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Azzini AM, Be G, Naso L, Lambertenghi L, Salerno ND, Coledan I, Bazaj A, Mirandola M, Miotti J, Mazzaferri F, Accordini S, Lo Cascio G, Tacconelli E. Risk factors for colonization with multidrug-resistant Gram-negative bacteria and Clostridioides difficile in Long Term Care Facilities (LTCFs) residents: the evidence from 27 facilities in a high endemic setting. Front Cell Infect Microbiol 2023; 13:1155320. [PMID: 37377644 PMCID: PMC10292821 DOI: 10.3389/fcimb.2023.1155320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/19/2023] [Indexed: 06/29/2023] Open
Abstract
Introduction Residency in LTCFs increases the likelihood of colonization with multidrug resistant Gram-negative bacteria (MDR-GNB). We assessed the prevalence and risk factors for enteric colonization by III-generation cephalosporins-resistant and carbapenem-resistant (CR) GNB in a large group of LTCFs in a high endemic setting. We also assessed the prevalence and risk factors for C. difficile colonization. Methods A point prevalence survey with rectal screening (RS) was conducted in 27 LTCFs in north Italy. Epidemiological and clinical variables on the survey day, history of hospitalization and surgery within one year, and antibiotics within three months, were collected. The presence of III-generation cephalosporin resistant and CR GNB was assessed using a selective culture on chromogenic medium and PCR for carbapenemase detection. The presence of C. difficile was assessed using ELISA for GDH and RT-PCR to identify toxigenic strains. Multi-variable analyses were performed using two-level logistic regression models. Results In the study period 1947 RSs were performed. The prevalence of colonization by at least one GNB resistant to III-generation cephalosporin was 51% (E. coli 65%, K. pneumoniae 14% of isolates). The prevalence of colonization by CR GNB was 6%. 6% of all isolates (1150 strains) resulted in a carbapenem-resistant K. pneumoniae, and 3% in a carbapenem-resistant E. coli. KPC was the most frequent carbapenemase (73%) identified by PCR, followed by VIM (23%). The prevalence of colonization by C. difficile was 11.7%. The presence of a medical device (OR 2.67) and previous antibiotic use (OR 1.48) were significantly associated with III-generation cephalosporin resistant GNB colonization. The presence of a medical device (OR 2.67) and previous hospitalization (OR 1.80) were significantly associated with CR GNB. The presence of a medical device (OR 2.30) was significantly associated with C. difficile colonization. Main previously used antibiotic classes were fluoroquinolones (32% of previously treated subjects), III-generation cephalosporins (21%), and penicillins (19%). Conclusion Antimicrobial stewardship in LTCFs is a critical issue, being previous antibiotic treatment a risk factor for colonization by MDR-GNB. The prevalence of colonization by III-generation cephalosporin and CR GNB among LTCF residents also underlines the importance to adhere to hand hygiene indications, infection prevention and control measures, and environmental hygiene protocols, more achievable than rigorous contact precautions in this type of social setting.
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Affiliation(s)
- Anna Maria Azzini
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giorgia Be
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- Infectious Disease Unit, Mater Salutis Hospital - ULSS 9 Scaligera, Legnago, Italy
| | - Laura Naso
- Microbiology and Virology Unit, AOUI Verona, Verona, Italy
| | - Lorenza Lambertenghi
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Nicola Duccio Salerno
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Ilaria Coledan
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
- SerT Suzzara, SC Ser.D. Mantova, ASST Mantova, Suzzara, Italy
| | - Alda Bazaj
- Microbiology Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Massimo Mirandola
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Jessica Miotti
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Fulvia Mazzaferri
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Simone Accordini
- Unit of Epidemiology and Medical Statistics, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
| | - Giuliana Lo Cascio
- Microbiology and Virology Unit, AOUI Verona, Verona, Italy
- Microbiology Unit, AUSL Piacenza, Piacenza, Italy
| | - Evelina Tacconelli
- Infectious Diseases Division, Department of Diagnostics and Public Health, University of Verona, Verona, Italy
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Armbruster CE, Brauer AL, Humby MS, Shao J, Chakraborty S. Prospective assessment of catheter-associated bacteriuria clinical presentation, epidemiology, and colonization dynamics in nursing home residents. JCI Insight 2021; 6:e144775. [PMID: 34473649 PMCID: PMC8525589 DOI: 10.1172/jci.insight.144775] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 09/01/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Catheterization facilitates continuous bacteriuria, for which the clinical significance remains unclear. This study aimed to determine the clinical presentation, epidemiology, and dynamics of bacteriuria in a cohort of long-term catheterized nursing home residents. METHODS Prospective urine culture, urinalysis, chart review, and assessment of signs and symptoms of infection were performed weekly for 19 study participants over 7 months. All bacteria ≥ 1 × 103 cfu/mL were cultured, isolated, identified, and tested for susceptibility to select antimicrobials. RESULTS In total, 226 of the 234 urine samples were polymicrobial (97%), with an average of 4.7 isolates per weekly specimen. A total of 228 urine samples (97%) exhibited ≥ 1 × 106 CFU/mL, 220 (94%) exhibited abnormal urinalysis, 126 (54%) were associated with at least 1 possible sign or symptom of infection, and 82 (35%) would potentially meet a standardized definition of catheter-associated urinary tract infection (CAUTI), but only 3 had a caregiver diagnosis of CAUTI. Bacterial isolates (286; 30%) were resistant to a tested antimicrobial agent, and bacteriuria composition was remarkably stable despite a combined total of 54 catheter changes and 23 weeks of antimicrobial use. CONCLUSION Bacteriuria composition was largely polymicrobial, including persistent colonization by organisms previously considered to be urine culture contaminants. Neither antimicrobial use nor catheter changes sterilized the urine, at most resulting in transient reductions in bacterial burden followed by new acquisition of resistant isolates. Thus, this patient population exhibits a high prevalence of bacteriuria coupled with potential indicators of infection, necessitating further exploration to identify sensitive markers of true infection. FUNDING This work was supported by the NIH (R00 DK105205, R01 DK123158, UL1 TR001412).
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Affiliation(s)
- Chelsie E Armbruster
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, and
| | - Aimee L Brauer
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, and
| | - Monica S Humby
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, and
| | - Jiahui Shao
- Department of Biostatistics, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York, USA
| | - Saptarshi Chakraborty
- Department of Biostatistics, School of Public Health and Health Professions, State University of New York at Buffalo, Buffalo, New York, USA
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Gaston JR, Johnson AO, Bair KL, White AN, Armbruster CE. Polymicrobial interactions in the urinary tract: is the enemy of my enemy my friend? Infect Immun 2021; 89:IAI.00652-20. [PMID: 33431702 DOI: 10.1128/iai.00652-20] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
The vast majority of research pertaining to urinary tract infection has focused on a single pathogen in isolation, and predominantly Escherichia coli. However, polymicrobial urine colonization and infection are prevalent in several patient populations, including individuals with urinary catheters. The progression from asymptomatic colonization to symptomatic infection and severe disease is likely shaped by interactions between traditional pathogens as well as constituents of the normal urinary microbiota. Recent studies have begun to experimentally dissect the contribution of polymicrobial interactions to disease outcomes in the urinary tract, including their role in development of antimicrobial-resistant biofilm communities, modulating the innate immune response, tissue damage, and sepsis. This review aims to summarize the epidemiology of polymicrobial urine colonization, provide an overview of common urinary tract pathogens, and present key microbe-microbe and host-microbe interactions that influence infection progression, persistence, and severity.
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Affiliation(s)
- Jordan R Gaston
- Department of Medicine, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo
| | - Alexandra O Johnson
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo
| | - Kirsten L Bair
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo
| | - Ashley N White
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo
| | - Chelsie E Armbruster
- Department of Microbiology and Immunology, Jacobs School of Medicine and Biomedical Sciences, State University of New York at Buffalo
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Dybowski BA, Zapała P, Bres-Niewada E, Zapała Ł, Miązek-Zapała N, Poletajew S, Młynarczyk G, Radziszewski P. Catheter-associated bacterial flora in patients with benign prostatic hyperplasia: shift in antimicrobial susceptibility pattern. BMC Infect Dis 2018; 18:590. [PMID: 30458721 PMCID: PMC6247620 DOI: 10.1186/s12879-018-3507-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2018] [Accepted: 11/07/2018] [Indexed: 11/26/2022] Open
Abstract
Background Men with urinary retention secondary to benign prostatic hyperplasia (BPH) are prone to genitourinary infections. Physicians should be aware of the current antimicrobial susceptibility pattern in this population if empirical treatment is needed. The goal of this study was to evaluate variations in prevalence, composition and antimicrobial susceptibility of bacterial flora in men with indwelling catheters subjected to surgery for BPH in chosen time periods since 1994. Necessary changes in empirical therapy were also assessed. Methods All patients with indwelling catheters admitted to a single urological center for BPH surgery in the years 1994–1996, 2004–2006, and 2011–2015 were considered. Catheterization times and results of urine cultures from samples collected at admission were evaluated. Susceptibility for selected antimicrobials was compared separately for Gram negative and Gram positive species. For each agent and for their combinations effectiveness of empirical therapy was calculated dividing the number of patients with bacteriuria susceptible to the agents by the total number of patients with bacteriuria. Results Bacteriuria was present in 70% of 169, 72% of 132, and 69% of 156 men in the respective time periods. The incidence of Gram-positive strains increased from 10 to 37% (P < 0.001). Their susceptibility to amoxicillin/clavulanate was fluctuating (81, 61, 77%; P=NS). No vancomycin-resistant strain was present. Gram-negative flora composition was stable. Their susceptibility decreased to ciprofloxacin (70 to 53%; P = 0.01) and amoxicillin/clavulanate (56 to 37%; P < 0.01) while it increased to gentamycin (64 to 88%; P < 0.001) and co-trimoxazole (14 to 62%; P < 0.001); susceptibility to amikacin remained high (> 85%). Only two cases of resistance to carbapenems in 2004–2006 were found. In vitro effectiveness of amikacin + amoxicillin/clavulanate in empirical therapy was slowly decreasing (87 to 77%; P=NS). Imipenem was found the most effective single agent (90–95%) and its efficacy was even improved by adding vancomycin (97–98%). Conclusions Substantial rise in the incidence of Gram-positive species and fluctuations in antimicrobial susceptibility patterns were found. Empirical therapy of genitourinary infection in catheterized men with BPH should now involve antimicrobial agents effective both to Enterococci and Enterobacteriaceae. Periodic monitoring and publishing data on antimicrobial susceptibility for this population is necessary.
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Affiliation(s)
- Bartosz A Dybowski
- Department of Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Piotr Zapała
- Department of Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland.
| | - Ewa Bres-Niewada
- Department of Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Łukasz Zapała
- Department of Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Nina Miązek-Zapała
- Department of Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Sławomir Poletajew
- Department of Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
| | - Grażyna Młynarczyk
- Department of Medical Microbiology, Medical University of Warsaw, Chalubinskiego 5, 02-004, Warsaw, Poland
| | - Piotr Radziszewski
- Department of Urology, Medical University of Warsaw, Lindleya 4, 02-005, Warsaw, Poland
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Aschbacher R, Pagani E, Confalonieri M, Farina C, Fazii P, Luzzaro F, Montanera PG, Piazza A, Pagani L. Review on colonization of residents and staff in Italian long-term care facilities by multidrug-resistant bacteria compared with other European countries. Antimicrob Resist Infect Control 2016; 5:33. [PMID: 27766146 PMCID: PMC5057254 DOI: 10.1186/s13756-016-0136-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2016] [Accepted: 09/27/2016] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Rates of colonization and infection with multidrug-resistant (MDR) bacteria are increasing worldwide, in both acute care hospitals and long-term care facilities (LTCFs). Italy has one of the highest prevalence of MDR bacteria in European countries, especially with regard to methicillin-resistant Staphylococcus aureus (MRSA) and extended-spectrum β-lactamase (ESBL) or carbapenemase producing Enterobacteriaceae (CPE). METHOD Review of studies on colonization by MDR bacteria from Italian LTCFs, risk factors for colonization and molecular characteristics of surveillance and clinical isolates, compared with other European countries. RESULTS High variability of MDR colonization has been reported within and especially between European countries. Only a few surveillance studies have been performed in Italian LTCFs; these show MRSA colonization prevalence of 7.8-38.7 % for residents and 5.2-7.0 % for staff members, ESBL prevalence of 49.0-64.0 % for residents and 5.2-14.5 % for staff and prevalence of CPE of 1.0-6.3 % for residents and 0.0-1.5 % for staff. In Italian LTCFs, as well as in other European countries, the most prevalent ESBLs from surveillance or clinical Escherichia coli isolates were found to be CTX-M-type enzymes, particularly CTX-M-15, expressed by the pandemic ST131 clonal group; this lineage also expresses carbapenemase genes of the blaVIM and blaKPC types. Various risk factors for colonization of residents by MDR bacteria were identified. CONCLUSIONS The limited data from Italian LTCFs confirms these settings as important reservoirs for MDR organisms, allowing important considerations regarding the infection risk by these organisms. Nevertheless, more extended and countrywide screening studies for MDR colonization in Italian LTCFs are required. To promote further studies of various microbiological aspects related to LTCFs, the Association of Italian Clinical Microbiologists (Associazione Microbiologi Clinici Italiani; AMCLI) in 2016 has set up a new Working Group for the Study of Infections in LTCFs (Gruppo di Lavoro per lo Studio delle Infezioni nelle Residenze Sanitarie Assistite e Strutture Territoriali assimilabili; GLISTer), consisting of Clinical Microbiologists represented by the authors of this review article.
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Affiliation(s)
- Richard Aschbacher
- Laboratorio Aziendale di Microbiologia e Virologia, Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | - Elisabetta Pagani
- Laboratorio Aziendale di Microbiologia e Virologia, Comprensorio Sanitario di Bolzano, Bolzano, Italy
| | | | - Claudio Farina
- Azienda Socio-Sanitaria Territoriale Papa Giovanni XXIII, USC Microbiologia e Virologia, Bergamo, Italy
| | - Paolo Fazii
- P.O. Spirito Santo Laboratorio Analisi, Pescara, Italy
| | - Francesco Luzzaro
- Ospedale A. Manzoni, Laboratorio Microbiologia e Virologia, Lecco, Italy
| | | | - Aurora Piazza
- Dipartimento SCCDP, Unità di Microbiologia e Microbiologia clinica, Pavia, Italy
| | - Laura Pagani
- Dipartimento SCCDP, Unità di Microbiologia e Microbiologia clinica, Pavia, Italy
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Sampathkumar P, Barth JW, Johnson M, Marosek N, Johnson M, Worden W, Lembke J, Twing H, Buechler T, Dhanorker S, Keigley D, Thompson R. Mayo Clinic Reduces Catheter-Associated Urinary Tract Infections Through a Bundled 6-C Approach. Jt Comm J Qual Patient Saf 2016; 42:254-61. [DOI: 10.1016/s1553-7250(16)42033-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Ismail MD, Luo T, McNamara S, Lansing B, Koo E, Mody L, Foxman B. Long-Term Carriage of Ciprofloxacin-Resistant Escherichia coli Isolates in High-Risk Nursing Home Residents. Infect Control Hosp Epidemiol 2016; 37:440-7. [PMID: 26782632 PMCID: PMC6194505 DOI: 10.1017/ice.2015.326] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
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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Affiliation(s)
- Miriam D. Ismail
- Center for Molecular and Clinical Epidemiology of Infectious Diseases, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Ting Luo
- Center for Molecular and Clinical Epidemiology of Infectious Diseases, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Sara McNamara
- Infection Prevention in Aging Research Group, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Bonnie Lansing
- Infection Prevention in Aging Research Group, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Evonne Koo
- Infection Prevention in Aging Research Group, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Lona Mody
- Infection Prevention in Aging Research Group, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, Michigan
| | - Betsy Foxman
- Center for Molecular and Clinical Epidemiology of Infectious Diseases, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
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Fagan M, Lindbæk M, Grude N, Reiso H, Romøren M, Skaare D, Berild D. Antibiotic resistance patterns of bacteria causing urinary tract infections in the elderly living in nursing homes versus the elderly living at home: an observational study. BMC Geriatr 2015; 15:98. [PMID: 26238248 PMCID: PMC4523906 DOI: 10.1186/s12877-015-0097-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Accepted: 07/23/2015] [Indexed: 01/02/2023] Open
Abstract
Background Antibiotic resistance is a problem in nursing homes. Presumed urinary tract infections (UTI) are the most common infection. This study examines urine culture results from elderly patients to see if specific guidelines based on gender or whether the patient resides in a nursing home (NH) are warranted. Methods This is a cross sectional observation study comparing urine cultures from NH patients with urine cultures from patients in the same age group living in the community. Results There were 232 positive urine cultures in the NH group and 3554 in the community group. Escherichia coli was isolated in 145 urines in the NH group (64 %) and 2275 (64 %) in the community group. There were no clinically significant differences in resistance. Combined, there were 3016 positive urine cultures from females and 770 from males. Escherichia coli was significantly more common in females 2120 (70 %) than in males 303 (39 %)(p < 0.05). Enterococcus faecalis was significantly less common in females 223(7 %) than males 137 (18 %) (p < 0.05). For females, there were lower resistance rates to ciprofloxacin among Escherichia coli (7 % vs 12 %; p < 0.05) and to mecillinam among Proteus mirabilis (3 % vs 12 %; p < 0.05). Conclusions Differences in resistance rates for patients in the nursing home do not warrant separate recommendations for empiric antibiotic therapy, but recommendations based on gender seem warranted.
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Affiliation(s)
- Mark Fagan
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130, Blindern, 0318, , Oslo, Norway.
| | - Morten Lindbæk
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130, Blindern, 0318, , Oslo, Norway. .,Antibiotic Centre for Primary Care, University of Oslo, Postboks 1130, Blindern, 0318, , Oslo, Norway.
| | - Nils Grude
- Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Postboks 2168, 3103, Tønsberg, Norway.
| | - Harald Reiso
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130, Blindern, 0318, , Oslo, Norway.
| | - Maria Romøren
- Institute of Health and Society, Faculty of Medicine, University of Oslo, Postboks 1130, Blindern, 0318, , Oslo, Norway.
| | - Dagfinn Skaare
- Department of Microbiology, Vestfold Hospital Trust, Tønsberg, Postboks 2168, 3103, Tønsberg, Norway.
| | - Dag Berild
- Department of Infectious Disease, Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, PO Box 4950, Nydalen, 0424, , Oslo, Norway.
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Abstract
From 5-10% of elderly residents of long-term care facilities require chronic indwelling catheters for management of urine voiding. These residents are always bacteriuric, because of biofilm formation along the catheter, and experience increased morbidity associated with urinary tract infection. A wide variety of bacteria or yeast species are isolated. Occasional episodes of symptomatic infection may be accompanied by localizing genitourinary findings. However, when fever is present and there are no localizing findings, symptomatic infection is a diagnosis of exclusion. Many of these episodes are not from a urinary source, so critical clinical evaluation is always necessary. A urine specimen for culture should be obtained from patients with symptomatic infection prior to institution of antimicrobial therapy. When the catheter has been present for 2 weeks or longer, it should be replaced and the urine specimen collected through the new catheter. This provides a specimen of bladder urine without biofilm contamination, and catheter replacement also improves clinical outcomes. Treatment algorithms with a goal of limiting inappropriate treatment of asymptomatic bacteriuria have been developed. Empiric antimicrobial therapy should be avoided when possible. Guidelines for prevention of catheter-acquired urinary infection should be followed. The most important of these is to avoid use of a urinary catheter whenever possible and, when there is no longer an indication for the catheter, to remove it promptly.
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Sundvall PD, Elm M, Gunnarsson R, Mölstad S, Rodhe N, Jonsson L, Ulleryd P. Antimicrobial resistance in urinary pathogens among Swedish nursing home residents remains low: a cross-sectional study comparing antimicrobial resistance from 2003 to 2012. BMC Geriatr 2014; 14:30. [PMID: 24625344 PMCID: PMC3975149 DOI: 10.1186/1471-2318-14-30] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/06/2014] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND There are several risk factors for the colonisation, infection and spreading of antibiotic resistant bacteria among elderly residents of nursing homes. An updated estimate of the native prevalence of antimicrobial resistance in uropathogens among Swedish nursing home residents is needed. METHODS Urine specimens were collected for culture and antimicrobial susceptibility testing against mecillinam, ampicillin, cefadroxil, trimethoprim, nitrofurantoin and quinolones from the residents of 32 and 22 nursing homes, respectively. The residents were capable of providing a voided urine sample in 2003 and 2012. In 2012 urine specimens were also collected from residents with urinary catheters. Any antibiotic treatment during the previous month was registered in 2003 as well as hospitalisation and any antibiotic treatment during the previous six months in 2012. RESULTS The proportion of positive urine cultures was 32% (207/651) in voided urine specimens in 2003, 35% (147/421) in 2012, and 46% (27/59) in urine samples from catheters in 2012. Escherichia coli (E. coli) was the most commonly occurring bacteria.Resistance rates in E. coli (voided urine specimens) in 2012 were; ampicillin 21%, trimethoprim 12%, mecillinam 7.7%, ciprofloxacin 3.4%, cefadroxil 2.6% and nitrofurantoin 0.85%. There were no significant changes in the average resistance rates in E. coli for antibiotics tested 2003-2012.In 2012, two isolates of E. coli produced extended spectrum beta-lactamase enzymes (ESBL) and one with plasmid mediated AmpC production.Any antibiotic treatment during the previous month increased the risk for resistance in E. coli, adjusted for age and gender; for mecillinam with an odds ratio (OR) of 7.1 (2.4-21; p = 0.00049), ampicillin OR 5.2 (2.4-11; p = 0.000036), nalidixic acid OR 4.6 (1.4-16; p = 0.014) and trimethoprim OR 3.9 (1.6-9.2; p = 0.0023). Hospitalisation during the previous six months increased the risk for antibiotic resistance in E. coli to ampicillin, ciprofloxacin and any antimicrobial tested, adjusted for age, gender and antibiotic treatments during the previous six months. CONCLUSIONS The average rates of antimicrobial resistance were low and did not increase between 2003 and 2012 in E. coli urinary isolates among Swedish nursing home residents. Antibiotic treatment during the previous month and hospitalisation during the previous six months predicted higher resistance rates.
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Affiliation(s)
- Pär-Daniel Sundvall
- Research and Development Unit, Primary Health Care in Southern Älvsborg County, Sven Eriksonsplatsen 4, SE-503 38, Borås, Sweden
- Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Box 100, SE-405 30 Gothenburg, Sweden
- Sandared Primary Health Care Centre, Sandared, Sweden
| | - Marie Elm
- Health Care Unit, Borås Municipality, Våglängdsgatan 21 B, SE-507 41 Borås, Sweden
| | - Ronny Gunnarsson
- Research and Development Unit, Primary Health Care in Southern Älvsborg County, Sven Eriksonsplatsen 4, SE-503 38, Borås, Sweden
- Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Box 100, SE-405 30 Gothenburg, Sweden
- Cairns Clinical School, School of Medicine and Dentistry, James Cook University, Cairns Base Hospital, PO Box 902, Cairns, QLD 4870, Australia
| | - Sigvard Mölstad
- Department of Clinical Sciences, General Practice, Lund University, CRC, Hus 28, Plan 11, Jan Waldenströms gata 35, Malmö, SE-205 02, Sweden
| | - Nils Rodhe
- Centre for Clinical Research, Dalarna, Sweden and Falu Vårdcentral, Södra Mariegatan 18, SE-791 70 Falun, Sweden
- Department of Public Health and Caring Sciences, Family Medicine, Uppsala University, Uppsala, Sweden
| | - Lars Jonsson
- Bio Imaging and Laboratory Medicine Unit, Södra Älvsborg Hospital, SE-501 82 Borås, SE-501 82, Sweden
| | - Peter Ulleryd
- Department of Infectious Diseases, Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Sweden and Department of Communicable Disease Control, Västra Götalandsregionen, SE-501 82 Borås, Sweden
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Griebling TL. Detrusor Underactivity and Urinary Retention in Geriatric Patients: Evaluation, Management and Recent Research. CURRENT BLADDER DYSFUNCTION REPORTS 2013. [DOI: 10.1007/s11884-013-0183-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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