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JAC Advance Access published online on June 26, 2007
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkm197
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© The Author 2007. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Determinants of carriage of resistant Escherichia coli in the Indonesian population inside and outside hospitals

D. Offra Duerink1,*, Endang S. Lestari2, Usman Hadi3, Nico J. D. Nagelkerke4, Juliëtte A. Severin5, Henri A. Verbrugh5, Monique Keuter6, Inge C. Gyssens5, Peterhans J. van den Broek on behalf of the study group ‘Antimicrobial Resistance in Indonesia: Prevalence and Prevention’ (AMRIN)1,{dagger}

1 Department of Infectious Diseases, Leiden University Medical Centre, Albinusdreef 2, 2333 ZA Leiden, The Netherlands 2 Department of Clinical Microbiology, Dr Kariadi Hospital—School of Medicine, Diponegoro University, Jalan Dr Soetomo 16-18, Semarang 50231, Indonesia 3 Department of Internal Medicine, Dr Soetomo Hospital—School of Medicine, Airlangga University, Jalan Prof. Dr Moestopo 6-8, Surabaya 60132, Indonesia 4 Department of Community Medicine, United Arab Emirates University, PO Box 17666, Al Ain, United Arab Emirates 5 Department of Medical Microbiology and Infectious Diseases, University Medical Centre Rotterdam, ‘s Gravendijkwal 230, 3015 CE Rotterdam, The Netherlands 6 Department of Internal Medicine, Nijmegen University Centre for Infectious Diseases International Health (NUCI-IH), Geert Grooteplein 10, 456, 6525 GA Nijmegen, The Netherlands

Received 19 February 2007; returned 11 March 2007; revised 1 May 2007; accepted 7 May 2007

* Corresponding author. Tel: +31-71-5262613; Fax: +31-71-5266758; E-mail: d.o.duerink{at}lumc.nl

Objectives: Antibiotic resistance is a worldwide healthcare problem exacerbated by antibiotic use and transmission of resistant bacteria. Not much is known about resistance in commensal flora and about determinants for resistance in Indonesia. This study analysed recent antibiotic use as well as demographic, socioeconomic, disease-related and healthcare-related determinants of rectal carriage of resistant Escherichia coli in the community and in hospitals in Indonesia.

Methods: Carriers of susceptible E. coli were compared with carriers of E. coli with resistance to any of the tested antibiotics. Logistic regression analysis was performed to determine which variables were associated with carriage of resistant E. coli. Individuals in the community with varying levels of contact with healthcare institutions and hospitalized patients were analysed as separate populations.

Results and conclusions: Of 3275 individuals (community 2494, hospital 781), 54% carried resistant E. coli. Recent antibiotic use was the most important determinant of resistance in both populations [community: odds ratio (OR) 1.8, 95% confidence interval (95% CI) 1.5–2.3; hospital: OR 2.5, 95% CI 1.6–3.9]. In the community, hospitalization (OR 2.4, 95% CI 2.0–3.0), diarrhoeal symptoms (OR 1.9, 95% CI 1.3–2.7) and age under 16 years (adults: OR 0.4, 95% CI 0.3–0.5) were associated with carriage of resistant E. coli. For hospitalized patients, having no health insurance was associated with less resistance (OR 0.6, 95% CI 0.4–0.9) and differences were observed between hospitals (Semarang: OR 2.2, 95% CI 1.5–3.3) and departments (Paediatrics: OR 4.3, 95% CI 1.7–10.7). Further research is needed to investigate whether transmission is responsible for these differences.

Key Words: antibacterial agents , drug resistance , risk factors

{dagger} Members of the AMRIN study group are listed in the Acknowledgements section.


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