Program Schedule

Susceptibility of Enterobacteriaceae in European and North American Long-term Care Facilities, 2011-2013

Session: Poster Abstract Session: Surveillance of Antimicrobial Resistance
Thursday, October 9, 2014
Room: The Pennsylvania Convention Center: IDExpo Hall BC

Background:   Pathogens in some long-term care (LTC) facilities have been reported to have high antimicrobial resistance with a large proportion of multi-drug resistant (MDR) strains. Using data from the Tigecycline Evaluation and Surveillance Trial (TEST), Enterobacteriaceae from LTC settings were compared to other inpatient and outpatient settings in Europe and North America.

Methods:  512 Enterobacteriaceae isolates from various specimen sources were collected from LTC facilities, and 27,569 Enterobacteriaceae from inpatient and outpatient settings in 15 countries in Europe and North America from 2011 to 2013.  MICs were determined at each site using CLSI broth microdilution method and interpreted according to CLSI/FDA guidelines. Isolates were categorized as MDR if resistant to ≥3 drug classes.

Results:   MIC90 (mcg/ml), % susceptible (%S), and % MDR among Enterobacteriaceae from each setting are shown below. %S values ≥ 90% are shaded.

Of the species with n >10, Enterobacter cloacae had the highest proportion of MDR strains in LTC and inpatient settings (41.4% and 39.8%, respectively), whereas Citrobacter freundii had the highest for outpatients (34.7%).

Conclusion: A significantly higher proportion of Enterobacteriaceae were MDR in LTC settings than in inpatients and outpatients. All study drugs showed lower susceptibility in LTC isolates than in the other two settings. Amikacin, meropenem, and tigecycline were the only drugs studied that showed only minor differences in %S between the three settings. These three agents also demonstrated the highest in vitro activity against Enterobacteriaceae, with susceptibility >90% in all three settings. Empiric therapy decisions should take into account the high proportion of MDR isolates in LTC settings.


Sibylle Lob, MD, MPH1, Brian Johnson, BS1, Robert Badal, BS1, Meredith Hackel, PhD, MPH1, Samuel Bouchillon, MD1 and Heidi Leister-Tebbe, BS2, (1)International Health Management Associates, Inc., Schaumburg, IL, (2)Pfizer Inc., Collegeville, PA


S. Lob, Pfizer: Independent Contractor, Consulting fee

B. Johnson, Pfizer: Independent Contractor, Consulting fee

R. Badal, Pfizer: Independent Contractor, Consulting fee

M. Hackel, Pfizer: Independent Contractor, Consulting fee

S. Bouchillon, Pfizer: Independent Contractor, Consulting fee

H. Leister-Tebbe, Pfizer: Employee, Salary

Findings in the abstracts are embargoed until 12:01 a.m. EDT, Oct. 8th with the exception of research findings presented at the IDWeek press conferences.

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