Korean J Fam Pract. 2017; 7(6): 864-869  https://doi.org/10.21215/kjfp.2017.7.6.864
Rate of Antimicrobial Resistant Urinary Pathogens and Associated Risk Factor in Older Adults Living in Long-Term Care Facilities in Seoul
Inyoung Hwang, Hyunjoon Kim, Younjung Son, Hyejin Jeong, Mooyoung Kim, Soohyoung Lee, Ki-hyon Park*
Department of Family Medicine, Seoul Medical Center, Seoul, Korea
Ki-hyon Park
Tel: +82-2-2276-7941, Fax: +82-2-2276-7377
E-mail: knuck0@seoulmc.or.kr
Received: March 8, 2017; Revised: May 16, 2017; Accepted: June 9, 2017; Published online: December 20, 2017.
© The Korean Academy of Family Medicine. All rights reserved.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract
Background: The risk of healthcare-associated infections is increasing due to the increasing use of long-term care facilities (LTCFs). Identifying LTCF patients at high risk for antimicrobial-resistant urinary tract infection (UTI) is important for empirical antimicrobial therapy.
Methods: A retrospective case-control study was performed at a Seoul Medical Center (500-bed public hospital) between September 1, 2015 and August 31, 2016. We selected LTCF patients by reviewing medical records.
Results: Of 196 patients with a UTI during the study period, 52 were from an LTCF. Antimicrobial-resistant UTI was found in 53.8% (n=28) of LTCF patients. Logistic regression model identified 2 clinical factors associated with antimicrobial-resistant UTI: dementia (odds ratio [OR], 0.088; 95% confidence interval [CI], 0.014–0.531) and readmission within 1 year (OR, 12.247; 95% CI, 1.982–75.693).
Conclusion: Clinical factors can be used to identify antimicrobial-resistant UTI in LTCF patients to aid in the selection of antibiotics.
Keywords: Urinary Tract Infection; Antibiotic Resistance; Nursing Home; Multidrug Resistant
References
  1. Curns AT, Holman RC, Sejvar JJ, Owings MF, Schonberger LB. Infectious disease hospitalizations among older adults in the United States from 1990 through 2002. Arch Intern Med 2005; 165: 2514-20.
    Pubmed CrossRef
  2. Gleckman R, Blagg N, Hibert D, Hall A, Crowley M, Pritchard A, et al. Acute pyelonephritis in the elderly. South Med J 1982; 75: 551-4.
    Pubmed CrossRef
  3. Gleckman R, Blagg N, Hibert D, Hall A, Crowley M, Pritchard A, et al. Communityacquired bacteremic urosepsis in the elderly patients: a prospective study of 34 consecutive episodes. J Urol 1982; 128: 79-81.
    CrossRef
  4. Tal S, Guller V, Levi S, Bardenstein R, Berger D, Gurevich I, et al. Profile and prognosis of febrile elderly patients with bacteremic urinary tract infection. J Infect 2005; 50: 296-305.
    Pubmed CrossRef
  5. Nicolle LE. Urinary tract infections in the elderly. Clin Geriatr Med 2009;25: 423-36.
    Pubmed CrossRef
  6. Friedman ND, Kaye KS, Stout JE, McGarry SA, Trivette SL, Briggs JP, et al. Health care--associated bloodstream infections in adults: a reason to change the accepted definition of community-acquired infections. Ann Intern Med 2002; 137: 791-7.
    Pubmed CrossRef
  7. Hidron AI, Edwards JR, Patel J, Horan TC, Sievert DM, Pollock DA, et al. NHSN annual update: antimicrobial-resistant pathogens associated with healthcare-associated infections: annual summary of data reported to the National Healthcare Safety Network at the Centers for Disease Control and Prevention, 2006-2007. Infect Control Hosp Epidemiol 2008; 29: 996-1011.
    Pubmed CrossRef
  8. Warshawsky B, Hussain Z, Gregson DB, Alder R, Austin M, Bruckschwaiger D, et al. Hospital- and community-based surveillance of methicillin-resistant Staphylococcus aureus: previous hospitalization is the major risk factor. Infect Control Hosp Epidemiol 2000; 21: 724-7.
    Pubmed CrossRef
  9. Smith PW, Seip CW, Schaefer SC, Bell-Dixon C. Microbiologic survey of long-term care facilities. Am J Infect Control 2000; 28: 8-13.
    CrossRef
  10. Aguilar-Duran S, Horcajada JP, Sorlí L, Montero M, Salvadó M, Grau S, et al. Community-onset healthcare-related urinary tract infections: comparison with community and hospital-acquired urinary tract infections. J Infect 2012; 64: 478-83.
    Pubmed CrossRef
  11. Khawcharoenporn T, Vasoo S, Ward E, Singh K. High rates of quinolone resistance among urinary tract infections in the ED. Am J Emerg Med 2012;30: 68-74.
    Pubmed CrossRef
  12. Faine BA, Harland KK, Porter B, Liang SY, Mohr N. A clinical decision rule identifies risk factors associated with antimicrobial-resistant urinary pathogens in the emergency department: a retrospective validation study. Ann Pharmacother 2015; 49: 649-55.
    Pubmed CrossRef
  13. Report the welfare facilities for the aged [Internet]. Sejong: Ministry of Health and Welfare; c2011-2015. [cited 2016].
    Available from: http://www.index.go.kr/potal/main/EachDtlPageDetail.do?idx_cd=2766
  14. Nicolle LE. A practical guide to antimicrobial management of complicated urinary tract infection. Drugs Aging 2001; 18: 243-54.
    Pubmed CrossRef
  15. Rubin RH, Beam TR Jr, Stamm WE. An approach to evaluating antibacterial agents in the treatment of urinary tract infection. Clin Infect Dis 1992; 14 Suppl 2: S246-51.
    Pubmed CrossRef
  16. Miller LG, Tang AW. Treatment of uncomplicated urinary tract infections in an era of increasing antimicrobial resistance. Mayo Clin Proc 2004; 79:1048-53.
    Pubmed CrossRef
  17. Vardi M, Kochavi T, Denekamp Y, Bitterman H. Risk factors for urinary tract infection caused by Enterobacteriaceae with extended-spectrum beta-lactamase resistance in patients admitted to internal medicine departments. Isr Med Assoc J 2012; 14: 115-8.
    Pubmed
  18. Strausbaugh LJ, Crossley KB, Nurse BA, Thrupp LD. Antimicrobial resistance in long-term-care facilities. Infect Control Hosp Epidemiol 1996; 17:129-40.
    Pubmed CrossRef
  19. McKinnell JA, Miller LG, Eells SJ, Cui E, Huang SS. A systematic literature review and meta-analysis of factors associated with methicillin-resistant Staphylococcus aureus colonization at time of hospital or intensive care unit admission. Infect Control Hosp Epidemiol 2013; 34: 1077-86.
    Pubmed KoreaMed CrossRef
  20. O’Fallon E, Gautam S, D’Agata EM. Colonization with multidrug-resistant gram-negative bacteria: prolonged duration and frequent cocolonization. Clin Infect Dis 2009; 48: 1375-81.
    Pubmed CrossRef
  21. D’Agata E, Loeb MB, Mitchell SL. Challenges in assessing nursing home residents with advanced dementia for suspected urinary tract infections. J Am Geriatr Soc 2013; 61: 62-6.
    Pubmed KoreaMed CrossRef
  22. High KP, Bradley SF, Gravenstein S, Mehr DR, Quagliarello VJ, Richards C, et al. Clinical practice guideline for the evaluation of fever and infection in older adult residents of long-term care facilities: 2008 update by the Infectious Diseases Society of America. J Am Geriatr Soc 2009; 57: 375-94.
    Pubmed CrossRef
  23. Kim MS, Shin JH, Jung YS, Joe JK, Choi JP. Clinical finding and MDRGNB associated Long term care facility. 63th Autumn conference of th Korean association of internal medicine. 2012; Seoul, Korea. 2012.
    Available from: http://210.101.116.28/W_files/kiss9/42847395_pv.pdf
  24. Choi JP, Cho EH, Lee SJ, Lee ST, Koo MS, Song YG. Influx of multidrug resistant, Gram-negative bacteria (MDRGNB) in a public hospital among elderly patients from long-term care facilities: a single-center pilot study. Arch Gerontol Geriatr 2012; 54: e19-22.
    Pubmed CrossRef
  25. Denkinger CM, Grant AD, Denkinger M, Gautam S, D’Agata EM. Increased multi-drug resistance among the elderly on admission to the hospital-a 12-year surveillance study. Arch Gerontol Geriatr 2013; 56: 227-30.
    Pubmed CrossRef
  26. Weber SG, Miller RR, Perencevich EN, Tolentino J, Meltzer D, Pitrak D, et al. Prevalence of antimicrobial-resistant bacteria isolated from older versus younger hospitalized adults: results of a two-centre study. J Antimicrob Chemother 2009; 64: 1291-8.
    Pubmed KoreaMed CrossRef
  27. Lautenbach E, Marsicano R, Tolomeo P, Heard M, Serrano S, Stieritz DD. Epidemiology of antimicrobial resistance among gram-negative organisms recovered from patients in a multistate network of long-term care facilities. Infect Control Hosp Epidemiol 2009; 30: 790-3.
    Pubmed KoreaMed CrossRef
  28. Ben-Ami R, Schwaber MJ, Navon-Venezia S, Schwartz D, Giladi M, Chmelnitsky I, et al. Influx of extended-spectrum beta-lactamase-producing enterobacteriaceae into the hospital. Clin Infect Dis 2006; 42: 925-34.
    Pubmed CrossRef
  29. European Centre for Disease Prevention and Control. Antimicrobial resistance surveillance in Europe 2011. Annual report of the European antimicrobial resistance surveillance network (EARS-Net) [Internet]. Stockholm:ECDC; 2012. [cited 2016].
    Available from: https://ecdc.europa.eu/sites/portal/files/media/en/publications/Publications/antimicrobial-resistance-surveillance-europe-2011.pdf

This Article


Services
Social Network Service

e-submission

Archives