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Colonization with Staphylococcus aureus in Swedish nursing homes: A cross-sectional study
Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Clinical and Experimental Medicine, Medical Microbiology. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in West Östergötland, Primary Health Care in Motala.
Department of Clinical Sciences in Malmö, Lund University, Sweden.
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2012 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 44, no 1, 3-8 p.Article in journal (Refereed) Published
Abstract [en]

Background: Screening for bacterial colonization among risk populations could provide better estimates of the volume of the bacteria-related disease reservoir and the level of antimicrobial resistance, than do conventional laboratory reports. Methods: Two hundred and one participants at 10 Swedish nursing homes were screened for colonization with Staphylococcus aureus between January and October 2009. Of the 201 participants, 61 (30%) were male. The median age was 86 y. All participants were systematically sampled from the nasal mucosa, the pharyngeal mucosa, the groin, and active skin lesions, if any. Results: Ninety-nine of 199 participants (50%) were colonized with S. aureus. The colonization rate was 34% for the nose, 35% for throat, 10% for groin, and 54% for active skin lesions. An antibiotic-resistant S. aureus isolate was identified in 8.5% of all participants regardless of colonization status. A total of 24 resistant isolates were detected, and 21 of these were resistant to fluoroquinolones. There was no case of colonization with methicillin-resistant S. aureus (MRSA). Conclusions: The presence of resistant isolates was generally low, and the greater part of the resistance was fluoroquinolone-related. To achieve reasonable precision, screening programmes of this kind must include samples from both the nose and throat, and, although low, the prevalence of antimicrobial resistance in Swedish nursing homes still calls for reflection on how to use the fluoroquinolones wisely. © 2012 Informa Healthcare.

Place, publisher, year, edition, pages
Informa Healthcare , 2012. Vol. 44, no 1, 3-8 p.
Keyword [en]
Colonization; Drug resistance (bacterial); Methicillin-resistant Staphylococcus aureus; Nursing homes; Staphylococcus aureus
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-74118DOI: 10.3109/00365548.2011.598875OAI: oai:DiVA.org:liu-74118DiVA: diva2:480891
Available from: 2012-01-20 Created: 2012-01-19 Last updated: 2017-12-08Bibliographically approved
In thesis
1. Microbiological Surveillance in Primary Health Care: New Aspects of Antimicrobial Resistance and Molecular Epidemiology in an Ageing Population
Open this publication in new window or tab >>Microbiological Surveillance in Primary Health Care: New Aspects of Antimicrobial Resistance and Molecular Epidemiology in an Ageing Population
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

The inexorable rise in antimicrobial resistance (AMR) interferes with the goals of health care services around the world, given how critical the antibacterials are in making infections treatable and surgical procedures doable. Nursing homes residents have been identified as a reservoir for AMR, possibly due to the combination of being physically and mentally frail, frequently treated with antibacterials, and frequently moved between nursing home and hospital. Microbiological surveillance is a key countermeasure against further AMR development. Yet, surveillance data is easily biased due to precision problems regarding how the data is collected and evaluated.

Methods

Beginning in 2008, we launched two programmes (“SHADES” and “MIDIO”) aimed to gathering AMR data in a systematic fashion from elderly nursing home residents and elderly people living in their own place of residence. In doing so, we focused on colonizing strains of the two most important nosocomial infectious agents, Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). The bacteria were collected from multiple body sites and analysed with respect to antimicrobial susceptibility and genetic diversity.

Results

Active surveillance of AMR showed that (i) a S. aureus isolate could be retrieved from 1 in every 2 individuals given a single round of sampling, but aggregating several rounds of sampling, this figure might reach 7 in every 10 individuals, (ii) an E. coli isolate could be retrieved from 4 in every 5 individuals, (iii) the overall prevalence of AMR was favourable when compared to the situation in many other countries, (iv) the genetic diversity of S. aureus was generally high and provided only limited evidence of clonal expansion or contraction, and (v) diabetes mellitus was one of very few patient-level factors to show an association with the degree of genetic diversity in S. aureus.

Conclusions

The prevalence of colonization with S. aureus and E. coli was somewhat higher than expected, but the degree of AMR was very low. The genetic diversity of S. aureus was generally high. Diabetes mellitus emerged as the only patient-level factor associated with a higher degree of genetic diversity in S. aureus.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. 76 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1556
Keyword
Colonization, Nosocomial, Bacteria
National Category
Family Medicine
Identifiers
urn:nbn:se:liu:diva-133246 (URN)10.3384/diss.diva-133246 (DOI)9789176856154 (ISBN)
Public defence
2017-02-07, Belladonna, Universitetssjukhuset i Linköping, ingång 78, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Funder
Medical Research Council of Southeast Sweden (FORSS)
Available from: 2016-12-19 Created: 2016-12-15 Last updated: 2016-12-22Bibliographically approved

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Olofsson, MagnusLindgren, Per-EricÖstgren, Carl JohanMölstad, Sigvard

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