Antimicrobial resistance in urinary pathogens among Swedish nursing home residents remains low: a cross-sectional study comparing antimicrobial resistance from 2003 to 2012

BMC Geriatrics

Research Article

Lars Jonsson¹  Nils Rodhe²  Sigvard Mölstad³  Peter Ulleryd⁴  Marie Elm⁵  Ronny Gunnarsson⁶  Pär-Daniel Sundvall⁷ 

[1] Bio Imaging and Laboratory Medicine Unit, Södra Älvsborg Hospital, SE-501 82, SE-501 82, Borås, Sweden;Centre for Clinical Research, Dalarna, Sweden and Falu Vårdcentral, Södra Mariegatan 18, SE-791 70, Falun, Sweden;Department of Public Health and Caring Sciences, Family Medicine, Uppsala University, Uppsala, Sweden;Department of Clinical Sciences, General Practice, Lund University, CRC, Hus 28, Plan 11, Jan Waldenströms gata 35, SE-205 02, Malmö, Sweden;Department of Infectious Diseases, Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Sweden and Department of Communicable Disease Control, Västra Götalandsregionen, SE-501 82, Borås, Sweden;Health Care Unit, Borås Municipality, Våglängdsgatan 21 B, SE-507 41, Borås, Sweden;Research and Development Unit, Primary Health Care in Southern Älvsborg County, Sven Eriksonsplatsen 4, SE-503 38, Borås, Sweden;Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Box 100, SE-405 30, Gothenburg, Sweden;Cairns Clinical School, School of Medicine and Dentistry, James Cook University, Cairns Base Hospital, PO Box 902, 4870, Cairns, QLD, Australia;Research and Development Unit, Primary Health Care in Southern Älvsborg County, Sven Eriksonsplatsen 4, SE-503 38, Borås, Sweden;Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Box 100, SE-405 30, Gothenburg, Sweden;Sandared Primary Health Care Centre, Sandared, Sweden;

关键词: Drug resistance;    Bacterial;    Bacteriuria;    Nursing homes;    Homes for the aged;    Urinary tract infections;    Antibiotics;   

DOI  :  10.1186/1471-2318-14-30

 received in 2013-10-23, accepted in 2014-03-06,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundThere are several risk factors for the colonisation, infection and spreading of antibiotic resistant bacteria among elderly residents of nursing homes. An updated estimate of the native prevalence of antimicrobial resistance in uropathogens among Swedish nursing home residents is needed.MethodsUrine specimens were collected for culture and antimicrobial susceptibility testing against mecillinam, ampicillin, cefadroxil, trimethoprim, nitrofurantoin and quinolones from the residents of 32 and 22 nursing homes, respectively. The residents were capable of providing a voided urine sample in 2003 and 2012. In 2012 urine specimens were also collected from residents with urinary catheters. Any antibiotic treatment during the previous month was registered in 2003 as well as hospitalisation and any antibiotic treatment during the previous six months in 2012.ResultsThe proportion of positive urine cultures was 32% (207/651) in voided urine specimens in 2003, 35% (147/421) in 2012, and 46% (27/59) in urine samples from catheters in 2012. Escherichia coli (E. coli) was the most commonly occurring bacteria.Resistance rates in E. coli (voided urine specimens) in 2012 were; ampicillin 21%, trimethoprim 12%, mecillinam 7.7%, ciprofloxacin 3.4%, cefadroxil 2.6% and nitrofurantoin 0.85%. There were no significant changes in the average resistance rates in E. coli for antibiotics tested 2003–2012.In 2012, two isolates of E. coli produced extended spectrum beta-lactamase enzymes (ESBL) and one with plasmid mediated AmpC production.Any antibiotic treatment during the previous month increased the risk for resistance in E. coli, adjusted for age and gender; for mecillinam with an odds ratio (OR) of 7.1 (2.4-21; p = 0.00049), ampicillin OR 5.2 (2.4-11; p = 0.000036), nalidixic acid OR 4.6 (1.4-16; p = 0.014) and trimethoprim OR 3.9 (1.6-9.2; p = 0.0023). Hospitalisation during the previous six months increased the risk for antibiotic resistance in E. coli to ampicillin, ciprofloxacin and any antimicrobial tested, adjusted for age, gender and antibiotic treatments during the previous six months.ConclusionsThe average rates of antimicrobial resistance were low and did not increase between 2003 and 2012 in E. coli urinary isolates among Swedish nursing home residents. Antibiotic treatment during the previous month and hospitalisation during the previous six months predicted higher resistance rates.

【 授权许可】

CC BY   
© Sundvall et al.; licensee BioMed Central Ltd. 2014