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Antibiotic-resistant pathogens associated with urinary tract infections in nursing homes: Summary of data reported to the National Healthcare Safety Network Long-Term Care Facility Component, 2013–2017

Published online by Cambridge University Press:  12 August 2020

Taniece R. Eure Open the ORCID record for Taniece R. Eure [Opens in a new window] ,
Nimalie D. Stone ,
Elisabeth A. Mungai ,
Jeneita M. Bell  and
Nicola D. Thompson
Taniece R. Eure*
Affiliation:
Division of Healthcare Quality and Promotion, Centers for Disease Control Prevention, Atlanta, GA, USA
Nimalie D. Stone
Affiliation:
Division of Healthcare Quality and Promotion, Centers for Disease Control Prevention, Atlanta, GA, USA
Elisabeth A. Mungai
Affiliation:
Division of Healthcare Quality and Promotion, Centers for Disease Control Prevention, Atlanta, GA, USA
Jeneita M. Bell
Affiliation:
Division of Healthcare Quality and Promotion, Centers for Disease Control Prevention, Atlanta, GA, USA
Nicola D. Thompson
Affiliation:
Division of Healthcare Quality and Promotion, Centers for Disease Control Prevention, Atlanta, GA, USA
*
Author for correspondence: Taniece R. Eure, E-mail: [email protected]
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Abstract

Objective:

Antibiotic resistance (AR) is a growing and highly prevalent problem in nursing homes. We describe selected AR phenotypes from pathogens causing urinary tract infections (UTIs) reported by nursing homes to the National Healthcare Safety Network (NHSN).

Design:

Pathogens and antibiotic susceptibility testing results for UTI events in nursing homes between January 2013 and December 2017 were analyzed. The pathogen distribution and pooled mean proportion of isolates that tested resistant to select antibiotic agents are reported.

Setting and Participants:

US nursing homes voluntarily participating in the Long-Term Care Facility component of the NHSN.

Results:

Overall, 243 nursing homes reported 1 or more UTIs: 121 (50%) were nonprofit facilities, median bed size was 91 (range: 9–801), and average occupancy was 87%. In total, 6,157 pathogens were reported for 5,485 UTI events. Moreover, 9 pathogens accounted for 90% of all reported UTIs; the 3 most frequently identified were Escherichia coli (41%), Proteus species (14%), and Klebsiella pneumoniae/oxytoca (13%). Among E. coli, fluoroquinolone, and extended-spectrum cephalosporin resistance were most prevalent (50% and 20%, respectively). Although Staphylococcus aureus and Enterococcus faecium represented <5% of pathogens reported, they had the highest rates of resistance (67% methicillin resistant and 60% vancomycin resistant, respectively). Multidrug resistance was most common in Pseudomonas aeruginosa (11%). For the resistant phenotypes we assessed, 36% of all UTIs reported were associated with a resistant pathogen.

Conclusions:

This is the first summary of AR among common pathogens causing UTIs reported to NHSN by nursing homes. Improved understanding of the resistance burden among common infections helps inform facility infection prevention and antibiotic stewardship efforts.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 42 , Issue 1 , January 2021 , pp. 31 - 36
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Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: Selected data included in this manuscript were presented in an oral abstract at IDWeek, October 7, 2017, in San Diego, California.

References

The core elements of antibiotic stewardship for nursing homes. Centers for Disease Control and Prevention website. http://www.cdc.gov/longtermcare/index.html Published 2015. Accessed May 6, 2019.Google Scholar
Antibiotic resistant threats in the United States, 2019. Centers for Disease Control and Prevention website. https://www.cdc.gov/drugresistance/pdf/threats-report/2019-ar-threats-report-508.pdf. Published 2019. Accessed July 21, 2020.Google Scholar
Genao, L, Buhr, G. T. Urinary tract infections in older adults residing in long-term care facilities. Ann Long-Term Care 2012;20:33–38.Google ScholarPubMed
Pulcini, C, Clerc-Urmes, I, Attinsounon, CA, Fougnot, S, Thilly, N. Antibiotic resistance of Enterobacteriaceae causing urinary tract infections in elderly patients living in the community and in the nursing home: a retrospective observational study. J Antimicrob Chemother 2019;74:775–781.CrossRefGoogle ScholarPubMed
Rosello, A, Hayward, AC, Hopkins, S, et al. Impact of long-term care facility residence on the antibiotic resistance of urinary tract Escherichia coli and Klebsiella . J Antimicrob Chemother 2017;72:1184–1192.Google ScholarPubMed
Lautenbach, E, Marsicano, R, Tolomeo, P, Heard, M, Serrano, S, Stieritz, DD. Epidemiology of antimicrobial resistance among gram-negative organisms recovered from patients in a multistate network of long-term care facilities. Infect Control Hosp Epidemiol 2009;30:790–793.CrossRefGoogle Scholar
Das, R, Perrelli, E, Towle, V, Van Ness, PH, Juthani-Mehta, M. Antimicrobial susceptibility of bacteria isolated from urine samples obtained from nursing home residents. Infect Control Hosp Epidemiol 2009;30:1116–1119.CrossRefGoogle ScholarPubMed
Weiner-Lastinger, LM, Abner, S, Edwards, JR, et al. Antimicrobial-resistant pathogens associated with adult healthcare-associated infections: summary of data reported to the National Healthcare Safety Network, 2015–2017. Infect Control Hosp Epidemiol 2020;41:1–18.CrossRefGoogle Scholar
Weiner, LM, Webb, AK, Limbago, B, et al. Antimicrobial-resistant pathogens associated with healthcare-associated infections: summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2011–2014. Infect Control Hosp Epidemiol 2016;37:1288–1301.CrossRefGoogle ScholarPubMed
Stone, ND, Ashraf, MS, Calder, J, et al. Surveillance definitions of infections in long-term care facilities: revisiting the McGeer criteria. Infect Control Hosp Epidemiol 2012;33:965–977.CrossRefGoogle ScholarPubMed
NSHN Long-term care facility component urinary tract infection. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/ltc/ltcf-uti-protocol-current.pdf. Updated January 2019. Accessed January 29, 2019.Google Scholar
Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial susceptibility testing: 24th informational supplement. Wayne, PA: CLSI; 2014:M100-S24.Google Scholar
Magiorakos, A-P, Srinivasan, A, Carey, RB, et al. Multidrug-resistance, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect 2012;18:268–281.CrossRefGoogle ScholarPubMed
Fagan, M, Lindbæk, M, Grude, N, et al. 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.CrossRefGoogle ScholarPubMed
De Vecchi, E, Sitia, S, Romanò, CL, Ricci, C, Mattina, R, Drago, L. Aetiology and antibiotic resistance patterns of urinary tract infections in the elderly: a 6-month study. J Med Microbiol 2013;62:859–863.CrossRefGoogle ScholarPubMed
Fridkin, SK, Pack, J, Licitra, G, et al. Creating reasonable antibiograms for antibiotic stewardship programs in nursing homes: Analysis of 260 facilities in a large geographic region, 2016–2017. Infect Control Hosp Epidemiol 2019;40:839–846.CrossRefGoogle Scholar
Tandan, M, Sloane, PD, Ward, K, et al. Antimicrobial resistance patterns of urine culture specimens from 27 nursing homes: impact of a two-year antimicrobial stewardship intervention. Infect Control Hosp Epidemiol 2019;40:780–786.CrossRefGoogle ScholarPubMed
Laupland, KB, Ross, T, Pitout, JD, Church, DL, Gregson, DB. Community-onset urinary tract infections: a population-based assessment. Infection 2007;35:150–153.CrossRefGoogle ScholarPubMed
Trautner, BW and Darouiche, RO. Role of biofilm in catheter-associated urinary tract infection. AM J Infect Control 2004;32:177–183.CrossRefGoogle ScholarPubMed
Kabbani, S, Hersh, AL, Shapiro, DJ, Fleming-Dutra, KE, Pavia, AT, Hicks, LA. Opportunities to improve fluroquinolone prescribing in the United States for adult ambulatory care visits. Clin Infect Dis 2018;67:134–136.CrossRefGoogle Scholar
Kabbani, S, Palms, D, Bartoces, M, Stone, N, Hicks, LA. Outpatient antibiotic prescribing for older adults in the United States: 2011 to 2014. J Am Geriat Soc 2018;66:1998–2002.CrossRefGoogle ScholarPubMed
Thompson, ND, Penna, A, Eure, TR, et al. Epidemiology of antibiotic use for urinary tract infection in nursing home residents. J Am Med Dir Assoc 2020;21:91–96.CrossRefGoogle ScholarPubMed
Reform of requirements for long-term care facilities: final rule (CMS-3260-P). Centers for Medicare & Medicaid Services website. https://www.federalregister.gov/documents/2016/10/04/2016-23503/medicare-and-medicaid-programs-reform-of-requirements-forlong-term-care-facilties. Published 2016. Accessed August 20, 2019.Google Scholar
Nace, DA, Fridkin, SK. Are antibiograms ready for prime time in the nursing home? J Am Med Dir Assoc 2020;21:8–11.CrossRefGoogle ScholarPubMed
The White House (US) national strategy for combating antibiotic-resistant bacteria. White House website. https://www.whitehouse.gov/sites/default/files/docs/carb_national_strategy.pdf. Published 2014. Accessed February 10, 2020.Google Scholar