Antimicrobial resistance patterns in long term geriatric care. Implications for drug therapy.
There is a high prevalence of bacterial infections in long term care facilities (4.4 to 16.2%). This, together with the fact that antimicrobial resistance is a big concern in current medical practice, makes infection control so important in nursing home care. This article covers the mechanisms of antibacterial resistance and focuses on 4 major antibacterial-resistant bacteria. Vancomycin is the treatment of choice for methicillin-resistant Staphylococcus aureus (MRSA). Colonisation with MRSA is not uncommon in nursing homes and eradication is probably not necessary. Any clinically important enterococcal infection should be tested for high-level resistance. An infectious disease consultation should be sought for vancomycin-resistant enterococcal infections. Gram-negative bacilli have developed multi-resistance. Susceptibility testing can identify the most appropriate therapy. Multiresistance should also be considered when treating Streptococcus pneumoniae. Overall, handwashing is highly recommended. Barrier precautions, minimising hospitalisations and avoiding unnecessary personnel rotation can reduce the chance of resistance spread.
Mao
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Division of Geriatric Medicine, Hospital of the University of Pennsylvania, Philadelphia, USA.
Siegler
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Abrutyn
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D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D016983:Enterococcus; D006090:Gram-Negative Bacteria / Q000187:drug effects*; D006801:Humans; D008134:Long-Term Care; D016106:Methicillin Resistance / Q000502:physiology*; D013296:Streptococcus pneumoniae / Q000187:drug effects; D014640:Vancomycin / Q000627:therapeutic use*
D000900:Anti-Bacterial Agents; D014640:Vancomycin