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Multiple antibiotic-resistant bacteria in long-term-care facilities: An emerging problem in the practice of
1Geriatric Care Center, University Hospitals of Cleveland, OH, USA. rab14@po.cwru.edu
Abstract:
Long-term-care facilities (LTCFs) are becoming a major component of the health care delivery system. The management of infections with antibiotic-resistant bacteria in elderly patients in LTCFs is presenting new challenges to our current therapeutic armamentarium. Among the enteric bacilli, resistance to ceftazidime, beta-lactam/beta-lactamase-inhibitor combinations, and trimethoprim-sulfamethoxazole present the foremost problems. Quinolone-resistant gram-negative and gram-positive bacteria are increasing in frequency because of the widespread use of these agents in empirical treatment. Among the resistant gram-positive organisms, methicillin-resistant Staphylococcus aureus, penicillin-resistant pneumococci, and vancomycin-resistant enterococci are the most feared pathogens. Education, antibiotic control measures, and fundamental epidemiological and scientific research are advocated as important preventive measures.
Insights
Antibiotic resistance in long-term-care facilities (LTCFs) poses significant challenges, particularly with common enteric bacilli and gram-positive pathogens. Strategies like education and antibiotic control are vital for prevention.
Area of Science:
- Infectious Diseases
- Geriatric Medicine
- Antimicrobial Resistance
Background:
- Long-term-care facilities (LTCFs) are increasingly integral to healthcare delivery.
- Managing antibiotic-resistant infections in elderly LTCF residents presents complex challenges.
- Rising antimicrobial resistance threatens effective treatment options for vulnerable populations.
Purpose of the Study:
- To highlight the growing problem of antibiotic-resistant bacteria in long-term-care facilities.
- To identify key problematic pathogens and resistance patterns in this setting.
- To advocate for preventive strategies to combat antimicrobial resistance.
Main Methods:
- Review of current challenges in managing infections within LTCFs.
- Identification of prevalent antibiotic-resistant organisms and their resistance profiles.
- Discussion of therapeutic limitations against resistant strains.
Main Results:
- Significant resistance observed in enteric bacilli to ceftazidime, beta-lactam/beta-lactamase inhibitors, and trimethoprim-sulfamethoxazole.
- Increasing frequency of quinolone-resistant gram-negative and gram-positive bacteria due to empirical treatment.
- Key resistant gram-positive pathogens include methicillin-resistant Staphylococcus aureus, penicillin-resistant pneumococci, and vancomycin-resistant enterococci.
Conclusions:
- Effective management of antibiotic-resistant infections in LTCFs requires a multi-faceted approach.
- Education, stringent antibiotic control measures, and robust research are essential preventive strategies.
- Addressing antimicrobial resistance in LTCFs is critical for patient safety and public health.