scholarly journals Uropathogens and Antibiotic Resistance Among Nursing Home Residents - National Healthcare Safety Network (NHSN)

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S51-S51
Author(s):  
Taniece Eure ◽  
Nimalie D Stone ◽  
Nicola D Thompson ◽  
Jeneita Bell ◽  
Elisabeth Mungai
Keyword(s):  
Antibiotic Resistance ◽  
Nursing Homes ◽  
Methicillin Resistance ◽  
Bacterial Species ◽  
Nursing Home Residents ◽  
Care Facility ◽  
Antibiotic Prescribing ◽  
Term Care ◽  
National Healthcare ◽  
National Healthcare Safety Network

Abstract Background Knowledge of urinary tract infection (UTI) pathogen and susceptibility patterns is necessary to inform antibiotic prescribing and monitor resistance. We describe bacterial pathogens and UTI antibiotic resistance patterns among residents in nursing homes (NHs) reporting to the National Healthcare Safety Network (NHSN) long-term care facility (LTCF) component. Methods All UTI events from January 1, 2013 to December 31, 2016 were included; up to three organisms per UTI event may be reported. Pathogen susceptibility results for selected antibiotics are reported as: Susceptible (S), Intermediate (I), Resistant (R), or Not tested (N). For this analysis, resistance was defined as I or R. We described pathogens and summarized antibiotic resistance only when ≥100 isolates of a bacterial species had susceptibility test results for a particular antibiotic reported to NHSN. Results In 166 NHs located in 37 states, a total of 4,054 pathogens were reported for 2,827 residents. Six organisms accounted for 81% of all UTI events (n = 3,599) (Table). A large proportion of Escherichia coli isolates, which accounted for 41% of uropathogens, were resistant to trimethoprim-sulfamethoxazole (35%) and levofloxacin (50%). Among Proteus mirabilis isolates, 53% were resistant to levofloxacin (Figure). Methicillin resistance was 74% among Staphylococcus aureus, and vancomycin resistance among Enterococcus spp. was 18%. Conclusion This is the first summary of UTI pathogens and susceptibility data from U.S. nursing homes reporting to a national surveillance system. Resistance to antibiotics commonly used to treat UTIs was high. Tracking and preventing resistance for key pathogens is a CDC priority and NHSN reporting by NHs provides a crucial opportunity to track antibiotic resistance, highlighting the importance of enrolling more NHs into NHSN. Disclosures All authors: No reported disclosures.

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

2020 ◽  
Vol 42 (1) ◽  
pp. 31-36
Author(s):  
Taniece R. Eure ◽  
Nimalie D. Stone ◽  
Elisabeth A. Mungai ◽  
Jeneita M. Bell ◽  
Nicola D. Thompson
Keyword(s):  
Urinary Tract ◽  
Nursing Homes ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Long Term Care Facility ◽  
National Healthcare ◽  
National Healthcare Safety Network ◽  
Tract Infections

AbstractObjective: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.

Implementation of core elements of antibiotic stewardship in nursing homes—National Healthcare Safety Network, 2016–2018

2021 ◽  
pp. 1-5
Author(s):  
Katryna A. Gouin ◽  
Sarah Kabbani ◽  
Angela Anttila ◽  
Josephine Mak ◽  
Elisabeth Mungai ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Antibiotic Stewardship ◽  
Antibiotic Use ◽  
Infection Prevention And Control ◽  
Term Care ◽  
National Healthcare ◽  
The Core ◽  
National Healthcare Safety Network ◽  
Core Elements

Abstract Objective: To assess the national uptake of the Centers for Disease Control and Prevention’s (CDC) core elements of antibiotic stewardship in nursing homes from 2016 to 2018 and the effect of infection prevention and control (IPC) hours on the implementation of the core elements. Design: Retrospective, repeated cross-sectional analysis. Setting: US nursing homes. Methods: We used the National Healthcare Safety Network (NHSN) Long-Term Care Facility Component annual surveys from 2016 to 2018 to assess nursing home characteristics and percent implementation of the core elements. We used log-binomial regression models to estimate the association between weekly IPC hours and the implementation of all 7 core elements while controlling for confounding by facility characteristics. Results: We included 7,506 surveys from 2016 to 2018. In 2018, 71% of nursing homes reported implementation of all 7 core elements, a 28% increase from 2016. The greatest increases in implementation from 2016 to 2018 were in education (19%), reporting (18%), and drug expertise (15%). In 2018, 71% of nursing homes reported pharmacist involvement in improving antibiotic use, an increase of 27% since 2016. Nursing homes that reported at least 20 hours of IPC activity per week were 14% (95% confidence interval, 7%–20%) more likely to implement all 7 core elements when controlling for facility ownership and affiliation. Conclusions: Nursing homes reported substantial progress in antibiotic stewardship implementation from 2016 to 2018. Improvements in access to drug expertise, education, and reporting antibiotic use may reflect increased stewardship awareness and resource use among nursing home providers under new regulatory requirements. Nursing home stewardship programs may benefit from increased IPC staff hours.

scholarly journals The National Healthcare Safety Network Long-term Care Facility Component early reporting experience: January 2013-December 2015

2018 ◽  
Vol 46 (6) ◽  
pp. 637-642 ◽  
Author(s):  
Danielle L. Palms ◽  
Elisabeth Mungai ◽  
Taniece Eure ◽  
Angela Anttila ◽  
Nicola D. Thompson ◽  
...  
Keyword(s):  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
National Healthcare ◽  
National Healthcare Safety Network

scholarly journals The Forgotten Psychopathology of Depressed Long-Term Care Facility Residents: A Call for Evidence-Based Practice

2021 ◽  
pp. 38-44
Author(s):  
Alcina Matos Queirós ◽  
Armin von Gunten ◽  
Manuela  Martins ◽  
Nathalie I.H. Wellens ◽  
Henk Verloo
Keyword(s):  
Older Adults ◽  
Nursing Homes ◽  
Psychiatric Disorders ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Care Facility ◽  
Term Care ◽  
Care Facilities ◽  
Health Complications

Introduction: As Earth’s population is rapidly aging, the question of how best to care for its older adults suffering from psychiatric disorders is becoming a constant and growing preoccupation. Depression is one of the most common psychiatric disorders among older adults, and depressed nursing home residents are at a particularly high risk of a decreased quality of life. The complex requirements of supporting and caring for depressed older adults in nursing homes demand the development and implementation of innovative clinical and organizational models that can ensure early identification of the disorder and high-quality multidisciplinary services for dealing with it. This perspective article aims to provide an overview of the literature and the state of the art of and the urgent need for research on the epidemiology and clinical treatment of depression among older adults. Method: In collaboration with a medical librarian, we conducted literature and bibliometric reviews of published articles in Medline Ovid SP from inception until September 30, 2020, to identify studies related to depression, depressive symptoms, mood disorders, dementia, cognitive disorders, and health complications in long-term care facilities and nursing homes. Results: We had 38,777 and 40,277 hits for depression and dementia, respectively, in long-term care facilities or nursing homes. The search equation found 536 and 1,447 studies exploring depression and dementia, respectively, and their related health complications in long-term care facilities or nursing homes. Conclusion: Depression’s relationships with other health complications have been poorly studied in long-term care facilities and nursing homes. More research is needed to understand them better.

scholarly journals Nursing home adoption of the National Healthcare Safety Network Long-term Care Facility Component

2019 ◽  
Vol 47 (1) ◽  
pp. 59-64 ◽  
Author(s):  
Andrew W. Dick ◽  
Jeneita M. Bell ◽  
Nimalie D. Stone ◽  
Ashley M. Chastain ◽  
Mark Sorbero ◽  
...  
Keyword(s):  
Nursing Home ◽  
Long Term Care ◽  
Care Facility ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
National Healthcare ◽  
National Healthcare Safety Network

Issues in the Management of Resistant Bacteria in Long-Term–Care Facilities

1999 ◽  
Vol 20 (05) ◽  
pp. 362-366 ◽  
Author(s):  
Suzanne F. Bradley
Keyword(s):  
Antibiotic Resistance ◽  
Nursing Homes ◽  
Long Term Care ◽  
Nursing Home Residents ◽  
Resistant Bacteria ◽  
Term Care ◽  
Antibiotic Resistant ◽  
Care Facilities ◽  
Scant Attention

AbstractThe prevalence of antibiotic-resistant bacteria in the long-term–care setting and the risk to nursing home residents is still unknown. Few studies have been done in community-based nursing homes, and most have focused on colonization rather than infection rates. Concerns about methicillin-resistantStaphylococcus aureusand vancomycin-resistant enterococci have been expressed most often, while relatively scant attention has been paid to the problem of antibiotic resistance in gram-negative bacilli. Antibiotic resistance precautions need to be developed for nursing homes that are simple, effective, inexpensive, and recognize the unique rehabilitative and long-term custodial missions of chronic-care facilities.

scholarly journals 178. Implementation of the Core Elements of Antibiotic Stewardship in Nursing Homes – National Healthcare Safety Network (NHSN), 2016–2018

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S96-S96
Author(s):  
Katryna A Gouin ◽  
Sarah Kabbani; Angela Anttila ◽  
Josephine Mak ◽  
Elisabeth Mungai ◽  
Ti Tanissha McCray ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Antibiotic Stewardship ◽  
Care Facility ◽  
Antibiotic Use ◽  
Infection Prevention And Control ◽  
Term Care ◽  
Long Term Care Facility ◽  
The Core ◽  
Use Of Resources ◽  
Core Elements

Abstract Background Since 2016, nursing homes (NHs) enrolled in the Centers for Disease Control and Prevention’s NHSN Long-term Care Facility (LTCF) Component have reported on their implementation of the core elements of antibiotic stewardship. In 2016, 42% of NHs reported implementing all seven core elements. Recent regulations require antibiotic stewardship programs in NHs. The objectives of this analysis were to track national progress in implementation of the core elements and evaluate how time dedicated to infection prevention and control (IPC) is associated with the implementation of the core elements. Methods We used the NHSN LTCF 2016–2018 Annual Surveys to assess NH characteristics and implementation of the core elements, defined as self-reported implementation of at least one corresponding stewardship activity. We reported absolute differences in percent implementation. We used log-binomial regression models to estimate the association between weekly IPC hours and the implementation of all seven core elements, while controlling for confounding by facility characteristics. Results We included 7,506 surveys from 2016–2018. In 2018, 71% of NHs reported implementation of all seven core elements, a 28% increase from 2016 (Fig. 1). The greatest increases in implementation from 2016–2018 were in Education (+19%), Reporting (+18%) and Drug Expertise (+15%) (Fig. 2). Ninety-eight percent of NHs had an individual responsible for antibiotic stewardship activities (Accountability), with 30% indicating that the role was fulfilled by an infection preventionist. Furthermore, 71% of NHs reported pharmacist involvement in improving antibiotic use, an increase of 27% since 2016. NHs that reported at least 20 hours of IPC activity per week were 14% more likely to implement all seven core elements, when controlling for facility ownership and affiliation, 95% CI: (1.07, 1.20). Conclusion NHs reported substantial progress in antibiotic stewardship implementation from 2016–2018. Improvements in accessing drug expertise, providing education and reporting antibiotic use may reflect increased stewardship awareness and use of resources among NH providers under new regulatory requirements. NHs with at least 20 hours dedicated to IPC per week may have greater capacity to implement all core elements. Disclosures All Authors: No reported disclosures

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

2020 ◽  
Vol 41 (S1) ◽  
pp. s118-s120
Author(s):  
Austin R. Penna ◽  
Taniece R. Eure Eure ◽  
Nimalie D. Stone ◽  
Grant Barney ◽  
Devra Barter ◽  
...  
Keyword(s):  
Nursing Home ◽  
Nursing Homes ◽  
Antibiotic Susceptibility ◽  
Clinical Decision Making ◽  
Service Providers ◽  
Urine Culture ◽  
Nursing Home Residents ◽  
Antibiotic Prescribing ◽  
E Coli ◽  
Susceptibility Data

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: NoneFunding: None

scholarly journals 2051. Frequency of Inappropriate Antibiotic Prescribing in Nursing Homes

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S691-S691
Author(s):  
Chitra Kanchagar ◽  
Brie N Noble ◽  
Christopher Crnich ◽  
Jessina C McGregor ◽  
David T Bearden ◽  
...  
Keyword(s):  
Nursing Homes ◽  
Tract Infection ◽  
Multidrug Resistant ◽  
Antibiotic Prescribing ◽  
Prescribing Practices ◽  
Term Care ◽  
Antibiotic Overuse ◽  
For Profit ◽  
Memory Care ◽  
Minimum Criteria

Abstract Background Antibiotics are among the most prescribed medications in nursing homes (NHs). The increasing incidence of multidrug-resistant and C. Difficile infections due to antibiotic overuse has driven the requirement for NHs to establish antibiotic stewardship programs (ASPs). However, estimates of the frequency of inappropriate antibiotic prescribing in NHs have varied considerably between studies. We evaluated the frequency of inappropriate antibiotic prescribing in a multi-state sample of NHs. Methods We utilized a retrospective, (20%) random sample of residents of 17 for-profit NHs in Oregon, California, and Nevada who received antibiotics between January 1, 2017 and May 31, 2018. Study NHs ranged in size from 50 to 188 beds and offered services including subacute care, long-term care, ventilator care, and Alzheimer’s/memory care. Data were collected from residents’ electronic medical records. Antibiotic appropriateness was defined using Loeb Minimum Criteria for initiation of antibiotics for residents with indications for lower respiratory tract infection (LRTI), urinary tract infection (UTI) and skin and soft-tissue infection (SSTI). Residents with other types of infections were excluded from the study. Results Among 232 antibiotic prescriptions reviewed, 61% (141/232) were initiated in the NH. Of these, 65% were for female residents and 81% were for residents above the age of 65. Nearly 70% (98/141) of antibiotic prescriptions were for an indication of an LRTI, UTI, or SSTI of which 51% (57% of LRTIs, 52% of UTIs, and 35% of SSTIs) did not meet the Loeb Minimum Criteria and were determined to be inappropriate. Among antibiotics that did not meet the Loeb Minimum Criteria, more than half were cephalosporins (40%) or fluoroquinolones (14%) and the median (interquartile range) duration of therapy was 7 (5–10) days. Conclusion These data from a multi-state sample of NHs suggest the continued need for improvement in antibiotic prescribing practices and the importance of ASPs in NHs. Disclosures All authors: No reported disclosures.

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