{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T07:46:59Z","timestamp":1791877619436,"version":"4.3.4"},"reference-count":35,"publisher":"Cambridge University Press (CUP)","issue":"7","license":[{"start":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T00:00:00Z","timestamp":1557100800000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/www.cambridge.org\/core\/terms"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Infect. Control Hosp. Epidemiol."],"published-print":{"date-parts":[[2019,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec id=\"S0899823X19001089_as1\"><jats:title>Objective:<\/jats:title><jats:p>Identify changes in the prevalence and antimicrobial resistance patterns of potentially pathogenic bacteria in urine cultures during a 2-year antimicrobial stewardship intervention program in nursing homes (NHs).<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X19001089_as2\"><jats:title>Design:<\/jats:title><jats:p>Before-and-after intervention study.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X19001089_as3\"><jats:title>Setting:<\/jats:title><jats:p>The study included 27 NHs in North Carolina.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X19001089_as4\"><jats:title>Methods:<\/jats:title><jats:p>We audited all urine cultures ordered before and during an antimicrobial stewardship intervention. Analyses compared culture rates, culture positive rates, and pathogen antimicrobial resistance patterns.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X19001089_as5\"><jats:title>Results:<\/jats:title><jats:p>Of 6,718 total urine cultures collected, 68% were positive for potentially pathogenic bacteria. During the intervention, significant reductions in the urine culture and positive culture rates were observed (<jats:italic>P<\/jats:italic>= .014). Most of the identified potentially uropathogenic isolates were<jats:italic>Escherichia coli<\/jats:italic>(38%),<jats:italic>Proteus<\/jats:italic>spp (13%), and<jats:italic>Klebsiella pneumoniae<\/jats:italic>(12%). A significant decrease was observed during the intervention period in nitrofurantoin resistance among<jats:italic>E. coli<\/jats:italic>(<jats:italic>P<\/jats:italic>\u2264 .001) and ciprofloxacin resistance among<jats:italic>Proteus<\/jats:italic>spp (<jats:italic>P<\/jats:italic>\u2264 .001); however carbapenem resistance increased for<jats:italic>Proteus<\/jats:italic>spp (<jats:italic>P<\/jats:italic>\u2264 .001). Multidrug resistance also increased for<jats:italic>Proteus<\/jats:italic>spp compared to the baseline. The high baseline resistance of<jats:italic>E. coli<\/jats:italic>to the commonly prescribed antimicrobials ciprofloxacin and trimethoprim-sulfamethoxazole (TMP\/SMX) did not change during the intervention.<\/jats:p><\/jats:sec><jats:sec id=\"S0899823X19001089_as6\"><jats:title>Conclusions:<\/jats:title><jats:p>The antimicrobial stewardship intervention program significantly reduced urine culture and culture-positive rates. Overall, very high proportions of antimicrobial resistance were observed among common pathogens; however, antimicrobial resistance trended downward but reductions were too small and scattered to conclude that the intervention significantly changed antimicrobial resistance. Longer intervention periods may be needed to effect change in resistance patterns.<\/jats:p><\/jats:sec>","DOI":"10.1017\/ice.2019.108","type":"journal-article","created":{"date-parts":[[2019,5,6]],"date-time":"2019-05-06T19:42:31Z","timestamp":1557171751000},"page":"780-786","source":"Crossref","is-referenced-by-count":19,"title":["Antimicrobial resistance patterns of urine culture specimens from 27 nursing homes: Impact of a two-year antimicrobial stewardship intervention"],"prefix":"10.1017","volume":"40","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7742-7980","authenticated-orcid":false,"given":"Meera","family":"Tandan","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philip D.","family":"Sloane","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kimberly","family":"Ward","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Weber","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Akke","family":"Vellinga","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine E.","family":"Kistler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sheryl","family":"Zimmerman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"56","published-online":{"date-parts":[[2019,5,6]]},"reference":[{"key":"S0899823X19001089_ref35","doi-asserted-by":"publisher","DOI":"10.1128\/JCM.02771-15"},{"key":"S0899823X19001089_ref33","doi-asserted-by":"publisher","DOI":"10.1007\/s40520-017-0841-5"},{"key":"S0899823X19001089_ref30","doi-asserted-by":"publisher","DOI":"10.1007\/s10096-014-2225-5"},{"key":"S0899823X19001089_ref29","doi-asserted-by":"publisher","DOI":"10.1017\/ice.2015.41"},{"key":"S0899823X19001089_ref25","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2018.01097"},{"key":"S0899823X19001089_ref24","doi-asserted-by":"publisher","DOI":"10.1016\/j.idc.2013.10.004"},{"key":"S0899823X19001089_ref23","doi-asserted-by":"publisher","DOI":"10.1038\/nrmicro3432"},{"key":"S0899823X19001089_ref22","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-135-1-200107030-00012"},{"key":"S0899823X19001089_ref20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-0691.2011.03570.x"},{"key":"S0899823X19001089_ref19","doi-asserted-by":"publisher","DOI":"10.1086\/668770"},{"key":"S0899823X19001089_ref18","volume-title":"Perfomance Standard for Antimicrobial Susceptability Testing\u201416th Informational Supplement","year":"2008"},{"key":"S0899823X19001089_ref17","first-page":"135","article-title":"FDA adds \u201cblack box\u201d warning label to fluoroquinolone antibiotics","volume":"337","author":"Tanne","year":"2008","journal-title":"BMJ"},{"key":"S0899823X19001089_ref13","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2008.01967.x"},{"key":"S0899823X19001089_ref12","doi-asserted-by":"publisher","DOI":"10.1111\/1469-0691.12089"},{"key":"S0899823X19001089_ref26","doi-asserted-by":"crossref","unstructured":"26. Sloane PD ZS , Ward K , Kistler KE , et al. Implementing antibiotic stewardship in community nursing homes: a two-year dissemination trial. Manuscript currently in review. 2018.","DOI":"10.1111\/jgs.16059"},{"key":"S0899823X19001089_ref10","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(05)70799-6"},{"key":"S0899823X19001089_ref34","volume-title":"Performance Standards for Antimicrobial Susceptibility Testing: 22nd Informational Supplement","year":"2012"},{"key":"S0899823X19001089_ref14","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/ciq257"},{"key":"S0899823X19001089_ref9","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2318-12-73"},{"key":"S0899823X19001089_ref27","doi-asserted-by":"publisher","DOI":"10.1086\/664757"},{"key":"S0899823X19001089_ref21","unstructured":"21. Nursing home compare. Centers for Medicare and Medicaid Services website. https:\/\/www.medicare.gov\/nursinghomecompare. 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