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Longitudinal Trends in Antimicrobial Susceptibilities Across Long-Term–Care Facilities: Emergence of Fluoroquinolone Resistance

Published online by Cambridge University Press:  21 June 2016

Melissa Viray ,
Darren Linkin ,
Joel N. Maslow ,
Donald D. Stieritz ,
Lesley S. Carson ,
Warren B. Bilker  and
Ebbing Lautenbach
Melissa Viray
Affiliation:
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Darren Linkin
Affiliation:
Center for Clinical Epidemiology and Biostatistics and the Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Joel N. Maslow
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Veterans Affairs Medical Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Donald D. Stieritz
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Lesley S. Carson
Affiliation:
Division of Geriatrics, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
Center for Clinical Epidemiology and Biostatistics and the Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Ebbing Lautenbach*
Affiliation:
Center for Clinical Epidemiology and Biostatistics and the Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
*
University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, 825 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021elautenb@cceb.med.upenn.edu
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Abstract

Background

Antibiotic resistance in the long-term-care facility (LTCF) setting is of increasing concern due to both the increased morbidity and mortality related to infections in this debilitated population and the potential for transfer of resistant organisms to other healthcare settings. Longitudinal trends in antibiotic resistance in LTCFs have not been well described.

Design:

Correlational longitudinal survey study.

Setting:

Four LTCFs in Pennsylvania.

Subjects:

All clinical cultures of residents of the participating LTCFs (700 total beds) from 1998 through 2003. We assessed the annual prevalence of resistance to various antimicrobials of interest for the following organisms: Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, and enterococcus species.

Results:

A total of 4,954 clinical isolates were obtained during the study. A high prevalence of antimicrobial resistance was noted for many organism-drug combinations. This was especially true for fluoroquinolone susceptibility among the Enterobacteriaceae (susceptibility range, 51.3% to 92.2%). In addition, the prevalence of resistance to various agents differed significantly across study sites. Finally, significant increasing trends in resistance were noted over time and were most pronounced for fluoroquinolone susceptibility among the Enterobacteriaceae.

Conclusions:

The prevalence of antimicrobial resistance has increased significantly in LTCFs, although trends have varied substantially across different institutions. These trends have been particularly pronounced for fluoroquinolone resistance among the Enterobacteriaceae. These findings demonstrate that antimicrobial resistance is widespread and increasing in LTCFs, highlighting the need for future studies to more clearly elucidate the risk factors for, and potential interventions against, emerging resistance in these settings.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 1 , January 2005 , pp. 56 - 62
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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References

1.Wiener, J, Quinn, JP, Bradford, PA, et al.Multiple antibiotic-resistant Klebsiella and Escherichia coli in nursing homes. JAMA 1999;281:517–523.CrossRefGoogle ScholarPubMed
2.Lautenbach, E, Strom, BL, Bilker, WB, Patel, JB, Edelstein, PH, Fishman, NO. Epidemiological investigation of fluoroquinolone resistance in infections due to extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae. Clin Infect Dis 2001;33:1288–1294.CrossRefGoogle ScholarPubMed
3.Lautenbach, E, Patel, JB, Bilker, WB, Edelstein, PH, Fishman, NO. Extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae: risk factors for infection and impact of resistance on outcomes. Clin Infect Dis 2001;32:1162–1171.CrossRefGoogle ScholarPubMed
4.Strausbaugh, LJ, Joseph, CL. The burden of infection in long-term care. Infect Control Hosp Epidemiol 2000;21:674–679.CrossRefGoogle ScholarPubMed
5.Lee, YL, Cesario, T, McCauley, V, Flionis, L, Pax, A, Thrupp, L. Low-level colonization and infection with ciprofloxacin-resistant gram-negative bacilli in a skilled nursing facility. Am J Infect Control 1998;26:552–557.CrossRefGoogle Scholar
6.Bonomo, RA. Multiple antibiotic-resistant bacteria in in long-term–care facilities: an emerging problem in the practice of infectious diseases. Clin Infect Dis 2000;31:1414–1422.CrossRefGoogle ScholarPubMed
7.Smith, PW, Rusnak, PG. Infection prevention and control in the in long-term–care facility. Infect Control Hosp Epidemiol 1997;18:831–849.CrossRefGoogle ScholarPubMed
8.Gavazzi, G, Krause, KH. Ageing and infection. Lancet Infect Dis 2002;2:659–666.CrossRefGoogle ScholarPubMed
9.Yoshikawa, TT. Antimicrobial resistance and aging: beginning of the end of the antibiotic era? J Am Geriatr Soc 2002;50(suppl):S226–S229.CrossRefGoogle ScholarPubMed
10.Nicolle, LE. Preventing infections in non-hospital settings: long term care. Emerg Infect Dis 2001;7:205–208.CrossRefGoogle ScholarPubMed
11.Strausbaugh, LJ, Crossley, KB, Nurse, BA, Thrupp, LD, SHEA In Long-Term–Care Committee. Antimicrobial resistance in in long-term–care facilities. Infect Control Hosp Epidemiol 1996;17:129–140.CrossRefGoogle ScholarPubMed
12.Loeb, M, Moss, L, Stiller, A, et al.Colonization with multiresistant bacteria and quality of life in residents of in long-term–care facilities. Infect Control Hosp Epidemiol 2001;22:67–68. Letter.CrossRefGoogle ScholarPubMed
13.Lee, YL, Cesario, T, Tran, C, Stone, G, Thrupp, L. Nasal colonization by methicillin-resistant coagulase-negative Staphylococcus in community skilled nursing facility patients. Am J Infect Control 2000;28:269–272.CrossRefGoogle ScholarPubMed
14.Terpenning, MS, Bradley, SF, Wan, JY, Chenoweth, CE, Jorgensen, KA, Kauffman, CA. Colonization and infection with antibiotic-resistant bacteria in a in long-term–care facility. J Am Geriatr Soc 1994;42:1062–1069.CrossRefGoogle Scholar
15.Friedmann, R, Hamburger, R, Shulman, C, Yinnon, AM, Raveh, D. Antimicrobial susceptibilities of urinary pathogens in a multidiscipli-nary long-term care facility. Diagn Microbiol Infect Dis 2003;46:217–222.CrossRefGoogle Scholar
16.Vromen, M, van der Ven, AJAM, Knols, A, Stobberingh, EE. Antimicrobial resistance patterns in urinary isolates from nursing home residents: fifteen years of data reviewed. J Antimicrob Chemother 1999;44:113–116.CrossRefGoogle ScholarPubMed
17.Spindel, SJ, Strausbaugh, LJ, Jacobson, C. Infections caused by Staphylococcus aureus in a Veterans' Affairs nursing home care unit: a 5-year experience. Infect Control Hosp Epidemiol 1995;16:217–223.CrossRefGoogle Scholar
18.National Committee for Clinical Laboratory Standards. Performance Standards for Antimicrobial Susceptibility Testing. Wayne, PA: National Committee for Clinical Laboratory Standards; 2001. Approved standard M100-S11.Google Scholar
19.Kleinbaum, DG, Kupper, LL, Morgenstern, H. Epidemiologie Research: Principles and Quantitative Methods. New York: Van Nostrand Reinhold; 1982.Google Scholar
20.Armitage, P. Test for linear trend in proportions and frequencies. Biometrics 1955;11:375–386.CrossRefGoogle Scholar
21.Flournoy, DJ, Johnson, S, Welch, D. Comparison of antimicrobial susceptibilities among hospitalized and nursing home patients from Oklahoma. J Okla State Med Assoc 1991;84:563–565.Google ScholarPubMed
22.Flournoy, DJ. Antimicrobial susceptibilities of bacteria from nursing home residents in Oklahoma. Gerontology 1994;40:53–56.CrossRefGoogle ScholarPubMed
23.Smith, PW, Selp, CW, Schaefer, SC, Bell-Dixon, C. Microbiologic survey of long-term care facilities. Am J Infect Control 2000;28:8–13.CrossRefGoogle ScholarPubMed
24.Scheid, WM. Maintaining fluoroquinolone class efficacy: review of influencing factors. Emerg Infect Dis 2003;9:1–9.Google Scholar
25.Lautenbach, E, Fishman, NO, Bilker, WB, et al.Risk factors for fluoroquinolone resistance in nosocomial Escherichia coli and Klebsiella pneumoniae infections. Arch Intern Med 2002;162:2469–2477.CrossRefGoogle ScholarPubMed
26.Loeb, M. Antibiotic use in in long-term–care facilities: many unanswered questions. Infect Control Hosp Epidemiol 2000;21:680–683.CrossRefGoogle ScholarPubMed
27.Hooper, DC. New uses for new and old quinolones and the challenge of resistance. Clin Infect Dis 2000;30:243–254.CrossRefGoogle ScholarPubMed
28.Masters, PA, O'Bryan, TA, Zurlo, J, Miller, DQ, Joshi, N. Trimethoprim-sulfamethoxazole revisited. Arch Intern Med 2003;163:402–410.CrossRefGoogle ScholarPubMed
29.Bishara, J, Pitlik, S, Samra, Z, Levy, I, Paul, M, Leibovici, L. Co-trimoxa-zole-sensitive, methicillin-resistant Staphylococcus aureus, Israel, 1988-1997. Emerg Infect Dis 2003;9:1168–1169.CrossRefGoogle ScholarPubMed
30.Rice, LB, Eckstein, EC, DeVente, J, Shlaes, DM. Ceftazidime-resistant Klebsiella pneumoniae isolates recovered at the Cleveland Department of Veterans Affairs Medical Center. Clin Infect Dis 1996;23:118–124.CrossRefGoogle ScholarPubMed
31.Rice, LB, Willey, SH, Papanicolaou, GA, et al.Outbreak of ceftazidime resistance caused by extended-spectrum beta-lactamases at a Massachusetts chronic-care facility. Antimicrob Agents Chemother 1990;34:2193–2199.CrossRefGoogle Scholar
32.Mylotte, JM, Tayara, A, Goodnough, S. Epidemiology of bloodstream infection in nursing home residents: evaluation in a large cohort from multiple homes. Clin Infect Dis 2002;35:1484–1490.CrossRefGoogle Scholar
33.Garrouste-Orgeas, M, Chevret, S, Arlet, G, et al.Oropharyngeal or gastric colonization and nosocomial pneumonia in adult intensive care unit patients: a prospective study based on genomic DNA analysis. Am J Respir Crit Care Med 1997;156:1647–1655.CrossRefGoogle ScholarPubMed
34.Edmond, MB, Ober, JF, Weinbaum, DL, et al.Vancomycin-resistant Enterococcus faecium bacteremia: risk factors for infection. Clin Infect Dis 1995;20:1126–1133.CrossRefGoogle ScholarPubMed
35.Horvat, RT, Klutman, NE, Lacy, MK, Grauer, D, Wilson, M. Effect of duplicate isolates of methicillin-susceptible and methicillin-resistant Staphylococcus aureus on antibiogram data. J Clin Microbiol 2003;41:4611–4616.CrossRefGoogle ScholarPubMed