Low level of antimicrobial resistance in Escherichia coli among Swedish nursing home residents

Abstract

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.

Keywords::

• Mass screening
• colonization
• nursing
• homes
• drug resistance
• bacterial
• Escherichia coli

Acknowledgements

We thank the Microbiology Laboratory in Jönköping (Ann-Sofie Ekblom and Maysae Quttineh) and docent Brian B. Magnusson for their support.

Declaration of interest: The authors report no conflict of interest. The authors alone are responsible for the content and writing of the paper.

Financial support for this study was provided by the County Council of Östergötland, Sweden and the Medical Research Council of Southeast Sweden (FORSS).