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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

Published online by Cambridge University Press:  12 August 2020

Taniece R. Eure*
Affiliation:
Division of Healthcare Quality and Promotion, Centers for Disease Control Prevention, Atlanta, GA, USA
Nimalie D. Stone
Affiliation:
Division of Healthcare Quality and Promotion, Centers for Disease Control Prevention, Atlanta, GA, USA
Elisabeth A. Mungai
Affiliation:
Division of Healthcare Quality and Promotion, Centers for Disease Control Prevention, Atlanta, GA, USA
Jeneita M. Bell
Affiliation:
Division of Healthcare Quality and Promotion, Centers for Disease Control Prevention, Atlanta, GA, USA
Nicola D. Thompson
Affiliation:
Division of Healthcare Quality and Promotion, Centers for Disease Control Prevention, Atlanta, GA, USA
*
Author for correspondence: Taniece R. Eure, E-mail: xge9@cdc.gov

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.

Type
Original Article
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved.

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Footnotes

PREVIOUS PRESENTATION: Selected data included in this manuscript were presented in an oral abstract at IDWeek, October 7, 2017, in San Diego, California.

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