VRE, MRSA, PRP, and DRGNB in LTCF: Lessons To Be Learned from This Alphabet

Abstract

n this issue ofJAGS, Brennen and colleagues provide one of I the first published series of cases of vancomycin-resistant enterococcus/enterococci (VRE) isolated from residents in a long-term care facility (LTCF).'.' However, VRE has been a well-described clinical problem in the setting of nosocomial infection^."^ Bacteremia caused by VRE is associated with a high mortality rate.' Moreover, patients who have VRE bacteremia appear to have a poorer prognosis than patients with blood stream infections with vancomycin-sensitive enterococci.6 In large part, this poor clinical outcome with VRE infections is a result of the unavailability of effective antibiotics against the organism and the severe clinical condition of the patient. Risk factors for VRE infection include severe underlying illness, immunosuppression, advanced age, requirement of intensive care unit treatment, prolonged hospitalization, surgical interventions, and previous exposure to antibiotics, especially vancomycin, third-generation cephalosporins, and antianaerobic Interestingly, in a recent report of 89 nonhospitalized patients infected with human immunodeficiency virus (HIV) who were receiving longterm antibiotic therapybut only one patient each receiving a cephalosporin or antianaerobic agentthere were no cases of rectal colonization with VRE."Enterococci were previously classified as streptococci of the Lancefield group D. There are two major pathogenic

Antimicrobial Resistance and Aging: Beginning of the End of the Antibiotic Era?

“…The most frequently isolated resistant pathogens in the older population have been penicillin‐resistant Streptococcus pneumoniae (PRSP), methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant enterococci (VRE), and multiple‐drug‐resistant gram‐negative bacilli (MDRGNB) 21 . In a recent study of a skilled‐care facility, 43% of 117 study participants were colonized with one or more resistant pathogens, which included MRSA (24% of participants), resistant gram‐negative bacilli (33%), and VRE (3.5%) 22 …”

“…A variety of gram‐negative bacilli resistant to many antibiotics have been reported, especially in older patients being treated for UTI in LTCFs 21 . Some common mechanisms of resistance include extended‐spectrum beta‐lactamases, which render many antibiotics inactive, including ceftazidime, inhibitor‐resistant beta‐lactamases (beta‐lactamases produced by bacteria that are resistant to beta‐lactamase inhibitors), and enzymatic inactivation of aminoglycosides (acetylation, phosphorylation, nucleotidylation) 20 .…”

Asymptomatic bacteriuria, antibiotic use, and suspected urinary tract infections in four nursing homes

“…Moreover, such treatments are potentially harmful. Antibiotic use in nursing homes is a strong driver for the emergence of multi-drug resistant organisms (MDROs) such as methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococci (VRE), and fluoroquinolone-resistant gram negative bacilli [15-21]. In addition, in an investigation in two Rhode Island nursing homes, residents with ASB who were treated with an antibiotic were 8.5 times more likely to develop Clostridium difficile within the three months following their course of antibiotics [22].…”

Antibiotics and resistance in dermatology: focus on treating the elderly

“…Penicillins have been the mainstay of treatment; vancomycin is used in individuals with penicillin allergy or infections with penicillin resistance. Like S. aureus , transmission of vancomycin‐resistant enterococcus from patient to patient has been described in hospitals and long‐term care facilities (10,11). Excellent wound management (debridement and irrigation) is the best therapy when enterococcus is present (12).…”