Epidemiology of Antimicrobial Resistance among Gram-Negative Organisms Recovered from Patients in a Multistate Network of Long-Term Care Facilities

Lautenbach, Ebbing; Marsicano, Roseann; Tolomeo, Pam; Heard, M.J.; Serrano, Steve; Stieritz, Donald D.

doi:10.1086/599070

Cited by 49 publications

(33 citation statements)

References 9 publications

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“…The prevalence and resistance patterns vary greatly depending on type and location of the facility [37] with prevalence rates averaging around 20% [38], but as high as 50% or more in some institutions. Resident-to-resident spread has been demonstrated [9, 11, 25, 37, 39, 40]. Focusing on residents with established risk factors uncovers worrisome trends: Fisch et al observed a prevalence of ciprofloxacin resistance of > 50% in NH residents with indwelling devices [8•].…”

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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“…Due to certain host and healthcare factors (e.g., immune senescence, comorbidities, and antibiotic use), LTCF residents are at significant risk for colonization and/or infection with antibiotic-resistant organisms [10–12]. In particular, fluoroquinolone-resistant Escherichia coli (FQREC) has dramatically increased in prevalence in LTCFs over the past decade, representing a major cause of infections in this vulnerable population [13–15]. …”

Section: Introductionmentioning

confidence: 99%

Epidemiology and characteristics of Escherichia coli sequence type 131 (ST131) from long-term care facility residents colonized intestinally with fluoroquinolone-resistant Escherichia coli

Han

Garrigan

Johnston

et al. 2017

Diagnostic Microbiology and Infectious Disease

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The objective of this study was to evaluate molecular and epidemiologic factors associated with Escherichia coli sequence type 131 (ST131) among long-term care facility (LTCF) residents who acquired gastrointestinal tract colonization with fluoroquinolone-resistant E. coli (FQREC). Colonizing isolates from 37 residents who newly developed FQREC colonization at three LTCFs from 2006–2008 were evaluated. Twenty-nine (78%) of 37 total FQREC colonizing isolates were ST131. Most ST131 isolates had a distinctive combination of gyrA and parC replacement mutations. The ST131 and non-ST131 isolates differed significantly for the prevalence of many individual virulence factors but not for the proportion that qualified molecularly as extraintestinal pathogenic E. coli (ExPEC) or aggregate virulence factor scores. E. coli ST131 was highly prevalent among LTCF residents with FQREC colonization. Future studies should determine the risk factors for infection among ST131-colonized residents, and assess the potential for increased transmissibility of ST131 in the long-term care setting.

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“…Both chromosomally mediated and plasmid-mediated FQ resistance emerged rapidly and have since progressed. The increasing prevalence of FQ resistance among uropathogens in hospitals and long term care facilities (LTCFs) is a threat to the use of FQs as empirical therapy for UTI 2–7…”

Section: Introductionmentioning

confidence: 99%

Risk factors for fluoroquinolone resistance in Gram-negative bacilli causing healthcare-acquired urinary tract infections

Rattanaumpawan¹,

Tolomeo²,

Bilker³

et al. 2010

Journal of Hospital Infection

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SUMMARYThe prevalence of urinary tract infections caused by fluoroquinolone-resistant Gram-negative bacilli (FQ-resistant GNB-UTIs) has been increasing. Previous studies that explored risk factors for FQ resistance have focused only on UTIs caused by Escherichia coli and/or failed to distinguish colonisation from infection. We conducted a case-control study at two medical centres within the University of Pennsylvania Health System to identify risk factors for FQ resistance among healthcare-acquired GNB-UTIs. Subjects with positive urine cultures for GNB and who met Centers for Disease Control and Prevention criteria for healthcare-acquired UTI were eligible. Cases were subjects with FQ-resistant GNB-UTI, controls were subjects with FQ-susceptible GNB-UTI matched to cases by month of isolation and species of infecting organism. In total, 251 cases and 263 controls were included from 1 January 2003 to 31 March 2005. Independent risk factors (adjusted odds ratio; 95% confidence interval) for FQ resistance included male sex (2.03; 1.21-3.39; P = 0.007), AfricanAmerican race (1.80; 1.10-2.94; P = 0.020), chronic respiratory disease (2.58; 1.18-5.62); P = 0.017], residence in a long term care facility (4.41; 1.79-10.88; P = 0.001), hospitalisation within the past two weeks (2.19; 1.31-3.64; P = 0.003), hospitalisation under a medical service (2.72; 1.63-4.54; P < 0.001), recent FQ exposure (15.73; 6.15-40.26; P < 0.001), recent cotrimoxazole exposure (2.49; 1.07-5.79; P = 0.033), and recent metronidazole exposure (2.89; 1.48-5.65; P = 0.002).

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Epidemiology of Antimicrobial Resistance among Gram-Negative Organisms Recovered from Patients in a Multistate Network of Long-Term Care Facilities

Cited by 49 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

Epidemiology and characteristics of Escherichia coli sequence type 131 (ST131) from long-term care facility residents colonized intestinally with fluoroquinolone-resistant Escherichia coli

Risk factors for fluoroquinolone resistance in Gram-negative bacilli causing healthcare-acquired urinary tract infections

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