May 22, 2023
IMPACT member, Rupak Datta, MD, PhD, is among authors who address antimicrobial resistance in homebound people living with dementia (PLWD) leading to urinary tract infections, a major public health threat. The authors evaluate national samples and determine more research is needed on antimicrobial resistance in homebound seniors.
Abstract
Annual prevalence of antimicrobial resistance among urine isolates (3,913 Escherichia coli isolates and 1,736 Klebsiella pneumoniae isolates) from home-based primary care patients with dementia were high between 2014 and 2018 (ciprofloxacin, 18%–23% and 5%–7%, respectively; multidrug resistance, 9%–11% and 5%–6%, respectively). Multidrug resistance varied by region. Additional studies of antimicrobial resistance in home-care settings are needed.
Urinary tract infection (UTI) is one of the most commonly diagnosed and treated infections in older adults. The microbial etiology of UTIs has been well described; Escherichia coli and Klebsiella pneumoniae are the predominant organisms isolated. Antimicrobial resistance is a major public health threat, and existing literature regarding antimicrobial resistance among UTIs in older adults has largely focused on nursing homes. Recent data from 243 nursing homes indicate that a substantial portion of UTIs due to E. coli and K. pneumoniae are multidrug-resistant.
In the United States, the population of homebound older adults is >1.5 times larger than the nursing home population. Similar to nursing home residents, homebound older adults often have dementia and are prone to UTI. Little is known regarding antimicrobial resistance among urine isolates from home care settings. Home-based primary care (HBPC) offers one method for homebound older adults to receive comprehensive care in their home. In this study, the authors evaluated antimicrobial resistance among E. coli and K. pneumoniae urine isolates from a national sample of homebound older adults with dementia who were enrolled in HBPC.