Hostname: page-component-cd9895bd7-gbm5v Total loading time: 0 Render date: 2024-12-22T22:18:43.978Z Has data issue: false hasContentIssue false
  • English
  • Français

Long-Term Carriage of Ciprofloxacin-Resistant Escherichia coli Isolates in High-Risk Nursing Home Residents

Published online by Cambridge University Press:  19 January 2016

Miriam D. Ismail ,
Ting Luo ,
Sara McNamara ,
Bonnie Lansing ,
Evonne Koo ,
Lona Mody  and
Betsy Foxman
Miriam D. Ismail
Affiliation:
Center for Molecular and Clinical Epidemiology of Infectious Diseases, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
Ting Luo
Affiliation:
Center for Molecular and Clinical Epidemiology of Infectious Diseases, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
Sara McNamara
Affiliation:
Infection Prevention in Aging Research Group, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Bonnie Lansing
Affiliation:
Infection Prevention in Aging Research Group, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Evonne Koo
Affiliation:
Infection Prevention in Aging Research Group, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Lona Mody
Affiliation:
Infection Prevention in Aging Research Group, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Betsy Foxman*
Affiliation:
Center for Molecular and Clinical Epidemiology of Infectious Diseases, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
*
Address correspondence to Betsy Foxman, PhD, Department of Epidemiology, University of Michigan, M5108 SPH II, 1415 Washington Heights, Ann Arbor, MI, 48109-2029 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

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.

Infect. Control Hosp. Epidemiol. 2016;37(4):440–447

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 4 , April 2016 , pp. 440 - 447
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Members of the Targeted Infection Prevention Study Team are listed at the end of the text.

References

REFERENCES

1. Lim, CJ, Cheng, AC, Kennon, J, et al. Prevalence of multidrug-resistant organisms and risk factors for carriage in long-term care facilities: a nested case-control study. J Antimicrob Chemother 2014;69:1972–1980.Google Scholar
2. van Buul, LW, van der Steen, JT, Veenhuizen, RB, et al. Antibiotic use and resistance in long term care facilities. J Am Med Dir Assoc 2012;13(568):e1–13.Google Scholar
3. O’Fallon, E, Pop-Vicas, A, D’Agata, E. The emerging threat of multidrug-resistant gram-negative organisms in long-term care facilities. J Gerontol A Biol Sci Med Sci 2009;64A:138–141.Google Scholar
4. LeDell, K, Muto, CA, Jarvis, WR, Farr, BM. SHEA guideline for preventing nosocomial transmission of multidrug-resistant strains of Staphylococcus aureus and Enterococcus . Infect Control Hosp Epidemiol 2003;24:639–641.Google Scholar
5. Smith, PW, Seip, CW, Schaefer, SC, Bell-Dixon, C. Microbiologic survey of long-term care facilities. Am J Infect Control 2000;28:8–13.Google Scholar
6. Daly, PB, Smith, PW, Rusnak, PG, Woods, GL. A microbiologic survey of long term care urinary catheters. Nebr Med J 1991;76:161–165.Google Scholar
7. Olofsson, M, Toepfer, M, Ostgren, CJ, et al. Low level of antimicrobial resistance in Escherichia coli among Swedish nursing home residents. Scand J Infect Dis 2013;45:117–123.Google Scholar
8. Jonsson, K, Claesson, BEB, Hedelin, H. Urine cultures from indwelling bladder catheters in nursing home patients: a point prevalence study in a Swedish county. Scand J Urol Nephrol 2011;45:265–269.Google Scholar
9. Mody, L, Maheshwari, S, Galecki, A, Kauffman, CA, Bradley, SF. Indwelling device use and antibiotic resistance in nursing homes: identifying a high-risk group. J Am Geriatr Soc 2007;55:1921–1926.Google Scholar
10. Fisch, J, Lansing, B, Wang, L, et al. New acquisition of antibiotic-resistant organisms in skilled nursing facilities. J Clin Microbiol 2012;50:1698–1703.Google Scholar
11. Han, JH, Maslow, J, Han, X, et al. Risk factors for the development of gastrointestinal colonization with fluoroquinolone-resistant Escherichia coli in residents of long-term care facilities. J Infect Dis 2014;209:420–425.Google Scholar
12. Dommeti, P, Wang, L, Flannery, EL, Symons, K, Mody, L. Patterns of ciprofloxacin-resistant gram-negative bacteria colonization in nursing home residents. Infect Control Hosp Epidemiol 2011;32:177–180.Google Scholar
13. Nicolas-Chanoine, M-H, Bertrand, X, Madec, J-Y. Escherichia coli ST131, an intriguing clonal group. Clin Microbiol Rev 2014;27:543–574.Google Scholar
14. Nicolas-Chanoine, M-H, Blanco, J, Leflon-Guibout, V, et al. Intercontinental emergence of Escherichia coli clone O25:H4-ST131 producing CTX-M-15. J Antimicrob Chemother 2008;61:273–281.Google Scholar
15. Coque, TM, Novais, A, Carattoli, A, et al. Dissemination of clonally related Escherichia coli strains expressing extended-spectrum beta-lactamase CTX-M-15. Emerg Infect Dis 2008;14:195–200.Google Scholar
16. van der Donk, CFM, Schols, JMGA, Driessen, CJ, Hagenouw, RGP, Meulendijks, A, Stobberingh, EE. Prevalence and spread of multidrug resistant Escherichia coli isolates among nursing home residents in the southern part of the Netherlands. J Am Med Dir Assoc 2013;14:199–203.Google Scholar
17. Burgess, MJ, Johnson, JR, Porter, SB, et al. Long-term care facilities are reservoirs for antimicrobial-resistant sequence type 131 Escherichia coli . Open Forum Infect Dis 2015;2:ofv011.Google Scholar
18. Mody, L, Krein, SL, Saint, SK, et al. A targeted infection prevention intervention in nursing home residents with indwelling devices: a randomized clinical trial [published erratum appears in JAMA Intern Med 2015;175:1247]. JAMA Intern Med 2015;175:714–723.Google Scholar
19. Harrington, C, Woolhandler, S, Mullan, J, Carrillo, H, Himmelstein, DU. Does investor ownership of nursing homes compromise the quality of care? Am J Public Health 2001;91:1452–1455.Google Scholar
20. Hillmer, MP, Wodchis, WP, Gill, SS, Anderson, GM, Rochon, PA. Nursing home profit status and quality of care: is there any evidence of an association? Med Care Res Rev 2005;62:139–166.Google Scholar
21. Mohapatra, BR, Mazumder, A. Comparative efficacy of five different rep-PCR methods to discriminate Escherichia coli populations in aquatic environments. Water Sci Technol J Int Assoc Water Pollut Res 2008;58:537–547.Google Scholar
22. Clermont, O, Dhanji, H, Upton, M, et al. Rapid detection of the O25b-ST131 clone of Escherichia coli encompassing the CTX-M-15-producing strains. J Antimicrob Chemother 2009;64:274–277.Google Scholar
23. Muder, RR, Brennen, C, Wagener, MM, et al. Methicillin-resistant staphylococcal colonization and infection in a long-term care facility. Ann Intern Med 1991;114:107–112.Google Scholar
24. Rothman, K. Epidemiology: An Introduction, 2nd ed. New York: Oxford University Press, 2012.Google Scholar
25. Hoogendoorn, M, Smalbrugge, M, Stobberingh, EE, van Rossum, SV, Vlaminckx, BJ, Thijsen, SF. Prevalence of antibiotic resistance of the commensal flora in Dutch nursing homes. J Am Med Dir Assoc 2013;14:336–339.Google Scholar
26. Hilty, M, Betsch, BY, Bögli-Stuber, K, et al. Transmission dynamics of extended-spectrum β-lactamase-producing Enterobacteriaceae in the tertiary care hospital and the household setting. Clin Infect Dis 2012;55:967–975.Google Scholar
27. Apisarnthanarak, A, Bailey, TC, Fraser, VJ. Duration of stool colonization in patients infected with extended-spectrum beta-lactamase-producing Escherichia coli and Klebsiella pneumoniae . Clin Infect Dis 2008;46:1322–1323.Google Scholar
28. Titelman, E, Hasan, CM, Iversen, A, et al. Faecal carriage of extended-spectrum β-lactamase-producing Enterobacteriaceae is common 12 months after infection and is related to strain factors. Clin Microbiol Infect Dis 2014;20:O508–O515.Google Scholar
29. Colpan, A, Johnston, B, Porter, S, et al. Escherichia coli sequence type 131 (ST131) subclone H30 as an emergent multidrug-resistant pathogen among US veterans. Clin Infect Dis 2013;57:1256–1265.Google Scholar