Colonisation of long-term care facilities residents with quinolone-resistant Gram-negative bacteria in Greece

Abstract number: 1134_02_264

Grammelis V., Tsekes G., Nikolakopoulou M., Gika M., Katsala D., Kanellakopoulou K., Giamarellou H., Lazanas M.C.

Objectives:

Quinolones (Q) are among the most frequently used agents for treating LTCF-acquired infections. Consequently, bacteria exhibit increasing resistance to Q. A multicentre survey was conducted in order to determine (I) the prevalence and risk factors for colonization with QRGN in Greek LTCF (II) the corresponding antimicrobial resistant rates (ÁR).

Methods:

A total of 28 LTCF were randomly selected from the public sanitation list of Attica province. Urine, nasopharyngeal and wound samples were collected from 668 elderly residents. We chose randomly 35% of the existing population from each LTCF (minimum sum 25 residents, age above 65 years). Gram negative bacteria were identified by API strips and underwent antimicrobial disk susceptibility testing, following the NCCLS guidelines. Data were also collected on resident factors and institutional variables. Univariate and multivariate analyses were performed. Odds ratios (OR) and P values were calculated.

Results:

412 Gram negative (GN) strains were isolated from 1448 samples (prevalence rate 28.5%). The majority of them were recovered from urine samples (86.8%). 53% of the residents had been taking systemic antibiotics during the preceding month. Q were the leading class (38%). ÁR of GN to ciprofloxacin (CIP) were estimated (Table). Multi-drug QRGN accounted for 11.5% of the isolated strains. The most prevalent phenotype was resistance to ampicilline, CIP and trimethoprim-sulfamethoxazole. In the multivariate analysis, only prior exposure to antimicrobial agents (P < 0.001; OR = 2), specifically to Q (P < 0.001; OR = 14), and the presence of a urinary catheter (P < 0.001; OR = 2) were significantly associated with colonization with QRGN.

Conclusions:

1. Colonization of residents in Greek LTCF with QRGN is relatively high. 2. Given the high rate of colonization with QRGN, empiric use of quinolones may not be appropriate. 3. Significant risk factors for colonization with QRGN are prior exposure to antimicrobial agents, specifically to quinolones, and the presence of a urinary catheter.