liu.seSearch for publications in DiVA
Change search
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rectal colonization and frequency of enterococcal cross-transmission among prolonged-stay patients in two Swedish intensive care units
Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
Swedish Institute for Infectious Disease Control, Solna, Sweden.
Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
Swedish Institute for Infectious Disease Control, Solna, Sweden.
Show others and affiliations
2005 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, Vol. 37, no 8, 561-571 p.Article in journal (Refereed) Published
Abstract [en]

The aims of this study were to gain insight into the dynamics of the rectal flora during prolonged ICU stay, with a particular focus on colonization and cross-transmission with resistant pathogens, and to evaluate methods for the rapid isolation of relevant bacteria from rectal swabs. Patients admitted to a general intensive care unit (GICU) or a cardiothoracic ICU (TICU) at the University Hospital of Linköping, Sweden, between 1 November 2001 and January 2002 with a length of stay > 5 d were included (n = 20). Chromogenic UTI agar medium was used for discrimination of different species, and appropriate antibiotics were added to detect resistance. Direct plating was compared to enrichment broth for a subset of specimens. The study showed an early alteration in rectal flora, with a dramatic decrease in Gram-negative rods in favour of Gram-positive bacteria. An ampicillin- and high-level gentamicin resistant clone of Enterococcus faecium was found in 6 of 10 patients in the GICU and 2 of 11 patients in the TICU. Enrichment broth did not enhance the detection of Gram-negative bacteria compared to direct plating on Chromogenic UTI medium, but enrichment broths were needed for optimal detection of resistant Gram-positive bacteria.

Place, publisher, year, edition, pages
2005. Vol. 37, no 8, 561-571 p.
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-30071DOI: 10.1080/00365540510038947Local ID: 15533OAI: oai:DiVA.org:liu-30071DiVA: diva2:250892
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-09-28
In thesis
1. Enterococci in Swedish intensive care units: studies on epidemiology, mechanisms of antibiotic resistance and virulence factors
Open this publication in new window or tab >>Enterococci in Swedish intensive care units: studies on epidemiology, mechanisms of antibiotic resistance and virulence factors
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The purpose of this thesis was to study enterococci in Sweden, their resistance to antibiotics in general and high-level gentamicin resistance (HLGR) in particular, with a special focus on the ICU setting. Dynamics of rectal colonisation during prolonged intensive care unit (ICU) stay was assessed. In addition, enterococcal virulence factors and the ability to adhere to abiotic surfaces such as urinary catheters were studied.

We found that among prolonged-stay patients admitted to ICUs, the rectal flora was altered, with a decrease in Gram-negative rods in favour of Gram-positive bacteria, mainly Coagulase negative staphylococci and enterococci.

Among clinical enterococcal isolates from patients admitted to Swedish ICUs, although vancomycin resistant enterococci (VRE) were only sporadically found, multidrug resistance was common. This was most apparent in Enterococcus faecium, where the majority of isolates were ampicillin- and quinolone resistant. Enterococcus faecalis was still the most frequently isolated enterococcal species in clinical specimens. Among patients admitted to Swedish ICUs 1996-1998, E. faecalis with HLGR was found in higher frequency (20%) than previously reported. The majority (89%) of these isolates belonged to two dominating clusters of genetically related E. faecalis. Cluster I (69%), which was predominantly found in the eastern and central parts of southern Sweden and Cluster II (20%) in south-western Sweden.

In the County of Östergötland, the first E. faecalis with HLGR isolated from blood cultures was found in 1996. The yearly incidence of isolates with HLGR in E. faecalis bacteraemia was studied from 1996-2001, and varied between 9-22%. The majority of these isolates were genetically related and belonged to Cluster I, also found in the previous study. The first blood isolate of E. faecium with HLGR in the County of Östergötland was found in 1999. A clone of E. faecium, with HLGR and ampicillin resistance, was found to colonise 6/10 and 2/11 prolonged-stay patients admitted from November 2001 through January 2002 to the general ICU and cardio-thoracic ICU, respectively, at the University Hospital of Linköping.

All studied isolates with HLGR carried the gene aac(6')-Ie-aph(2'')-Ia encoding the bifunctional aminoglycoside modifying enzyme Aac(6')Ie-Aph(2'')Ia, which conveys resistance to all commercially available amino-glycosides except streptomycin. The location of the gene, aac(6')Ie-aph(2'')-Ia, was studied in 45 E. faecalis isolates and the gene was carried on a Tn5281-like transposon in all isolates except one. The 30 µg disc diffusion test, as recommended by the SRGA, had 100% sensitivity and specificity when compared to PCR detection of aac(6')-Ie-aph(2'')-Ia.

E. faecalis isolates with HLGR belonging to widely disseminated clusters of genetically related isolates were more likely to carry both the gene encoding enterococcal surface protein (esp) and the gene encoding aggregation substance (asa1) compared to unique isolates. Esp was the only virulence factor found among E. faecium isolates, where it was common. E. faecalis isolates adhered with higher bacterial densities to urinary tract catheters compared to E. faecium isolates. In vitro adherence to urinary tract catheters was not affected by esp.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2005. 99 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 880
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-28709 (URN)13876 (Local ID)91-737-3861-1 (ISBN)13876 (Archive number)13876 (OAI)
Public defence
2005-02-18, Berzeliussalen, Hälsouniversitetet, Campus US, Linköpings Universitet, Linköping, 13:00 (English)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-09-28Bibliographically approved

Open Access in DiVA

No full text

Other links

Publisher's full text

Authority records BETA

Hällgren, AnitaIsaksson, BarbroNilsson, LennartSaeedi, BaharakWalther, StenHanberger, Håkan

Search in DiVA

By author/editor
Hällgren, AnitaIsaksson, BarbroNilsson, LennartSaeedi, BaharakWalther, StenHanberger, Håkan
By organisation
Department of Molecular and Clinical MedicineFaculty of Health Sciences
In the same journal
Scandinavian Journal of Infectious Diseases
Medical and Health Sciences

Search outside of DiVA

GoogleGoogle Scholar

doi
urn-nbn

Altmetric score

doi
urn-nbn
Total: 313 hits
CiteExportLink to record
Permanent link

Direct link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf