Testing probiotic strain Escherichia coli Nissle 1917 (Mutaflor) for its ability to reduce carriage of multidrug-resistant E. coli by elderly residents in long-term care facilities

A high carriage rate of multidrug-resistant Escherichia coli (MDREC) was observed in elderly residents in long-term care facilities. A double-blinded, placebo-controlled trial was carried out to determine whether the probiotic product E. coli strain Nissle 1917 (Mutaflor) would compete with MDREC in the bowel and thereby reduce the prevalence of the multiresistant bacteria in faeces and urine. Sixty-nine patients excreting norfloxacin-resistant E. coli were randomized to probiotic or placebo groups and administered capsules twice daily. The daily dose of probiotic was 5×109–5×1010 bacteria. Faecal and urine samples were cultured at baseline and during and after the treatment period. A reduction in baseline carriage was not influenced by probiotic administration. The probiotic strain was detected in faecal specimens collected during the treatment period of only two out of 12 probiotic group subjects that were tested. Genotyping of norfloxacin-resistant E. coli isolates showed that 32 strains were prevalent among the patients. Thus, E. coli Nissle 1917 does not have the capacity to compete effectively with MDREC in the bowel of elderly patients.

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Long-Term Care Facilities Are Reservoirs for Antimicrobial-Resistant Sequence Type 131 Escherichia coli

Open Forum Infectious Diseases ◽

10.1093/ofid/ofv011 ◽

2015 ◽

Vol 2 (1) ◽

Cited By ~ 25

Author(s):

Mary J. Burgess ◽

James R. Johnson ◽

Stephen B. Porter ◽

Brian Johnston ◽

Connie Clabots ◽

...

Keyword(s):

Risk Factors ◽

Escherichia Coli ◽

Gel Electrophoresis ◽

Long Term Care ◽

Pulsed Field Gel Electrophoresis ◽

Sequence Type ◽

Term Care ◽

E Coli ◽

Care Facilities

Abstract Background. Emerging data implicate long-term care facilities (LTCFs) as reservoirs of fluoroquinolone-resistant (FQ-R) Escherichia coli of sequence type 131 (ST131). We screened for ST131 among LTCF residents, characterized isolates molecularly, and identified risk factors for colonization. Methods. We conducted a cross-sectional study using a single perianal swab or stool sample per resident in 2 LTCFs in Olmsted County, Minnesota, from April to July 2013. Confirmed FQ-R E. coli isolates underwent polymerase chain reaction-based phylotyping, detection of ST131 and its H30 and H30-Rx subclones, extended virulence genotyping, and pulsed-field gel electrophoresis (PFGE) analysis. Epidemiological data were collected from medical records. Results. Of 133 fecal samples, 33 (25%) yielded FQ-R E. coli, 32 (97%) of which were ST131. The overall proportion with ST131 intestinal colonization was 32 of 133 (24%), which differed by facility: 17 of 41 (42%) in facility 1 vs 15 of 92 (16%) in facility 2 (P = .002). All ST131 isolates represented the H30 subclone, with virulence gene and PFGE profiles resembling those of previously described ST131 clinical isolates. By PFGE, certain isolates clustered both within and across LTCFs. Multivariable predictors of ST131 colonization included inability to sign consent (odds ratio [OR], 4.16 [P = .005]), decubitus ulcer (OR, 4.87 [ P = .04]), and fecal incontinence (OR, 2.59 [P = .06]). Conclusions. Approximately one fourth of LTCF residents carried FQ-R ST131 E. coli resembling ST131 clinical isolates. Pulsed-field gel electrophoresis suggested intra- and interfacility transmission. The identified risk factors suggest that LTCF residents who require increased nursing care are at greatest risk for ST131 colonization, possibly due to healthcare-associated transmission.

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Colonization by multidrug-resistant bacteria in long-term care facilities in Italy: a point-prevalence study

10.26226/morressier.56d6be7dd462b80296c95997 ◽

2016 ◽

Author(s):

Maria Giufre'

Keyword(s):

Long Term Care ◽

Multidrug Resistant ◽

Point Prevalence ◽

Prevalence Study ◽

Resistant Bacteria ◽

Multidrug Resistant Bacteria ◽

Term Care ◽

Point Prevalence Study ◽

Care Facilities

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Low prevalence of colonization with multidrug-resistant gram-negative bacteria in long-term care facilities in Graz, Austria

American Journal of Infection Control ◽

10.1016/j.ajic.2017.07.004 ◽

2018 ◽

Vol 46 (1) ◽

pp. 76-80 ◽

Cited By ~ 1

Author(s):

Eva Leitner ◽

Elisabeth Zechner ◽

Elisabeth Ullrich ◽

Gernot Zarfel ◽

Josefa Luxner ◽

...

Keyword(s):

Long Term Care ◽

Multidrug Resistant ◽

Gram Negative Bacteria ◽

Term Care ◽

Gram Negative ◽

Care Facilities ◽

Low Prevalence

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High prevalence of multidrug resistant Enterobacteriaceae among residents of long term care facilities in Amsterdam, the Netherlands

PLoS ONE ◽

10.1371/journal.pone.0222200 ◽

2019 ◽

Vol 14 (9) ◽

pp. e0222200 ◽

Cited By ~ 1

Author(s):

Eline van Dulm ◽

Aletta T. R. Tholen ◽

Annika Pettersson ◽

Martijn S. van Rooijen ◽

Ina Willemsen ◽

...

Keyword(s):

The Netherlands ◽

Long Term Care ◽

Multidrug Resistant ◽

Term Care ◽

High Prevalence ◽

Care Facilities

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Escherichia coli Sequence Type 131 Is a Dominant, Antimicrobial-Resistant Clonal Group Associated with Healthcare and Elderly Hosts

Infection Control and Hospital Epidemiology ◽

10.1086/669865 ◽

2013 ◽

Vol 34 (4) ◽

pp. 361-369 ◽

Cited By ~ 87

Author(s):

Ritu Banerjee ◽

Brian Johnston ◽

Christine Lohse ◽

Stephen B. Porter ◽

Connie Clabots ◽

...

Keyword(s):

Escherichia Coli ◽

Long Term Care ◽

Tertiary Care ◽

Sequence Type ◽

Olmsted County ◽

Term Care ◽

Clonal Group ◽

E Coli ◽

Healthcare Settings

Objective.To determine prevalence, predictors, and outcomes of infection due to Escherichia coli sequence type ST131.Design.Retrospective cohort.Setting.All healthcare settings in Olmsted County, Minnesota (eg, community hospital, tertiary care center, long-term care facilities, and ambulatory clinics).Patients.Ambulatory and hospitalized children and adults with extraintestinal E. coli isolates.Methods.We analyzed 299 consecutive, nonduplicate extraintestinal E. coli isolates submitted to Olmsted County laboratories in February and March 2011. ST131 was identified using single-nucleotide polymorphism polymerase chain reaction and further evaluated through pulsed-field gel electrophoresis. Associated clinical data were abstracted through medical record review.Results.Most isolates were from urine specimens (90%), outpatients (68%), and community-associated infections (61%). ST131 accounted for 27% of isolates overall and for a larger proportion of those isolates resistant to fluoroquinolones (81%), trimethoprim-sulfamethoxazole (42%), gentamicin (79%), and ceftriaxone (50%). The prevalence of ST131 increased with age (accounting for 5% of isolates from those 11–20 years of age, 26% of isolates from those 51–60 years of age, and 50% of isolates from those 91–100 years of age). ST131 accounted for a greater proportion of healthcare-associated isolates (49%) than community-associated isolates (15%) and for fully 76% of E. coli isolates from long-term care facility (LTCF) residents. Multivariable predictors of ST131 carriage included older age, LTCF residence, previous urinary tract infection, high-complexity infection, and previous use of fluoroquinolones, macrolides, and extended-spectrum cephalosporins. With multivariable adjustment, ST131-associated infection outcomes included receipt of more than 1 antibiotic (odds ratio [OR], 2.54 [95% confidence interval (CI), 1.25–5.17]) and persistent or recurrent symptoms (OR, 2.53 [95% CI, 1.08–5.96]). Two globally predominant ST131 pulsotypes accounted for 45% of STB 1 isolates.Conclusions.ST131isa dominant, antimicrobial-resistant clonal group associated with healthcare settings, elderly hosts, and persistent or recurrent symptoms.

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1238. A National Comparison of Antibiograms Between Veterans Affairs Long-Term Care Facilities and Affiliated Hospitals

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.1071 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S376-S377 ◽

Cited By ~ 1

Author(s):

Maria-Stephanie Tolg ◽

Aisling Caffrey ◽

Haley Appaneal ◽

Robin Jump ◽

Vrishali Lopes ◽

...

Keyword(s):

Long Term Care ◽

Veterans Affairs ◽

Self Report ◽

Chi Square ◽

Term Care ◽

E Coli ◽

Care Facilities ◽

National Comparison ◽

Research Grant

Abstract Background Long-term care facilities (LTCFs) face several barriers to creating antibiograms. Here, we evaluate if LTCFs can use antibiograms from affiliated hospitals as their own antibiogram. Methods Facility-specific antibiograms were created for all Veterans Affairs (VA) LTCFs and VA Medical Centers (VAMCs) for 2017. LTCFs and affiliated VAMCs were paired and classified as being on the same campus or geographically distinct campuses based on self-report. For each pair, Escherichia coli susceptibility rates (%S) to cefazolin, ceftriaxone, cefepime, ciprofloxacin, nitrofurantoin, sulfamethoxazole/trimethoprim, ampicillin/sulbactam, piperacillin/tazobactam, and imipenem were compared. As guidelines discourage empiric use of antibiotics if susceptibility rates are <80%, we assessed clinical discordance between each LTCF and affiliated VAMC antibiogram at a threshold of 80% susceptible. The proportions of concordant susceptibilities between LTCFs and VAMCs on the same campus vs. geographically distinct campuses were compared using Chi-square tests. Results A total of 119 LTCFs and their affiliated VAMCs were included in this analysis, with 70.6% (n = 84) of facilities located on the same campus and 29.4% (n = 35) on geographically distinct campuses. The table below shows the overall clinical concordance (agreement) of LTCFs with their affiliated VAMC in regards to E. coli %S to the compared antibiotics. No significant differences were found when comparing LTCFs on the same campus vs. geographically distinct campuses. Conclusion Antibiograms between LTCFs and affiliated VAMCs had a high concordance, except for sulfamethoxazole/trimethoprim, cefazolin and ceftriaxone in regards to susceptibility rates of E. coli. Facilities on the same campus were found to have similar concordance rates to geographically distinct facilities. Future studies are needed to investigate how the various approaches to creating LTCF-specific antibiograms are associated with clinical outcomes. Disclosures M. S. Tolg, Veterans Affairs: Investigator, Research grant. A. Caffrey, Veterans Affairs: Investigator, Research grant. H. Appaneal, Veterans Affairs: Grant Investigator, Research grant. R. Jump, Veterans Affairs: Investigator, Research grant. V. Lopes, Veterans Affairs: Investigator, Research grant. D. Dosa, Veterans Affairs: Grant Investigator, Research grant. K. LaPlante, Veterans Affairs: Investigator, Research grant.

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