Journals of Gerontology Series A: Biological Sciences and Medical Sciences, Vol 54, Issue 6 B260-B267, Copyright © 1999 by The Gerontological Society of America
Emerging issues in antibiotic resistant infections in long-term care facilities
RA Bonomo and LB Rice
Division of Geriatrics, University Hospitals of Cleveland, Ohio, USA. rab14@cwru.edu
Managing patients infected with antibiotic resistant bacteria is becoming
one of the major clinical obstacles facing physicians who treat patients in
long-term care facilities (LTCFs). Penicillin- resistant pneumococci (PRP),
vancomycin-resistant enterococci (VRE), gram-negative bacteria that produce
extended-spectrum and ampC-type beta-lactamase enzymes, and
quinolone-resistant gram-positive and gram- negative bacteria are the major
resistant pathogens that are emerging in these settings. The mechanisms
responsible for the evolution of these antibiotic resistant organisms
(molecular rearrangement of penicillin binding protein genes, acquisition
of a mobile genetic element, and point mutation that alter the active site)
are reviewed. Vancomycin intermediate Staphylococcus aureus (VISA) and
multidrug efflux pumps in gram-negative bacteria are also threatening our
most potent antimicrobials. Aggressive screening, education, antibiotic-
control measures, and immunization are advocated as important preventive
measures. The combined efforts of the medical directors, infection-control
personnel, and administrators are needed to stem this problem.
