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Microbiological Surveillance in Primary Health Care: New Aspects of Antimicrobial Resistance and Molecular Epidemiology in an Ageing Population
Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences.ORCID iD: 0000-0003-3391-7141
2016 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Background

The inexorable rise in antimicrobial resistance (AMR) interferes with the goals of health care services around the world, given how critical the antibacterials are in making infections treatable and surgical procedures doable. Nursing homes residents have been identified as a reservoir for AMR, possibly due to the combination of being physically and mentally frail, frequently treated with antibacterials, and frequently moved between nursing home and hospital. Microbiological surveillance is a key countermeasure against further AMR development. Yet, surveillance data is easily biased due to precision problems regarding how the data is collected and evaluated.

Methods

Beginning in 2008, we launched two programmes (“SHADES” and “MIDIO”) aimed to gathering AMR data in a systematic fashion from elderly nursing home residents and elderly people living in their own place of residence. In doing so, we focused on colonizing strains of the two most important nosocomial infectious agents, Staphylococcus aureus (S. aureus) and Escherichia coli (E. coli). The bacteria were collected from multiple body sites and analysed with respect to antimicrobial susceptibility and genetic diversity.

Results

Active surveillance of AMR showed that (i) a S. aureus isolate could be retrieved from 1 in every 2 individuals given a single round of sampling, but aggregating several rounds of sampling, this figure might reach 7 in every 10 individuals, (ii) an E. coli isolate could be retrieved from 4 in every 5 individuals, (iii) the overall prevalence of AMR was favourable when compared to the situation in many other countries, (iv) the genetic diversity of S. aureus was generally high and provided only limited evidence of clonal expansion or contraction, and (v) diabetes mellitus was one of very few patient-level factors to show an association with the degree of genetic diversity in S. aureus.

Conclusions

The prevalence of colonization with S. aureus and E. coli was somewhat higher than expected, but the degree of AMR was very low. The genetic diversity of S. aureus was generally high. Diabetes mellitus emerged as the only patient-level factor associated with a higher degree of genetic diversity in S. aureus.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2016. , p. 76
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1556
Keywords [en]
Colonization, Nosocomial, Bacteria
National Category
General Practice
Identifiers
URN: urn:nbn:se:liu:diva-133246DOI: 10.3384/diss.diva-133246ISBN: 9789176856154 (print)OAI: oai:DiVA.org:liu-133246DiVA, id: diva2:1056882
Public defence
2017-02-07, Belladonna, Universitetssjukhuset i Linköping, ingång 78, Linköping, 13:00 (Swedish)
Opponent
Supervisors
Funder
Medical Research Council of Southeast Sweden (FORSS)Available from: 2016-12-19 Created: 2016-12-15 Last updated: 2018-01-13Bibliographically approved
List of papers
1. Colonization with Staphylococcus aureus in Swedish nursing homes: A cross-sectional study
Open this publication in new window or tab >>Colonization with Staphylococcus aureus in Swedish nursing homes: A cross-sectional study
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2012 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 44, no 1, p. 3-8Article in journal (Refereed) Published
Abstract [en]

Background: Screening for bacterial colonization among risk populations could provide better estimates of the volume of the bacteria-related disease reservoir and the level of antimicrobial resistance, than do conventional laboratory reports. Methods: Two hundred and one participants at 10 Swedish nursing homes were screened for colonization with Staphylococcus aureus between January and October 2009. Of the 201 participants, 61 (30%) were male. The median age was 86 y. All participants were systematically sampled from the nasal mucosa, the pharyngeal mucosa, the groin, and active skin lesions, if any. Results: Ninety-nine of 199 participants (50%) were colonized with S. aureus. The colonization rate was 34% for the nose, 35% for throat, 10% for groin, and 54% for active skin lesions. An antibiotic-resistant S. aureus isolate was identified in 8.5% of all participants regardless of colonization status. A total of 24 resistant isolates were detected, and 21 of these were resistant to fluoroquinolones. There was no case of colonization with methicillin-resistant S. aureus (MRSA). Conclusions: The presence of resistant isolates was generally low, and the greater part of the resistance was fluoroquinolone-related. To achieve reasonable precision, screening programmes of this kind must include samples from both the nose and throat, and, although low, the prevalence of antimicrobial resistance in Swedish nursing homes still calls for reflection on how to use the fluoroquinolones wisely. © 2012 Informa Healthcare.

Place, publisher, year, edition, pages
Informa Healthcare, 2012
Keywords
Colonization; Drug resistance (bacterial); Methicillin-resistant Staphylococcus aureus; Nursing homes; Staphylococcus aureus
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-74118 (URN)10.3109/00365548.2011.598875 (DOI)
Available from: 2012-01-20 Created: 2012-01-19 Last updated: 2017-12-08Bibliographically approved
2. Prevalence and molecular epidemiology of Staphylococcus aureus in Swedish nursing homes – as revealed in the SHADES study
Open this publication in new window or tab >>Prevalence and molecular epidemiology of Staphylococcus aureus in Swedish nursing homes – as revealed in the SHADES study
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2014 (English)In: Epidemiology and Infection, ISSN 0950-2688, E-ISSN 1469-4409, Vol. 142, no 6, p. 1310-1316Article in journal (Refereed) Published
Abstract [en]

Knowledge of carriage and population dynamics of Staphylococcus aureus is crucial for infection risk assessment and to reveal transmission patterns of strains. We report the prevalence and molecular epidemiology of S. aureus in elderly people (n = 290) living in nursing homes in three cities in the south of Sweden. The overall carriage prevalence rate was 48% when results from nares (31%) and throat (34%) samples were combined. Common spa types were equally distributed but a frequent type, t160, was found only in one of the regions. Carriage of different spa types was detected in 23% of individuals and antimicrobial resistance rates were higher in S. aureus isolates from those carrying more than one spa type. Five of the 21 individuals who carried different spa types were colonized simultaneously with resistant and non-resistant strains. Seventeen per cent of the individuals carried S. aureus of the same spa type on all occasions. Methicillin resistance was not detected. In conclusion we found a high prevalence of S. aureus in this elderly population with a high rate of dual colonization with different spa types. We also found signs of institutional spread of one strain.

Place, publisher, year, edition, pages
Cambridge University Press, 2014
Keywords
Colonization, molecular typing, multiclonality, nursing home, spa type
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-97342 (URN)10.1017/S0950268813002033 (DOI)000334247600020 ()23962597 (PubMedID)
Available from: 2013-09-10 Created: 2013-09-10 Last updated: 2017-12-06Bibliographically approved
3. Low level of antimicrobial resistance in Escherichia coli among Swedish nursing home residents
Open this publication in new window or tab >>Low level of antimicrobial resistance in Escherichia coli among Swedish nursing home residents
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2013 (English)In: Scandinavian journal of infectious diseases, ISSN 1651-1980, Vol. 45, no 2, p. 117-123Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Informa Healthcare, 2013
Keywords
Mass screening, colonization, nursing homes, drug resistance, bacterial, Escherichia coli
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-85105 (URN)10.3109/00365548.2012.717232 (DOI)000313677200006 ()22992114 (PubMedID)
Available from: 2012-11-02 Created: 2012-11-02 Last updated: 2016-12-19

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