Distribution of Extended-Spectrum β-Lactamase Genes and Antimicrobial Susceptibility among Residents in Geriatric Long-Term Care Facilities in Japan

A high prevalence of extended-spectrum β-lactamase-producing Enterobacterales (ESBL-PE) may call for monitoring in geriatric long-term care facilities (g-LTCFs). We surveyed the distribution of ESBL-causative gene types and antimicrobial susceptibility in ESBL-PE strains from residents in g-LTCFs, and investigated the association between ESBL-causative gene types and antimicrobial susceptibility. First, we analyzed the types of ESBL-causative genes obtained from 141 ESBL-PE strains collected from the feces of residents in four Japanese g-LTCFs. Next, we determined the minimum inhibitory concentration values for alternative antimicrobial agents against ESBL-PE, including β-lactams and non-β-lactams. Escherichia coli accounted for 96% of the total ESBL-PE strains. Most strains (94%) contained blaCTX-M group genes. The genes most commonly underlying resistance were of the blaCTX-M-9 and blaCTX-M-1 groups. Little difference was found in the distribution of ESBL-causative genes among the facilities; however, antimicrobial susceptibility differed widely among the facilities. No specific difference was found between antimicrobial susceptibility and the number of ESBL-causative genes. Our data showed that ESBL-PEs were susceptible to some antimicrobial agents, but the susceptibility largely differed among facilities. These findings suggest that each g-LTCF may require specific treatment strategies based on their own antibiogram. Investigations into drug resistance should be performed in g-LTCFs as well as acute medical facilities.

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Association Between Length of Residence and Prevalence of Mrsa Colonization Among Residents in Geriatric Long-term Care Facilities

10.21203/rs.3.rs-74833/v1 ◽

2020 ◽

Author(s):

Teppei Sasahara ◽

Ryusuke Ae ◽

Akio Yoshimura ◽

Koki Kosami ◽

Kazumasa Sasaki ◽

...

Keyword(s):

Long Term Care ◽

Length Of Residence ◽

Term Care ◽

Initial Testing ◽

High Prevalence ◽

Care Facilities ◽

Cross Transmission ◽

Mrsa Colonization ◽

Geriatric Long Term Care

Abstract Background: A high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization has been reported among residents in geriatric long-term care facilities (LTCFs). Some studies indicate that MRSA might be imported from hospitals into LTCFs via resident transfer; however, other studies report that high MRSA prevalence might be caused by cross-transmission inside LTCFs. We aimed to assess which factors have a large impact on the high MRSA prevalence among residents of geriatric LTCFs.Methods: We conducted a cohort study among 260 residents of four geriatric LTCFs in Japan. Dividing participants into two cohorts, we separately analyzed (1) the association between prevalence of MRSA carriage and length of LTCF residence (Cohort 1: n=204), and (2) proportion of residents identified as MRSA negative who were initially tested at admission but subsequently identified as positive in secondary testing performed at ≥2 months after their initial test (Cohort 2: n=79).Results: Among 204 residents in Cohort 1, 20 (9.8%) were identified as positive for MRSA. Compared with residents identified as MRSA negative, a larger proportion of MRSA-positive residents had shorter periods of residence from the initial admission (median length of residence: 5.5 vs. 2.8 months), although this difference was not statistically significant (p=0.084). Among 79 residents in Cohort 2, 60 (75.9%) were identified as MRSA negative at the initial testing. Of these 60 residents, only one (1.7%) had subsequent positive conversion in secondary MRSA testing. In contrast, among 19 residents identified as MRSA positive in the initial testing, 10 (52.6%) were negative in secondary testing.Conclusions: The prevalence of MRSA was lower among residents with longer periods of LTCF residence than among those with shorter periods. Furthermore, few residents were found to become MRSA carrier after their initial admission. These findings highlight that MRSA in LTCFs is most likely to be associated with resident transfer rather than spread via cross-transmission inside LTCFs.

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Evolving Epidemiology and Cost of Resistance to Antimicrobial Agents in Long-Term Care Facilities

Journal of the American Medical Directors Association ◽

10.1097/01.jam.0000066029.00660.5a ◽

2003 ◽

Vol 4 (SUPPLEMENT) ◽

pp. S90-S99 ◽

Cited By ~ 1

Author(s):

Blair Capitano ◽

David P. Nicolau

Keyword(s):

Antimicrobial Agents ◽

Long Term Care ◽

Term Care ◽

Care Facilities ◽

Cost Of Resistance

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Behavioral Staff Training and Management in Geriatric Long-Term Care Facilities

Handbook of Clinical Behavior Therapy with the Elderly Client ◽

10.1007/978-1-4899-0638-0_19 ◽

1991 ◽

pp. 423-438 ◽

Cited By ~ 6

Author(s):

Louis D. Burgio

Keyword(s):

Staff Training ◽

Long Term Care ◽

Term Care ◽

Care Facilities ◽

Geriatric Long Term Care

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Association between length of residence and prevalence of MRSA colonization among residents in geriatric long-term care facilities

BMC Geriatrics ◽

10.1186/s12877-020-01885-1 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Teppei Sasahara ◽

Ryusuke Ae ◽

Akio Yoshimura ◽

Koki Kosami ◽

Kazumasa Sasaki ◽

...

Keyword(s):

Long Term Care ◽

Length Of Residence ◽

Term Care ◽

Initial Testing ◽

High Prevalence ◽

Care Facilities ◽

Cross Transmission ◽

Mrsa Colonization ◽

Geriatric Long Term Care

Abstract Background A high prevalence of methicillin-resistant Staphylococcus aureus (MRSA) colonization has been reported among residents in geriatric long-term care facilities (LTCFs). Some studies indicate that MRSA might be imported from hospitals into LTCFs via resident transfer; however, other studies report that high MRSA prevalence might be caused by cross-transmission inside LTCFs. We aimed to assess which factors have a large impact on the high MRSA prevalence among residents of geriatric LTCFs. Methods We conducted a cohort study among 260 residents of four geriatric LTCFs in Japan. Dividing participants into two cohorts, we separately analyzed (1) the association between prevalence of MRSA carriage and length of LTCF residence (Cohort 1: n = 204), and (2) proportion of residents identified as MRSA negative who were initially tested at admission but subsequently identified as positive in secondary testing performed at ≥2 months after their initial test (Cohort 2: n = 79). Results Among 204 residents in Cohort 1, 20 (9.8%) were identified as positive for MRSA. Compared with residents identified as MRSA negative, a larger proportion of MRSA-positive residents had shorter periods of residence from the initial admission (median length of residence: 5.5 vs. 2.8 months), although this difference was not statistically significant (p = 0.084). Among 79 residents in Cohort 2, 60 (75.9%) were identified as MRSA negative at the initial testing. Of these 60 residents, only one (1.7%) had subsequent positive conversion in secondary MRSA testing. In contrast, among 19 residents identified as MRSA positive in the initial testing, 10 (52.6%) were negative in secondary testing. Conclusions The prevalence of MRSA was lower among residents with longer periods of LTCF residence than among those with shorter periods. Furthermore, few residents were found to become MRSA carrier after their initial admission. These findings highlight that MRSA in LTCFs might be associated with resident transfer rather than spread via cross-transmission inside LTCFs.

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Extended-spectrum β-lactamase-producing Enterobacteriaceae colonisation in long-term care facilities: a systematic review and meta-analysis

International Journal of Antimicrobial Agents ◽

10.1016/j.ijantimicag.2017.08.003 ◽

2017 ◽

Vol 50 (5) ◽

pp. 649-656 ◽

Cited By ~ 21

Author(s):

Myrto Eleni Flokas ◽

Michail Alevizakos ◽

Fadi Shehadeh ◽

Nikolaos Andreatos ◽

Eleftherios Mylonakis

Keyword(s):

Systematic Review ◽

Long Term Care ◽

Meta Analysis ◽

Term Care ◽

Extended Spectrum ◽

Care Facilities

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Prevalence and Risk Factors for Multidrug-Resistant Organisms Colonization in Long-Term Care Facilities Around the World: A Review

Antibiotics ◽

10.3390/antibiotics10060680 ◽

2021 ◽

Vol 10 (6) ◽

pp. 680

Author(s):

Ángel Rodríguez-Villodres ◽

Cecilia Martín-Gandul ◽

Germán Peñalva ◽

Ana Belén Guisado-Gil ◽

Juan Carlos Crespo-Rivas ◽

...

Keyword(s):

Risk Factors ◽

Long Term Care ◽

Multidrug Resistant ◽

Term Care ◽

Extended Spectrum ◽

Increased Risk ◽

Modifiable Factors ◽

Care Facilities ◽

Multidrug Resistant Organisms

Elderly people confined to chronic care facilities face an increased risk of acquiring infections by multidrug-resistant organisms (MDROs). This review presents the current knowledge of the prevalence and risk factors for colonization by MDROs in long-term care facilities (LTCF), thereby providing a useful reference to establish objectives for implementing successful antimicrobial stewardship programs (ASPs). We searched in PubMed and Scopus for studies examining the prevalence of MDROs and/or risk factors for the acquisition of MDROs in LTCF. One hundred and thirty-four studies published from 1987 to 2020 were included. The prevalence of MDROs in LTCF varies between the different continents, where Asia reported the highest prevalence of extended-spectrum ß-lactamase (ESBL) Enterobacterales (71.6%), carbapenem resistant (CR) Enterobacterales (6.9%) and methicillin-resistant Staphylococcus aureus (MRSA) (25.6%) and North America the highest prevalence to MDR Pseudomonas aeruginosa (5.4%), MDR Acinetobacter baumannii (15.0%), vancomycin-resistant Enterococcus spp. (VRE) (4.0%), and Clostridioides difficile (26.1%). Furthermore, MDRO prevalence has experienced changes over time, with increases in MDR P. aeruginosa and extended spectrum ß-lactamase producing Enterobacterales observed starting in 2015 and decreases of CR Enterobacterales, MDR A. baumannii, VRE, MRSA and C. difficile. Several risk factors have been found, such as male sex, chronic wounds, the use of medical devices, and previous antibiotic use. The last of these aspects represents one of the most important modifiable factors for reducing colonization with MDROs through implementing ASPs in LTCF.

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Surveillance of Community-Based Reservoirs Reveals the Presence of CTX-M, Imported AmpC, and OXA-30 β-Lactamases in Urine Isolates of Klebsiella pneumoniae and Escherichia coli in a U.S. Community

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00877-08 ◽

2008 ◽

Vol 52 (10) ◽

pp. 3814-3816 ◽

Cited By ~ 31

Author(s):

Nancy D. Hanson ◽

Ellen Smith Moland ◽

S. G. Hong ◽

Katie Propst ◽

Deborah J. Novak ◽

...

Keyword(s):

Escherichia Coli ◽

Klebsiella Pneumoniae ◽

Long Term Care ◽

Outpatient Clinics ◽

Community Based ◽

Term Care ◽

Extended Spectrum ◽

Care Facilities

ABSTRACT β-Lactamases produced by urine isolates from patients in long-term care facilities (LTCFs), outpatient, clinics, and one hospital in a U.S. community were characterized. A total of 1.3% of all Escherichia coli and Klebsiella pneumoniae isolates collected from patients in 30 LTCFs and various outpatient clinics produced extended-spectrum β-lactamases (ESBLs) and/or imported AmpC β-lactamases.

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