The emergence of resistance to the fluoroquinolone (FQ) antibiotics is an issue of great concern at both the clinical and public health level. FQ resistance is particularly worrisome for Escherichia coli, the most common gram-negativebacterial pathogen. The emergence of FQ-resistant E. coli (FQR-EC) is of exceptional concern for long-term care facilities (LTCFs), because FQs, as the only oral antibiotic class with broad spectrum activity against gram-negative pathogens, are uniquely useful in treating infections in LTCF residents that would otherwise require hospitalization. Investigating FQR-EC in the LTCF setting is critical given the expected exponential future growth of the LTCF population, their high degree of debilitation with resultant high risk of poor outcomes due to infection, and the fact that LTCF residents, because of frequent visits to acute care facilities, may serve to introduce and disseminate FQR-EC to other healthcare settings. Despite these concerns, risk factors for FQR-EC in the LTCF have not been studied. While risk factors for FQR-EC have been identified in hospitalized patients, extrapolating these results to the LTCF is problematic because of the unique characteristics of the LTCF setting and its residents. Developing effective approaches to limit emergence of FQR-EC in the LTCF requires elucidation of the complex nature of the epidemiology of FQ resistance. Based on existing in vitro and clinical data, 1 may conceptualize 3 stages in the biological evolution of FQR-EC in an individual: 1) acquisition of new FQR-EC fecal colonization;2) persistence of FQR-EC fecal colonization;and 3) progression to clinical FQR-EC infection. The primary reason to conceptualize these different stages is to increase the sensitivity in identifying critical components of the pathway that can be interrupted or manipulated clinically. To identify novel future interventions, the potential role of clinical risk factors (e.g., antibiotic use), transmission (e.g., exogenous acquisition of FQR-EC), and isolate characteristics (e.g., FQ resistance mechanism, virulence factor profile) must be considered at each of these stages in the evolution of FQR-EC. The primary aims of this study are: 1) to identify risk factors for new FQR-EC colonization in LTCF patients, 2) to identify risk factors for prolonged FQR-EC colonization in LTCF patients, and 3) to identify risk factors for clinical FQR-EC infection in FQR-EC colonized LTCF patients.

Agency
National Institute of Health (NIH)
Institute
National Institute on Aging (NIA)
Type
Research Project (R01)
Project #
5R01AG023792-05
Application #
7591122
Study Section
Special Emphasis Panel (ZRG1-HOP-N (90))
Program Officer
Nayfield, Susan G
Project Start
2005-07-01
Project End
2011-04-30
Budget Start
2009-05-01
Budget End
2011-04-30
Support Year
5
Fiscal Year
2009
Total Cost
$558,147
Indirect Cost
Name
University of Pennsylvania
Department
Internal Medicine/Medicine
Type
Schools of Medicine
DUNS #
042250712
City
Philadelphia
State
PA
Country
United States
Zip Code
19104
Han, Jennifer H; Garrigan, Charles; Johnston, Brian et al. (2017) Epidemiology and characteristics of Escherichia coli sequence type 131 (ST131) from long-term care facility residents colonized intestinally with fluoroquinolone-resistant Escherichia coli. Diagn Microbiol Infect Dis 87:275-280
Manning, Sara; Lautenbach, Ebbing; Tolomeo, Pam et al. (2015) Risk factors for infection with Escherichia coli in nursing home residents colonized with fluoroquinolone-resistant E. coli. Infect Control Hosp Epidemiol 36:575-7
Han, Jennifer H; Maslow, Joel; Han, Xiaoyan et al. (2014) Risk factors for the development of gastrointestinal colonization with fluoroquinolone-resistant Escherichia coli in residents of long-term care facilities. J Infect Dis 209:420-5
Lautenbach, Ebbing; Han, Jennifer; Santana, Evelyn et al. (2012) Colonization with extended-spectrum ýý-lactamase-producing Escherichia coli and Klebsiella species in long-term care facility residents. Infect Control Hosp Epidemiol 33:302-4
Lautenbach, Ebbing; Babson, Andrew; Santana, Evelyn et al. (2009) Assessment of the use of urine samples to detect colonization with fluoroquinolone-susceptible and fluoroquinolone-resistant Escherichia coli. Infect Control Hosp Epidemiol 30:396-7
Lautenbach, Ebbing; Tolomeo, Pam; Black, Nicole et al. (2009) Risk factors for fecal colonization with multiple distinct strains of Escherichia coli among long-term care facility residents. Infect Control Hosp Epidemiol 30:491-3
Lautenbach, Ebbing; Marsicano, Roseann; Tolomeo, Pam et al. (2009) Epidemiology of antimicrobial resistance among gram-negative organisms recovered from patients in a multistate network of long-term care facilities. Infect Control Hosp Epidemiol 30:790-3
Lautenbach, Ebbing; Bilker, Warren B; Tolomeo, Pam et al. (2008) Impact of diversity of colonizing strains on strategies for sampling Escherichia coli from fecal specimens. J Clin Microbiol 46:3094-6
Lautenbach, Ebbing; Santana, Evelyn; Lee, Abby et al. (2008) Efficient recovery of fluoroquinolone-susceptible and fluoroquinolone-resistant Escherichia coli strains from frozen samples. Infect Control Hosp Epidemiol 29:367-9