title: Risk factors for the development of gastrointestinal colonization with fluoroquinolone-resistant Escherichia coli in residents of long-term care facilities.
abstract: BACKGROUND
  The objective of this study was to assess risk factors for the development of fluoroquinolone (FQ)-resistant Escherichia coli gastrointestinal tract colonization in long-term care facility (LTCF) residents.
  
  
  METHODS
  A prospective cohort study was conducted from 2006 to 2008 at 3 LTCFs. Residents initially colonized with FQ-susceptible E. coli were followed by means of serial fecal sampling for new FQ-resistant E. coli colonization for up to 12 months or until discharge or death. A Cox proportional hazards regression model was developed to identify risk factors for new FQ-resistant E. coli colonization, with antibiotic and device exposures modeled as time-varying covariates.
  
  
  RESULTS
  Fifty-seven (47.5%) of 120 residents became newly colonized with FQ-resistant E. coli, with a median time to colonization of 57 days. Fecal incontinence (hazard ratio [HR], 1.78; 95% confidence interval [CI], 1.04-3.06; P = .04) was significantly associated with FQ-resistant E. coli acquisition. Receipt of amoxicillin-clavulanate (HR, 6.48; 95% CI, 1.43-29.4; P = .02) and the presence of a urinary catheter (HR, 3.81; 95% CI, 1.06-13.8; P = .04) during LTCF stay increased the risk of new FQ-resistant E. coli colonization.
  
  
  CONCLUSIONS
  Acquisition of FQ-resistant E. coli was common, with nearly half of LTCF residents developing new FQ-resistant E. coli colonization. Further studies are needed on interventions to limit the emergence of FQ-resistant E. coli in LTCFs.
authors.affiliation: Division of Infectious Diseases, Department of Medicine.
authors.forename: Jennifer H
authors.initials: JH
authors.lastname: Han
authors.forename: Joel
authors.initials: J
authors.lastname: Maslow
authors.forename: Xiaoyan
authors.initials: X
authors.lastname: Han
authors.forename: Sharon X
authors.initials: SX
authors.lastname: Xie
authors.forename: Pam
authors.initials: P
authors.lastname: Tolomeo
authors.forename: Evelyn
authors.initials: E
authors.lastname: Santana
authors.forename: Lesley
authors.initials: L
authors.lastname: Carson
authors.forename: Ebbing
authors.initials: E
authors.lastname: Lautenbach
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002353:Carrier State / Q000453:epidemiology* / Q000382:microbiology; D015331:Cohort Studies; D024881:Drug Resistance, Bacterial; D004926:Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D004927:Escherichia coli Infections / Q000453:epidemiology* / Q000382:microbiology; D005243:Feces / Q000382:microbiology; D005260:Female; D024841:Fluoroquinolones / Q000494:pharmacology*; D041981:Gastrointestinal Tract / Q000382:microbiology*; D006801:Humans; D008134:Long-Term Care; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones
keywords: Escherichia coli; fluoroquinolones; long-term care; resistance; risk factors