Cefotaxime-Resistant Bacteria Colonizing Older People Admitted to an Acute Care Hospital
Article first published online: 26 MAR 2003
Journal of the American Geriatrics Society
Volume 51, Issue 4, pages 519–522, April 2003
How to Cite
Bonomo, R. A., Donskey, C. J., Blumer, J. L., Hujer, A. M., Hoyenm, C. K., Jacobs, M. R., Whalen, C. C. and Salata, R. A. (2003), Cefotaxime-Resistant Bacteria Colonizing Older People Admitted to an Acute Care Hospital. Journal of the American Geriatrics Society, 51: 519–522. doi: 10.1046/j.1532-5415.2003.51161.x
- Issue published online: 26 MAR 2003
- Article first published online: 26 MAR 2003
- long-term care facilities;
- antibiotic resistance
OBJECTIVES: To determine the frequency of fecal colonization by cefotaxime-resistant gram-negative bacilli in older patients living in the community and in long-term care facilities (LTCFs) admitted to an acute care hospital.
DESIGN: Case-control, point prevalence study.
PARTICIPANTS: One hundred forty-three patients aged 65 and older.
MEASUREMENTS: Rectal swab cultures, antibiotic drug sensitivity, beta lactamase isolation, and clonal identity.
RESULTS: Of the 190 surveillance cultures obtained from 143 patients, 26 cefotaxime-resistant gram-negative isolates from 22 patients were recovered. The prevalence rate of cefotaxime-resistant isolates on admission was 13.3% (19/143). A logistic regression model using cefotaxime colonization as the dependent variable found that multiple comorbidities, admission to a surgical service, and having a diagnosis of infection on presentation and a transfusion history were factors associated with the presence of colonization. These four clinical items accurately classified 74% of patients colonized. Antibiotic use and nursing home residence were not associated with the presence of colonization by cefotaxime-resistant organisms. Twelve of the cefotaxime-resistant isolates (46%) were identified as Pseudomonas aeruginosa, and 14 (54%) were other gram-negative bacilli. In six of the 14 isolates that were not P. aeruginosa (36%), it was possible to demonstrate the presence of an AmpC β-lactamase related to the CMY-2 β-lactamase, a plasmid-borne cephalosporinase.
CONCLUSION: These data raise awareness that there are community- and LTCF-dwelling older patients colonized with gram-negative enteric bacilli resistant to third-generation cephalosporins on admission to the hospital. The “reservoir of resistant bacteria” in older people is no longer confined to LTCFs.