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Longitudinal Trends in Antimicrobial Susceptibilities Across Long-Term–Care Facilities: Emergence of Fluoroquinolone Resistance

Published online by Cambridge University Press:  21 June 2016

Melissa Viray ,
Darren Linkin ,
Joel N. Maslow ,
Donald D. Stieritz ,
Lesley S. Carson ,
Warren B. Bilker  and
Ebbing Lautenbach
Melissa Viray
Affiliation:
Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Darren Linkin
Affiliation:
Center for Clinical Epidemiology and Biostatistics and the Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Joel N. Maslow
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Veterans Affairs Medical Center, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Donald D. Stieritz
Affiliation:
Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Pathology and Laboratory Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Lesley S. Carson
Affiliation:
Division of Geriatrics, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Warren B. Bilker
Affiliation:
Center for Clinical Epidemiology and Biostatistics and the Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Ebbing Lautenbach*
Affiliation:
Center for Clinical Epidemiology and Biostatistics and the Center for Education and Research on Therapeutics, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Department of Biostatistics and Epidemiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania Division of Infectious Diseases, Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
*
University of Pennsylvania School of Medicine, Center for Clinical Epidemiology and Biostatistics, 825 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104-6021elautenb@cceb.med.upenn.edu
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Abstract

Background

Antibiotic resistance in the long-term-care facility (LTCF) setting is of increasing concern due to both the increased morbidity and mortality related to infections in this debilitated population and the potential for transfer of resistant organisms to other healthcare settings. Longitudinal trends in antibiotic resistance in LTCFs have not been well described.

Design:

Correlational longitudinal survey study.

Setting:

Four LTCFs in Pennsylvania.

Subjects:

All clinical cultures of residents of the participating LTCFs (700 total beds) from 1998 through 2003. We assessed the annual prevalence of resistance to various antimicrobials of interest for the following organisms: Escherichia coli, Klebsiella pneumoniae, Proteus mirabilis, Pseudomonas aeruginosa, Staphylococcus aureus, and enterococcus species.

Results:

A total of 4,954 clinical isolates were obtained during the study. A high prevalence of antimicrobial resistance was noted for many organism-drug combinations. This was especially true for fluoroquinolone susceptibility among the Enterobacteriaceae (susceptibility range, 51.3% to 92.2%). In addition, the prevalence of resistance to various agents differed significantly across study sites. Finally, significant increasing trends in resistance were noted over time and were most pronounced for fluoroquinolone susceptibility among the Enterobacteriaceae.

Conclusions:

The prevalence of antimicrobial resistance has increased significantly in LTCFs, although trends have varied substantially across different institutions. These trends have been particularly pronounced for fluoroquinolone resistance among the Enterobacteriaceae. These findings demonstrate that antimicrobial resistance is widespread and increasing in LTCFs, highlighting the need for future studies to more clearly elucidate the risk factors for, and potential interventions against, emerging resistance in these settings.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 1 , January 2005 , pp. 56 - 62
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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