr Geri Rep

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“…29–31 However, as with the regional antibiogram, this assumes that the bacterial susceptibilities and emerging resistances are similar between the facilities, which may not always be the case. 28,32,33…”

Section: Discussionmentioning

confidence: 99%

Antimicrobial Stewardship in Long-Term Care Facilities: Approaches to Creating an Antibiogram when Few Bacterial Isolates Are Cultured Annually

Tolg

Dosa

Jump

et al. 2018

Journal of the American Medical Directors Association

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Antibiograms are important clinical tools to report and track antibiotic susceptibility and help guide empiric antimicrobial therapy. Antibiograms support compliance with antimicrobial stewardship (AMS) requirements from the Centers for Medicare and Medicaid Services and are in line with recommendations from the Centers for Disease Control and Prevention Core Elements of AMS for nursing homes/long-term care facilities (LTCFs). Unlike most acute-care settings, LTCFs are challenged in creating antibiograms because of the low number of bacterial isolates collected annually. Determining the best methodology for creating clinically useful antibiograms for LTCFs needs to be explored. Possible approaches include (1) extending the isolate data beyond 1 year, (2) combining isolate data from the same geographic region, (3) using a nearby acute-care facility's antibiogram as a proxy, or (4) collapsing isolate data. This article discusses the benefits and limitations of each approach.

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“…Obtaining information about resistant bacteria from these facilities has been problematic for various reasons (14)(15)26). There is no consistent support for active surveillance in nonoutbreak situations, and LTCFs are grossly underfunded and understaffed for these types of undertakings.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Remel Spectra CRE Agar for Detection of Carbapenem-Resistant Bacteria from Rectal Swabs Obtained from Residents of a Long-Term-Care Facility

LaBombardi

Urban²,

Kreiswirth

et al. 2015

J Clin Microbiol

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We compared the Remel Spectra CRE agar plate to CDC standard methodology for the isolation of carbapenem-resistant Enterobacteriaceae (CRE) from 300 rectal swab specimens obtained from patients residing in a long-term-care facility (LTCF). Multiplex PCR experiments were performed on isolates to identify specific Klebsiella pneumoniae carbapenemases (KPC) and additional ␤-lactamases. Of the 300 patients, 72 (24%) harbored CRE and were PCR positive for KPC enzymes. The Remel Spectra CRE plates detected KPC-type CRE in isolates from 70 of 72 patients (97.2%), while the CDC method detected CRE in 56 of 72 (77.8%). CRE identification results were available in 18 h compared to 36 h for the CDC method. Remel Spectra CRE agar plates can provide useful means for a fast and reliable method for detecting KPC-type CRE and for accelerated institution of appropriate infection control precautions. K lebsiella pneumoniae carbapenemases (KPC) are predominantly found in Klebsiella pneumoniae worldwide and have become endemic in major cities of the United States (1-4). They have also been characterized in Klebsiella oxytoca, Escherichia coli, Enterobacter spp., Citrobacter spp., Serratia spp., Acinetobacter baumannii, Salmonella spp., and Pseudomonas spp (1-3). Although KPC-type carbapenemases are the leading cause of carbapenem resistance among Enterobacteriaceae (CRE) in the United States, carbapenem resistance can be mediated by many other enzymes alone or in combination with other resistance mechanisms, including efflux and porin mutations (3, 5). Infections with these organisms are associated with higher mortality rates than those infections with more susceptible strains (6, 7). Patients who are asymptomatic carriers can serve as a source for nosocomial spread of these carbapenem-resistant organisms, necessitating the prompt detection of carriers and institution of appropriate infection control measures (8-11). Surveillance for CRE is especially useful among immunocompromised patients, including those in intensive care and transplant units (11,12). Screening residents of long-term-care facilities (LTCF) prior to admission and/or transfer to a hospital may be of increasing importance, as they may harbor antibiotic-resistant isolates (13-15). Although they are rapid, PCR-based technologies can be expensive and limited, as they only interrogate specific genes that are being screened and a positive result does not always predict the expression of resistance. While traditional culture methods are slow and may lack sensitivity, the use of chromogenic media to culture CRE and other multidrug-resistant microorganisms (MDRO) may facilitate the detection of these organisms in a timelier manner (16-18). The purpose of this investigation was to compare Remel Spectra CRE agar plates to the standard CDC method for the isolation of CRE from rectal swab specimens obtained from patients residing in an LTCF. Remel Spectra CRE agar is a selective and differential agar intended for use in the qualitative and presumptive identification of carbape...

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Comparison of a Hospital‐Wide Antibiogram with That of an Associated Long‐Term Care Facility

Cited by 8 publications

References 9 publications

Colonization with Multidrug-Resistant Organisms in Nursing Homes: Scope, Importance, and Management

Colonization with Multidrug-Resistant Organisms in Nursing Homes: Scope, Importance, and Management

Antimicrobial Stewardship in Long-Term Care Facilities: Approaches to Creating an Antibiogram when Few Bacterial Isolates Are Cultured Annually

Evaluation of Remel Spectra CRE Agar for Detection of Carbapenem-Resistant Bacteria from Rectal Swabs Obtained from Residents of a Long-Term-Care Facility

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