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

Sundvall, Pär-Daniel, Elm, Marie, Gunnarsson, Ronny, Mölstad, Sigvard, Rodhe, Nils, Jonsson, Lars, and Ulleryd, Peter (2014) Antimicrobial resistance in urinary pathogens among Swedish nursing home residents remains low: a cross-sectional study comparing antimicrobial resistance from 2003 to 2012. In: Presentations from the 43rd Annual Scientific Meeting of Society for Academic Primary Care. p. 57. From: SAPC 2014: 43rd Annual Scientific Meeting of Society for Academic Primary Care, 9-11 July 2014, Edinburgh, UK.

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Abstract

The problem: There 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.

The approach: Urine 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 indwelling 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.

Findings: The 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. There were growths of mixed bacterial flora in all but one of the cultures obtained from catheters, classified as negative. 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. There was a trend towards higher resistance rates in E. coli in urine specimens from catheters compared to voided urine for ampicillin (p=0.079) and ciprofloxacin (p=0.11).

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.

Consequences: There were still comparatively low levels of antimicrobial resistance in urinary pathogens among Swedish nursing home residents with no major changes between 2003 and 2012. This may be partly due to successful efforts in Sweden to lower antibiotics usage and the choice of narrow spectrum antibiotics in favour of e.g. ciprofloxacin. Any antibiotic courses during the previous month predicted higher resistance rates in this study. It is important to use antibiotics properly and continue analysing antimicrobial resistance in nursing homes due to the potentially high risk for increasing antibiotic resistance in this population.

Item ID: 37978
Item Type: Conference Item (Presentation)
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Date Deposited: 08 Apr 2015 22:27
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1108 Medical Microbiology > 110801 Medical Bacteriology @ 40%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111717 Primary Health Care @ 60%
SEO Codes: 92 HEALTH > 9205 Specific Population Health (excl. Indigenous Health) > 920502 Health Related to Ageing @ 100%
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