Increased multi-drug resistance among the elderly on admission to the hospital—A 12-year surveillance study
Department of Medicine, Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA 02446, USA. Archives of gerontology and geriatrics
(Impact Factor: 1.85).
06/2012; 56(1). DOI: 10.1016/j.archger.2012.05.006
Resistance to antimicrobials continues to increase worldwide. Data suggest that older patients are among the main reservoirs of multidrug-resistant organisms (MDROs) in the hospital. We hypothesized that older patients (≥65 years of age) are more likely to harbor MDRO at hospital admission. We compared rates of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and multidrug-resistant gram-negative bacteria (MDRGN) recovered from clinical cultures within the first 48h of admission to an adult acute care hospital between the elderly (≥65 years old) and young per 1000 age-stratified admissions over a 12-year study period. Trends in antimicrobial resistance, sites of recovery and species for MDRGN were also characterized. An average of 7534 positive bacterial cultures were collected per year. The admission prevalence per 1000 age-stratified admissions was consistently higher among the elderly for all three MDRO under investigation. Among the elderly, the admission prevalence increased significantly for VRE (0.89 in 1998 to 3.62 in 2009 per 1000 admissions; p<0.001) and MDRGN (1.41 in 1998 to 11.33 in 2009 per 1000 admissions; p<0.001). Percentage resistant for all three MDRO increased as well. These data suggest that elderly patients are contributing substantially to the influx of MDRO into the hospital setting.
Available from: Yoshihiro Suzuki
- "Unfortunately, some enterococci are opportunistic pathogens that infect compromised hosts such as infants, hospital patients, and elderly.    With the development of new antimicrobial agents and use of increased dosage of antimicrobials in the medical treatment, drug-resistant enterococci that cause serious problems in the treatment of nosocomial infections have arisen.   Furthermore, the most serious drug-resistant enterococci, with high-level Address correspondence to Yoshihiro Suzuki, Department of Civil and Environmental Engineering, Faculty of Engineering, University of Miyazaki, Miyazaki 889-2192, Japan, E-mail: email@example.com "
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ABSTRACT: As a first step for assessing the risk to human health posed by vancomycin-resistant enterococci (VRE) in the aquatic environment, we screened sewage and urban river water samples from Miyazaki, Japan for VRE. Because vancomycin-resistant organisms are not as prevalent in sewage and river water as vancomycin-susceptible organisms, the samples were screened by minimum inhibitory concentration test using the vancomycin-supplemented membrane-Enterococcus indoxyl-β-d-glucoside (mEI) agar. The isolates, presumed to be enterococci, were identified using 16S rRNA sequencing analysis. The percentages of VRE isolates screened using 4 μg mL(-1) vancomycin-supplemented mEI agar from sewage and urban river water samples were 12% and 24%, respectively. The vancomycin-resistant genes vanC1 and vanC2/3 were detected in the isolates from both samples by PCR analysis. All enterococci isolates containing vanC1, which is a specific gene for vanC-type of VRE, were identified as Enterococcus casseliflavus/gallinarum. Further, 92% enterococci isolates containing vanC2/3 were identified as E. casseliflavus/gallinarum, the remaining isolates containing vanC2/3 were E. faecium (4%) and E. faecalis (4%). Thereafter, the distribution of E. faecium and E. faecalis, which are the major types of enterococci in humans containing vanC2/3, was observed in the water samples collected.
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Vancomycin-resistant enterococci (VRE) can be associated with serious bacteraemia. The focus of this study was to characterize the molecular epidemiology of VRE from bacteraemia cases that were isolated from 1999 to 2009 as part of Canadian Nosocomial Infection Surveillance Program (CNISP) surveillance activities.
From 1999 to 2009, enterococci were collected from across Canada in accordance with the CNISP VRE surveillance protocol. MICs were determined using broth microdilution. PCR was used to identify vanA, B, C, D, E, G and L genes. Genetic relatedness was examined using multilocus sequence typing (MLST).
A total of 128 cases of bacteraemia were reported to CNISP from 1999 to 2009. In 2007, a significant increase in bacteraemia rates was observed in western and central Canada. Eighty-one of the 128 bacteraemia isolates were received for further characterization and were identified as Enterococcus faecium. The majority of isolates were from western Canada (60.5%), followed by central (37.0%) and eastern (2.5%) Canada. Susceptibilities were as follows: daptomycin, linezolid, tigecycline and chloramphenicol, 100%; quinupristin/dalfopristin, 96.3%; high-level gentamicin, 71.6%; tetracycline, 50.6%; high-level streptomycin, 44.4%; rifampicin, 21.0%; nitrofurantoin, 11.1%; clindamycin, 8.6%; ciprofloxacin, levofloxacin and moxifloxacin, 1.2%; and ampicillin, 0.0%. vanA contributed to vancomycin resistance in 90.1% of isolates and vanB in 9.9%. A total of 17 sequence types (STs) were observed. Beginning in 2006 there was a shift in ST from ST16, ST17, ST154 and ST80 to ST18, ST412, ST203 and ST584.
The increase in bacteraemia observed since 2007 in western and central Canada appears to coincide with the shift of MLST STs. All VRE isolates remained susceptible to daptomycin, linezolid, chloramphenicol and tigecycline.
Available from: Stephanie Dancer
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ABSTRACT: There are enormous challenges facing infection control in the 21st century. Countries across the world are confronted by ageing populations, restricted healthcare resources, demands for modern medicine and increasing antimicrobial resistance. Problem pathogens in the community are set to invade hospitals, and those created in hospitals are seeding into the community. Continued consumption of antimicrobial agents is generating and consolidating resistance to nearly all classes of drugs. New resistance mechanisms arising in one locality rapidly spread across the 'global village' courtesy of migration, conflict and international travel. We are facing unprecedented threats to the management of infection both in healthcare and communities across the world. This review summarises the current challenges for infection control and proposes a range of solutions encompassing novel strategies and technologies aimed at protecting us against untreatable infection. © 2013 Australasian College for Infection Prevention and Control.
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