Antimicrobial resistance patterns of urine culture specimens from 27 nursing homes: Impact of a two-year antimicrobial stewardship intervention

Abstract

Objective:Identify changes in the prevalence and antimicrobial resistance patterns of potentially pathogenic bacteria in urine cultures during a 2-year antimicrobial stewardship intervention program in nursing homes (NHs).Design:Before-and-after intervention study.Setting:The study included 27 NHs in North Carolina.Methods:We audited all urine cultures ordered before and during an antimicrobial stewardship intervention. Analyses compared culture rates, culture positive rates, and pathogen antimicrobial resistance patterns.Results:Of 6,718 total urine cultures collected, 68% were positive for potentially pathogenic bacteria. During the intervention, significant reductions in the urine culture and positive culture rates were observed (P= .014). Most of the identified potentially uropathogenic isolates wereEscherichia coli(38%),Proteusspp (13%), andKlebsiella pneumoniae(12%). A significant decrease was observed during the intervention period in nitrofurantoin resistance amongE. coli(P≤ .001) and ciprofloxacin resistance amongProteusspp (P≤ .001); however carbapenem resistance increased forProteusspp (P≤ .001). Multidrug resistance also increased forProteusspp compared to the baseline. The high baseline resistance ofE. colito the commonly prescribed antimicrobials ciprofloxacin and trimethoprim-sulfamethoxazole (TMP/SMX) did not change during the intervention.Conclusions:The antimicrobial stewardship intervention program significantly reduced urine culture and culture-positive rates. Overall, very high proportions of antimicrobial resistance were observed among common pathogens; however, antimicrobial resistance trended downward but reductions were too small and scattered to conclude that the intervention significantly changed antimicrobial resistance. Longer intervention periods may be needed to effect change in resistance patterns.

Spectrum of uropathogens and their susceptibility to antimicrobials in pregnant women: a retrospective analysis of 5-year hospital data

“…The findings of this study showed that E. coli was the most commonly identified pathogen, which was in line with the findings of previous studies, such as that by Tandan et al. 10 in which E. coli was found to be the commonest UTI-causing organism. In addition, Gessese et al.…”

“…The second most common uropathogen identified in our study was Staphylococcus species. The findings of the antimicrobial resistance profile are supported by the findings of numerous previous studies 5 , 10 showing that Staphylococcus species are highly resistant gram-negative bacteria. In addition, most isolated gram-negative bacteria are sensitive to gentamicin, ceftazidime, and ciprofloxacin whereas these bacteria are resistant to ampicillin, chloramphenicol, and amoxycillin.…”

Prevalence of Multi-Resistant Microorganisms and Antibiotic Stewardship among Hospitalized Patients Living in Residential Care Homes in Spain: A Cross-Sectional Study

“…Nevertheless, it is very difficult to determine the original source of transmission in this population. The crucial role of care homes in the transmission of MDRO infections has been consistently reported [13][14][15][16]. A number of factors could explain this high transmission, e.g., healthcare personnel simultaneously working in several care homes, the high rate of hospitalization and antibiotic use in this vulnerable population, or a lack of resources and training in infection prevention measures, as previously suggested in Spain [17].…”

“…Although the aforementioned review did not show conclusive results regarding the usefulness of strategies to reduce AMR in care homes [14], some evidence shows promising results. For instance, a recent antimicrobial stewardship intervention for older people in nursing homes conducted in North Carolina significantly reduced urine culture positive MDRO rates [16]. Based on these facts, it seems clear that nursing homes, care homes and long-stay residences should be considered in addition to hospitals when planning regional and national infection control strategies to reduce AMDR.…”

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

“…These results are similar to common pathogens reported from either UTI or urine cultures from nursing home residents in other studies. 4,[14][15][16][17][18] Within nursing homes, levels of antibiotic resistance, including MDR, were generally higher among the CA-SUTI events than UTIs not associated with catheters, most notably for vancomycin resistance in E. faecium and extended-spectrum cephalosporin and carbapenem resistance in Klebsiella spp. These differences observed among nursing-home UTI event types may be explained by the role that biofilm formation on indwelling devices plays in the selection and emergence of antibiotic resistance.…”