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Antimicrobial Agents and Chemotherapy, June 2000, p. 1479-1484, Vol. 44, No. 6
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.

A between-Species Comparison of Antimicrobial Resistance in Enterobacteria in Fecal Flora

Monica Österblad,1,* Antti Hakanen,1 Raija Manninen,2 Tiina Leistevuo,1,dagger Reijo Peltonen,3 Olli Meurman,4 Pentti Huovinen,1 and Pirkko Kotilainen3

Antimicrobial Research Laboratory, National Public Health Institute,1 Department of Medical Microbiology, Turku University,2 and Department of Medicine3 and Central Laboratory, Department of Clinical Microbiology,4 Turku University Central Hospital, Turku, Finland

Received 16 September 1999/Returned for modification 14 January 2000/Accepted 3 March 2000

Enterobacteria in fecal flora are often reported to be highly resistant. Escherichia coli is the main species; resistance data on other species are rare. To assess the effect of the host's environment, antimicrobial resistance was determined in fecal species of the family Enterobacteriaceae from three populations: healthy people (HP)(n = 125) with no exposure to antimicrobials for 3 months preceding sampling, university hospital patients (UP) (n = 159) from wards where the antibiotic use was 112 defined daily doses (DDD)/bed/month, and geriatric long-term patients (LTP) (n = 74) who used 1.8 DDD/bed/month. The mean length of hospital stay was 5 days for the UP and 22 months for the LTP. The isolates were identified to at least genus level, and MICs of 16 antimicrobials were determined. From the university hospital, resistance data on clinical Enterobacteriaceae isolates were also collected. Resistance data for on average two different isolates per sample (range, 1 to 5) were analyzed: 471 E. coli isolates and 261 other Enterobacteriaceae spp. Resistance was mainly found among E. coli; even in HP, 18% of E. coli isolates were resistant to two or more antimicrobial groups, with MIC patterns indicative of transferable resistance. Other fecal enterobacteria were generally susceptible, with little typically transferable multiresistance. Clinical Klebsiella and Enterobacter isolates were significantly more resistant than fecal isolates. The resistance patterns at both hospitals mirrored the patterns of antibiotic use, but LTP E. coli isolates were significantly more resistant than those from UP. Conditions permitting an efficient spread may have been more important in sustaining high resistance levels in the LTP. E. coli was the main carrier of antimicrobial resistance in fecal flora; resistance in other species was rare in the absence of antimicrobial selection.

* Corresponding author. Mailing address: Antimicrobial Research Laboratory, National Public Health Institute, Kiinamyllynkatu 13, P.O. Box 57, Turku, FIN-20521, Finland. Phone: 358-2-2519 255. Fax: 358-2-2519 254. E-mail: monica.osterblad{at}utu.fi.

dagger Present address: Department of Physical Medicine and Rehabilitation, Turku University Central Hospital, Turku, Finland.

Antimicrobial Agents and Chemotherapy, June 2000, p. 1479-1484, Vol. 44, No. 6
0066-4804/00/$04.00+0
Copyright © 2000, American Society for Microbiology. All rights reserved.


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