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

Abstract

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.

Antibiotic Exposure during the Preceding Six Months Is Related to Intestinal ESBL-Producing Enterobacteriaceae Carriage in the Elderly

“…Overall prevalence of ESBLs-PE carriage in the general population in Netherland from 2013 to 2017 was 4.3% (260/5983) [ 21 ]. Therefore, it is likely the ESBL-PE carriage in the elderly is much higher than that of the general population based on this study and previous reports [ 10 , 11 ]. This might be attributed to more antibiotics exposure in the elderly.…”

“…The results of this study demonstrate that antimicrobial exposure during the preceding 6 months significantly increased the risk of intestinal ESBL-PE colonization. This is a much longer period than reported in previous studies that showed antibiotic exposure only within the past 3 months or less influenced the intestinal carriage of ESBL-PE [ 10 , 11 , 12 ]. Similarly, the guidelines for hospital-acquired and ventilator-associated pneumonia states that the previous intravenous antibiotic used within the past 3 months was one of the risk factors of multi-drug resistant pathogen infections [ 17 ].…”

“…Rather, most studies have focused on the prevalence of ESBL-PE carriage in nursing home residents. The reported prevalence was 3% to 11.2% in Sweden, Hungary, Belgium, and Germany [ 9 , 10 ], and 40.5% to 53% in Northern Ireland and Japan [ 10 , 11 ]. In 2014, intestinal ESBL-PE carriage was identified in 46.9% of 390 residents (≥65 years of age) in seven nursing homes in Shanghai, China [ 12 ].…”

The Effect of Infection Precautions on Extended-Spectrum Beta-Lactamase Enterobacteriaceae Colonization Among Nurses in Three Beirut Hospitals

“…Second, it is possible that nursing staff may have felt more "secure" that isolation was no longer required, and consequently became less compliant with strict adherence to standard precautions. A third possible explanation is that environmental contamination may have played a role [49][50][51], as ESBL-PE can survive on surfaces for many months if disinfection is not well performed [10,52], leading to concerns about direct causality. Consequently, evaluating the environmental contamination and monitoring the established cleaning processes are critical [53].…”

Factors associated with urinary tract infection in a Nursing Home

“…In other researches, the results reaffirm this relationship, in which patients with intestinal incontinence developed UTI three times more than patients without intestinal incontinence (9,13) . On the other hand, it is important to note that research with urine culture isolates, in addition to reaffirming this association, identified in their findings a high prevalence in NH of elderly people with Enterobacteriaceae producing extendedspectrum beta-lactamase, i.e., multi-resistant bacteria (14)(15) . The authors also emphasize that those with intestinal incontinence should not sit or lie with feces for long periods, as it facilitates the transport of microorganisms, especially when in diarrheal situations.…”