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Gut microbiology of UK care home residents: cross-sectional analysis from a randomised controlled trial

Gillespie, David ORCID:, Wootton, Mandy, Ray, Ruby, Calder, Philip, Lau, Tin Man Mandy ORCID:, Owen-Jones, Eleri ORCID:, Lowe, Rachel, Davies, Leanne, Richards, Jennifer, Hood, Kerenza ORCID:, Castro-Herrera, Vivian, Davies, Jane ORCID:, Francis, Nick A, Hobbs, F.D. Richard, Lown, Mark, Moore, Michael, Shepherd, Victoria ORCID: and Buttler, Christopher C. 2023. Gut microbiology of UK care home residents: cross-sectional analysis from a randomised controlled trial. Clinical Microbiology and Infection 29 (11) , pp. 1437-1442. 10.1016/j.cmi.2023.08.001

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Objective To describe prevalence of potentially clinically relevant gut pathogens and associations with carriage of resistant organisms in UK care home residents. Methods: Stool samples were collected pre-randomisation from care home residents participating in a randomised placebo-controlled trial. Cultivable clinically relevant bacteria were analysed. Antimicrobial susceptibility testing was performed by agar dilution (amoxicillin, co-amoxiclav, gentamicin, trimethoprim, nitrofurantoin, and ciprofloxacin). We also aimed to detect resistance to third-generation cephalosporins, carbapenems, and vancomycin. Results: Stool samples were available for 159/310 residents participating in the trial (51%) from 23 care homes between 2016 and 2018. In total, 402 bacterial isolates were cultured from 158 stool samples and 29 different species were cultured. The five most common species were Escherichia coli (155/158, 98%), Pseudomonas aeruginosa (40/158, 25%), Enterococcus faecalis (35/158, 22%), Enterococcus faecium (30/158, 19%), and Proteus mirabilis (25/158, 16%). Enterobacterales isolates were cultured from 157 samples (99%), and resistance to at least one of the tested antimicrobials was found in 119 of these (76%). There were high levels of variation in outcomes by care home. Conclusions: We demonstrated that care home residents harbour significant levels of antimicrobial-resistant organisms in their stool. This work emphasises the importance of both enhanced infection control practices and antimicrobial stewardship programmes to support appropriate use of antimicrobials in this setting.

Item Type: Article
Date Type: Publication
Status: Published
Schools: Medicine
Centre for Trials Research (CNTRR)
Publisher: Elsevier
ISSN: 1198-743X
Funders: MRC, NIHR, Chief Scientist Office - Scotland. Health and Care Rsearch Wales, Helath and Social Care Research and Development Division Northern Ireland, Probiotics to Reduce Infections in Care Home Residents [PRINCES]
Date of First Compliant Deposit: 21 August 2023
Date of Acceptance: 1 August 2023
Last Modified: 27 Nov 2023 16:01

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