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Low level of antimicrobial resistance in Escherichia coli among Swedish nursing home residents
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Primary Health Care Centres.
County Hospital Ryhov, Jönköping.
Linköping University, Department of Medical and Health Sciences, General Practice. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in the West of Östergötland, Primary Health Care Centres.
Division of General Practice/Family Medicine, Department of Clinical Sciences in Malmö, Lund University .
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2013 (English)In: Scandinavian journal of infectious diseases, ISSN 1651-1980, Vol. 45, no 2, 117-123 p.Article in journal (Refereed) Published
Abstract [en]

Background: Screening for bacterial colonization and antimicrobial resistance (AMR) among a defined population could aid in the identification of at-risk populations and provide targets for antibiotic stewardship and infection control programmes. Methods: Two hundred and sixty-eight participants at 11 Swedish nursing homes underwent serial screening for colonization with Escherichia coli between March 2008 and September 2010. Seventy-two of the 268 participants (27%) were male. The median age was 85 y. Samples were collected from urine, the rectal mucosa, the groin, and active skin lesions. Results: Two hundred and nine of 268 participants (78%) were colonized with E. coli at any body site/fluid. The specific colonization rates were 81% (rectum), 48% (urine), 30% (groin), 59% (unknown), and 13% (skin lesion). An antibiotic-resistant E. coli isolate was identified in 18% of all participants regardless of colonization status; all together, 87 resistant isolates were detected. Only 1 participant carried isolates with resistance to third-generation cephalosporins (cefotaxime and ceftazidime). Conclusions: The presence of resistance was generally low, and the greater part of the resistant cases was connected with 3 common antibiotics: ampicillin, trimethoprim/sulfamethoxazole, and ciprofloxacin. In spite of generally increasing resistance against third-generation cephalosporins in E. coli in Sweden, this study does not implicate residence at a Swedish nursing home as a risk factor for the acquisition of expressed cephalosporin resistance.

Place, publisher, year, edition, pages
Informa Healthcare, 2013. Vol. 45, no 2, 117-123 p.
Keyword [en]
Mass screening, colonization, nursing homes, drug resistance, bacterial, Escherichia coli
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:liu:diva-85105DOI: 10.3109/00365548.2012.717232ISI: 000313677200006PubMedID: 22992114OAI: oai:DiVA.org:liu-85105DiVA: diva2:564710
Available from: 2012-11-02 Created: 2012-11-02 Last updated: 2016-12-19
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, MagnusÖstgren, Carl JohanLindgren, Per-EricMölstad, Sigvard

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