Extended-spectrum β-lactamase-producing Enterobacteriaceae colonisation in long-term care facilities: a systematic review and meta-analysis

Flokas, Myrto Eleni; Alevizakos, Michail; Shehadeh, Fadi; Andreatos, Nikolaos; Mylonakis, Eleftherios

doi:10.1016/j.ijantimicag.2017.08.003

Cited by 63 publications

(58 citation statements)

References 62 publications

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“…Approximately 20% of nursing home residents have been shown to be colonized with ESBL-producing Enterobacteriaceae . 40 , 41 In ICUs, similar estimates have been reported. 42 Although these limited data preclude broad generalizations, it may not be unreasonable to estimate the prevalence of ESBL-producing gram-negative bacilli in palliative care settings to be on the order of 15% to 20%.…”

Section: Burden Of Mdrossupporting

confidence: 77%

Burden and Management of Multidrug-Resistant Organisms in Palliative Care

Datta

Juthani‐Mehta

2017

Palliat�Care

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Palliative care includes comprehensive strategies to optimize quality of life for patients and families confronting terminal illness. Infections are a common complication in terminal illness, and infections due to multidrug-resistant organisms (MDROs) are particularly challenging to manage in palliative care. Limited data suggest that palliative care patients often harbor MDRO. When MDROs are present, distinguishing colonization from infection is challenging due to cognitive impairment or metastatic disease limiting symptom assessment and the lack of common signs of infection. Multidrug-resistant organisms also add psychological burden through infection prevention measures including patient isolation and contact precautions which conflict with the goals of palliation. Moreover, if antimicrobial therapy is indicated per goals of care discussions, available treatment options are often limited, invasive, expensive, or associated with adverse effects that burden patients and families. These issues raise important ethical considerations for managing and containing MDROs in the palliative care setting.

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Section: Burden Of Mdrossupporting

confidence: 77%

Burden and Management of Multidrug-Resistant Organisms in Palliative Care

Datta

Juthani‐Mehta

2017

Palliat�Care

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“…While previous published data of this target population mainly focused on faecal or rectal samples to evaluate the carriage of ARB [4], a survey by March A. et al indicated a proportion of ARB present in the oropharyngeal area in addition to the other sites [7]. However, to date, few researchers have addressed this issue in the oral cavity.…”

Section: Introductionmentioning

confidence: 99%

“…Adequate active surveillances still have to clarify the colonisation rates by MDR bacteria among the elderly residing in LTCFs nationwide [3]. Moreover, surveillances for ARB carriage among LTCFs residents have been almost exclusively for faecal or rectal samples [4].…”

Section: Introductionmentioning

confidence: 99%

Oral colonisation by antimicrobial-resistant Gram-negative bacteria among long-term care facility residents: prevalence, risk factors, and molecular epidemiology

Kayama

Yoshikawa

et al. 2020

Antimicrob Resist Infect Control

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Background: For residents of long-term care facilities (LTCFs), antimicrobial-resistant bacteria (ARB) are a risk factor, yet their oral colonisation, potentially leading to aspiration pneumonia, remains unclear. This study was undertaken to survey the prevalence, phenotypic characteristics, and molecular epidemiology of antimicrobial-resistant Gramnegative bacteria in the oral cavity of LTCF residents, and to analyse the risk factors for such carriers. Methods: This study involved 98 residents of a LTCF in Hiroshima City, Japan, aged between 55 and 101 years. Oropharyngeal swabs were collected and plated on screening media for ESBL-producing and carbapenem-resistant bacteria; isolates were identified and tested for antibiotic susceptibility; biofilm formation was tested in vitro; identification of epidemic clones were pre-determined by PCR; resistance genes, sequence types, and wholegenome comparison of strains were conducted using draft genome sequences. Demographic data and clinical characterisations were collected and risk factors analysed. Results: Fifty-four strains from 38% of the residents grew on screening media and comprised predominantly of Acinetobacter spp. (35%), Enterobacteriaceae spp. (22%), and Pseudomonas spp. (19%). All Escherichia coli isolates carried CTX-M-9 group and belonged to the phylogroup B2, O25:H4 ST131 fimH30 lineage. Six Acinetobacter baumannii isolates presented identical molecular characteristics and revealed more biofilm production than the others, strongly suggesting their clonal lineage. One Acinetobacter ursingii isolate displayed extensive resistance to various ß-lactams due to multiple acquired resistance genes. One Pseudomonas aeruginosa isolate showed exceptional resistance to all ßlactams including carbapenems, aminoglycosides, and a new quinolone, showing a multidrug-resistant Pseudomonas aeruginosa (MDRP) phenotype and remarkable biofilm formation. Genome sequence analysis revealed this isolate was the bla IMP-1 -positive clone ST235 in Japan. Strokes (cerebral infarction or cerebral haemorrhage) and percutaneous endoscopic gastrostomy tubes were recognised as risk factors for oral colonisation by ARB in the LTCF residents. Conclusions: ARB, as defined by growth on screening agar plates, which carried mobile resistance genes or elements or conferred high biofilm formation, were already prevalent in the oral cavity of LTCF residents. Health-care workers involved in oral care should be aware of antimicrobial resistance and pay special attention to transmission prevention and infection control measures to diminish ARB or mobile resistance elements dissemination in LTCFs.

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“…E o que se observa é que alguns fatores estão implicados na colonização, entre os quais: uso recente de antibióticos (últimos seis meses), hospitalização prévia (últimos 2,5 anos), procedimentos invasivos, colonização prévia por ESBL, história de infecção de trato urinário e uso de cateter urinário. 25 Do exposto, fica clara a necessidade de políticas de uso racional de antibióticos e da adoção das medidas de precaução de contato, sobretudo no HUGV, pois a microbiota da instituição com índice geral de ESBL de 39,34% reflete microbiota selecionada e mais resistente.…”

Section: Resultsunclassified

Ocorrência de Escherichia coli e Klebsiella spp produtoras de ESBL em Hospital Universitário, na cidade de Manaus - AM

Diniz

Santos

2019

Rev Epidemiol Control Infect

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Justificativa e Objetivos:Bactérias produtoras de betalactamase de espectro ampliado (ESBL) são crescentes, sobretudo, pelo uso rotineiro de antibióticos. Causam principalmente, infecções urinárias e de feridas operatórias e, caracterizam-se pela resistência às cefa-losporinas de terceira geração, aztreonam e associação de cefalosporinas com ácido clavulânico. Este estudo teve como objetivo conhecer a frequência de Escherichia coli ESBL e Klebsiella spp.ESBL através da análise fenotípica. Métodos:Teste de sensibilidade in vitro por aproximação de discos (CLSI), de bactérias isoladas de meios biológicos dos pacientes atendidos no HUGV entre 2017 e 2018. Resultados: 34,66% eram Escherichia coli ESBL e 46,80% Klebsiella spp.ESBL, totalizando 39,34% de amostras ESBL. Dos meios biológicos predomina-ram ESBL na: urina (56,25%) e feridas cirúrgicas (22,91%). Clínicas com maior ocorrência de ESBL: médica e cirúrgica. Conclusão: Os índices de ESBL no HUGV estão próximos ou até mais altos do que em algumas regiões do país. Consoante a literatura revisada, predomina a Escherichia coli nos isolados e há mais Klebisella spp. ESBL do queEscherichia coliESBL. Descritores:Fenótipo. Escherichia coli. Klebsiella. ESBL. Infecção Hospitalar

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Extended-spectrum β-lactamase-producing Enterobacteriaceae colonisation in long-term care facilities: a systematic review and meta-analysis

Cited by 63 publications

References 62 publications

Burden and Management of Multidrug-Resistant Organisms in Palliative Care

Burden and Management of Multidrug-Resistant Organisms in Palliative Care

Oral colonisation by antimicrobial-resistant Gram-negative bacteria among long-term care facility residents: prevalence, risk factors, and molecular epidemiology

Ocorrência de Escherichia coli e Klebsiella spp produtoras de ESBL em Hospital Universitário, na cidade de Manaus - AM

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