Advertisement

To check or not to check. Rectal ESBL colonization in hospitalized elderly patients

      Background

      The worldwide spread of extended-spectrum-beta-lactamase (ESBL) producing bacteria has affected health care. ESBL confers resistance to the majority of beta-lactam antibiotics.

      Materials and Methods

      We intended to quantify the rates of rectal ESBL-positive and negative patients that eventually developed fever and urinary tract infection (UTI). All rectal ESBL-positive patients were to be initially treated with the conventional antibiotics that have anti-ESBL activity (amikacin or ertapenem), while ESBL-negative patients were given ceftriaxone.

      Results

      Most patients were rectal ESBL-positive (60.7%). Fever was in 51% patients; 67.8% of them developed signs and symptoms of UTI. Most patients with UTI were urinary ESBL-positive (79%), most rectal ESBL-negative patients were urinary ESBL-negative (75%), (χ2 = 18.5, df = 1, P < .001). Overall mortality was higher in the febrile group (39, 34.8%) versus the afebrile (1, 0.9%) (χ2 = 42, df = 1, P < .001). The mortality rate in the febrile group was significantly higher in the rectal ESBL-positive patients (χ2 = 7.5, df = 1, P = .006).

      Discussion

      The direct correlation of rectal ESBL-positive and negative and respectively urinary ESBL-positive and negative patients' advocate for the use of antibiotics with anti-ESBL activity as an empiric treatment of rectal ESBL-positive patients with suspected UTI.

      Conclusion

      In our opinion, it is worthwhile to identify rectal ESBL-positivity on hospital admission.

      Key Words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Infection Control
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Ebihara S.
        Infectious disease in the aging.
        Lancet Infect Dis. 2011; 11: 271
        • Castle S.C.
        Clinical relevance of age-related immune dysfunction.
        Clin Infect Dis. 2000; 31: 578-585
        • Staykova S.
        Urinary tract infections in geriatric patients. Web Med Central.
        Nephrology. 2013; 4 (1 WMC003968)
        • Mody L.
        • Juthani-Mehta M.
        Urinary tract infections in older women. a clinical review.
        JAMA. 2014; 311: 844-854
        • Richardson J.P.
        Bacteremia in the elderly.
        J Gen Intern Med. 1993; 8: 89-92
        • Htwe T.H.
        • Mushtaq A.
        • Robinson S.B.
        • Rosher R.B.
        • Khardori N.
        Infection in the elderly.
        Infect Dis Clin. 2007; 21: 711-743
        • Little M.O.
        Diagnostic challenge of blood stream infections in long-term care.
        J Am Med Dir Assoc. 2011; 12: 166-168
        • Yoshikawa T.T.
        Antimicrobial resistance and aging: beginning of the end of the antibiotic era?.
        J Am Geriatr Soc. 2002; 50: S226-S229
        • Bradford P.A.
        Extended-spectrum beta-lactamases in the 21st century: characterization, epidemiology, and detection of this important resistance threat.
        Clin Microbiol Rev. 2001; 14: 933-951
        • Pilmis B.
        • Cattoir V.
        • Lecointe D.
        • Limelette A.
        • Grall I.
        • Mizrahi A.
        • et al.
        Carriage of ESBL-producing Enterobacteriaceae in French hospitals: the PORTABLSE study.
        J Hosp Infect. 2018; 98: 247-252
        • McDanel J.
        • Schweizer M.
        • Crabb V.
        • Nelson R.
        • Samore M.
        • Khader K.
        • et al.
        Incidence of Extended-Spectrum β-Lactamase (ESBL)-producing Escherichia coli and Klebsiella infections in the United States: a systematic literature review.
        Infect Control Hosp Epidemiol. 2017; 38: 1209-1215
        • Picozzi S.
        • Ricci C.
        • Gaeta M.
        • Macchi A.
        • Dinang E.
        • Paola G.
        • et al.
        Do we really know the prevalence of multi-drug resistantEscherichia coli in the territorial and nosocomial population?.
        Urol Ann. 2013; 5: 25-29
        • Briongos-Figuero L.S.
        • Gómez-Traveso T.
        • Bachiller-Luque P.
        • Domínguez-Gil González M.
        • Gómez-Nieto A.
        • Palacios-Martín T.
        • et al.
        Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria.
        Int J Clin Pract. 2012; 66: 891-896
        • Ho P.L.
        • Chau P.H.
        • Yan M.K.
        • Chow K.-H.
        • Chen J.H.
        • Wong S.C.
        • et al.
        High burden of extended-spectrum beta-lactamase-positive Escherichia coli in geriatric patients.
        J Med Microbiol. 2014; 63: 878-883
        • Jallad M.A.
        • Naoufal R.J.
        • Irani E.
        Extended spectrum beta-lactamase carriage state among elderly nursing home residents in Beirut.
        Sci World J. 2015; 2015 (Article ID 987580): 1-7
        • Tian S.F.
        • Chen B.Y.
        • Chu Y.Z.
        • Wang S.
        Prevalence of rectal carriage of extended-spectrum beta-lactamase-producing Escherichia coli among elderly people in community settings in China.
        Can J Microbiol. 2008; 54: 781-785
        • Blom A.
        • Ahl J.
        • Månsson F.
        • Resman F.
        • Tham J.
        The prevalence of ESBL-producing Enterobacteriaceae in a nursing home setting compared with elderly living at home: a cross-sectional comparison.
        BMC Infect Dis. 2016; 16: 111
        • Bertrand X.
        • Amara M.
        • Sauget M.
        • Clément M.C.
        • Talon D.
        • Domelier-Valentin A.S.
        • et al.
        Extended-spectrum beta-lactamase-producing Enterobacteriacae: unexpected low prevalence of carriage in elderly French residents.
        Age Ageing. 2012; 41: 233-237
        • Rooney P.J.
        • O'Leary M.C.
        • Loughrey A.C.
        • McCalmont M.
        • Smyth B.
        • Donaghy P.
        • et al.
        Nursing homes as a reservoir of ESBL-producing ciprofloxacin-resistant E. coli.
        J Antimicrob Chemother. 2009; 64: 635-641
        • Bergman J.
        • Schjøtt J.
        • Blix H.S.
        Prevention of urinary tract infections in nursing homes: lack of evidence-based prescription?.
        BMC Geriatr. 2011; 11: 69
        • Adukauskiene D.
        • Cicinskaite I.
        • Vitkauskiene A.
        • Macas A.
        • Tamosiūnas R.
        • Kinderyte A.
        Hospital-acquired urinary tract infections.
        Medicina (Kaunas). 2006; 42: 957-964
        • Kalsy J.
        • Arya M.
        • Wilson P.
        • Mundy A.
        Hospital acquired urinary tract infection.
        Int J Clin Pract. 2003; 57: 388-391