title: Antimicrobial resistance in urinary pathogens among Swedish nursing home residents remains low: a cross-sectional study comparing antimicrobial resistance from 2003 to 2012.
abstract: BACKGROUND
  There are several risk factors for the colonisation, infection and spreading of antibiotic resistant bacteria among elderly residents of nursing homes. An updated estimate of the native prevalence of antimicrobial resistance in uropathogens among Swedish nursing home residents is needed.
  
  
  METHODS
  Urine specimens were collected for culture and antimicrobial susceptibility testing against mecillinam, ampicillin, cefadroxil, trimethoprim, nitrofurantoin and quinolones from the residents of 32 and 22 nursing homes, respectively. The residents were capable of providing a voided urine sample in 2003 and 2012. In 2012 urine specimens were also collected from residents with urinary catheters. Any antibiotic treatment during the previous month was registered in 2003 as well as hospitalisation and any antibiotic treatment during the previous six months in 2012.
  
  
  RESULTS
  The proportion of positive urine cultures was 32% (207/651) in voided urine specimens in 2003, 35% (147/421) in 2012, and 46% (27/59) in urine samples from catheters in 2012. Escherichia coli (E. coli) was the most commonly occurring bacteria.Resistance rates in E. coli (voided urine specimens) in 2012 were; ampicillin 21%, trimethoprim 12%, mecillinam 7.7%, ciprofloxacin 3.4%, cefadroxil 2.6% and nitrofurantoin 0.85%. There were no significant changes in the average resistance rates in E. coli for antibiotics tested 2003-2012.In 2012, two isolates of E. coli produced extended spectrum beta-lactamase enzymes (ESBL) and one with plasmid mediated AmpC production.Any antibiotic treatment during the previous month increased the risk for resistance in E. coli, adjusted for age and gender; for mecillinam with an odds ratio (OR) of 7.1 (2.4-21; p = 0.00049), ampicillin OR 5.2 (2.4-11; p = 0.000036), nalidixic acid OR 4.6 (1.4-16; p = 0.014) and trimethoprim OR 3.9 (1.6-9.2; p = 0.0023). Hospitalisation during the previous six months increased the risk for antibiotic resistance in E. coli to ampicillin, ciprofloxacin and any antimicrobial tested, adjusted for age, gender and antibiotic treatments during the previous six months.
  
  
  CONCLUSIONS
  The average rates of antimicrobial resistance were low and did not increase between 2003 and 2012 in E. coli urinary isolates among Swedish nursing home residents. Antibiotic treatment during the previous month and hospitalisation during the previous six months predicted higher resistance rates.
authors.affiliation: Research and Development Unit, Primary Health Care in Southern Älvsborg County, Sven Eriksonsplatsen 4, SE-503 38, Borås, Sweden. par-daniel.sundvall@vgregion.se.
authors.forename: Pär-Daniel
authors.initials: PD
authors.lastname: Sundvall
authors.forename: Marie
authors.initials: M
authors.lastname: Elm
authors.forename: Ronny
authors.initials: R
authors.lastname: Gunnarsson
authors.forename: Sigvard
authors.initials: S
authors.lastname: Mölstad
authors.forename: Nils
authors.initials: N
authors.lastname: Rodhe
authors.forename: Lars
authors.initials: L
authors.lastname: Jonsson
authors.forename: Peter
authors.initials: P
authors.lastname: Ulleryd
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D004352:Drug Resistance, Microbial / Q000502:physiology; D005260:Female; D006707:Homes for the Aged / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009735:Nursing Homes / Q000639:trends*; D013548:Sweden / Q000453:epidemiology; D014552:Urinary Tract Infections / Q000175:diagnosis* / Q000453:epidemiology* / Q000652:urine