Risk Factors for the Development of Gastrointestinal Colonization With Fluoroquinolone-Resistant Escherichia coli in Residents of Long-Term Care Facilities

Han, Jennifer; Maslow, Joel N.; Han, Xiaoyan; Xie, Sharon X.; Tolomeo, Pam; Santana, Evelyn; Carson, Lesley; Lautenbach, Ebbing

doi:10.1093/infdis/jit471

Cited by 17 publications

(27 citation statements)

References 23 publications

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“…An increase in fl uoroquinolone-resistant E-coli has been described in one of the adult long-term care facilities of the elderly in which urinary catheters and antibiotics were found to be risk factors. However, this study did not mention specifi cally if any of the residents had with developmental disabilities [ 97 ].…”

Section: Antibiotic Resistancementioning

confidence: 91%

Infectious Diseases, Immunizations and Universal Precautions

Khasawneh

Wallen²,

Davies³

2016

Health Care for People With Intellectual and Developmental Disabilities Across the Lifespan

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Primary care physicians often have to care for clients with different developmental disabilities. This chapter related to infectious diseases issues in individuals with developmental disability summarizes the main issues to be cognizant of and emphasizes the role of primary care provider following this population. Multidisciplinary approaches are best in managing these individuals with better coordination by primary care providers that have adequate knowledge to manage and advocate for this special population. Anticipatory guidance to address relevant health issues appropriately will enhance opportunities for independent living and even assumption of active roles within their communities.There is a dynamic interaction between infections and outcomes of developmental disabilities. Some perinatal and post natal infections lead to developmental disabilities. In turn, people with developmental disabilities are prone to certain infections based on the underlying pathology and associated anatomical and functional defects or behavioral characteristics. Delivering immunizations for persons with disabilities often necessitates taking into consideration special precautions such as for children with metabolic disorders. Primary care providers should also be aware of the overwhelming evidence supporting the absence of a relationship between autism and immunization with any vaccine. Some underlying conditions are associated with increased frequency of certain respiratory, gastrointestinal, urinary or skin infections. Primary care providers play a pivotal role in guiding and managing dental caries. Individuals with restricted body mobility are at risk of pressure sores that should be examined for during follow up visits. As these individuals grow up, other aspects that should also be addressed by anticipatory guidance include the risk of sexually transmitted diseases and occupational hazards. Judicious use of appropriate antibiotics and application of universal precautions help limit antibiotic exposure and reduce the risk of emergence of resistant pathogens.

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Section: Antibiotic Resistancementioning

confidence: 91%

Infectious Diseases, Immunizations and Universal Precautions

Khasawneh

Wallen²,

Davies³

2016

Health Care for People With Intellectual and Developmental Disabilities Across the Lifespan

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“…However, as there is no standardized approach for the selection of antimicrobial exposure thresholds or durations, these measures vary considerably among studies. The most common method dichotomizes exposure at a specific threshold over a time period, such as any versus no antimicrobial use during the prior 30 days (3,6,7,9,10,12,13). Another common approach expresses exposure as the cumulative number of days patients are on antimicrobials.…”

Section: Defining Antimicrobial Exposurementioning

confidence: 99%

“…In designing a prospective study, this precision must be weighed against practical issues including greater personnel effort, patient burden, and costs. Several prospective studies reviewed in Table 1 collected multiple swabs at varying intervals (6,7,9,10,12,13,15). …”

Section: Timing Of Mdro Acquisitionmentioning

confidence: 99%

Examining the relationship between multidrug-resistant organism acquisition and exposure to antimicrobials in long-term care populations: a review

Shaffer

D’Agata

Habtemariam

et al. 2016

Annals of Epidemiology

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Purpose Methodological approaches to examining the association between antimicrobial exposure and multidrug resistant organism (MDRO) acquisition are complex. This report’s objectives are to review approaches used in and findings of prior studies in the long-term care setting, illustrate how these challenges were addressed in a recently completed large prospective study, and discuss strategies for future studies. Methods Key design and analytic approaches used in studies conducted since 2000 examining the association between antimicrobial exposure and MDRO acquisition in the long-term care setting were reviewed. The Study of Pathogen Resistance and Exposure to Antimicrobials in Dementia (SPREAD) in nursing home residents in Boston from 2009 to 2014 is used to illustrate how to approach these challenges. Results Prior investigations reporting the association between antimicrobial exposure and MDRO acquisition vary considerably in their approaches. In SPREAD, grouped-time hazard models with complementary log-log link function were used to model acquisition accounting for clustering within facilities using generalized estimating equations and including all days of exposure prior to acquisition. Conclusions Future studies in these populations should make use of all available acquisition status data, incorporate the timing of antimicrobial exposure relative to acquisition, and collect detailed covariate information that facilitates examining confounding by indication.

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“…A 2014 Pennsylvanian study of 3 NHs estimated the incidence of fluoroquinolone-resistant E. coli acquisition as 47.5% within a median of 57 days, with increased risks associated with urinary catheter use and fecal incontinence. 11 More than one-third (34%) of E. coli isolated in a 2011 Michigan study of 14 NHs were ciprofloxacin-resistant E. coli (CipREc); CipREc occurred twice as frequently among isolates from residents with medical devices (50% vs 26%). 12 …”

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confidence: 99%

Long-Term Carriage of Ciprofloxacin-Resistant Escherichia coli Isolates in High-Risk Nursing Home Residents

Ismail

Luo

McNamara

et al. 2016

Infect. Control Hosp. Epidemiol.

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BACKGROUND Rates of multidrug-resistant gram-negative organisms are surpassing those of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in nursing homes (NHs). OBJECTIVE To characterize the incidence and duration of carriage of ciprofloxacin-resistant Escherichia coli (CipREc) in NHs and identify those in the O25b-ST131 lineage. METHODS We collected 227 CipREc isolates obtained by routine and regular surveillance of high-risk NH residents with indwelling devices. Repetitive element palindromic (REP)–polymerase chain reaction assay and multiplex polymerase chain reaction amplification for O25b-ST131 E. coli detection were performed using (GTG)5-primers and O25pabBspe and trpA2 primer pairs, respectively. RESULTS We found a high period prevalence of CipREc colonization (21.5%), high rates of recolonization with the same strain following clearing (0.46 recolonizations/person/year), and an acquisition incidence of 1.05 cases/1,000 person-days. Almost three-quarters of colonized residents carried strains in the O25b-ST131 E. coli lineage. Compared with isolates not in the lineage, O25b-ST131 isolates were carried significantly longer (10 vs 3 months). We identified 18 different REP-types; 2 occurred in 55% of the residents colonized with CipREc, and in more than 1 NH. Duration of CipREc carriage varied by REP-type and averaged 6 months. CONCLUSION CipREc occurred frequently in NH residents and is carried for long durations, and reacquisition following clearance is common. Trial registration. ClinicalTrials.gov identifier: NCT01062841.

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Risk Factors for the Development of Gastrointestinal Colonization With Fluoroquinolone-Resistant Escherichia coli in Residents of Long-Term Care Facilities

Abstract: Acquisition of FQ-resistant E. coli was common, with nearly half of LTCF residents developing new FQ-resistant E. coli colonization. Further studies are needed on interventions to limit the emergence of FQ-resistant E. coli in LTCFs.

Cited by 17 publications

References 23 publications

Infectious Diseases, Immunizations and Universal Precautions

Infectious Diseases, Immunizations and Universal Precautions

Examining the relationship between multidrug-resistant organism acquisition and exposure to antimicrobials in long-term care populations: a review

Long-Term Carriage of Ciprofloxacin-Resistant Escherichia coli Isolates in High-Risk Nursing Home Residents

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