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Journal of Clinical Microbiology, November 1999, p. 3509-3513, Vol. 37, No. 11
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.

Near Absence of Vancomycin-Resistant Enterococci but High Carriage Rates of Quinolone-Resistant Ampicillin-Resistant Enterococci among Hospitalized Patients and Nonhospitalized Individuals in Sweden

Erik Torell,1,* Otto Cars,1 Barbro Olsson-Liljequist,2 Britt-Marie Hoffman,2 Johan Lindbäck,3 Lars G. Burman,2 and The Enterococcal Study Groupdagger

Department of Infectious Diseases, Akademiska Hospital, SE-751 85 Uppsala,1 and Departments of Bacteriology2 and Epidemiology,3 Swedish Institute for Infectious Disease Control, S-171 82 Solna, Sweden

Received 8 April 1999/Returned for modification 4 June 1999/Accepted 22 July 1999

Rates of colonization with enterococci with acquired resistance to vancomycin (vancomycin-resistant enterococci [VRE]) and ampicillin (ampicillin-resistant enterococci [ARE]) were determined by using fecal samples from 670 nonhospitalized individuals and 841 patients in 27 major hospitals. Of the hospitalized patients, 181 (21.5%) were carriers of ARE and 9 (1.1%) were carriers of VRE. In univariate analyses, length of hospital stay (odds ratio [OR], 4.6; 95% confidence interval [CI], 2.5 to 8.9) and antimicrobial therapy (OR, 4.7; 95% CI, 3.3 to 6.7) were associated with ARE colonization, as were prior treatment with penicillins (OR, 3.1; 95% CI, 1.8 to 5.5), cephalosporins (OR, 2.9; 95% CI, 1.7 to 5.0), or quinolones (OR, 2.7; 95% CI, 1.5 to 4.7). In logistic regression analysis, antimicrobial therapy for at least 5 days was independently associated with ARE carriage (adjusted OR, 3.8; 95% CI, 2.6 to 5.4). Over 90% of the ARE isolates were fluoroquinolone resistant, whereas 14% of the ampicillin-susceptible Enterococcus faecium isolates were fluoroquinolone resistant. ARE carriage rates correlated with the use of fluoroquinolones (P = 0.04) but not with the use of ampicillin (P = 0.68) or cephalosporins (P = 0.40). All nine VRE isolates were E. faecium vanB and were found in one hospital. Seven of these isolates were related according to their types as determined by pulsed-field gel electrophoresis. Among the nonhospitalized individuals, the ARE carriage rate was lower (6%; P < 0.05), and only one person, who had recently returned from Africa, harbored VRE (E. faecium vanA). The absence of VRE colonization in nonhospitalized individuals reflects an epidemiological situation in Sweden radically different from that in countries in continental Europe where glycopeptides have been widely used for nonmedical purposes.

* Corresponding author. Mailing address: Department of Infectious Diseases, Akademiska Hospital, S-751 85 Uppsala, Sweden. Phone: 46 18 66 56 45 or 46 18 66 28 08. Fax: 46 18 66 56 50. E-mail: erik.torell{at}infektion.uu.se.

dagger Members of the Swedish Enterococcal Study Group are J. Hannover and K. Johansson (Boden); L. Johnsson, A. Palmé, and A. Lundkvist (Borås); C. G. Sundin, B. Pettersson, and S. Montelius (Eskilstuna); C. Hjortzberg-Nordlund, B. Loré, and I. Vig (Falun); H. Gnarpe, M. Isaksson, and G. Lekås (Gävle); L. Larsson and E. Ek (Göteborg); A. C. Karell and G. Andersson (Halmstad); J. Rydberg, I. B. Möller, and B. Johansson (Helsingborg); L. Sörén, P. Lindberg, and J. Aagesen (Jönköping); I. Eliasson, L. Bernhoff, and H. Lind (Kalmar); I. Blomberg and G. Johansson (Karlskrona); T. Kjerstadius, G. Fridh, and L. Romhed, (Karlstad); C. Hansson (Kristianstad), B. Isaksson, J. Jonasson, A. Antonsson Schütz, and H. Abednazari (Linköping); C. Schalen and A. C. Pettersson (Lund); M. Walder, K. Svensson, and B. Svantesson (Malmö); B. Claesson and C. Johansson (Skövde); S. Olofsson and B. Telander (Stockhom Huddinge Hospital); U. Ransjö and M. Rylander (Stockhom Karolinska Hospital); M. Sörberg and H. Jörbäck (Stockholm Danderyd Hospital); K. Dornbusch, E. Broman, and S. Hovmöller (Sundsvall); E. Wiksten, I. Johansson, and U. G. Andersson (Uddevalla); R. Lundholm, A. Dahlberg, and J. Wiström (Umeå); A. Hambraeus and M. Edvall (Uppsala); E. Ekelöv-Andström and G. Hage (Visby); A. Johansson, B. Gärd, and M. Höfer (Västerås); G. Kahlmeter and L. Nilsson (Växjö); and E. Törnkvist, A. Hjerpe-Åhman, J. Källman (Örebro), and L. Eriksson (Norrköping).

Journal of Clinical Microbiology, November 1999, p. 3509-3513, Vol. 37, No. 11
0095-1137/99/$04.00+0
Copyright © 1999, American Society for Microbiology. All rights reserved.


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