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Multiply Antibiotic Resistant Gram-Negative Bacilli in a Long Term Care Facility A Case Control Study of Patient rick Factors and Prior Antibiotic Use

Published online by Cambridge University Press:  02 January 2015

Robert R Muder ,
Carole Brennen ,
Stephanie D. Drenning ,
Janet E. Stout  and
Marilyn M. Wagener
Robert R Muder*
Affiliation:
Veterans' Affairs Medical Center University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Medicine University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Carole Brennen
Affiliation:
Veterans' Affairs Medical Center University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Stephanie D. Drenning
Affiliation:
Veterans' Affairs Medical Center University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Janet E. Stout
Affiliation:
Veterans' Affairs Medical Center University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Medicine University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
Marilyn M. Wagener
Affiliation:
Veterans' Affairs Medical Center University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania Department of Medicine University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
*
Infectious Disease Section, Veterans' Affairs Medical Center, University Dr C, Pittsburgk PA 15240
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Abstract

Objective:

To determine the relation between prior exposure to specific antimicrobials and acquisition of gram-negative bacilli resistant to multiple ß-lactam and aminoglycoside antibiotics among long-term-care patients.

Design:

Case-control study. Cases were patients from whom multiply resistant Enterobacteriaceae or Pseudomonas aeruginosa were isolated; controls were patients from whom nonresistant bacteria of the same species were isolated. Prospectively defined risk factors included underlying illness, activity level, presence of decu-bitus ulcers, presence of indwelling devices, and prior exposure to specific antimicrobial agents. Resistant and control isolates of P aeruginosa were compared using pulsed-field gel electrophoresis (PFGE) of genomic DNA after digestion with XbaI.

Setting:

390-bed long-term Veterans' Affairs facility.

Results:

We identified 35 patients with multiply resistant Enterobacteriaceae and 24 patients with multiply resistant P aeruginosa. Of the resistant Enterobacteriaceae, 87% of isolates were resistant to piperacillin, 55% to ceftazidime, and 90% to gentamicin. Acquisition of multiply resistant Enterobacteriaceae was associated with presence of decubitus ulcers (odds ratio [OR], 12.2; 95% confidence interval [CI95], 3.3-44.2; P=.0002) and prior receipt of ampicillm (OR, 13.7; CI95, 2.2-84; P=.005). Of resistant isolates of P aeruginosa, 88% were resistant to piperacillin, 25% to ceftazidime, 42% to imipenem, and 67% to ciprofloxacin. Isolation of a multiply resistant P aeruginosa was associated with total days of antimicrobial exposure (OR, 1.07; CI95, 1.01-1.12; P=.011) and not with prior receipt of any individual agent. Eleven multiply resistant isolates shared a common PFGE pattern.

Conclusions:

In our long-term-care facility, acquisition of multiply resistant Enterobacteriaceae was associated with the presence of decubitus ulcers and prior exposure to ampicillin. Acquisition of resistant P aeruginosa was associated with total antibiotic exposure. Molecular typing of P aeruginosa isolates implicated patient-to-patient transmission of a limited number of resistant strains.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 18 , Issue 12 , December 1997 , pp. 809 - 813
Copyright
Copyright © The Society for Healthcare Epidemiology of America 1997

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References

1. Strausbaugh, LJ, Crossley, KB, Nurse, BA, Thrupp, LD. Antimicrobial resistance in long-termcare facilities. Infect Control Hosp Epidemiol 1996;17:129–140.CrossRefGoogle Scholar
2. Muder, RR, Brennen, C, Wagener, MM, Goetz, AM. Bacteremia in a long-term care facility: a five year prospective study of 163 consecutive episodes. Clin Infect Dis 1992;14:647–654.CrossRefGoogle Scholar
3. Sanders, CC, Sanders, WE. ß-Lactam resistance in gram-negative bacteria: global trends and clinical impact. Clin Infect Dis 1992;15:824–839.CrossRefGoogle Scholar
4. Chow, JW, Fine, MJ, Shlaes, DM, et al. Enterobacter bacteremia: clinical features and emergence of antibiotic resistance during therapy. Ann Intern Med 1991;115:585–590.CrossRefGoogle ScholarPubMed
5. Mermel, LA, Josephson, SL, Giorgio, C. A pseudo-epidemic involving bone allografts. Infect Control Hosp Epidemiol 1994;15:757–758.CrossRefGoogle ScholarPubMed
6. Hla, SW, Kok, PH, Wan, CT, Bow, HO. Genomic macrorestriction analysis of sequential Pseudomonas aeruginosa isolates from bronchiectasis patients without cystic fibrosis. J Clin Microbiol 1996;34:575–578.CrossRefGoogle ScholarPubMed
7. Bjork, DT, Pelletier, LL, Tight, RR. Urinary tract infections with antibiotic resistant organisms in catheterized nursing home patients. Infect Control- 1984;5:173–186.CrossRefGoogle ScholarPubMed
8. John, JF, Ribner, BS. Antibiotic resistance in long-termcare facilities. Infect Control Hosp Epidemiol 1991;12:245–250.CrossRefGoogle Scholar
9. Fluomoy, DJ. Antimicrobial susceptibilities of bacteria from nursing home residents in Oklahoma. Gerontology 1994;40:53–56.Google Scholar
10. Rice, LB, Willey, SH, Papanicolau, GA, et al. Outbreak of cef-tazidime resistance caused by extended-spectrum ß-lacta-mases at a Massachusetts chronic-care facility. Antimicrob Agents Chemother 1990;34:2193–2199.CrossRefGoogle Scholar
11. MacArthur, RD, Lehman, MH, McCurrie-McCumber, CA, et al. The epidemiology of gentamicin-resistant Pseudomonas aerugi-nosa on an intermediate care unit. Am J Epidemiol 1988;128:821–827.CrossRefGoogle Scholar
12. Wingard, E, Shlaes, JH, Mortimer, EA, Shlaes, DM. Colonization and cross-colonization of nursing home patients with trimetho-prim-resistant bacilli. Clin Infect Dis 1993;16:75–81.CrossRefGoogle ScholarPubMed
13. Gaynes, RP, Weinstein, RA, Chamberlin, W, Kabins, SA. Antibiotic-resistant flora in nursing home patients admitted to the hospital. Arch Intern Med 1985;145:1804–1807.CrossRefGoogle ScholarPubMed
14. Terpenning, MS, Bradley, SF, Wan, JY, Chenoweth, CE, Jorgensen, KA, Kauffman, CA Colonization and infection with antibiotic-resistant bacteria in a long-term-care facility. J Am Geriatr Soc 1994;42:1062–1069.CrossRefGoogle Scholar
15. Shlaes, DM, Lehman, MH, Currie-McCumber, CA, Rotter, G, Floyd, R Prevalence of colonization with antibiotic-resistant gram-negative bacilli in a nursing-home care unit: the importance of cross-colonization as documented by plasmid analysis. Infect Control 1986;7:538–545.CrossRefGoogle Scholar
16. Muder, RR, Brennen, C, Goetz, AM, Wagener, MM, Rihs, JD. Association with prior fluoroquinolone therapy of widespread ciprofloxacin resistance among gram-negative isolates in a Veterans' Affairs Medical Center. Antimicrob Agents Chemother 1991;35:256–258.CrossRefGoogle Scholar
17. Jones, SR, Parker, DE Leibow, ES, Kimbrough, RC, Frear, RS. Appropriate use of antibiotic therapy in long-term care facilities. Am J Med 1987;83:499–502.CrossRefGoogle ScholarPubMed
18. Katz, PR, Beam, TR, Brand, F, Boyce, K. Antibiotic use in the nursing home. Arch Intern Med 1990;150:1465–1468.CrossRefGoogle ScholarPubMed
19. Warren, JH, Palumbo, FB, Fitterman, L, Speedie, SM. Incidence and characteristics of antibiotic use in aged nursing home patients. J Am Geriatr Soc 1991;39:963–972.CrossRefGoogle ScholarPubMed
20. Yee, YC, Muder, RR, Hseih, MH, Lee, TC. Molecular epidemiology of endemic ciprofloxacin susceptible and resistant Enterobacteriaceae . Infect Control Hosp Epidemiol 1992; 13:706–710.CrossRefGoogle ScholarPubMed
21. Phillipon, A, Labia, R, Jacoby, G. Extended-spectrum ß-lacta-mases. Antimicrob Agents Chemother 1989;33:1131–1136.CrossRefGoogle Scholar
22. Jacoby, GA, Madeiros, A. More extended-spectrum ß-lacta-mases. Antimicrob Agents Chemother 1991;1697–1704.Google Scholar
23. Jacoby, GA, Sutton, L. Properties of plasmids responsible for production of extended-spectrum ß-lactamases. Antimicrob Agents Chemother 1991;35:164–169.CrossRefGoogle Scholar
24. Shaugnessy, PW, Kramer, AM. The increased needs of patients in nursing homes and patients receiving home health care. N Engl J Med 1990;322:21.CrossRefGoogle Scholar
25. Price, LE, Sarubbi, FA, Rutala, WA. Infection control programs in twelve North Carolina extended care facilities. Infect Control 1985;6:437–441.CrossRefGoogle ScholarPubMed
26. Crossley, KB. Irvine, R Kaszar, DJ, Loewenson, RB. Infection control practices in Minnesota nursing homes. JAMA 1985;254:2918–2921.CrossRefGoogle ScholarPubMed