Risk Factors for Infection with <i>Escherichia coli</i> in Nursing Home Residents Colonized with Fluoroquinolone-Resistant <i>E. coli</i>

Manning, Sara A.; Lautenbach, Ebbing; Tolomeo, Pam; Han, Jennifer H.

doi:10.1017/ice.2015.3

Cited by 5 publications

(3 citation statements)

References 11 publications

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“…Up to 13% of men and 12% of women have an indwelling urinary catheter on admission to the nursing home, and urinary tract infection (UTI) is one of the leading causes of infection among nursing home residents . Although progress has been made in reducing catheter utilization with long-term use at 5% to 8% nationally, catheters still remain in place for long periods, leading to higher risk of infections, especially antimicrobial-resistant infections . Furthermore, knowledge of evidence-based practices to care for these devices among health care personnel in the long-term setting is suboptimal .…”

Section: Introductionmentioning

confidence: 99%

A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents

et al. 2017

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IMPORTANCE Catheter-associated urinary tract infection (UTI) in nursing home residents is a common cause of sepsis, hospital admission, and antimicrobial use leading to colonization with multidrug-resistant organisms. OBJECTIVE To develop, implement, and evaluate an intervention to reduce catheter-associated UTI. DESIGN, SETTING, AND PARTICIPANTS A large-scale prospective implementation project was conducted in community-based nursing homes participating in the Agency for Healthcare Research and Quality Safety Program for Long-Term Care. Nursing homes across 48 states, Washington, DC, and Puerto Rico participated. Implementation of the project was conducted between March 1, 2014, and August 31, 2016. INTERVENTIONS The project was implemented over 12-month cohorts and included a technical bundle: catheter removal, aseptic insertion, using regular assessments, training for catheter care, and incontinence care planning, as well as a socioadaptive bundle emphasizing leadership, resident and family engagement, and effective communication. MAIN OUTCOMES AND MEASURES Urinary catheter use and catheter-associated UTI rates using National Healthcare Safety Network definitions were collected. Facility-level urine culture order rates were also obtained. Random-effects negative binomial regression models were used to examine changes in catheter-associated UTI, catheter utilization, and urine cultures and adjusted for covariates including ownership, bed size, provision of subacute care, 5-star rating, presence of an infection control committee, and an infection preventionist. RESULTS In 4 cohorts over 30 months, 568 community-based nursing homes were recruited; 404 met inclusion criteria for analysis. The unadjusted catheter-associated UTI rates decreased from 6.78 to 2.63 infections per 1000 catheter-days. With use of the regression model and adjustment for facility characteristics, the rates decreased from 6.42 to 3.33 (incidence rate ratio [IRR], 0.46; 95% CI, 0.36-0.58; P < .001). Catheter utilization was 4.5% at baseline and 4.9% at the end of the project. Catheter utilization remained unchanged (4.50 at baseline, 4.45 at conclusion of project; IRR, 0.95; 95% CI, 0.88-1.03; P = .26) in adjusted analyses. The number of urine cultures ordered for all residents decreased from 3.49 per 1000 resident-days to 3.08 per 1000 resident-days. Similarly, after adjustment, the rates were shown to decrease from 3.52 to 3.09 (IRR, 0.85; 95% CI, 0.77-0.94; P = .001). CONCLUSIONS AND RELEVANCE In a large-scale, national implementation project involving community-based nursing homes, combined technical and socioadaptive catheter-associated UTI prevention interventions successfully reduced the incidence of catheter-associated UTIs.

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Section: Introductionmentioning

confidence: 99%

A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents

et al. 2017

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“…Extended‐spectrum β‐lactamase‐producing Enterobacteriaceae is an emerging infectious species raising global concerns . Many Enterobacteriaceae species are part of the endogenous bacterial flora of the intestinal tract in humans, which poses a challenge in efforts to prevent spread of ESBL‐E as part of healthcare‐related infection control.…”

Section: Introductionmentioning

confidence: 99%

Risk factors of fecal colonization with extended‐spectrum β‐lactamase‐producing Enterobacteriaceae in special nursing homes in Japan

Yokoyama

Uehara

Sasaki

et al. 2018

J of Gen and Family Med

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ObjectiveJapanese welfare facilities for the elderly are called as special nursing home (SNH), providing conventional‐type with group care or unit‐type with individual care. We investigated the risk factors of fecal colonization with extended‐spectrum β‐lactamase‐producing Enterobacteriaceae (ESBL‐E) of elderly who required care at SNH in Japan.MethodsThe feces discharged on diaper were obtained from the total of 100 residents with fecal incontinence in 9 SNHs located in Tokyo, Japan. The samples were cultured on ESBL selection agar, and ESBL‐E were determined by the antimicrobial susceptibility test and genetic analysis. The status of the residents and the characteristics of facilities, especially about the incontinence care, were obtained by questionnaire methods. Statistical analysis was performed to determine the factors related to carriage of ESBL‐E.ResultsExtended‐spectrum β‐lactamase‐producing Enterobacteriaceae was isolated from 53 of 100 SNH residents. Risk factors of colonization among the individual residents were not found. The prevalence of ESBL‐E carriage was significantly higher in the 6 conventional‐type facilities than in the 3 unit‐type facilities (P = .015). The cart for diaper exchange was used in 5 of 6 conventional‐type facilities in 9 SNHs, and their residents tended to show high of ESBL‐E colonization rate. The residents living in unit‐type facilities which do not use gloves for changing diaper tended to show high ESBL‐E colonization rate than other 2 facilities using gloves.ConclusionsIt is suggested that using the cart for changing diaper has relation to carry ESBL‐E. In the facilities using cart, revision of their methods of excretion care will be needed.

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“…It should be recognized that ethical concerns related to FMT for treatment of asymptomatic MDRO decolonization may be different from those related to treatment of severe, recurrent CDI. Only about 20% of intensive care unit (ICU) patients who are colonized with an MDRO develop an infection with the same MDRO during their ICU stay [15, 16]; the risk of infection may be lower among patients in long term care facilities [17, 18], which have been identified as important reservoirs for MDROs in several studies [19]. While FMT holds promise as a groundbreaking strategy for control of MDROs in these settings, its therapeutic index must be proven to be very high before treatment of asymptomatic patients who may be at low risk of infection can be justified.…”

mentioning

confidence: 99%

Environmental management in the gut: fecal transplantation to restore the intestinal ecosystem

Young

Hayden

2016

Infectious Diseases

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Risk Factors for Infection with Escherichia coli in Nursing Home Residents Colonized with Fluoroquinolone-Resistant E. coli

Cited by 5 publications

References 11 publications

A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents

A National Implementation Project to Prevent Catheter-Associated Urinary Tract Infection in Nursing Home Residents

Risk factors of fecal colonization with extended‐spectrum β‐lactamase‐producing Enterobacteriaceae in special nursing homes in Japan

Environmental management in the gut: fecal transplantation to restore the intestinal ecosystem

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