36% of nursing home UTIs associated with resistant pathogens
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More than one-third of all UTIs reported in nursing homes were associated with a resistant pathogen, according to data published in Infection Control & Hospital Epidemiology.
“Antibiotic resistance (AR) is a global issue that impacts all health care settings. They can be used to inform facility infection prevention and antibiotic stewardship efforts,” Taniece R. Eure, MPH, public health professional for healthcare antibiotic resistance in the CDC’s Division of Healthcare Quality Promotion, told Healio. “The CDCs National Healthcare Safety Network (NHSN) has published AR data beginning in 2008, primarily for acute-care hospitals. This report, including selected AR phenotypes from UTIs reported to CDC’s NHSN, is the first to focus on nursing homes.”
Eure and colleagues analyzed pathogen and antibiotic susceptibility testing results for UTIs in nursing homes between January 2013 and December 2017.
According to the study, 243 nursing homes reported one or more UTIs, with more than 6,000 pathogens reported for 5,485 UTI events. The study showed that nine pathogens accounted for 90% of all reported UTIs, with the three most frequently identified being Escherichia coli (41%), Proteus species (14%) and Klebsiella pneumoniae/oxytoca (13%).
The study also showed that among E. coli, fluoroquinolone and extended-spectrum cephalosporin resistance were most prevalent 50% and 20%, respectively although Staphylococcus aureus and Enterococcus faecium had the highest rates of resistance (67% methicillin resistant and 60% vancomycin resistant, respectively). Additionally, multidrug resistance was most common in Pseudomonas aeruginosa (11%).
In their analysis, the researchers grouped pathogens and defined antibiotic resistance phenotypes based on criteria established by the NHSN. Of the 5,485 UTIs reported during the study period, 1,983 (36%) were caused by a pathogen that was resistant to one or more of those pathogen-antibiotic phenotypes.
”Monitoring AR in nursing homes is necessary to be able to understand the burden and inform antibiotic stewardship practices,” Eure concluded. “For example, we found that approximately 50% of UTIs caused by the pathogen E. coli were resistant to fluroquinolones, a class of antibiotics commonly used in nursing homes. Utilizing data from NHSN like this can further efforts on addressing the problem of AR in nursing homes.”
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