scholarly journals ESBL Types and Plasmid Heterogeneity in Urinary E. coli Isolates: Results From a Nationwide Multicenter Study in Croatia

2020 ◽  
Vol 41 (S1) ◽  
pp. s63-s64
Author(s):  
Tomislav Mestrovic ◽  
Marija Krilanovic ◽  
Maja Tomic-Paradzik ◽  
Natasa Beader ◽  
Zoran Herljevic ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Long Term Care ◽  
Regional Distribution ◽  
Care Facility ◽  
Multidrug Resistant ◽  
Resistance Pattern ◽  
Term Care ◽  
E Coli ◽  
Group 1

Background: The prevalence of Escherichia coli strains producing extended-spectrum β-lactamases (ESBLs) has increased both in the community and in healthcare settings. Furthermore, recent studies in nursing homes and long-term care facilities have shown that these institutions can act as potential reservoirs of ESBL- and CTX-M–producing E. coli. Consequently, we aimed to characterize ESBLs produced by E. coli isolates causing hospital-onset, long-term care facility and community infections throughout Croatia (Europe), as well as to compare antimicrobial sensitivity patterns, molecular specificities, plasmid types and epidemiological features. Methods: From a total pool of 16,333 E. coli isolates, 164 ESBL-producing strains with reduced susceptibility to third-generation cephalosporins were used for further appraisal. Phenotypic tests for the detection of ESBLs and plasmid-mediated AmpC β-lactamases were initially pursued (including a novel version of modified CIM test named cephalosporin inactivation method), followed by conjugation experiments, molecular detection of resistance genes, plasmid extraction with PCR-based replicon typing, serotyping, genotyping with pulsed-field gel electrophoresis, and whole-genome sequencing (WGS). Results: The isolates in this study exhibited a high level of resistance to expanded-spectrum cephalosporins and carried CTX-M or TEM β-lactamases, and all of them were classified as multidrug-resistant due to their resistance pattern to other antimicrobial drugs. The β-lactamase content did not differ among isolated E. coli strains from various sources (ie, hospitals, nursing homes, and the community). According to the genotyping results, the isolates were allocated into 8 clusters, which contained subclusters. Serotyping results revealed that O25 antigen was the dominant one; furthermore, isolates subjected to WGS belonged to the ST131 sequence type. The most pervasive plasmid types in the isolates from the country’s capital (Zagreb) were IncFII and FIA, whereas FIA alone was a dominant plasmid type in the southern part of the country. Conversely, eastern parts were characterized by plasmids belonging to IncB/O and IncW groups. Conclusions: Our study demonstrated the dissemination of group 1 CTX-M–positive E. coli not only in different geographic regions of Croatia but also in different arms of the healthcare system (ie, hospitals, nursing homes, and the community). Our results also confirmed the switch from previously pervasive SHV-2 and SHV-5 ESBLs to the nationwide predominance of group 1 CTX-M β-lactamases; however, regional distribution was associated with different plasmid types carrying blaCTX-M genes. These types of nationwide studies are indispensable for informing global decision making that addresses the issue of antimicrobial resistance.Funding: NoneDisclosures: None

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

2020 ◽  
Vol 42 (1) ◽  
pp. 31-36
Author(s):  
Taniece R. Eure ◽  
Nimalie D. Stone ◽  
Elisabeth A. Mungai ◽  
Jeneita M. Bell ◽  
Nicola D. Thompson
Keyword(s):  
Urinary Tract ◽  
Nursing Homes ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Long Term Care Facility ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Tract Infections

AbstractObjective: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.

scholarly journals Prolonged colonisation with Escherichia coli O25:ST131 versus other extended-spectrum beta-lactamase-producing E. coli in a long-term care facility with high endemic level of rectal colonisation, the Netherlands, 2013 to 2014

2016 ◽  
Vol 21 (42) ◽  
Author(s):  
Ilse Overdevest ◽  
Manon Haverkate ◽  
Jacobien Veenemans ◽  
Yvonne Hendriks ◽  
Carlo Verhulst ◽  
...  
Keyword(s):  
Long Term Care ◽  
Care Facility ◽  
Beta Lactamase ◽  
Term Care ◽  
Extended Spectrum Beta Lactamase ◽  
Long Term Care Facility ◽  
E Coli ◽  
Transmission Rates ◽  
Reproduction Numbers

The extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli clone ST131 (ESBL-ST131) has spread in healthcare settings worldwide. The reasons for its successful spread are unknown, but might include more effective transmission and/or longer persistence. We evaluated the colonisation dynamics of ESBL-producing E. coli (ESBL-EC), including ESBL-ST131, in a long-term care facility (LTCF) with an unusually high prevalence of rectal ESBL-EC colonisation. During a 14-month period, rectal or faecal samples were obtained from 296 residents during six repetitive prevalence surveys, using ESBL-selective culture. Transmission rates, reproduction numbers, and durations of colonisation were compared for ESBL-ST131 vs other ESBL-EC. Furthermore, the likely time required for ESBL-ST131 to disappear from the LTCF was estimated. Over time, the endemic level of ESBL-ST131 remained elevated whereas other ESBL-EC returned to low-level prevalence, despite comparable transmission rates. Survival analysis showed a half-life of 13 months for ESBL-ST131 carriage, vs two to three months for other ESBL-EC (p < 0.001). Per-admission reproduction numbers were 0.66 for ESBL-ST131 vs 0.56 for other ESBL-EC, predicting a mean time of three to four years for ESBL-ST131 to disappear from the LTCF under current conditions. Transmission rates were comparable for ESBL-ST131 vs other ESBL-EC. Prolonged rectal carriage explained the persistence of ESBL-ST131 in the LTCF.

No more nursing homes? Changes in consumer preferences for long-term care facilities following COVID-19

2020 ◽  
Vol 26 (11) ◽  
pp. 276-280
Author(s):  
Amber F Schultz ◽  
Jia Yu
Keyword(s):  
Nursing Homes ◽  
Long Term Care ◽  
Consumer Preferences ◽  
Care Facility ◽  
The Elderly ◽  
Term Care ◽  
Long Term Care Facility ◽  
Medical Disorders ◽  
Care Facilities

Since the first COVID-19 case was discovered in December 2019, over 12.1 million cases have been reported in more than 188 countries and territories. In the USA, the Centers for Disease Control and Prevention has confirmed almost 3.05 million COVID-19 cases, with more than 132 000 deaths. The COVID-19 pandemic has had a particularly dramatic impact on the elderly and those with chronic underlying medical disorders. Before the second outbreak in July, long-term care facilities were the most severely affected in terms of case numbers, especially nursing homes. This article provides information and insight into the potential changes in consumer preferences toward long-term care facility selection and the possible structural change of the long-term care industry in three aspects; structure, conduct and performance.

Pneumonia in the Long-Term-Care Facility

2002 ◽  
Vol 23 (3) ◽  
pp. 159-164 ◽  
Author(s):  
Thomas J. Marrie
Keyword(s):  
Long Term Care ◽  
Care Facility ◽  
Multidrug Resistant ◽  
Term Care ◽  
Long Term Care Facility ◽  
Anticholinergic Medications ◽  
Care Facilities ◽  
Profound Disability ◽  
Common Infection

AbstractPneumonia is a common infection among residents of long-term-care facilities (LTCFs), with an incidence of 1.2 episodes per 1,000 patient-days. This rate is believed to be six- to tenfold higher than the rate of pneumonia among elderly individuals living in the community. The risk factors for pneumonia among residents of LTCFs are profound disability, bedridden state, urinary incontinence, difficulty swallowing, malnutrition, tube feedings, contractures, and use of benzodiazepines and anticholinergic medications. An elevated respiratory rate is often an early clue to pneumonia in this group of patients. Staphylococcus aureus (including methicillin-resistant S. aureus) and aerobic gram-negative bacilli (including multidrug-resistant isolates) are more frequent causes of pneumonia in this setting than in the community. Criteria have been developed that help identify patients for treatment in their LTCFs.

scholarly journals The Niche for Escherichia coli Sequence Type 131 Among Veterans: Urinary Tract Abnormalities and Long-Term Care Facilities

2016 ◽  
Vol 3 (3) ◽  
Author(s):  
Dimitri M. Drekonja ◽  
Michael A. Kuskowski ◽  
Ruth Anway ◽  
Brian D. Johnston ◽  
James R. Johnson
Keyword(s):  
Escherichia Coli ◽  
Long Term Care ◽  
Severe Disease ◽  
Care Facility ◽  
Epidemiological Data ◽  
Initial Therapy ◽  
Sequence Type ◽  
Term Care ◽  
E Coli

Abstract Background.  Antimicrobial resistance among Escherichia coli is increasing, driven largely by the global emergence of sequence type 131 (ST131). However, the clinical significance of ST131 status is unknown. Among veterans, we assessed whether ST131 causes more severe, persistent, or recurrence-prone infections than non-ST131 E. coli. Methods.  Isolates were assessed by polymerase chain reaction for membership in ST131 and relevant subclones thereof (H30R and H30Rx) and by broth microdilution for susceptibility to 11 antibiotics. Clinical and epidemiological data were systematically abstracted from the medical record. Between-group comparisons were made using t tests and Fisher's exact test. Results.  Of the 311 unique E. coli isolates, 61 (19.6%) represented ST131. Of these, most (51 of 61, 83.6%) represented the H30R subclone; only 5 of 51 (9.8%) represented H30Rx. Relative to non-ST131 and non-H30R isolates, neither ST131 nor H30R were associated with more severe disease, worse clinical outcomes, or more robust hosts. Instead, both were more likely to be isolated from patients without manifestations of infection (for ST131, 36.1% vs 21.2% [P = .02]; for H30R, 39% vs 21% [P = .008]) and who had prior healthcare contact or long-term care facility (LTCF) exposure (for ST131, 33% vs 14% [P = .002]; for H30R, 37% vs 14% [P &lt; .001]). Despite a greater likelihood of discordant initial therapy, outcomes did not differ between ST131 and H30R isolates vs other E. coli isolates. Conclusions.  Among veterans, ST131 and its H30R subclone were associated with LTCF-exposed hosts but not with worse outcomes.

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