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Fluoroquinolone Resistance 'Rampant' in Nursing Homes: Presented at ICAAC
By Charlene Laino
CHICAGO, IL -- September 15, 2003 -- There is significant in vitro bacterial resistance to the commonly used fluoroquinolones ciprofloxacin and levofloxacin in nursing homes, according to what the researchers say is the most extensive surveillance of antibiotic resistance in long-term care facilities to be presented in the United States.
Thomas L. Wallace, PhD, Clinical Liaison for Medical Affairs, Roche Laboratories Inc., The Woodlands, Texas, spoke about the study during a poster session here on September 14th at the 43rd Annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
Dr. Wallace said the study was undertaken to fill a gap in knowledge about the extent of antibiotic resistance in long-term care facilities -- the vast majority of which are nursing homes -- at a time when the U.S. Centers for Disease Control and Prevention predicts 200% growth in such facilities over the next 2 to 5 years.
From 2001 to 2002, the researchers collected data from 41,282 residents in 944 long-term care facilities in 30 states. About three-fourths of residents were women and 82% were at least 70 years of age.
Antibiotic susceptibility data were determined for 16 Gram-negative and Gram-positive bacteria and 56 antibiotics, based on nursing home incidence, and reported from a central laboratory that used Food and Drug Administration-approved NCCLS breakpoints.
The study showed that enteric Gram-negative rods remain the most commonly isolated bacteria in long-term care facilities, with extended spectrum beta lactamase producing strains of Gram-negative rods minimally present.
When all 16 bacteria were considered, the antimicrobial susceptibility rates were 93% for ceftriaxone, 88% for gentamicin, 86% for ticarcillin/clavulanate, 63% for levofloxacin and 59% for ciprofloxacin,, Dr. Wallace said.
"There is rampant resistance to fluoroquinolones in nursing homes," Dr. Wallace said in an interview. "It's much worse than we thought and much worse than in acute care hospitals."
Noting that is not always practical or possible to obtains cultures from infected residents prior to or following antimicrobial treatment, he said, "physicians need to be aware of antibiotic susceptibility in their own institution and decide, based on that, [the best] empiric therapy for their patients."
[Study title: Antibiotic Resistance in Long-Term Care Facilities in the U.S. Abstract C2-193]
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