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Gastrointestinal Infection

Prevalence of fecal carriage of antibiotic-resistant bacteria in patients with acute surgical abdominal infections

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Pages 1203-1210 | Received 18 Mar 2010, Accepted 19 May 2010, Published online: 03 Jun 2010
 

Abstract

Objective. Antibiotic resistance is increasing worldwide. The aims of the current study were to determine the fecal carriage of antibiotic-resistant bacteria and antibiotic treatment in surgical patients admitted to hospital due to acute intra-abdominal infections. Materials and methods. Eight Swedish surgical units participated in this prospective multicenter investigation. Rectal swabs were obtained on admission to hospital. Cultures were performed on chromogenic agar and antibiotic susceptibility testing was performed using the disk diffusion method. Extended-spectrum beta-lactamase (ESBL)-phenotype was confirmed by Etest. Results. Rectal samples were obtained and analyzed from 208 patients with intra-abdominal surgical infections. Surgery was performed in 134 patients (65%). Cephalosporins were the most frequently used empirical antibiotic therapy. The highest rates of resistance among Enterobacteriaceae were detected for ampicillin (54%), tetracycline (26%), cefuroxime (26%) and trimethoprim-sulfamethoxazole (20%). The prevalence of decreased susceptibility (I + R) for the other antibiotics tested was for ciprofloxacin 20%, piperacillin-tazobactam 17%, cefotaxime 14%, ertapenem 12%, gentamicin 3% and imipenem 0%. ESBL-producing Enterobacteriaceae were found in samples from 10 patients (5%). Three patients had five E. coli isolates producing AmpC enzymes. Conclusions. This study shows a high rate of resistance among Enterobacteriaceae against antibiotics which are commonly used in Sweden and should have implications for the future choice of antibiotics for surgical patients.

Acknowledgements

The authors thank M. Nilsson and A. Johansson, Clinical Microbiology, Department of Clinical and Experimental Medicine, Linköping University, for skilful laboratory assistance and data collection and L. Bergkvist, K. Nilsson and E. Strand, Centre of Clinical Research, Central Hospital, Västerås, for assistance with statistical support and data collection. The following surgeons participated in the study: A. Rosemar (östra sjukhuset, Göteborg), P.-A. Larsson (Helsingborgs lasarett), P. Loftås (Vrinnevi-sjukhuset, Norrköping), M. Andersson (Universitetssjukhuset, örebro) C. Wallon (Universitetssjukhuset, Linköping) and P. Jestin (Akademiska sjukhuset, Uppsala).

Declaration of interest: Financial support was provided by an unrestricted grant from Merck Sharp & Dohme (MSD), Sweden. MSD had no involvement in the design and conduct of the study or the data analysis and publication.

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