scholarly journals Feasibility of Developing Traditional Facility-Specific Nursing Home Antibiograms

2020 ◽  
Vol 41 (S1) ◽  
pp. s234-s234
Author(s):  
Lindsay Taylor ◽  
Michael Howe ◽  
Fauzia Osman ◽  
Christopher Crnich
Keyword(s):  
Escherichia Coli ◽  
Nursing Home ◽  
Nursing Homes ◽  
Regional Level ◽  
Absolute Difference ◽  
Antibiotic Prescribing ◽  
Specific Data ◽  
Laboratory Network ◽  
The Mean ◽  
Isolated Species

Background: An antibiogram is a tool for tracking and reporting antimicrobial resistance; the CDC has endorsed as part of a comprehensive antimicrobial stewardship program in nursing homes. We have previously shown that antibiogram utilization has increased in nursing homes, but most facilities employ tools that are not based on facility-specific data. In this study, we investigate the feasibility to develop antibiograms using facility-specific data and compare these results with antibiograms developed using data from multiple facilities that share the same lab and geographic region. Methods: Raw, de-identified culture results from January 1 through December 31st, 2018 were collected from participating nursing homes and their consulting microbiology laboratories under an IRB-exempt protocol. Culture results were entered and stored in REDCap. Number of isolates per species was examined based on nursing home, nursing home laboratory network, and region. Percentage sensitivities of the most frequently isolated species to commonly used antibiotics were calculated at the nursing home and regional level and compared. T tests of the absolute difference between nursing home- and regional level percentage sensitivities were performed. All data analyses were performed in R software. Results: The mean annual cultures per nursing home was 23.5 (SE, ±3.29). Grouping cultures by lab and region increased the mean culture count 6-fold and 12-fold, respectively. The most commonly isolated species were Escherichia coli (29.7%), Enterococcus spp (11.6%), Proteus spp (10%), Klebsiella spp (8.5%). None of the nursing homes had >30 isolates of a single species (Fig. 1). Escherichia coli was the only species that exceeded the 30-isolate threshold when aggregated at the laboratory network level (Fig. 2). Grouping nursing home cultures by region provided the greatest average isolate count across the most common species. The greatest differences in percentage sensitivity between nursing homes and their region were noted for Escherichia coli and Proteus spp to fluoroquinolones (>20% difference; P < .01). The difference in sensitivity was <5% for Escherichia coli to nitrofurantoin. Conclusions: Nursing homes do not generate enough annual isolates to create antibiograms compliant with Clinical Laboratory Standard Institute guidelines. Grouping isolates from multiple nursing homes at the regional level does reliably exceed the 30-isolate threshold for multiple bacterial species but leads to susceptibility estimates that may vary substantially from those observed at the facility level. Alternative tools for tracking antibiotic resistance and guiding antibiotic prescribing decisions at the local level are needed.Funding: NoneDisclosures: None

scholarly journals Antibiotic Susceptibility of Common Organisms Isolated from Urine Cultures of Nursing Home Residents

2020 ◽  
Vol 41 (S1) ◽  
pp. s118-s120
Author(s):  
Austin R. Penna ◽  
Taniece R. Eure Eure ◽  
Nimalie D. Stone ◽  
Grant Barney ◽  
Devra Barter ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Antibiotic Susceptibility ◽  
Clinical Decision Making ◽  
Service Providers ◽  
Urine Culture ◽  
Nursing Home Residents ◽  
Antibiotic Prescribing ◽  
E Coli ◽  
Susceptibility Data

Background: With the emergence of antibiotic resistant threats and the need for appropriate antibiotic use, laboratory microbiology information is important to guide clinical decision making in nursing homes, where access to such data can be limited. Susceptibility data are necessary to inform antibiotic selection and to monitor changes in resistance patterns over time. To contribute to existing data that describe antibiotic resistance among nursing home residents, we summarized antibiotic susceptibility data from organisms commonly isolated from urine cultures collected as part of the CDC multistate, Emerging Infections Program (EIP) nursing home prevalence survey. Methods: In 2017, urine culture and antibiotic susceptibility data for selected organisms were retrospectively collected from nursing home residents’ medical records by trained EIP staff. Urine culture results reported as negative (no growth) or contaminated were excluded. Susceptibility results were recorded as susceptible, non-susceptible (resistant or intermediate), or not tested. The pooled mean percentage tested and percentage non-susceptible were calculated for selected antibiotic agents and classes using available data. Susceptibility data were analyzed for organisms with ≥20 isolates. The definition for multidrug-resistance (MDR) was based on the CDC and European Centre for Disease Prevention and Control’s interim standard definitions. Data were analyzed using SAS v 9.4 software. Results: Among 161 participating nursing homes and 15,276 residents, 300 residents (2.0%) had documentation of a urine culture at the time of the survey, and 229 (76.3%) were positive. Escherichia coli, Proteus mirabilis, Klebsiella spp, and Enterococcus spp represented 73.0% of all urine isolates (N = 278). There were 215 (77.3%) isolates with reported susceptibility data (Fig. 1). Of these, data were analyzed for 187 (87.0%) (Fig. 2). All isolates tested for carbapenems were susceptible. Fluoroquinolone non-susceptibility was most prevalent among E. coli (42.9%) and P. mirabilis (55.9%). Among Klebsiella spp, the highest percentages of non-susceptibility were observed for extended-spectrum cephalosporins and folate pathway inhibitors (25.0% each). Glycopeptide non-susceptibility was 10.0% for Enterococcus spp. The percentage of isolates classified as MDR ranged from 10.1% for E. coli to 14.7% for P. mirabilis. Conclusions: Substantial levels of non-susceptibility were observed for nursing home residents’ urine isolates, with 10% to 56% reported as non-susceptible to the antibiotics assessed. Non-susceptibility was highest for fluoroquinolones, an antibiotic class commonly used in nursing homes, and ≥ 10% of selected isolates were MDR. Our findings reinforce the importance of nursing homes using susceptibility data from laboratory service providers to guide antibiotic prescribing and to monitor levels of resistance.Disclosures: NoneFunding: None

scholarly journals The Urine-culturing Cascade: Variation in Nursing Home Urine Culturing and Association With Antibiotic Use and Clostridiodes difficile Infection

2019 ◽  
Vol 70 (8) ◽  
pp. 1620-1627 ◽  
Author(s):  
Kevin Antoine Brown ◽  
Nick Daneman ◽  
Kevin L Schwartz ◽  
Bradley Langford ◽  
Allison McGeer ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Regression Models ◽  
Urine Culture ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Adjusted Risk ◽  
Adjusted Risk Ratio ◽  
Before And After

Abstract Background Rates of antibiotic use vary widely across nursing homes and cannot be explained by resident characteristics. Antibiotic prescribing for a presumed urinary tract infection is often preceded by inappropriate urine culturing. We examined nursing home urine-culturing practices and their association with antibiotic use. Methods We conducted a longitudinal, multilevel, retrospective cohort study based on quarterly nursing home assessments between April 2014 and January 2017 in 591 nursing homes and covering &gt;90% of nursing home residents in Ontario, Canada. Nursing home urine culturing was measured as the proportion of residents with a urine culture in the prior 14 days. Outcomes included receipt of any systemic antibiotic and any urinary antibiotic (eg, nitrofurantoin, trimethoprim/sulfonamides, ciprofloxacin) in the 30 days after the assessment and Clostridiodes difficile infection in the 90 days after the assessment. Adjusted Poisson regression models accounted for 14 resident covariates. Results A total of 131 218 residents in 591 nursing homes were included; 7.9% of resident assessments had a urine culture in the prior 14 days; this proportion was highly variable across the 591 nursing homes (10th percentile = 3.4%, 90th percentile = 14.3%). Before and after adjusting for 14 resident characteristics, nursing home urine culturing predicted total antibiotic use (adjusted risk ratio [RR] per doubling of urine culturing, 1.21; 95% confidence interval [CI], 1.18–1.23), urinary antibiotic use (RR, 1.33; 95% CI, 1.28–1.38), and C. difficile infection (incidence rate ratio, 1.18; 95% CI, 1.07–1.31). Conclusions Nursing homes have highly divergent urine culturing rates; this variability is associated with higher antibiotic use and rates of C. difficile infection.

scholarly journals Evaluation of the elderlies’s attitudes towards young people Yaşlı bireylerin gençlere yönelik tutumlarının değerlendirilmesi

2016 ◽  
Vol 13 (2) ◽  
pp. 2682 ◽  
Author(s):  
Seda Kıpçak ◽  
Özden Dedeli
Keyword(s):  
Nursing Home ◽  
Statistical Analysis ◽  
Young People ◽  
Nursing Homes ◽  
Attitude Scale ◽  
Cross Sectional ◽  
Negative Attitudes ◽  
Positive Attitudes ◽  
Demographic Questionnaire ◽  
The Mean

The purpose of this study was to assess the elderlies who stay in nursing home’ attitudes towards young people. This study which is descriptive and cross sectional was conducted with 134 elderlies living in three nursing homes in Manisa (n=134). The data were collected by a demographic questionnaire and Attitude Scale Towards Young People (ASTYP). Kruskal Wallis, Mann Whitney U and  Spearman’ s rho correlation analysis were  used  in  statistical analysis. The mean age of elderlies were 74.0±6.7 (66-95) years,  69.4% were male. The elderlies’ mean scores of ASTYP were found 167.7 ± 12.7 (118.0-211.0).  The results of this study show that the elderlies, staying in nursing homes, have a negative attitudes towards young people. But; the elderlies, having more children and grandchildren than another and divorced or widowed, have more positive attitudes towards young people. ÖzetBu çalışmada amaç, huzurevinde kalan yaşlı bireylerin gençlere yönelik tutumlarının değerlendirilmesidir. Tanımlayıcı ve kesitsel tipteki araştırma, Manisa ili sınırları içerisinde üç huzurevinde yaşayan 134 yaşlı birey ile yürütüldü (n=134). Araştırmada veriler, araştırmacı tarafından sosyodemografik bilgiler soru formu ve Gençlere Yönelik Tutum Ölçeği (GYTÖ)’i kullanılarak toplandı. Verilerin değerlendirilmesinde, Kruskal Wallis, Mann Whitney U ve Spearman’s rho korelasyon analizleri kullanılmıştır. Araştırmaya katılan yaşlı bireylerin yaş ortalaması 74.0±6.7 yıl (66-95) olup büyük çoğunluğu (%69.4) erkekti. Yaşlı bireylerin GYTÖ’ den almış oldukları toplam puan ortalaması 167.7±12.7 (118.0-211.0)’ dir. Araştırma sonucunda, huzurevinde kalan yaşlı bireylerin gençlere yönelik olumsuz tutumlara sahip olduğu bulundu. Yaşlı bireylerin genel tutumları olumsuz olmasına rağmen çocuk ve torun sayısı fazla olan ve eşi ölmüş ya da boşanmış olan yaşlı bireylerin gençlere yönelik tutumları olumlu yöndeydi.

scholarly journals Appropriateness of Initiating Antibiotics for Urinary Tract Infection Among Nursing Home Residents

2020 ◽  
Vol 41 (S1) ◽  
pp. s127-s128
Author(s):  
Taniece R. Eure ◽  
Nicola D. Thompson ◽  
Austin Penna ◽  
Wendy M. Bamberg ◽  
Grant Barney ◽  
...  
Keyword(s):  
Nursing Home ◽  
Urinary Tract ◽  
Nursing Homes ◽  
Treatment Guidelines ◽  
Nursing Home Residents ◽  
Antibiotic Use ◽  
Antibiotic Prescribing ◽  
Emerging Infections ◽  
Tract Infections ◽  
Uncomplicated Cystitis

Background: Antibiotics are among the most commonly prescribed drugs in nursing homes; urinary tract infections (UTIs) are a frequent indication. Although there is no gold standard for the diagnosis of UTIs, various criteria have been developed to inform and standardize nursing home prescribing decisions, with the goal of reducing unnecessary antibiotic prescribing. Using different published criteria designed to guide decisions on initiating treatment of UTIs (ie, symptomatic, catheter-associated, and uncomplicated cystitis), our objective was to assess the appropriateness of antibiotic prescribing among NH residents. Methods: In 2017, the CDC Emerging Infections Program (EIP) performed a prevalence survey of healthcare-associated infections and antibiotic use in 161 nursing homes from 10 states: California, Colorado, Connecticut, Georgia, Maryland, Minnesota, New Mexico, New York, Oregon, and Tennessee. EIP staff reviewed resident medical records to collect demographic and clinical information, infection signs, symptoms, and diagnostic testing documented on the day an antibiotic was initiated and 6 days prior. We applied 4 criteria to determine whether initiation of treatment for UTI was supported: (1) the Loeb minimum clinical criteria (Loeb); (2) the Suspected UTI Situation, Background, Assessment, and Recommendation tool (UTI SBAR tool); (3) adaptation of Infectious Diseases Society of America UTI treatment guidelines for nursing home residents (Crnich & Drinka); and (4) diagnostic criteria for uncomplicated cystitis (cystitis consensus) (Fig. 1). We calculated the percentage of residents for whom initiating UTI treatment was appropriate by these criteria. Results: Of 248 residents for whom UTI treatment was initiated in the nursing home, the median age was 79 years [IQR, 19], 63% were female, and 35% were admitted for postacute care. There was substantial variability in the percentage of residents with antibiotic initiation classified as appropriate by each of the criteria, ranging from 8% for the cystitis consensus, to 27% for Loeb, to 33% for the UTI SBAR tool, to 51% for Crnich and Drinka (Fig. 2). Conclusions: Appropriate initiation of UTI treatment among nursing home residents remained low regardless of criteria used. At best only half of antibiotic treatment met published prescribing criteria. Although insufficient documentation of infection signs, symptoms and testing may have contributed to the low percentages observed, adequate documentation in the medical record to support prescribing should be standard practice, as outlined in the CDC Core Elements of Antibiotic Stewardship for nursing homes. Standardized UTI prescribing criteria should be incorporated into nursing home stewardship activities to improve the assessment and documentation of symptomatic UTI and to reduce inappropriate antibiotic use.Funding: NoneDisclosures: None

scholarly journals Reliability of nonlocalizing signs and symptoms as indicators of the presence of infection in nursing-home residents

2020 ◽  
pp. 1-10
Author(s):  
Theresa A. Rowe ◽  
Robin L.P. Jump ◽  
Bjørg Marit Andersen ◽  
David B. Banach ◽  
Kristina A. Bryant ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Drug Effects ◽  
Signs And Symptoms ◽  
Antibiotic Use ◽  
Drug Dose ◽  
Antibiotic Prescribing ◽  
Negative Consequences ◽  
Clostridioides Difficile

Antibiotics are among the most common medications prescribed in nursing homes. The annual prevalence of antibiotic use in residents of nursing homes ranges from 47% to 79%, and more than half of antibiotic courses initiated in nursing-home settings are unnecessary or prescribed inappropriately (wrong drug, dose, or duration). Inappropriate antibiotic use is associated with a variety of negative consequences including Clostridioides difficile infection (CDI), adverse drug effects, drug–drug interactions, and antimicrobial resistance. In response to this problem, public health authorities have called for efforts to improve the quality of antibiotic prescribing in nursing homes.

Variability of total phenytoin serum concentrations within elderly nursing home residents

Neurology ◽  
2003 ◽  
Vol 60 (4) ◽  
pp. 555-559 ◽  
Author(s):  
A. Birnbaum ◽  
N. A. Hardie ◽  
I. E. Leppik ◽  
J. M. Conway ◽  
S. E. Bowers ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Resident ◽  
Nursing Home Residents ◽  
The Elderly ◽  
The United States ◽  
Serum Concentrations ◽  
Minimum Concentration ◽  
Elderly Nursing Home Resident ◽  
The Mean

Background: Approximately 6% of all elderly nursing home residents receive phenytoin. Phenytoin concentrations are often measured to guide therapy.Objective: To evaluate the intraresident variability among multiple measurements of total phenytoin serum concentrations in nursing home residents.Methods: This was an observational study of 56 elderly (≥65 years) nursing home residents from 32 nursing homes who had at least 3 phenytoin concentrations measured while on the same dose of phenytoin for at least 4 weeks and who were not taking any interfering concomitant medications. These were a subset of 387 elderly nursing home residents from 112 nursing homes across the United States who had total phenytoin concentration measurements between June 1998 and December 2000.Results: The mean age was 80.1 years (range, 65 to 100 years) and 58.9% were women. The mean daily dose of phenytoin per resident was 4.9 ± 1.5 mg/kg. Total phenytoin concentrations within an elderly nursing home resident varied as much as two- to threefold, even though there was no change in dose. The person with the smallest variability had a minimum concentration of 10.0 μg/mL and a maximum of 10.4 μg/mL. The person with the largest variability had a minimum concentration of 9.7 μg/mL and a maximum of 28.8 μg/mL.Conclusions: There is considerable variability in the total phenytoin concentrations in the elderly nursing home resident and measurement of a single total phenytoin concentration should not be used to guide treatment.

scholarly journals Patterns and Predictors of UTI Treatment Practices in Nursing Homes

2020 ◽  
Vol 41 (S1) ◽  
pp. s345-s345
Author(s):  
James H. Ford ◽  
Dee Heller ◽  
Kathi Selle ◽  
Susan Nordman-Oliveira ◽  
Jennifer Robinson ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Treatment Duration ◽  
Urine Culture ◽  
Retention Rates ◽  
Management Tool ◽  
Antibiotic Prescribing ◽  
Full Time ◽  
Prescribing Practices ◽  
Part Time

Background: Suspicion of urinary tract infection (UTI) is the most common justification for prescribing antibiotics in nursing homes. More than half of antibiotic prescriptions for treatment of UTI in nursing homes are either unnecessary or inappropriate. Achieving a better understanding of the factors that underlie UTI treatment decisions is necessary to improve the quality of antibiotic prescribing in nursing homes. An ongoing hybrid type 2 effectiveness-implementation cluster randomized trial of a recently developed nursing home UTI recognition and management tool kit provided us with an opportunity to explore the influence of organizational, clinical, and staff attributes on UTI antibiotic prescribing practices in nursing homes. Methods: Data on antibiotic starts for suspected UTIs were collected in 29 nursing homes over a 9-month period. Antibiotic practices evaluated included total antibiotic starts per 1,000 resident days, % antibiotic starts with treatment duration >7 days, % antibiotic starts in which the initial antibiotic choice was a fluoroquinolone, and % antibiotic starts meeting UTI tool-kit criteria of appropriateness. Prior research and bivariate analyses were used to select clinical and organizational attributes as well as individual nursing staff-level retention rates for inclusion in a stepwise linear regression model for each antibiotic practice outcome. Results: In total, 602 UTI antibiotic events were evaluated. Four associations were identified for antibiotic starts including nursing home urine culture rate, ICP status, nonprofit and part-time LPN retention. Nursing homes with higher full-time LPN retention had a lower rate of antibiotic treatment duration >7 days. Full-time CNAs and part-time LPNs retention and for-profit status was associated with the proportion of fluoroquinolone antibiotic starts. No attributes influenced the proportion of antibiotic starts meeting appropriateness criteria (Fig. 1). Urine culture rates are driving overall nursing home antibiotic prescribing. Conclusions: Urine culture practices was strongly associated with UTI treatment rates in nursing homes. A variety of organizational characteristics were also associated with UTI treatment rates as well as other UTI antibiotic prescribing practices. Some of these associations appear paradoxical but may reflect increasing resident acuity and increased capacity to standardize practices through organizational centralization.Funding: Support for the project provided by the Wisconsin Partnership Program.Disclosures: None

scholarly journals 449 - How much frequency do residents fall at nursing homes in Japan ? - THE JADE STUDY

2020 ◽  
Vol 32 (S1) ◽  
pp. 169-169
Author(s):  
Nozomu Oya ◽  
Nobutaka Ayani ◽  
Akiko Kuwahara ◽  
Riki Kitaoka ◽  
Mio Sakuma ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Adverse Drug Events ◽  
Observation Time ◽  
Drug Event ◽  
Institutional Review Boards ◽  
Medical Doctors ◽  
Careful Monitoring ◽  
Institutional Review ◽  
The Mean

IntroductionJapan has become an aging society rapidly, and the percentage of the population over 65 was about 28.1% (around 36 million people) in 2018 in Japan. Then, the number of residents in nursing home has been also increasing.Many residents in nursing home are receiving pharmacotherapy, and drug-related falls are a major problem at the institution. Fall due to medication sometimes occurs and results in serious consequences.Then, the aim of this study was to identify the incidence of falls and its association with medication.MethodThe Japan Adverse Drug Event (JADE) study for nursing home is a series of cohort studies. The JADE study for nursing home is a prospective cohort study that was conducted at 4 nursing home for elder people in Japan.Based on the validated methodology, trained psychologists, medical doctors reviewed all charts to identify ADEs (Adverse Drug Events, injuries due to medication), suspected to being associated with medication. Simultaneously, we collected all falls regardless of drug association.After collecting these events, 4 medical doctors independently made a secondary review. This study was approved by the institutional review boards of the Kyoto Prefectural University of Medicine.ResultWe enrolled 459 residents, which yielded 3315 resident-months of observation time. The mean (SD) age was 85.8 (7) years and 344 (75%) were female. We identified 655 falls in 196 residents (39.6%) during the study period (incidence: 16.9 per 100 resident-months). 568 falls (86.7%) in 166 residents were related to ADEs. Among them, 10.9% (62/568) were accompanied by injuries, and 2.6% (15/568) of them resulted in fracture. The most common class of drugs associated with falls was benzodiazepine hypnotics (23.2%, 132/568) and atypical antipsychotics (17.4%, 99/568).ConclusionThe frequency of falls in nursing homes in Japan was comparable to other countries (L. Z, Rubenstein, 1996). Since significant portion of them were associated with medication, careful monitoring of medication is required.

scholarly journals Racial Segregation Across U.S. Nursing Homes: A Systematic Review of Measurement and Outcomes

2019 ◽  
Vol 60 (3) ◽  
pp. e218-e231 ◽  
Author(s):  
Deborah S Mack ◽  
Bill M Jesdale ◽  
Christine M Ulbricht ◽  
Sarah N Forrester ◽  
Pryce S Michener ◽  
...  
Keyword(s):  
Systematic Review ◽  
Nursing Home ◽  
Nursing Homes ◽  
Negative Impact ◽  
Racial Segregation ◽  
The United States ◽  
Regional Level ◽  
Data Set ◽  
Facility Level ◽  
Nursing Home Facilities

Abstract Background and Objectives Nursing homes remain subjected to institutional racial segregation in the United States. However, a standardized approach to measure segregation in nursing homes does not appear to be established. A systematic review was conducted to identify all formal measurement approaches to evaluate racial segregation among nursing home facilities, and to then identify the association between segregation and quality of care in this context. Research Design and Methods PubMed, Scopus, and Web of Science databases were searched (January 2018) for publications relating to nursing home segregation. Following the PRISMA guidelines, studies were included that formally measured racial segregation of nursing homes residents across facilities with regional-level data. Results Eight studies met the inclusion criteria. Formal segregation measures included the Dissimilarity Index, Disparities Quality Index, Modified Thiel’s Entropy Index, Gini coefficient, and adapted models. The most common data sources were the Minimum Data Set (MDS; resident-level), the Certification and Survey Provider Enhanced Reporting data (CASPER; facility-level), and the Area Resource File/ U.S. Census Data (regional-level). Most studies showed evidence of racial segregation among U.S. nursing home facilities and documented a negative impact of segregation on racial minorities and facility-level quality outcomes. Discussion and Implications The measurement of racial segregation among nursing homes is heterogeneous. While there are limitations to each methodology, this review can be used as a reference when trying to determine the best approach to measure racial segregation in future studies. Moreover, racial segregation among nursing homes remains a problem and should be further evaluated.

scholarly journals Duration of Colonisation With Extended-spectrum Beta-lactamase-producing Escherichia Coli: Results of an Open Cohort Study With Dutch Nursing Home Residents (2013 – 2019)

2020 ◽  
Author(s):  
Veronica Weterings ◽  
Tineke de Goede ◽  
Yvonne Hendriks ◽  
Linda Kilsdonk ◽  
Ans Mulders ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Survival Analysis ◽  
Nursing Home ◽  
Nursing Homes ◽  
Nursing Home Residents ◽  
Whole Genome Sequencing Data ◽  
Sequencing Data ◽  
Extended Spectrum Beta Lactamase ◽  
E Coli ◽  
Extended Spectrum

Abstract Background Escherichia coli sequence type ST131 is a recently emerged worldwide pandemic clonal group. Antibiotic resistance, virulence factors or colonisation fitness are mentioned among other as possible factors contributing to the worldwide success. In this study, we assessed the duration of rectal ESBL- producing E. coli colonisation in the residents, and compare duration of colonisation for ESBL-ST131 versus ESBL-non-ST131.MethodsRectal or faecal samples were obtained from residents of nursing home A between 2013 and 2019 and nursing home B between 2017 and 2019, with repeated point prevalence surveys at intervals of three to six months. Extended-spectrum β-lactamase (ESBL)-producing strains of E. coli were identified on selective culture and selective enrichment broth, and examined by antimicrobial susceptibility testing. In nursing home A multilocus sequence typing (MLST) and cluster analyse was performed by respectively O25:ST131-specific PCR and amplified fragment length polymorphism (AFLP). In nursing home B whole genome sequencing data were used to determine MLST and to perform a cluster analyse. Kaplan Meier survival analysis was performed to calculate the median time of rectal colonisation of ESBL-EC with a Log-Rank analysis to test for differences between ESBL-ST131 and ESBL-non-ST131.ResultsA total of 144 residents were included: 84 residents (58%) with ESBL-ST131 rectal colonisation and 60 residents (42%) with ESBL-non-ST131 rectal colonisation. Survival analysis showed a median colonisation length of 13 months for ESBL-ST131 (95%CI: 7,2 – 18,7) versus 8,3 months (95%CI: 2,8 – 13,8) for ESBL-non-ST131 (p = 0,028). Remarkably, in the subgroup ST131 the median colonisation length was significantly longer in female than in males: 25,7 months versus 8,1 months (p = 0,013).ConclusionHere we found a prolonged colonisation duration of ESBL-ST131 compared to ESBL-non-ST131 in residents of Dutch nursing homes. Prolonged colonisation duration complicates the controlling and ending an ESBL-ST131 outbreak, especially in long stay settings such as nursing homes.

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