Aging Clinical and Experimental Research

, Volume 30, Issue 7, pp 839–843 | Cite as

Comparative characteristic of antimicrobial resistance in geriatric hospital: a retrospective cohort study

  • G. Goltsman
  • E. H. Mizrahi
  • A. Leibovitz
  • G. Gal
  • O. Gorelik
  • E. Lubart
Original Article


Background and aims

To examine antimicrobial resistance of commonly isolated pathogens in elderly hospitalized patients.


Data regarding all clinically significant isolates from blood and urine cultures of patients admitted to a multilevel geriatric hospital during March 2015 to April 2016 were collected. Antimicrobial susceptibility testing was performed according to Clinical and Laboratory Standard Institute guidelines.


Escherichia coli, Proteus mirabilis, and Klebsiella pneumoniae were the most common isolates, with proportions of extended spectrum beta-lactamase positivity of 60, 40, and 61% respectively. Adjusted logistic regression models indicated that resistance of Escherichia coli to ceftriaxone [odds ratio (OR) 2.8, 95% confidence interval (CI) 1.5–5.1], ceftazidime (OR 2.8, 95% CI 1.5–5.1), ciprofloxacin (OR 2.2, 95% CI 1.2–4.0), amoxicillin/clavulanic acid (OR 2.3, 95% CI 1.2–4.3), and trimethoprim/sulfamethoxazole (OR 2.4, 95% CI 1.4–4.3) was significantly higher in skilled nursing wards than in acute geriatric wards. Resistance of Proteus mirabilis to ceftriaxone (OR 3.1, 95% CI 1.5–6.4) and Klebsiella pneumoniae to ciprofloxacin (OR 3.2, 95% CI 1.3–7.9) was significantly higher in skilled nursing wards than in acute wards.

Conclusions and discussion

Antimicrobial resistance was found to be high in a multilevel geriatric hospital, especially in skilled nursing wards. These findings call for rethinking of the empirical antimicrobial therapy and of the efforts for prevention of nosocomial infection.


Antimicrobial resistance ESBL Infection Geriatric hospital 


Compliance with ethical standards


The study did not have specific funding.

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

The study was approved by the institutional ethical committee.

Statement of human and animal rights

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

For this type of study, formal consent is not required.


  1. 1.
    Augustine S, Bonomo RA (2011) Taking stock of infections and antibiotic resistance in the elderly and long-term care facilities: a survey of existing and upcoming challenges. Eur J Microbiol Immunol 1:190–197CrossRefGoogle Scholar
  2. 2.
    Fagan M, Lindbaek M, Grude N et al (2015) Antibiotic resistance patterns of bacteria causing urinary tract infections in the elderly living in nursing homes versus the elderly living at home: an observational study. BMC Geriatr. doi: 10.1186/s12877-015-0097-x PubMedPubMedCentralGoogle Scholar
  3. 3.
    Yoshikawa TT (2002) Antimicrobial resistance and aging: beginning of the end of the antibiotic era? J Am Geriatr Soc 50:S226–S229CrossRefPubMedGoogle Scholar
  4. 4.
    Castle SC (2000) Clinical relevance of age-related immune dysfunction. Clin Infect Dis 31:578–585CrossRefPubMedGoogle Scholar
  5. 5.
    Staykova S (2013) Urinary tract infections in geriatric patients. Webmed Cent Nephrol 4:WMC003968Google Scholar
  6. 6.
    Wester AL, Dunlop O, Melby KK et al (2013) Age-related differences in symptoms, diagnosis and prognosis of bacteremia. BMC Infect Dis 13:346CrossRefPubMedPubMedCentralGoogle Scholar
  7. 7.
    Lubart E, Segal R, Haimov E et al (2011) Bacteremia in a multilevel geriatric hospital. J Am Med Dir Assoc 12:204–207CrossRefPubMedGoogle Scholar
  8. 8.
    Lubart E, Kornitsky R, Dan M et al (2014) Bacteremia in a multilevel geriatric hospital, second look 5 years later. Br J Med Med Res 4:1729–1738Google Scholar
  9. 9.
    Mylotte JM, Tayara A, Goodnough S (2002) Epidemiology of bloodstream infection in nursing home residents: evaluation in a large cohort from multiple homes. Clin Infect Dis 35:1484–1490CrossRefPubMedGoogle Scholar
  10. 10.
    Richards CL Jr (2007) Infection control in long-term care facilities. J Am Med Dir Assoc 8:S18–S25CrossRefPubMedGoogle Scholar
  11. 11.
    Little MO (2011) Diagnostic challenge of bloodstream infections in long-term care. J Am Med Dir Assoc 12:166–168CrossRefGoogle Scholar
  12. 12.
    Picozzi S, Ricci C, Gaeta M et al (2013) Do we really know the prevalence of multi-drug resistant Escherichia coli in the territorial and nosocomial population? Urol Ann 5:25–29CrossRefPubMedPubMedCentralGoogle Scholar
  13. 13.
    Briongos-Figuero LS, Gómez-Traveso T, Bachiller-Luque P et al (2012) Epidemiology, risk factors and comorbidity for urinary tract infections caused by extended-spectrum beta-lactamase (ESBL)-producing enterobacteria. Int J Clin Pract 66:891–896CrossRefPubMedGoogle Scholar
  14. 14.
    Lu PL, Liu YC, Toh HS et al (2012) Epidemiology and antimicrobial susceptibility profiles of Gram-negative bacteria causing urinary tract infections in the Asia-Pacific region: 2009–2010 results from the Study for Monitoring Antimicrobial Resistance Trends (SMART). Int J Antimicrob Agents 40:S37–S43CrossRefPubMedGoogle Scholar
  15. 15.
    De Vecchi E, Sitia S, Romanó CL et al (2013) Aetiology and antibiotic resistance patterns of urinary tract infection in the elderly: a 6-month study. J Med Microbiol 62:859–863CrossRefPubMedGoogle Scholar
  16. 16.
    Ho PL, Chau PH, Yan MK et al (2014) High burden of extended-spectrum beta-lactamase - positive Escherichia coli in geriatric patients. J Med Microbiol 63:878–883CrossRefPubMedGoogle Scholar
  17. 17.
    Warshaw G, Mehdizadeh S, Applebaum RA (2001) Infections in nursing homes: assessing quality of care. J Gerontol A Biol Sci Med Sci 56:M120–M123CrossRefPubMedGoogle Scholar
  18. 18.
    McKinnell JA, Stollenwerk NS, Jung CW et al (2011) Nitrofurantoin compares favorably to recommended agents as empirical treatment of uncomplicated urinary tract infections in a decision and cost analysis. Mayo Clin Proc 86:480–488CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Richards CL Jr (2005). Infections in long-term-care facilities: screen or clean? Infect Control Hosp Epidemiol 26:800–801CrossRefGoogle Scholar
  20. 20.
    Yoshikawa TT, Norman DC (1995) Infection control in long-term care. Clin Geriatr Med 11:467–480PubMedGoogle Scholar
  21. 21.
    Yoshikawa TT, Norman DC (1996) Approach to fever and infection in the nursing home. J Am Geriatr Soc 44:74–82CrossRefPubMedGoogle Scholar
  22. 22.
    van Buul LW, van der Steen JT, Veenhuizen RB et al (2012) Antibiotic use and resistance in long term care facilities. J Am Med Dir Assoc 13:568.e1–13PubMedGoogle Scholar
  23. 23.
    Barlam TF, Cosgrove SE, Abbo LM et al (2016) Executive summary: implementing an Antibiotic Stewardship Program: guidelines by the Infectious Diseases Society of America and the Society for Healthcare Epidemiology of America. Clin Infect Dis 62:1197–2002CrossRefGoogle Scholar
  24. 24.
    Cosgrove SE, Hermsen ED, Rybak MJ (2014)Guidance for the knowledge and skills required for antimicrobial stewardship leaders. Infect Control Hosp Epidemiol 35:1444–1451CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG 2017

Authors and Affiliations

  • G. Goltsman
    • 1
    • 2
  • E. H. Mizrahi
    • 1
    • 3
  • A. Leibovitz
    • 1
    • 3
  • G. Gal
    • 4
  • O. Gorelik
    • 1
    • 2
  • E. Lubart
    • 1
    • 3
  1. 1.The Sackler Faculty of MedicineTel Aviv UniversityTel AvivIsrael
  2. 2.Asaf Harofeh Medical CenterZerifinIsrael
  3. 3.Shmuel Harofeh Geriatric Medical CenterBeer YaakovIsrael
  4. 4.School of Behavioral SciencesTel Aviv-Jaffa Academic CollegeJaffaIsrael

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