Prevalence of fecal carriage of antibiotic-resistant bacteria in patients with acute surgical abdominal infections.
OBJECTIVE
Antibiotic resistance is increasing worldwide. The aims of the current study were to determine the fecal carriage of antibiotic-resistant bacteria and antibiotic treatment in surgical patients admitted to hospital due to acute intra-abdominal infections.


METHODS
Eight Swedish surgical units participated in this prospective multicenter investigation. Rectal swabs were obtained on admission to hospital. Cultures were performed on chromogenic agar and antibiotic susceptibility testing was performed using the disk diffusion method. Extended-spectrum beta-lactamase (ESBL)-phenotype was confirmed by Etest.


RESULTS
Rectal samples were obtained and analyzed from 208 patients with intra-abdominal surgical infections. Surgery was performed in 134 patients (65%). Cephalosporins were the most frequently used empirical antibiotic therapy. The highest rates of resistance among Enterobacteriaceae were detected for ampicillin (54%), tetracycline (26%), cefuroxime (26%) and trimethoprim-sulfamethoxazole (20%). The prevalence of decreased susceptibility (I + R) for the other antibiotics tested was for ciprofloxacin 20%, piperacillin-tazobactam 17%, cefotaxime 14%, ertapenem 12%, gentamicin 3% and imipenem 0%. ESBL-producing Enterobacteriaceae were found in samples from 10 patients (5%). Three patients had five E. coli isolates producing AmpC enzymes.


CONCLUSIONS
This study shows a high rate of resistance among Enterobacteriaceae against antibiotics which are commonly used in Sweden and should have implications for the future choice of antibiotics for surgical patients.
Department of Surgery, Uppsala University, Central Hospital, Västerås, Sweden. abbas.chabok@ltv.se
Abbas
A
Chabok
Maria
M
Tärnberg
Kenneth
K
Smedh
Lars
L
Påhlman
Lennart E
LE
Nilsson
Christian
C
Lindberg
Håkan
H
Hanberger
D000006:Abdomen, Acute / Q000601:surgery; D018784:Abdominal Abscess / Q000382:microbiology* / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001420:Bacteria, Aerobic / Q000187:drug effects / Q000302:isolation & purification*; D001421:Bacteria, Anaerobic / Q000187:drug effects / Q000302:isolation & purification*; D001424:Bacterial Infections / Q000453:epidemiology / Q000382:microbiology*; D024901:Drug Resistance, Multiple, Bacterial; D005243:Feces / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015995:Prevalence; D011446:Prospective Studies; D012494:Sampling Studies; D013531:Surgicenters; D013548:Sweden / Q000453:epidemiology
D000900:Anti-Bacterial Agents