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

Abstract

Objective: 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.

Antimicrobial Resistance Among Uropathogens: Surveillance Report From South India

“…In our analysis, in both periods, the most common organisms were Escherichia coli (56.6% vs 51.6%), Klebsiella pneumoniae (14.7% vs 16.5%), Enterococcus faecalis (11.6% vs 12%), and Pseudomonas aeruginosa (4.5% vs 5%). This spectrum is similar to the previous studies by Meena et al [ 12 ], and Shah et al [ 6 ] from India; Sorlozano et al [ 13 ] from Spain; Eure et al [ 14 ] and Sharma et al [ 15 ] from Grenada; and Lagunas-Rangel [ 16 ] from Mexico. Most authors have reported Escherichia coli and Klebsiella pneumoniae among the top three causative organisms for UTI (Table 4 ), which is similar to our study.…”

Ecological Analysis of the Decline in Incidence Rates of COVID-19 Among Nursing Home Residents Associated with Vaccination, United States, December 2020-January 2021

“…CDC's NHSN is the nation's surveillance program for health careeassociated conditions. 17,18 For the purposes of monitoring the pandemic, in collaboration with CMS, NHSN was able to rapidly expand from approximately 3000 nursing homes performing monthly reporting to receiving weekly reporting from the approximately 15,400 CMS-certified nursing homes and more than 1000 additional facilities for assisted living and intermediate care for individuals with intellectual disabilities. 9,19,20 The results of this study and others 7,8,21 demonstrate the importance of NHSN as a national surveillance infrastructure for nursing homes and other health care delivery populations.…”

Copper Resistance Promotes Fitness of Methicillin-Resistant Staphylococcus aureus during Urinary Tract Infection

“…S. saprophyticus is a more frequent cause of UTI in otherwise healthy young women ( 7 , 16 ). Antibiotic-resistant isolates, particularly methicillin-resistant S. aureus (MRSA), are widely disseminated and are common causes of community-acquired MRSA infections, including UTI ( 11 , 17 – 22 ). However, our knowledge on the pathogenesis and host response during UTI caused by staphylococci is limited ( 16 , 23 ).…”