Long-term care: 'Reservoir for quinolone resistance'

San Francisco-A study at one of the largest health systems in Vancouver, British Columbia, has found that long-term care facilities have become a significant reservoir for resistance to fluoroquinolone antibiotics. The rise of resistance appears to be the result of the increased use of quinolones for empiric treatment of urinary tract infections and pneumonia in residents of these facilities.

"We expected to see acute care emerge as the reservoir for quinolone resistance," said Leanne Kwan, BSc, clinical pharmacist at Providence Health Care in Vancouver. "Instead, we found long-term care was the hot spot. There is significant danger of exporting this resistance from long-term care into acute care facilities and other settings."

Based on time from admission to culture, nearly all of the quinolone-resistant uropathogens appeared to arise in the long-term care setting, not as a result of having been brought in to long-term care by patients transferred from acute care.

"We think the problem is empiric treatment of UTIs," Kwan said. "We need to work with the clinical staff in long-term care ... to choose antibiotics based on susceptibility results as they become available. If empiric therapy is needed, it has to be something other than a quinolone."

A new UTI treatment protocol has been adopted by Providence Health Care, she added. Along with avoiding empiric therapy and waiting for susceptibility testing, the new guidelines advise against treatment of asymptomatic bacteriuria.

"We really have to be more vigilant in terms of antibiotic use," Kwan said. "Based on the SHEA (Society of Healthcare and Epidemiology of America) criteria, we are recommending now not to treat unless patients are symptomatic. We are also recommending that each facility profile its own resistance patterns to guide drug selection locally."