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A world inside: Gastrointestinal microbiota in healthy Swedish children at day care centers and aspects on antibiotic resistance, enteric pathogens and transmission
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Antibiotic resistance is a growing threat to human health and is defined by the World Health Organization as a crisis that must be managed with the utmost urgency. Antibiotic resistant bacteria increase both mortality and morbidity and have a great impact on the global economy. Resistance is not confined to human health care, but is present also among animals and in our environment at large. Indeed, resistant bacterial strains have now been found in virtually all parts of the world, even in locations without direct human contact.

The human gastrointestinal tract is populated by a complex, dynamic, diverse and highly interactive collection of microorganisms, including bacteria, archaea, fungi, yeasts and viruses, which constitutes our gastrointestinal microbiota. This microbiota is an important reservoir of resistance genes (our gastrointestinal resistome) and a “melting pot” for transfer of resistance genes between microbes, including potential pathogens.

In this thesis I investigated the prevalences of two clinically important kinds of antibiotic resistance: extended-spectrum β-lactamases (ESBL) and vancomycin-resistant enterococci (VRE), as well as asymptomatic carriage of potential enteropathogens among healthy preschool children in Uppsala. Fecal samples from unidentified, individual diapers were collected in 2010 (125+313 samples) and in 2016 (334 samples). In addition, 204 environmental samples from the children’s preschools were collected in autumn 2016.

A prevalence of 2.9% ESBL-producing Enterobactericeae was demonstrated in the first samples from 2010. No VRE were found and the occurrence of enteropathogens were reassuringly low. Results on ESBL prevalence in 2016 and transmission of resistance between children will be presented when the manuscript is published and at the dissertation.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2017. , p. 75
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1285
Keyword [en]
ESBL, VRE, enteropathogens, antibiotic resistance, children, preschool
National Category
Pediatrics
Research subject
Pediatrics
Identifiers
URN: urn:nbn:se:uu:diva-310335ISBN: 978-91-554-9781-1 (print)OAI: oai:DiVA.org:uu-310335DiVA, id: diva2:1056157
Public defence
2017-02-17, Rosénsalen, Akademiska barnsjukhuset, ing 95/96 NBV, Uppsala, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2017-01-27 Created: 2016-12-14 Last updated: 2017-02-01
List of papers
1. Prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae in healthy Swedish preschool children
Open this publication in new window or tab >>Prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae in healthy Swedish preschool children
2013 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 012, no 6, p. 655-660Article in journal (Refereed) Published
Abstract [en]

AIM:

The objective was to determine the prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in faeces from healthy Swedish preschool children and to establish whether transmission took place between children in preschools.

METHODS:

Diapers from children attending preschools in Uppsala city were collected during September to October 2010, and the faeces was cultured. Antibiotic profiles and carriage of CTX-M, TEM, SHV and AmpC type enzymes were determined. PCR-positive isolates were further characterized by sequencing and epidemiological typing. Statistics on antibiotic use and ESBL producers in paediatric patients at Uppsala University Hospital were extracted for comparison.

RESULTS:

A total of 313 stool specimens were obtained, representing 24.5% of all preschool children in Uppsala city. The carriage rate of ESBL-producing Enterobacteriaceae was 2.9% among these healthy children. The corresponding figure for patients in the same age group was 8.4%. Escherichia coli with CTX-M type enzymes predominated, and only one E. coli isolate carried genes-encoding CMY. CTX-M-producing E. coli isolates with identical genotypes were found in children with no familial relation at two different preschools.

CONCLUSIONS:

Using diapers, the prevalence of ESBL-producing Enterobacteriaceae in children was quickly established, and, most likely, a transmission of ESBL-producing E. coli was for the first time documented between children at the same preschool.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-197308 (URN)10.1111/apa.12206 (DOI)000318562500033 ()23419070 (PubMedID)
Available from: 2013-03-21 Created: 2013-03-21 Last updated: 2017-12-06
2. Zero Prevalence of Vancomycin-Resistant Enterococci Among Swedish Preschool Children
Open this publication in new window or tab >>Zero Prevalence of Vancomycin-Resistant Enterococci Among Swedish Preschool Children
2015 (English)In: Microbial Drug Resistance, ISSN 1076-6294, E-ISSN 1931-8448, Vol. 21, no 1, p. 65-68Article in journal (Refereed) Published
Abstract [en]

Objectives: Enterococci are a natural part of the bacterial flora of humans, animals, and insects and are frequently found in the community. Vancomycin-resistant enterococci (VRE) have emerged as a growing problem, associated with high morbidity and mortality. The aim of this study was to investigate the prevalence of VRE among healthy Swedish preschool children and ascertain whether they constitute a reservoir for the bacteria.

Methods: In total, 313 individual diapers were collected from preschools in Uppsala, Sweden. Fecal samples were screened by analyzing the color change in a broth followed by polymerase chain reaction for vanA and vanB genes, which are associated with vancomycin resistance.

Results: Neither vanA nor vanB genes could be detected from the samples.

Conclusions: Preschool children in Uppsala do not constitute a reservoir for VRE. The zero prevalence is consistent with the overall decline in VRE prevalence in Sweden during the last years.

National Category
Microbiology in the medical area
Identifiers
urn:nbn:se:uu:diva-237456 (URN)10.1089/mdr.2014.0043 (DOI)000349013000009 ()25140598 (PubMedID)
Available from: 2014-12-02 Created: 2014-12-02 Last updated: 2018-01-11
3. Reassuringly low carriage of enteropathogens among healthy Swedish children in day care centres
Open this publication in new window or tab >>Reassuringly low carriage of enteropathogens among healthy Swedish children in day care centres
Show others...
2016 (English)In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 140, p. 221-227Article in journal (Refereed) Published
Abstract [en]

Objectives: Infectious gastroenteritis is one of the most common diseases among children and has a considerable impact on health and socio-economy. Day care centres are highrisk environments for infections. The aim of this study was to investigate if asymptomatic preschool children constitute a reservoir for potential enteropathogens. Study design: In total, 438 individual diapers were collected from day care centres in Uppsala, Sweden, during spring and autumn, and molecular techniques were used to estimate the prevalence of asymptomatic carriage of multiple enteropathogens. Methods: Faecal samples were analysed with multiplex polymerase chain reaction (PCR) (xTAG® Gastrointestinal Pathogen Panel; Luminex Corporation, Toronto, Canada) targeting 21 different pathogens. Samples with a median fluorescence intensity above threshold were re-analysed with a second PCR assay. Results: Sixteen of the 438 samples were positive for enteropathogens, 1.6% for enteric adenovirus, 0.7% for Campylobacter spp., and 0.7% for norovirus. Conclusions: Preschool children in Uppsala constitute a limited reservoir for potential enteropathogens

National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:uu:diva-310319 (URN)10.1016/j.puhe.2016.05.011 (DOI)000389398200033 ()27527845 (PubMedID)
Available from: 2016-12-14 Created: 2016-12-14 Last updated: 2017-11-29Bibliographically approved
4. Increase in carriage rates of cefotaxime-resistant Enterobactericeae in healthy Swedish children.
Open this publication in new window or tab >>Increase in carriage rates of cefotaxime-resistant Enterobactericeae in healthy Swedish children.
(English)Manuscript (preprint) (Other academic)
National Category
Pediatrics
Identifiers
urn:nbn:se:uu:diva-310320 (URN)
Available from: 2016-12-14 Created: 2016-12-14 Last updated: 2016-12-14

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