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Health & Medicine for Senior Citizens

Antibiotic-Resistant Strain of E. Coli Increasing Among Senior Citizens in Nursing Homes

Spread of E. coli ST131 already a pandemic but has received little attention in the U.S. – ‘making development of strategies to halt further emergence and spread of these strains a public health priority’

doctors,healthcare,jobs,technicians,laboratories,medicine,microscopes,occupations,people,physicians,researchers,science,womenMarch 12, 2013 - Antibiotic-resistant Escherichia coli (E. coli) continues to proliferate, driven largely by expansion of a strain of E. coli know as sequence type ST131. A new study points to hospitals and long-term care facilities (LTCF) as settings in which this antibiotic-resistant strain is increasingly found, particularly among senior citizens.

"The expansion of E. coli strain ST131 is recognized as a pandemic, but has received comparatively little attention in the United States," said Ritu Banerjee, lead investigator of the study.

"Alarmingly, the pace of new antibiotic development has not kept up with the emergence of antibiotic-resistant E. coli, making development of strategies to halt further emergence and spread of these strains a public health priority."

The study is published in the April issue of Infection Control and Hospital Epidemiology, the journal of the Society for Healthcare Epidemiology of America.

E. coli is the most common gram-negative pathogen, causing both gastrointestinal disease and extra-intestinal infections such as pneumonia, meningitis, and bloodstream, urinary tract, abdominal, and wound infections.

 

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Strains of E. coli that are resistant to single or multiple classes of antibiotics are becoming more prevalent. E. coli ST131 is commonly associated with fluoroquinolone resistance.

In this retrospective study, investigators evaluated nearly 300 consecutive patients in Olmsted County, Minnesota with extra-intestinal E. coli infections and found ST131 to be a dominant, antimicrobial-resistant clonal group associated with older age, long-term care facility residence, complicated infections, history of urinary tract infection, and prior antimicrobial use.

LTCF residence was the strongest predictor of ST131 infection, with LTCF residents having 8 times the risk of contracting E. coli ST131 compared with non-LTCF residents.

About Fluoroquinolone (Wikipedia)

The quinolones are a family of synthetic broad-spectrum antibacterial drugs. The first generation of the quinolones began with the introduction of nalidixic acid in 1962 for treatment of urinary tract infections in humans. Nalidixic acid was discovered by George Lesher and coworkers in a distillate during an attempt at chloroquine synthesis.

They prevent bacterial DNA from unwinding and duplicating. (See Mechanism of Action)

The majority of quinolones in clinical use belong to the subset fluoroquinolones, which have a fluorine atom attached to the central ring system, typically at the 6-position or C-7 position.

About Escherichia coli (E. coli) (Centers for Disease Control...)

Escherichia coli (E. coli) bacteria normally live in the intestines of people and animals. Most E. coli are harmless and actually are an important part of a healthy human intestinal tract. However, some E. coli are pathogenic, meaning they can cause illness, either diarrhea or illness outside of the intestinal tract. The types of E. coli that can cause diarrhea can be transmitted through contaminated water or food, or through contact with animals or persons.

E. coli consists of a diverse group of bacteria. Pathogenic E. coli strains are categorized into pathotypes. Six pathotypes are associated with diarrhea and collectively are referred to as diarrheagenic E. coli.

Elderly most endangered

This trend coincides with the increasing prevalence of ST131 among patients 65 years and older. It is likely that extensive antibiotic exposure, close contact with other antibiotic-exposed individuals, age and health-associated alterations in intestinal microbiota all contribute to the high prevalence of ST131 among the elderly population.

Patients with ST131 isolates were often treated with ineffective antibiotics at first and as a result they had recurrent or persistent symptoms. In the cohort, ST131 isolates were also more than twice as likely to be healthcare-associated infections as compared to community-associated infections.

"The finding that clonal expansion of ST131 is occurring primarily in healthcare and long-term care facilities indicates an urgent need for improved antibiotic use and infection control practices within such institutions, both to reduce selection for ST131 and to block further transmission. Efforts that focus on reducing overuse and misuse of fluoroquinolones are likely to have the greatest impact on ST131 prevalence, given the strong association between ST131 and fluoroquinolone resistance," said Banerjee.

Notes:

Published through a partnership between the Society for Healthcare Epidemiology of America and The University of Chicago Press, Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 15 out of 140 journals in its discipline in the latest Journal Citation Reports from Thomson Reuters.

SHEA is a professional society representing more than 2,000 physicians and other healthcare professionals around the world with expertise in healthcare epidemiology and infection prevention and control. SHEA's mission is to prevent and control healthcare-associated infections and advance the field of healthcare epidemiology. The society leads this field by promoting science and research and providing high-quality education and training in epidemiologic methods and prevention strategies. SHEA upholds the value and critical contributions of healthcare epidemiology to improving patient care and healthcare worker safety in all healthcare settings. Visit SHEA online at http://www.shea-online.org, on Twitter @SHEA_Epi and Facebook at http://www.facebook.com/SHEApreventingHAIs.

Source:

Ritu Banerjee, Brian Johnston, Christine Lohse, Stephen B.Porter, Connie Clabots and James R. Johnson. "Escherichia coli Sequence Type 131 Is a Dominant, Antimicrobial-Resistant Clonal Group Associated with Healthcare and Elderly Hosts." Infection Control and Hospital Epidemiology 34:4 (April 2013).

 

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