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JAC Advance Access originally published online on March 13, 2003
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Journal of Antimicrobial Chemotherapy (2003) 51, 1029-1032
© 2003 The British Society for Antimicrobial Chemotherapy

Hospitalization, a risk factor for antibiotic-resistant Escherichia coli in the community?

N. Bruinsma1, P. M. G. Filius2, A. E. van den Bogaard1, S. Nys1, J. Degener3, H. Ph. Endtz2 and E. E. Stobberingh1,*

1 Department of Medical Microbiology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht; 2 Department of Medical Microbiology and Infectious Diseases, Erasmus MC, University Medical Center Rotterdam, Rotterdam; 3 Department of Medical Microbiology, University Hospital Groningen, Groningen, The Netherlands

Received 8 October 2002; returned 8 November 2002; revised 19 January 2003; accepted 20 January 2003

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).

Conclusion: 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.

Keywords: antibiotic resistance, hospitalization, community, E. coli, faecal flora

* Corresponding author. Tel: +31-43-387-4644; Fax: +31-43-387-6643; E-mail: est{at}lmib.azm.nl


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