title: Low frequency of antibiotic resistance among urine isolates of Escherichia coli in the community, despite a major hospital outbreak with Klebsiella pneumoniae producing CTX-M-15 in Uppsala County.
abstract: A screening programme introduced during a major outbreak of a Klebsiella pneumoniae strain producing extended spectrum beta-lactamase (ESBL), indicated a dissemination of ESBL-producing Escherichia coli in the community. A total of 360 urine samples, yielding 205 isolates, were therefore collected from primary care patients with lower urinary tract infections (UTI) in Uppsala County. The susceptibility pattern of the isolates was investigated with the disk diffusion method. The majority of the positive cultures contained E. coli (76%). Of the members of the Enterobacteriaceae family, only 2 E. coli isolates were resistant to cefpodoxime, of which one produced ESBL. The antibiotic resistance for E. coli isolates was as follows: ampicillin 29.5%, trimethoprim 18.6%, nalidixic acid 7.7%, mecillinam 1.3%, nitrofurantoin 1.3%, and cefpodoxime 1.3%. Approximately 5% of the E. coli isolates showed a combined resistance to 3 or more antibiotic drugs. Negative cultures were common, especially in men, and it was obvious that there were difficulties with the definition of both uncomplicated and lower UTI. In conclusion, a dissemination of ESBL-producing E. coli in the primary care population of Uppsala County could not be confirmed when using urine samples. The antibiotic resistance in E. coli isolates was low overall, with the exception of ampicillin and trimethoprim.
authors.affiliation: Primary Health Care Centre, Knivsta vårdcentral Uppsala County, Sweden. heidi.lindback@lul.se
authors.forename: Heidi
authors.initials: H
authors.lastname: Lindbäck
authors.forename: Johan
authors.initials: J
authors.lastname: Lindbäck
authors.forename: Staffan
authors.initials: S
authors.lastname: Sylvan
authors.forename: Asa
authors.initials: A
authors.lastname: Melhus
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology; D002648:Child; D002675:Child, Preschool; D017714:Community-Acquired Infections / Q000382:microbiology*; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology; D004196:Disease Outbreaks; D024881:Drug Resistance, Bacterial; D004927:Escherichia coli Infections / Q000382:microbiology*; D005260:Female; D006801:Humans; D007223:Infant; D007710:Klebsiella Infections / Q000453:epidemiology* / Q000382:microbiology; D007711:Klebsiella pneumoniae / Q000201:enzymology / Q000302:isolation & purification; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D013548:Sweden / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000382:microbiology*; D014556:Urine / Q000382:microbiology; D056689:Uropathogenic Escherichia coli / Q000187:drug effects* / Q000302:isolation & purification; D055815:Young Adult; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D000900:Anti-Bacterial Agents; C473109:beta-lactamase CTX-M-15; D001618:beta-Lactamases