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Long-Term Carriage of Ciprofloxacin-Resistant Escherichia coli Isolates in High-Risk Nursing Home Residents

Published online by Cambridge University Press:  19 January 2016

Miriam D. Ismail ,
Ting Luo ,
Sara McNamara ,
Bonnie Lansing ,
Evonne Koo ,
Lona Mody  and
Betsy Foxman
Miriam D. Ismail
Affiliation:
Center for Molecular and Clinical Epidemiology of Infectious Diseases, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
Ting Luo
Affiliation:
Center for Molecular and Clinical Epidemiology of Infectious Diseases, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
Sara McNamara
Affiliation:
Infection Prevention in Aging Research Group, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Bonnie Lansing
Affiliation:
Infection Prevention in Aging Research Group, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Evonne Koo
Affiliation:
Infection Prevention in Aging Research Group, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Lona Mody
Affiliation:
Infection Prevention in Aging Research Group, Division of Geriatric and Palliative Medicine, University of Michigan Medical School, Ann Arbor, Michigan.
Betsy Foxman*
Affiliation:
Center for Molecular and Clinical Epidemiology of Infectious Diseases, Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, Michigan
*
Address correspondence to Betsy Foxman, PhD, Department of Epidemiology, University of Michigan, M5108 SPH II, 1415 Washington Heights, Ann Arbor, MI, 48109-2029 (bfoxman@umich.edu).
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Abstract

BACKGROUND

Rates of multidrug-resistant gram-negative organisms are surpassing those of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci in nursing homes (NHs).

OBJECTIVE

To characterize the incidence and duration of carriage of ciprofloxacin-resistant Escherichia coli (CipREc) in NHs and identify those in the O25b-ST131 lineage.

METHODS

We collected 227 CipREc isolates obtained by routine and regular surveillance of high-risk NH residents with indwelling devices. Repetitive element palindromic (REP)–polymerase chain reaction assay and multiplex polymerase chain reaction amplification for O25b-ST131 E. coli detection were performed using (GTG)5-primers and O25pabBspe and trpA2 primer pairs, respectively.

RESULTS

We found a high period prevalence of CipREc colonization (21.5%), high rates of recolonization with the same strain following clearing (0.46 recolonizations/ person/ year), and an acquisition incidence of 1.05 cases/1,000 person-days. Almost three-quarters of colonized residents carried strains in the O25b-ST131 E. coli lineage. Compared with isolates not in the lineage, O25b-ST131 isolates were carried significantly longer (10 vs 3 months). We identified 18 different REP-types; 2 occurred in 55% of the residents colonized with CipREc, and in more than 1 NH. Duration of CipREc carriage varied by REP-type and averaged 6 months.

CONCLUSION

CipREc occurred frequently in NH residents and is carried for long durations, and reacquisition following clearance is common

Trial registration. ClinicalTrials.gov identifier: NCT01062841.

Infect. Control Hosp. Epidemiol. 2016;37(4):440–447

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 37 , Issue 4 , April 2016 , pp. 440 - 447
Copyright
© 2016 by The Society for Healthcare Epidemiology of America. All rights reserved 

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Footnotes

Members of the Targeted Infection Prevention Study Team are listed at the end of the text.

References

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