This study investigated the impact of an antimicrobial stewardship program on fluoroquinolone (FLQ) resistance in urinary Enterobacteriaceae isolated from residents of 3 French nursing homes.
A multicentric retrospective before-and-after study was conducted.
Setting and Participants
All the first urinary Enterobacteriaceae isolates obtained from nursing home residents were included. Two time frames were analyzed: 2013-2015 and 2016-2017.
The antimicrobial stewardship program started in 2015 and was based on (1) 1-day training for use of an “antimicrobial stewardship kit for nursing homes;” and (2) daily support and training of the coordinating physician by an antibiotic mobile team (AMT) in 2 of 3 nursing homes.
Overall, 338 urinary isolates were analyzed. Escherichia coli was the most frequent species (212/338, 63%). A significant reduction of resistance to ofloxacin was observed between 2013-2015 and 2016-2017 in general (Δ = −16%, P = .004) and among isolates obtained from patients hospitalized in the county nursing home with AMT support (Δ = −28%, P < .01). A nonstatistically significant reduction in ofloxacin resistance was also observed in the hospital nursing home with AMT support (Δ = −18%, P = .06).
Conclusions and Implications
Our antimicrobial stewardship program resulted in a decrease in resistance to FLQ among urinary Enterobacteriaceae isolated from nursing home residents. The support of an AMT along with continuous training of the coordinating physician seems to be an important component to ensure efficacy of the intervention.
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 Journal of the American Medical Directors Association
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- Strategies and challenges of antimicrobial stewardship in long-term care facilities.Clin Microbiol Infect. 2015; 21: 10-19
- Antibiotic prescribing for residents in long-term-care facilities across the UK.J Antimicrob Chemother. 2019; 74: 1447-1451
- Antibiotic use and resistance in long term care facilities.J Am Med Dir Assoc. 2012; 13: 568.e1-568.e13
- Urine cultures in a long-term care facility (nursing home): Time for improvement.BMC Geriatr. 2018; 18: 221
- Multidrug-resistant infections in long-term care facilities: Extended-spectrum β-lactamase-producing Enterobacteriaceae and hypervirulent antibiotic resistant Clostridium difficile.Diagn Microbiol Infect Dis. 2018; 91: 275-281
- Outpatient antibiotic use in Europe and association with resistance: A cross-national database study.Lancet. 2005; 365: 579-587
- Ciprofloxacin dosage and emergence of resistance in human commensal bacteria.J Infect Dis. 2009; 200: 390-398
- Incomplete recovery and individualized responses of the human distal gut microbiota to repeated antibiotic perturbation.Proc Natl Acad Sci U S A. 2011; : 4554-4561
- Mechanisms of drug resistance: Quinolone resistance.Ann N Y Acad Sci. 2015; 1354: 12-31
- Fluoroquinolone restriction as an effective antimicrobial stewardship intervention.Curr Infect Dis Rep. 2018; 20: 7
- Impact of restricting fluoroquinolone prescription on bacterial resistance in an intensive care unit.J Hosp Infect. 2005; 59: 83-89
- EMERGEncy ID Net Study Group fluoroquinolone-resistant and extended-spectrum β-lactamase–producing Escherichia coli infections in patients with pyelonephritis, United States.Emerg Infect Dis. 2016; 22: 1594-1603
- Impact of quinolone restriction on resistance patterns of Escherichia coli isolated from urine by culture in a community setting.Clin Infect Dis. 2009; 49: 869-875
- Fluoroquinolone use and methicillin-resistant Staphylococcus aureus isolation rates in hospitalized patients: A quasi experimental study.Clin Infect Dis. 2006; 42: 778-784
- Impact of a multimodal strategy combining a new standard of care and restriction of carbapenems, fluoroquinolones and cephalosporins on antibiotic consumption and resistance of Pseudomonas aeruginosa in a French intensive care unit.Int J Antimicrob Agents. 2019; 53: 416-422
- Health care spending in the United States and other high-income countries.JAMA. 2018; 319: 1024-1039
- European surveillance of antimicrobial consumption (ESAC): Outpatient antibiotic use in Europe (1997–2009).J Antimicrob Chemother. 2011; 66: vi3-vi12
- National multidrug-resistant bacteria (MDRB) surveillance in France through the RAISIN network: A 9 year experience.J Antimicrob Chemother. 2013; 68: 954-959
- Success stories of implementation of antimicrobial stewardship: A narrative review.Clin Microbiol Infect. 2014; 20: 954-962
- European recommendations for antimicrobial resistance surveillance.Clin Microbiol Infect. 2004; 10: 349-383
- Observatoire des Médicaments, des Dispositifs Médicaux et de l'Innovation Thérapeutique: la juste prescription.(Available at:)http://www.omedit-idf.fr/Date accessed: May 14, 2019
- Expert systems in clinical microbiology.Clin Microbiol Rev. 2011; 24: 515-556
- Breakpoint tables for interpretation of MICs and zone diameters. Version 9.0.(Available at:)http://www.eucast.orgDate: 2019
- European Committee on Antimicrobial Susceptibility Testing: Archive of EUCAST.(Available at:)http://www.eucast.org/ast_of_bacteria/previous_versions_of_documents/Date accessed: May 10, 2019
- Antibiotic resistance of Enterobacteriaceae causing urinary tract infections in elderly patients living in the community and in the nursing home: A retrospective observational study.J Antimicrob Chemother. 2019; 74: 775-781
- Antimicrobial resistance patterns of urine culture specimens from 27 nursing homes: Impact of a two-year antimicrobial stewardship intervention.Infect Control Hosp Epidemiol. 2019; 40: 780-786
- Impact of a long-term antibiotic stewardship program targeting fluoroquinolones in a French local hospital.Med Mal Infect. 2019; 49: 442-446
- Antimicrobial stewardship programs in long-term care settings: A meta-analysis and systematic review.J Am Geriatr Soc. 2019; 67: 392-399
- Antimicrobial consumption and impact of antimicrobial stewardship programmes in long-term care facilities.Clin Microbiol Infect. 2019; 25: 562-569
- Can a multifaceted educational intervention targeting both nurses and physicians change the prescribing of antibiotics to nursing home residents? A cluster randomized controlled trial.J Antimicrob Chemother. 2011; 66: 2659-2666
- Antimicrobial prescribing and infections in long-term care facilities (LTCF): A multilevel analysis of the HALT 2016 study, Ireland, 2017.Eur Surveill. 2018; 23 (1800278)
- Understanding the determinants of antimicrobial prescribing within hospitals: The role of “prescribing etiquette”.Clin Infect Dis. 2013; 57: 188-196
- Effective antimicrobial stewardship in a long-term care facility through an infectious disease consultation service: Keeping a LID on antibiotic use.Infect Control Hosp Epidemiol. 2012; 33: 1185-1192
- European Centre for Disease Prevention and Control: Surveillance Atlas of Infectious Diseases.(Available at:)http://atlas.ecdc.europa.eu/public/index.aspxDate accessed: January 4, 2020
Published online: March 18, 2020
The authors declare no conflicts of interest.
© 2020 AMDA - The Society for Post-Acute and Long-Term Care Medicine.