title: Hospitalization, a risk factor for antibiotic-resistant Escherichia coli in the community?
abstract: OBJECTIVE
  The impact of hospitalization on the prevalence of resistant Escherichia coli in the intestinal flora of patients admitted to the surgical wards of three Dutch university-affiliated hospitals was analysed prospectively.
  
  
  METHODS
  Faecal samples were obtained on admission to the hospital, at the time of discharge, and 1 and 6 months after discharge. All samples were examined for resistance to nine antibiotic agents.
  
  
  RESULTS
  For the total patient population, no significant differences in the prevalence of resistance were observed at the different sampling intervals, except for a significant decrease in cefazolin resistance between the time of discharge and 6 months after discharge (10% to 3%, P < 0.05). This decrease was mainly observed in patients from the university hospital Maastricht (azM), in which a significant decrease from 17% to 6% was detected (P < 0.05). Moreover, despite dissimilarities in patient characteristics and the marked variations in antibiotic use, no significant differences in the prevalence of antibiotic resistance were observed between the three hospitals, except for the overall higher prevalence of cefazolin-resistant E. coli in azM patients (P < 0.05).
  
  
  CONCLUSIONS
  In this study, hospitalization did not seem to have any substantial effect on the prevalence of antibiotic-resistant E. coli at the different time intervals. However, as our study population consisted of surgical patients with a relatively moderate antibiotic use, and the prevalence of antibiotic resistance was only analysed for faecal E. coli, further investigation should be encouraged, as the understanding of the interaction between different resistance reservoirs is important for directing future intervention studies.
authors.affiliation: Department of Medical Microbiology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
authors.forename: N
authors.initials: N
authors.lastname: Bruinsma
authors.forename: P M G
authors.initials: PM
authors.lastname: Filius
authors.forename: A E
authors.initials: AE
authors.lastname: van den Bogaard
authors.forename: S
authors.initials: S
authors.lastname: Nys
authors.forename: J
authors.initials: J
authors.lastname: Degener
authors.forename: H Ph
authors.initials: HP
authors.lastname: Endtz
authors.forename: E E
authors.initials: EE
authors.lastname: Stobberingh
mesh_terms: D024881:Drug Resistance, Bacterial; D004363:Drug Utilization; D004926:Escherichia coli / Q000187:drug effects*; D004927:Escherichia coli Infections / Q000453:epidemiology*; D005243:Feces / Q000382:microbiology; D006760:Hospitalization; D006801:Humans; D007422:Intestines / Q000382:microbiology; D008826:Microbial Sensitivity Tests; D009426:Netherlands / Q000453:epidemiology; D011446:Prospective Studies; D012307:Risk Factors