Hostname: page-component-78c5997874-xbtfd Total loading time: 0 Render date: 2024-11-05T08:37:13.716Z Has data issue: false hasContentIssue false
  • English
  • Français

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
Get access Rights & Permissions [Opens in a new window]

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

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.)

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