Management of Extended-Spectrum Beta-Lactamase Urinary Tract Infections: Diagnostic and Treatment Considerations for the Older Adult

2019 ◽  
Vol 34 (10) ◽  
pp. 645-659
Author(s):  
Kalin M. Clifford ◽  
Jennifer L. Grelle ◽  
John C. Tawwater ◽  
Meenakshi Ramanathan ◽  
Nakia Duncan
Keyword(s):  
Urinary Tract ◽  
Long Term Care ◽  
Care Facility ◽  
Beta Lactamase ◽  
Term Care ◽  
Extended Spectrum Beta Lactamase ◽  
Long Term Care Facility ◽  
Extended Spectrum ◽  
Tract Infections

OBJECTIVE: To review the treatment options for extended-spectrum beta-lactamase (ESBL) urinary tract infections (UTIs) in the long-term care facility setting.<br/> DATA SOURCES: A PubMed search from January 1, 1990, through December 31, 2018, using terms "extended spectrum beta lactamase" and "urinary tract infection" was performed. Current guidelines, drug databases, and manufacturer package inserts were also used.<br/> STUDY SELECTION: All English-language articles during the above time frame appearing in these searches were reviewed for relevance to this paper. In addition, their bibliographies were reviewed to identify any articles not originally identified.<br/> DATA SYNTHESIS: ESBL UTIs are a growing concern in the long-term care facility as these pathogens are becoming more prevalent. Patients residing in long-term care facilities have fewer treatment modalities because of medication administration and care issues. This review highlights the data on different antibiotics and their efficacy toward ESBLs in the setting of UTI.<br/> CONCLUSIONS: Despite the challenges and limitations, there are still options for clinicians to provide optimal care, including antibiotics with different routes of administration, as well as different administration techniques. Clinicians can be successful with treating ESBL UTIs in older adults.

Management of Extended-Spectrum Beta-Lactamase Urinary Tract Infections: Diagnostic and Treatment Considerations for the Older Adult

2019 ◽  
Vol 34 (10) ◽  
pp. 645-659
Author(s):  
Kalin M. Clifford ◽  
Jennifer L. Grelle ◽  
John C. Tawwater ◽  
Meenakshi Ramanathan ◽  
Nakia Duncan
Keyword(s):  
Urinary Tract ◽  
Long Term Care ◽  
Care Facility ◽  
Beta Lactamase ◽  
Term Care ◽  
Extended Spectrum Beta Lactamase ◽  
Long Term Care Facility ◽  
Extended Spectrum ◽  
Tract Infections

OBJECTIVE: To review the treatment options for extended-spectrum beta-lactamase (ESBL) urinary tract infections (UTIs) in the long-term care facility setting.<br/> DATA SOURCES: A PubMed search from January 1, 1990, through December 31, 2018, using terms "extended spectrum beta lactamase" and "urinary tract infection" was performed. Current guidelines, drug databases, and manufacturer package inserts were also used.<br/> STUDY SELECTION: All English-language articles during the above time frame appearing in these searches were reviewed for relevance to this paper. In addition, their bibliographies were reviewed to identify any articles not originally identified.<br/> DATA SYNTHESIS: ESBL UTIs are a growing concern in the long-term care facility as these pathogens are becoming more prevalent. Patients residing in long-term care facilities have fewer treatment modalities because of medication administration and care issues. This review highlights the data on different antibiotics and their efficacy toward ESBLs in the setting of UTI.<br/> CONCLUSIONS: Despite the challenges and limitations, there are still options for clinicians to provide optimal care, including antibiotics with different routes of administration, as well as different administration techniques. Clinicians can be successful with treating ESBL UTIs in older adults.

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.

scholarly journals Prolonged colonisation with Escherichia coli O25:ST131 versus other extended-spectrum beta-lactamase-producing E. coli in a long-term care facility with high endemic level of rectal colonisation, the Netherlands, 2013 to 2014

2016 ◽  
Vol 21 (42) ◽  
Author(s):  
Ilse Overdevest ◽  
Manon Haverkate ◽  
Jacobien Veenemans ◽  
Yvonne Hendriks ◽  
Carlo Verhulst ◽  
...  
Keyword(s):  
Long Term Care ◽  
Care Facility ◽  
Beta Lactamase ◽  
Term Care ◽  
Extended Spectrum Beta Lactamase ◽  
Long Term Care Facility ◽  
E Coli ◽  
Transmission Rates ◽  
Reproduction Numbers

The extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli clone ST131 (ESBL-ST131) has spread in healthcare settings worldwide. The reasons for its successful spread are unknown, but might include more effective transmission and/or longer persistence. We evaluated the colonisation dynamics of ESBL-producing E. coli (ESBL-EC), including ESBL-ST131, in a long-term care facility (LTCF) with an unusually high prevalence of rectal ESBL-EC colonisation. During a 14-month period, rectal or faecal samples were obtained from 296 residents during six repetitive prevalence surveys, using ESBL-selective culture. Transmission rates, reproduction numbers, and durations of colonisation were compared for ESBL-ST131 vs other ESBL-EC. Furthermore, the likely time required for ESBL-ST131 to disappear from the LTCF was estimated. Over time, the endemic level of ESBL-ST131 remained elevated whereas other ESBL-EC returned to low-level prevalence, despite comparable transmission rates. Survival analysis showed a half-life of 13 months for ESBL-ST131 carriage, vs two to three months for other ESBL-EC (p < 0.001). Per-admission reproduction numbers were 0.66 for ESBL-ST131 vs 0.56 for other ESBL-EC, predicting a mean time of three to four years for ESBL-ST131 to disappear from the LTCF under current conditions. Transmission rates were comparable for ESBL-ST131 vs other ESBL-EC. Prolonged rectal carriage explained the persistence of ESBL-ST131 in the LTCF.

scholarly journals Colonization with Extended-Spectrum β-Lactamase-ProducingEscherichia coliandKlebsiellaSpecies in Long-Term Care Facility Residents

2012 ◽  
Vol 33 (3) ◽  
pp. 302-304 ◽  
Author(s):  
Ebbing Lautenbach ◽  
Jennifer Han ◽  
Evelyn Santana ◽  
Pam Tolomeo ◽  
Warren B. Bilker ◽  
...  
Keyword(s):  
Risk Factors ◽  
Fecal Incontinence ◽  
Long Term Care ◽  
Care Facility ◽  
Infect Control Hosp ◽  
Term Care ◽  
Term Care Facility ◽  
Long Term Care Facility ◽  
Extended Spectrum

We describe the prevalence of and risk factors for colonization with extended-spectrum (3-lactamase-producing Enterobacteriaceae (ESBL-EB) in the long-term care facility (LTCF) setting. Colonization prevalence differed significantly across the 3 LTCFs evaluated in the study, with recent use of levofloxacin and fecal incontinence demonstrating borderline significant associations with ESBL-EB colonization.Infect Control Hosp Epidemiol2012;33(3):302-304

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