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Antibiotic Susceptibility of Common Organisms Isolated from Urine Cultures of Nursing Home Residents

Published online by Cambridge University Press:  02 November 2020

Austin R. Penna
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention. Atlanta, GA
Taniece R. Eure Eure
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention. Atlanta, GA
Nimalie D. Stone
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention. Atlanta, GA
Grant Barney
Affiliation:
New York Emerging Infections Program. Rochester, NY
Devra Barter
Affiliation:
Colorado Department of Public Health and Environment. Denver, CO
Paula Clogher
Affiliation:
Connecticut Emerging Infections Program and the Yale School of Public Health. New Haven, CT
Ghinwa Dumyati
Affiliation:
New York Emerging Infections Program and University of Rochester Medical Center. Rochester, NY
Erin Epson
Affiliation:
California Department of Health. Richmond, CA
Christina B. Felsen
Affiliation:
New York Emerging Infections Program and University of Rochester Medical Center. Rochester, NY
Linda Frank
Affiliation:
California Emerging Infections Program. Oakland, CA
Deborah Godine
Affiliation:
California Emerging Infections Program. Oakland, CA
Lourdes Irizarry
Affiliation:
New Mexico Department of Health. Santa Fe, NM
Helen Johnston
Affiliation:
Colorado Department of Public Health and Environment. Denver, CO
Marion A. Kainer
Affiliation:
Tennessee Department of Health. Nashville, TN
Linda Li
Affiliation:
Maryland Department of Health. Baltimore, MD
Ruth Lynfield
Affiliation:
Minnesota Department of Health. St. Paul, MN
JP Mahoehney
Affiliation:
Minnesota Department of Health. St. Paul, MN
Joelle Nadle
Affiliation:
California Emerging Infections Program. Oakland, CA
Susan M. Ray
Affiliation:
Georgia Emerging Infections Program and Emory University. Atlanta, GA
Sarah Shrum Davis
Affiliation:
New Mexico Department of Health. Santa Fe, NM
Marla Sievers
Affiliation:
New Mexico Department of Health. Santa Fe, NM
Krithika Srinivasan
Affiliation:
Connecticut Emerging Infections Program and the Yale School of Public Health. New Haven, CT
Lucy E. Wilson
Affiliation:
Maryland Department of Health. Baltimore, MD
Alexia Y. Zhang
Affiliation:
Oregon Health Authority. Portland, OR
Shelley S. Magill
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention. Atlanta, GA
Nicola D. Thompson
Affiliation:
Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention. Atlanta, GA
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Abstract

Background: With the emergence of antibiotic resistant threats and the need for appropriate antibiotic use, laboratory microbiology information is important to guide clinical decision making in nursing homes, where access to such data can be limited. Susceptibility data are necessary to inform antibiotic selection and to monitor changes in resistance patterns over time. To contribute to existing data that describe antibiotic resistance among nursing home residents, we summarized antibiotic susceptibility data from organisms commonly isolated from urine cultures collected as part of the CDC multistate, Emerging Infections Program (EIP) nursing home prevalence survey. Methods: In 2017, urine culture and antibiotic susceptibility data for selected organisms were retrospectively collected from nursing home residents’ medical records by trained EIP staff. Urine culture results reported as negative (no growth) or contaminated were excluded. Susceptibility results were recorded as susceptible, non-susceptible (resistant or intermediate), or not tested. The pooled mean percentage tested and percentage non-susceptible were calculated for selected antibiotic agents and classes using available data. Susceptibility data were analyzed for organisms with ≥20 isolates. The definition for multidrug-resistance (MDR) was based on the CDC and European Centre for Disease Prevention and Control’s interim standard definitions. Data were analyzed using SAS v 9.4 software. Results: Among 161 participating nursing homes and 15,276 residents, 300 residents (2.0%) had documentation of a urine culture at the time of the survey, and 229 (76.3%) were positive. Escherichia coli, Proteus mirabilis, Klebsiella spp, and Enterococcus spp represented 73.0% of all urine isolates (N = 278). There were 215 (77.3%) isolates with reported susceptibility data (Fig. 1). Of these, data were analyzed for 187 (87.0%) (Fig. 2). All isolates tested for carbapenems were susceptible. Fluoroquinolone non-susceptibility was most prevalent among E. coli (42.9%) and P. mirabilis (55.9%). Among Klebsiella spp, the highest percentages of non-susceptibility were observed for extended-spectrum cephalosporins and folate pathway inhibitors (25.0% each). Glycopeptide non-susceptibility was 10.0% for Enterococcus spp. The percentage of isolates classified as MDR ranged from 10.1% for E. coli to 14.7% for P. mirabilis. Conclusions: Substantial levels of non-susceptibility were observed for nursing home residents’ urine isolates, with 10% to 56% reported as non-susceptible to the antibiotics assessed. Non-susceptibility was highest for fluoroquinolones, an antibiotic class commonly used in nursing homes, and ≥ 10% of selected isolates were MDR. Our findings reinforce the importance of nursing homes using susceptibility data from laboratory service providers to guide antibiotic prescribing and to monitor levels of resistance.

Disclosures: None

Funding: None

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