title: Cefotaxime-resistant bacteria colonizing older people admitted to an acute care hospital.
abstract: OBJECTIVE
  To determine the frequency of fecal colonization by cefotaxime-resistant gram-negative bacilli in older patients living in the community and in long-term care facilities (LTCFs) admitted to an acute care hospital.
  
  
  METHODS
  Case-control, point prevalence study.
  
  
  METHODS
  Hospital.
  
  
  METHODS
  One hundred forty-three patients aged 65 and older.
  
  
  METHODS
  Rectal swab cultures, antibiotic drug sensitivity, beta lactamase isolation, and clonal identity.
  
  
  RESULTS
  Of the 190 surveillance cultures obtained from 143 patients, 26 cefotaxime-resistant gram-negative isolates from 22 patients were recovered. The prevalence rate of cefotaxime-resistant isolates on admission was 13.3% (19/143). A logistic regression model using cefotaxime colonization as the dependent variable found that multiple comorbidities, admission to a surgical service, and having a diagnosis of infection on presentation and a transfusion history were factors associated with the presence of colonization. These four clinical items accurately classified 74% of patients colonized. Antibiotic use and nursing home residence were not associated with the presence of colonization by cefotaxime-resistant organisms. Twelve of the cefotaxime-resistant isolates (46%) were identified as Pseudomonas aeruginosa, and 14 (54%) were other gram-negative bacilli. In six of the 14 isolates that were not P. aeruginosa (36%), it was possible to demonstrate the presence of an AmpC beta-lactamase related to the CMY-2 beta-lactamase, a plasmid-borne cephalosporinase.
  
  
  CONCLUSIONS
  These data raise awareness that there are community- and LTCF-dwelling older patients colonized with gram-negative enteric bacilli resistant to third-generation cephalosporins on admission to the hospital. The "reservoir of resistant bacteria" in older people is no longer confined to LTCFs.
authors.affiliation: Infectious Disease Section, Geriatric and Extended Care, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio 44106, USA. Robert.Bonomo@med.va.gov
authors.forename: Robert A
authors.initials: RA
authors.lastname: Bonomo
authors.forename: Curtis J
authors.initials: CJ
authors.lastname: Donskey
authors.forename: Jeffery L
authors.initials: JL
authors.lastname: Blumer
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Hujer
authors.forename: Claudia K
authors.initials: CK
authors.lastname: Hoyenm
authors.forename: Michael R
authors.initials: MR
authors.lastname: Jacobs
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Whalen
authors.forename: Robert A
authors.initials: RA
authors.lastname: Salata
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D002439:Cefotaxime / Q000494:pharmacology*; D024881:Drug Resistance, Bacterial; D005260:Female; D006090:Gram-Negative Bacteria / Q000187:drug effects* / Q000302:isolation & purification; D006707:Homes for the Aged; D006760:Hospitalization; D006801:Humans; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D009735:Nursing Homes
chemical_list: D002439:Cefotaxime