1540. Risk Factors for the Development of Gastrointestinal Colonization with Fluoroquinolone-Resistant Escherichia coli in Residents of Long-Term Care Facilities
Session: Poster Abstract Session: Infections in Non-Acute Healthcare Settings
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
  • FQ LTCF poster.pdf (410.2 kB)
  • Background: Infections due to fluoroquinolone-resistant Escherichia coli (FQREC) are associated with significant morbidity and mortality. An improved understanding of FQREC acquisition is needed in the long-term care setting. The objective of this study was to assess risk factors for the development of new FQREC gastrointestinal tract colonization in residents of long-term care facilities (LTCFs), including the impact of antibiotic exposure during LTCF residence.

    Methods: A prospective cohort study was conducted from 2006 to 2008 at three LTCFs within an academic long-term care network. Residents initially colonized with fluoroquinolone-susceptible E. coli (FQSEC) were followed with serial fecal sampling for new FQREC colonization for up to 12 months or until discharge or death. A Cox proportional hazards regression model was developed to identify risk factors for new FQREC colonization, with antibiotic and indwelling device exposures modeled as time-varying covariates. 

    Results: Fifty-seven (47.5%) of a total of 120 residents became newly colonized with FQREC, with a median time to colonization of 57 days (interquartile range, 28-155). Fecal incontinence (hazard ratio [HR] 1.78, 95% confidence interval [CI] 1.04-3.06, P=0.04) was significantly associated with FQREC acquisition. Receipt of amoxicillin-clavulanate (HR 6.48, 95% CI 1.43-29.4, P=0.02) and the presence of a urinary catheter (HR 3.81, 95% CI 1.06-13.8, P=0.04) during LTCF stay increased the risk of new FQREC colonization.

    Conclusion: Acquisition of FQREC was common, with nearly half of residents developing new FQREC colonization. Further studies are needed on optimal interventions to limit the emergence of FQREC in the long-term care setting, including antibiotic stewardship programs and efforts to decrease indwelling device exposure.

    Jennifer Han, MD, MSCE1, Joel Maslow, MD, PhD2, Xiaoyan Han, MS1, Sharon Xie, PhD1, Pam Tolomeo, MPH1, Evelyn Santana, MS1, Lesley Carson, MD1, Ebbing Lautenbach, MD, MPH, MSCE1 and the CDC Prevention Epicenter Program, (1)University of Pennsylvania School of Medicine, Philadelphia, PA, (2)Morristown Memorial Hospital, Morristown, NJ


    J. Han, None

    J. Maslow, None

    X. Han, None

    S. Xie, None

    P. Tolomeo, None

    E. Santana, None

    L. Carson, None

    E. Lautenbach, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.