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Prevalence of fecal carriage of antibiotic-resistant bacteria in patients with acute surgical abdominal infections
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Colorectal Surgery.
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2010 (English)In: Scandinavian Journal of Gastroenterology, ISSN 0036-5521, E-ISSN 1502-7708, Vol. 45, no 10, 1203-1210 p.Article in journal (Refereed) Published
Abstract [en]

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.

MATERIALS AND 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.

Place, publisher, year, edition, pages
2010. Vol. 45, no 10, 1203-1210 p.
Keyword [en]
Abdominal infection, antibiotics, antibiotic resistance, bacteria, resistance
National Category
Medical and Health Sciences
Identifiers
URN: urn:nbn:se:uu:diva-133102DOI: 10.3109/00365521.2010.495417ISI: 000282151500010PubMedID: 20521871OAI: oai:DiVA.org:uu-133102DiVA: diva2:360104
Available from: 2010-11-02 Created: 2010-11-02 Last updated: 2017-12-12Bibliographically approved
In thesis
1. Colonic Diverticulitis: Diagnostic and Therapeutic Aspects
Open this publication in new window or tab >>Colonic Diverticulitis: Diagnostic and Therapeutic Aspects
2012 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The overall aims of this thesis were to evaluate diagnostic and therapeutic aspects of colonic diverticulitis.

In the first study, a systematic review of the literature was performed to evaluate radiological diagnostics for patients with acute left-sided diverticulitis. Forty-nine relevant articles were found and read in full and data were extracted or calculated. Twenty-nine of these were excluded. The best evidence for the diagnosis of diverticulitis in the literature was to be found with US. Only one small study of good quality was found for both CT and MRI.

In the second paper, a prospective multicentre study was performed to determine the faecal carriage of antibiotic-resistant bacteria and antibiotic treatment in 208 surgical patients with acute intra-abdominal infections. 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- and AmpC producing Enterobacteriaceae were found in samples from 13 patients (6.3%).  We found high rates of resistance among Enterobacteriaceae against antibiotics which were commonly used in Sweden.

In the third paper, a multicentre randomized study was performed to investigate the need of antibiotic treatment in acute uncomplicated diverticulitis. Six hundred and twenty-three patients were randomized to treatment with (314 patients) or without (309 patients) antibiotics. Complications were found in six patients (1.9%) in the no antibiotic and three (1.0%) in the antibiotic group (p=0.302). The median hospital stay was three days in both groups. Recurrent diverticulitis follow-up was similar in both groups (16%, p=0.895). We conclude that antibiotic treatment for acute uncomplicated diverticulitis neither accelerated recovery nor prevented complications or recurrence. Based on the results, antibiotics should therefore be reserved mainly for the treatment of complicated diverticulitis.

The fourth paper presents a prospective observational study performed in two centres to evaluate CT colonography in the follow-up of acute diverticulitis as regards patient acceptance and diagnostic accuracy in 108 patients. Patients experienced colonoscopy as more painful (p<0.001) and uncomfortable (p<0.001). Diverticulosis and polyps were detected in 94% and 20% with colonoscopy and in 94% and 29% with CTC, respectively. Sensitivity and specificity for CTC in the detection of diverticulosis was 99% and 67%, with a level of relatively good agreement (К= 0.71). Regarding detection of polyps, the sensitivity and specificity were 47% and 75%, with a poor agreement (К= 0.17). We concluded that CTC was less painful and unpleasant. CTC detected diverticulosis with good accuracy while the accuracy of detection of small polyps was poor. CTC could be an alternative, especially in cases of incomplete colonoscopy or in a situation with limited colonoscopy resources.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2012. 74 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 739
National Category
Clinical Medicine
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-168282 (URN)978-91-554-8268-8 (ISBN)
Public defence
2012-03-17, Aulan ingång 21, Västmanlandssjukhus, Västerås, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2012-02-24 Created: 2012-02-07 Last updated: 2012-03-01Bibliographically approved

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