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Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments: a cross-sectional survey
  1. Helene Skjøt-Arkil1,2,
  2. Christian Backer Mogensen1,
  3. Annmarie Touborg Lassen3,
  4. Isik S Johansen4,
  5. Ming Chen5,
  6. Poul Petersen6,
  7. Karen V Andersen7,
  8. Svend Ellermann-Eriksen8,
  9. Jørn M Møller9,
  10. Marc Ludwig10,
  11. David Fuglsang-Damgaard11,
  12. Finn Erland Nielsen12,
  13. Dan B Petersen13,
  14. Ulrich S Jensen14,
  15. Flemming S Rosenvinge15
  1. 1 Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
  2. 2 Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
  3. 3 Department of Emergency Medicine, Odense University Hospital, Odense, Denmark
  4. 4 Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
  5. 5 Department of Clinical Microbiology, Hospital Sønderjylland, Soenderborg, Denmark
  6. 6 Regional Hospital West Jutland, Herning, Denmark
  7. 7 Emergency Department, Aarhus University Hospital, Aarhus, Denmark
  8. 8 Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
  9. 9 Emergency Department, Aalborg University Hospital, Aalborg, Denmark
  10. 10 Emergency Department, North Denmark Regional Hospital, Hjørring, Denmark
  11. 11 Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
  12. 12 Emergency Department, Slagelse Sygehus, Slagelse, Denmark
  13. 13 Emergency Department, Zealand University Hospital, Køge, Denmark
  14. 14 Department of Clinical Microbiology, Slagelse Sygehus, Slagelse, Denmark
  15. 15 Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
  1. Correspondence to Dr. Helene Skjøt-Arkil; Helene.Skjoet-Arkil{at}


Objectives The aim of this study was to describe the carrier prevalence and demographic variation of four different multiresistant bacteria (MRB) among acute patients in Danish emergency departments (EDs): methicillin-resistant Staphylococcus aureus (MRSA), carbapenemase-producing enterobacteria (CPE), extended-spectrum beta-lactamase-producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE), and to analyse the association of MRB carriage to a range of potential risk factors.

Design Multicentre descriptive and analytic cross-sectional survey.

Setting Eight EDs and four clinical microbiology departments in Denmark.

Participants Adults visiting the ED.

Main outcome measures Swabs from nose, throat and rectum were collected and analysed for MRSA, ESBL, VRE and CPE. The primary outcome was the prevalence of MRB carriage, and secondary outcomes relation to risk factors among ED patients.

Results We included 5117 patients in the study. Median age was 68 years (54–77) and gender was equally distributed. In total, 266 (5.2%, 95% CI 4.6 to 5.8) were colonised with at least one MRB. No significant difference was observed between male and female patients, between age groups and between university and regional hospitals. Only 5 of the 266 patients with MRB were colonised with two of the included bacteria and none with more than two. CPE prevalence was 0.1% (95% CI 0.0 to 0.2), MRSA prevalence was 0.3% (95% CI 0.2 to 0.5), VRE prevalence was 0.4% (95% CI 0.3 to 0.6) and ESBL prevalence was 4.5% (95% CI 3.9 to 5.1). Risk factors for MRB carriage were previous antibiotic treatment, previous hospital stay, having chronic respiratory infections, use of urinary catheter and travel to Asia, Oceania or Africa.

Conclusion Every 20th patient arriving to a Danish ED brings MRB to the hospital. ESBL is the most common MRB in the ED. The main risk factors for MRB carriage are recent antibiotic use and travel abroad.

Trial registration number NCT03352167;Post-results.

  • carrier prevalence
  • risk factors
  • methicillin resistant staphylococcus aureus
  • carbapenemase-producing enterobacteria
  • extended-spectrum beta-lactamase-producing enterobacteria
  • vancomycin resistant enterococci

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  • Contributors HS-A, CBM, FSR, ATL, MC and ISJ conceptualised and all authors designed the study and data collection instrument in detail. HS-A, ATL, PP, KVA, JMM, ML, FEN and DBP supervised data collection. SE-E, DF-D, USJ and FSR supervised the microbiological analysis. HS-A, CBM and FSR participated in data analysis, and HS-A and CBM contributed to manuscript development. HS-A, CBM, ATL, ISJ, MC, PP, KVA, SE-E, JMM, ML, DF-D, FEN, DBP, USJ and FSR participated in the critical scrutiny and revision of the manuscript, and approved the final version. HS-A, CBM and FSR are responsible for the overall content as guarantors. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding This work was supported by the Ministry of Health Denmark and Region of Southern Denmark.

  • Disclaimer The financial sponsors had no influence on the data, analysis, results or content of publication.

  • Competing interests None declared.

  • Ethics approval The project was approved by the Regional Committees on Health Research Ethics for Southern Denmark (no. S-20170182), registered by the Danish Data Protection Agency (Journal nr. 17/44444) and by (NCT03352167).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Due to Danish laws on personal data, data cannot be shared publicly. To requestthese data, please contact the corresponding author for more information.

  • Patient consent for publication Not required.

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