1617. Targeted Infection Prevention (TIP) Study: Epidemiology of antibiotic resistant gram-negative bacilli colonization in nursing home residents with indwelling devices
Session: Poster Abstract Session: Multidrug-Resistant Gram Negative Rods
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C

Background : We characterize the clinical and epidemiologic characteristics of antibiotic resistant gram-negative bacilli (R-GNB) and the extent to which it has emerged in community based nursing homes (NH).

Methods :  As a part of a cluster-randomized study, we evaluated the prevalence of ciprofloxacin-resistant (CIP-R GNB) and ceftazidime-resistant gram-negative bacilli (CTZ-R GNB) among 418 residents with urinary catheters or feeding tubes in 12 NHs over 3 years of enrollment. Cultures (from nares, oropharynx, groin, perianal area, and wounds, feeding tube site and suprapubic catheter site, if present) and clinical data were obtained at enrollment, after 15 days, and every 30 days thereafter.

Results : A total of 6525 anatomic sites were cultured, 1422 (21.8%) swabs were positive for 2227 R-GNB, 1396 (21.4%) swabs positive for 1730 CIP-R GNB, and 447 (6.9%) swabs positive for 497 CTZ-R GNB. The most common site of R-GNB colonization was groin (559, 34%), followed by perianal area (438, 53.5%), suprapubic catheter (145, 43.9%), oropharynx (100, 7.9%), feeding tube (81, 10.6%), wounds (n=53, 58.2%) and nares (46, 2.9%). 408 sites were co-colonized with CIP-R GNB and CTZ-R GNB with groin and perianal being the most common sites of co-colonization. The most common species of R-GNB were Proteus mirabilis (28.4%), Escherichia coli (25.1%), Klebsiella pneumoniae (11.8%), Acinetobacter baumanii (8.5%), and Pseudomonas aeruginosa (6.2%). Resistant P. mirabilis, K. pneumonia and P. aeruginosa most commonly colonized the groin, while resistant E. coli was most commonly found in the perianal area. Anatomic site colonization and colonizing organism distribution was similar for both CIP-R GNB and CTZ-R GNB.

Conclusion : Multi-site R-GNB colonization is common in nursing home residents with indwelling devices. Our data show that R-GNB colonization is dynamic, and has implications for designing of infection prevention strategies in this frail and functionally impaired population. 

Sara Mcnamara, MT(ASCP), MPH1, Bonnie Lansing, LPN1,2, Kathy Symons, BA3, Lona Mody, MD, MSc4 and TIP Study Team, (1)University of Michigan and Ann Arbor VA Healthcare System, Ann Arbor, MI, (2)Geriatrics, AnVA Healthcare System, Ann Arbor, MI, (3)Geriatrics, Ann Arbor VA Healthcare System, Ann Arbor, MI, (4)University of Michigan, Ann Arbor, MI

Disclosures:

S. Mcnamara, None

B. Lansing, None

K. Symons, None

L. Mody, None

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