Nursing Home Residents andEnterobacteriaceaeResistant to Third-Generation Cephalosporins

Abstract

Limited data identify the risk factors for infection with Enterobacteriaceae resistant to third-generation cephalosporins among residents of long-term-care facilities. Using a nested case-control study design, nursing home residents with clinical isolates of Enterobacteriaceae resistant to third-generation cephalosporins were compared to residents with isolates of Enterobacteriaceae susceptible to third-generation cephalosporins. Data were collected on antimicrobial drug exposure 10 weeks before detection of the isolates, facility-level demographics, hygiene facilities, and staffing levels. Logistic regression models were built to adjust for confounding variables. Twenty-seven case-residents were identified and compared to 85 controls. Exposure to any cephalosporin (adjusted odds ratio [OR] 4.0, 95% confidence interval [CI] 1.2 to13.6) and log percentage of residents using gastrostomy tubes within the nursing home (adjusted OR 3.9, 95% CI 1.3 to 12.0) were associated with having a clinical isolate resistant to third-generation cephalosporins.

Inguinal skin colonization with multidrug-resistant bacteria among residents of elderly care facilities: Frequency, persistence, molecular analysis and clinical impact

“…Previous antibiotic exposure, in particular to fluoroquinolones and third generation cephalosporins, is frequently described to be associated with carriage of ESBL-producing bacteria in nursing home residents (Mendelson et al, 2005;Sandoval et al, 2004). This appears to be a dose related process since it was shown that the duration of exposure plays an important role in the selection of resistant strains (Rooney et al, 2009;Tinelli et al, 2012).…”

Taking stock of infections and antibiotic resistance in the elderly and long-term care facilities: A survey of existingand upcoming challenges

“…LTCFs are faced with methicillin-resistant Staphylococcus aureus, MRSA. Currently, colonization by MRSA has reached staggering proportions in LTCFs [13][14][15][16][17][18]. Furthermore, multidrug resistant (MDR) Gram-negative pathogens (especially Escherichia coli, Klebsiella pneumoniae and Acinetobacter baumannii harboring extended-spectrum beta-lactamases/cephalosporinases that confer resistance to cefotaxime, ceftazidime, ceftriaxone and carbapenemases (e.g.…”

Antibacterial resistance associated with long-term care facilities

“…Both ciprofloxacin and trimethoprim-sufamethoxazole use was linked to dissemination of ESBL producing organisms in this report, unlike the earlier outbreak in Massachusetts in which ceftazidime use was the driving force for selection and proliferation [32]. Other publications have since followed documenting the presence of such enzymes in LTCFs [37][38][39][40]. Evolution and progression to carbapenem resistance in Enterobacteraceae soon followed as a result of carbapenem therapy widely accepted for treatment of patients with ESBL harboring bacteria [14].…”