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Antibiotic susceptibility patterns and clones of Pseudomonas aeruginosa in Swedish ICUs
Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
Department of Anaesthesiology, Ullevål University Hospital, University of Oslo, Oslo, Norway.
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2008 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, Vol. 40, no 6-7, 487-494 p.Article in journal (Refereed) Published
Abstract [en]

Pseudomonas aeruginosa is 1 of the bacteria most adaptive to anti-bacterial treatment. Previous studies have shown nosocomial spread and transmission of clonal strains of P. aeruginosa in European hospitals. In this study we investigated antibiotic susceptibility and clonality in 101 P. aeruginosa isolates from 88 patients admitted to 8 Swedish ICUs during 2002. We also compared phenotypes and genotypes of P. aeruginosa and carried out cluster analysis to determine if phenotypic data can be used for surveillance of clonal spread. All isolates were collected on clinical indication as part of the NPRS II study in Sweden and were subjected to AFLP analysis for genotyping. 68 isolates with unique genotypes were found. Phenotyping was performed using MIC values for 5 anti-pseudomonal agents. Almost 6% of the isolates were multi-drug resistant (MDR), and this figure rose to almost 8% when intermediate isolates were also included. We found probable clonal spread in 9 cases, but none of them was found to be an MDR strain. Phenotypical cluster analysis produced 40 clusters. Comparing partitions did not demonstrate any significant concordance between the typing methods. The conclusion of our study is that cross-transmission and clonal spread of MDR P. aeruginosa does not present a clinical problem in Swedish ICUs, but probable cross-transmission of non-MDR clones indicate a need for improved hygiene routines bedside. The phenotype clusters were not concordant with genotype clusters, and genotyping is still recommended for epidemiological tracking.

Place, publisher, year, edition, pages
2008. Vol. 40, no 6-7, 487-494 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-12666DOI: 10.1080/00365540701864641OAI: diva2:16801
Available from: 2007-10-18 Created: 2007-10-18 Last updated: 2010-01-19
In thesis
1. Surveillance of Antibiotic Consumption and Antibiotic Resistance in Swedish Intensive Care Units
Open this publication in new window or tab >>Surveillance of Antibiotic Consumption and Antibiotic Resistance in Swedish Intensive Care Units
2007 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Introduction: Nosocomial infections remain a major cause of mortality and morbidity. The problem is most apparent in intensive care units (ICUs). Most ICU patients are compromised and vulnerable as a result of disease or severe trauma. One in ten people admitted to hospital is given an antibiotic for infection. The risk of acquiring a nosocomial infection in a European ICU is approximately 20%. It is vitally important that ways are found to prevent transmission between patients and personnel, and that local hygiene routines and antibiotic policies are developed. This thesis is a holistic work focused particularly on antimicrobial antibiotic resistance, antibiotic consumption and to some extent on hygiene in Swedish ICUs.

Aims: The general aim of this thesis was to investigate bacterial resistance and antibiotic consumption in Swedish ICUs and to try to correlate ICU demographic data with antibiotic consumption and antibiotic resistance. Additional aims were to investigate on which clinical indications antibacterial drugs are prescribed in the ICU, and to investigate the emergence of resistance and transmission of Pseudomonas aeruginosa in the ICU using cluster analysis based on antibiograms and genotype data obtained by AFLP.

Material and methods: In paper 1-3, antibiotic consumption data together with bacterial antibiotic resistance data and specific ICU-demographic data were collected from an increasing number of ICUs over the years 1997-2001. Data from ICUs covering up to six million out of Sweden’s nine million inhabitants were included. In paper 4, the indications for antibiotic prescribing were studied during two weeks in 2000. Paper 5 investigated Pseudomonas aeruginosa isolates in order to detect cross-transmission with genotype obtained by AFLP, and antibiogram-based cluster analysis was also performed in order to see if this could be a quicker and easier substitute for AFLP.

Results: This thesis has produced three important findings. Firstly, antibiotic consumption in participating ICUs was relatively high during the study period, and every patient received on average more than one antimicrobial drug per day (I-IV). Secondly, levels of antimicrobial drug resistance seen in S. aureus, E. coli and Klebsiella spp remained low when data were pooled from all ICUs throughout the study period, despite relatively high antibiotic consumption (I-V). Thirdly, the prevalence of antibiotic resistance in CoNS and E. faecium, cefotaxime resistance in Enterobacter, and ciprofloxacin and imipenem resistance in P. aeruginosa was high enough to cause concern.

Conclusion: For the period studied, multidrug resistance in Swedish ICUs was not a major problem. Signs of cross-transmission with non-multiresistant bacteria were observed, indicating a hygiene problem and identifying simple improvements that could be made in patient care guidelines and barrier precautions. A need for better follow up of prescribed antibiotics was evident. With further surveillance studies and monitoring of antibiotics and bacterial resistance patterns in the local setting as well as on a national and international level, some of the strategic goals in the prevention and control of the emergence of antimicrobial-resistant microbes may be achievable.

Place, publisher, year, edition, pages
Institutionen för molekylär och klinisk medicin, 2007
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1019
Bacterial Antibiotic resistance, Antibiotic Consumption, ICU, Surveillance programme, Multi drug resistance, Pseudomonas aeruginosa, ICU demography
National Category
Infectious Medicine
urn:nbn:se:liu:diva-10049 (URN)978-91-85895-77-9 (ISBN)
Public defence
2007-10-26, Elsa Brändströmsalen, University Hospital, Linköping University, 581 85 Linköping, 09:00 (English)
Available from: 2007-10-18 Created: 2007-10-18 Last updated: 2009-08-22

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Erlandsson, MarcusGill, HansNilsson, Lennart E.Walther, StenHanberger, Håkan
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