Cross-sectional study on fecal carriage of Enterobacteriaceae with resistance to extended-spectrum cephalosporins in primary care patients

Microb Drug Resist. 2013 Oct;19(5):362-9. doi: 10.1089/mdr.2013.0013. Epub 2013 Apr 23.

Abstract

The aim of this study was to gain knowledge of the local epidemiology of extended-spectrum cephalosporin-resistant bacteria in primary care patients in a Swiss community. Fecal swabs were obtained from 291 primary care patients. Phenotyping and genotyping methods were used for further characterization of the isolates. Risk factors associated with carriage of ß-lactam-resistant strains were determined. Extended-spectrum cephalosporin-resistant Enterobacteriaceae were detected in 15 (5.2%) of the primary care patients. Thirteen isolates were CTX-M producers, one produced SHV-12, and three carried CMY-2. The pathogenic pandemic clone Escherichia coli ST131 was detected in 26.6% of the patients. Two patients (13.3%) carried two distinct strains simultaneously. There was a statistically significant risk of carriage of resistant strains for persons with a history of antibiotic therapy 4 months before sampling (p=0.05), markedly for therapy with ß-lactam (p=0.01). Age, gender, or history of hospitalization 4 months before sampling was not a risk factor for the acquisition of resistant bacteria in the analyzed patients. The relatively low prevalence of extended-spectrum cephalosporin-resistant strains in the community reflects the nationwide restrictive policy of antibiotic prescription as well as local implementation thereof. Nevertheless, our study shows that a potent antimicrobial resistance reservoir is present in primary care patients.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / therapeutic use*
  • Bacterial Typing Techniques
  • Cephalosporins / therapeutic use*
  • Cross-Sectional Studies
  • Enterobacteriaceae / drug effects*
  • Enterobacteriaceae / enzymology
  • Enterobacteriaceae / genetics
  • Enterobacteriaceae / isolation & purification
  • Enterobacteriaceae Infections / drug therapy*
  • Enterobacteriaceae Infections / epidemiology*
  • Enterobacteriaceae Infections / microbiology
  • Feces / microbiology*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Primary Health Care
  • Switzerland / epidemiology
  • beta-Lactam Resistance / drug effects
  • beta-Lactam Resistance / genetics
  • beta-Lactamases / genetics
  • beta-Lactamases / metabolism

Substances

  • Anti-Bacterial Agents
  • Cephalosporins
  • beta-Lactamases