Abstract
BackgroundWe evaluated data from isolates of nursing home (NH) patients sent to the Swiss centre for antibiotic resistance (ANRESIS). We focussed on carbapenem-resistance (CR) among Gram-negative pathogens, extended-spectrum cephalosporin-resistant (ESC-R) Escherichia coli/Klebsiella pneumoniae, methicillin-resistant Staphylococcus aureus (MRSA), and glycopeptide-resistant enterococci (GRE).MethodsNH patient isolates from 01/2007 to 10/2017 were extracted. Temporal trends in resistance were described and risk factors associated with ESC-R and MRSA were assessed. For every administrative subdivision in Switzerland (i.e. canton), we calculated a coverage rate, defined as number of beds of governmentally-supported nursing homes, which sent ≥1 isolate in each 2014, 2015, and 2016, divided by the total number of supported beds.ResultsWe identified 16′804 samples from 9′940 patients. A majority of samples (12′040; 71.6%) originated from the French/Italian speaking part of Switzerland. ESC-R E. coli increased from 5% (16/299) in 2007 to 22% (191/884) in 2017 (P < 0.01), whereas MRSA decreased from 34% (35/102) to 26% (21/81) (P < 0.01). Provenience from the German (vs. French/Italian) speaking part of Switzerland was associated with decreased risk for ESC-R (OR 0.5, 95% CI 0.4–0.7) and for MRSA (OR 0.1, 95% CI 0.1–0.2). CR among Pseudomonas aeruginosa was 10% (105/1096) and showed an increasing trend over time; CR among Enterobacteriaceae (37/12′423, 0.3%) and GRE (5/1′273, 0.4%) were uncommon. Overall coverage rate was 9% (range 0–58% per canton). There was a significant difference between the French/Italian (median 13%, interquartile range [IQR] 4–43%) and the German speaking cantons (median 0%, IQR 0–5%) (P = 0.02).ConclusionsESC-R among E. coli is emerging in Swiss NHs, whereas MRSA show a declining trend over time. A minority of NHs are represented in ANRESIS, with a preponderance of institutions from the French/Italian speaking regions. Efforts should be undertaken to improve resistance surveillance in this high-risk setting.
Highlights
We evaluated data from isolates of nursing home (NH) patients sent to the Swiss centre for antibiotic resistance (ANRESIS)
extendedspectrum cephalosporin-resistant (ESC-R) was more common among E. coli (14.1%) compared to K. pneumoniae (7.0%)
Co-resistances were more frequent in the ESC-R group, for both E. coli and K. pneumoniae
Summary
We evaluated data from isolates of nursing home (NH) patients sent to the Swiss centre for antibiotic resistance (ANRESIS). In a recent point-prevalence study from four different LTCF in Italy, the prevalence of extended-spectrum beta-lactamase (ESBL)-carriage was 57% and of methicillin-resistant Staphylococcus aureus (MRSA) 17% [4]. Residence in an LTCF has been shown to be a risk factor for carriage of MRSA and glycopeptide-resistant enterococci (GRE) [6, 7]. Risk factors for resistant pathogens among nursing home (NH) residents include previous antibiotic treatment, invasive devices, age, open wounds, sharing a room with a colonized patient, bedriddenness, or high degree of disability [2, 4, 5, 8, 9]. In light of the alarming trends in antibiotic resistance from LTCF in neighboring countries, we aimed to assess temporal trends in the prevalence of antibiotic resistant isolates from patients in Swiss NHs and to identify risk factors associated with resistance
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