Göran Hedin

Molecular Epidemiology of Extended-Spectrum β-Lactamases among Escherichia coli Isolates Collected in a Swedish Hospital and Its Associated Health Care Facilities from 2001 to 2006

ABSTRACT The genetic characteristics and molecular epidemiology of extended-spectrum β-lactamases (ESBLs) among Escherichia coli isolates were investigated at a general hospital and its associated health care facilities in Stockholm, Sweden, during the period from 2001 to 2006. Of 87 consecutive nonduplicate ESBL-positive isolates, 80 isolates encoded CTX-M-type ESBLs, 64 of which were group 1 enzymes. TEM-type and OXA-type β-lactamases were encoded in 63 and 59% of the ESBL isolates, respectively. Pulsed-field gel electrophoresis (PFGE) analysis revealed 40 different pulsotypes, consisting of 11 clones accounting for 66% of all isolates, and 29 unique patterns. Moreover, of the 11 clones, clones 1 and 4 comprised half of the clonally related isolates (28 of 57). Clone 1 was a persistent endemic clone in the area throughout the years, and clone 4 emerged in 2003. However, in recent years, clone 1 isolates were no longer predominant and were gradually replaced by new emerging strains. Concerning β-lactamase gene profiles in relation to PFGE pulsotypes, clone-related bla profiles were observed in certain clones, while in most cases different bla profiles could be observed in the same clone, and the same bla profile could be present in different clones. The molecular epidemiology of ESBL-positive E. coli in the area shows shifts in predominant strains and increased clonal diversity over time. The study also indicated that both clonal spread of epidemic strains and transfer of transposable genetic elements might contribute to the proliferation of ESBLs.

A prospective epidemiological survey of candidaemia in Sweden

A prospective epidemiological survey of candidaemia was performed in central Sweden from January 1998 to December 1999. In total, 191 episodes were reported with an overall rate of 0.32/1000 admissions. Candida albicans was identified in 128 cases (67%), followed by Candida glabrata in 30 (15.7%) and Candida parapsilosis in 14 (7.3%). Predisposing factors included surgery (31.4%), intensive care (18.8%), solid tumour or haematological malignancy (15.7%), and foetal immaturity (15.7%). Non-albicans Candida species were more prevalent among patients with haematological malignancies (56%), compared to surgical (30%) and ICU patients (19%). The crude mortality rate of candidaemia was 31%. The highest mortality rate was observed in patients with haematological malignancies (41.2%), age >70 y (41%), surgery (38.5%) and infections with >1 Candida species (40%) or C. glabrata (38%).

Genetic diversity of community-associated methicillin-resistant Staphylococcus aureus in southern Stockholm, 2000-2005

This study investigated the molecular epidemiology of 104 community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) isolates from southern Stockholm during the period 2000-2005. The isolates were analysed by pulsed-field gel electrophoresis (PFGE), multilocus sequence typing, staphylococcal chromosomal cassette (SCC) mec typing and detection of genes encoding Panton-Valentine leukocidin (PVL). Overall, 28 distinct PFGE patterns and 13 sequence types (STs) were identified. ST80, ST8, ST88 and ST150 were the major CA-MRSA clones in the area, and these accounted for 75% (78/104) of all CA-MRSA isolates. ST150 isolates, which have, to date, been found only in Sweden, were isolated exclusively from a group of homeless individuals. Eighty-six (83%) of the 104 isolates in the study possessed SCCmecIV, found in ten different STs, while 16 isolates possessed SCCmecV. The PVL genes were detected in 56% (58/104) of the isolates. Strain ST80-MRSA-IV carrying PVL genes predominated over the 6-year period and accounted for 38% of all isolates. However, a polyclonal tendency was observed among the CA-MRSA isolates recovered in recent years.

Molecular Epidemiological Analysis of Escherichia coli Isolates Producing Extended-Spectrum β-Lactamases for Identification of Nosocomial Outbreaks in Stockholm, Sweden

ABSTRACT From June to October of 2002, a cluster of Escherichia coli isolates producing extended-spectrum β-lactamases (ESBLs) was detected in Stockholm. The isolates were grouped into two clones, one of which had already circulated in the same area before the outbreak. CTX-M-type ESBLs and coresistance to ciprofloxacin were identified in the strains.

Evaluation of Two New Chromogenic Media, CHROMagar MRSA and S. aureus ID, for Identifying Staphylococcus aureus and Screening Methicillin-Resistant S. aureus

ABSTRACT Thirty-nine methicillin-resistant Staphylococcus aureus (MRSA) isolates with diverse genetic backgrounds and two reference strains were correctly identified as S. aureus on CHROMagar MRSA and S. aureus ID media. Growth inhibition on CHROMagar MRSA was noted. A combination of cefoxitin disk and S. aureus ID was found suitable for rapid MRSA screening.

Use of Cefoxitin-Based Selective Broth for Improved Detection of Methicillin-Resistant Staphylococcus aureus

ABSTRACT A cefoxitin-based selective broth was evaluated for its efficiency in detecting methicillin-resistant Staphylococcus aureus (MRSA) by the use of laboratory reference strains, clinical isolates of different clones, and clinical samples. The cefoxitin-based broth was proved to be more sensitive and rapid for the detection of MRSA strains, especially heterogeneously resistant strains, than the oxacillin-based broth.

Prevalence of qnr determinants among extended-spectrum β-lactamase-positive Enterobacteriaceae clinical isolates in southern Stockholm, Sweden

Three hundred and nineteen extended-spectrum beta-lactamase-positive Enterobacteriaceae clinical isolates were screened for qnr genes. Twelve isolates were positive for qnr, including one qnrA1, two qnrB1, three qnrB2, one qnrB4, one qnrB6 and four qnrS1. No qnr-positive strains were identified among the isolates recovered before 2006. The first qnr-positive Escherichia coli was detected from a patient in 2006. qnr genes remained rare in E. coli (6/288; 2.1%), but appeared to be more prevalent in Klebsiella pneumoniae (4/25; 16%) and Enterobacter cloacae (2/3; 66.7%). All qnr-positive isolates were resistant to nalidixic acid while presenting varied susceptibilities to fluoroquinolones. Isolates harbouring qnrB4 or qnrB6 were highly resistant to all the fluoroquinolones tested. Their high-level resistance is associated with multiple chromosomal substitutions in gyrA and parC. Alterations at codons Ser-83 and Asp-87 in GyrA and at codons Ser-80 and Glu-84 in ParC were observed in these isolates.

ICU stay promotes enrichment and dissemination of multiresistant coagulase-negative staphylococcal strains

Patients in the intensive care unit (ICU) are prone to be colonized and infected by multi-resistant bacteria. It is previously known that nosocomial infections are often preceded by cross-transmission events. The aim of the present investigation was to study the impact of the patients length of ICU stay on the resistance patterns, diversity and dissemination of coagulase-negative staphylococci (CoNS) within and between patients. Two groups of patients were studied, including 20 consecutive patients sampled within 2 h from admission (short-stayers, SS), and all patients treated for at least 5 d in the ICU (long-stayers, LS), available for sampling every second week (n = 15). Sampling was performed from 5 sites: oropharynx, nares, neck, axilla and perineum. A total of 868 CoNS isolates deriving from LS patients and 403 isolates from SS patients were analysed for antimicrobial susceptibility, clonal diversity and dissemination within and between patients. The highest resistance rates were seen for oxacillin and ciprofloxacin, being 92% and 83%, respectively. Long-stayers were at significantly higher risk of being colonized with CoNS isolates resistant against oxacillin, clindamycin, ciprofloxacin, gentamicin as well as with multiresistant strains. By genotyping 22 phenotypes that were shared among at least 2 patients, 32 PFGE types of which 16 colonized more than 1 individual were identified. One of the clones was isolated from 10 individuals, including 2 SS patients, indicating an epidemic strain. Prolonged ICU stay was significantly correlated to decreased clonal diversity, increased endogenous dissemination of resistant strains and cross-transmission. The results emphasize the importance of good infection control practice, especially in this vulnerable group of patients.

Outbreaks of methicillin-resistant Staphylococcus aureus among staff and dogs in Swedish small animal hospitals.

Abstract Methicillin-resistant Staphylococcus aureus (MRSA) was found in a dog for the first time in Sweden in 2006. Between October 2006 and May 2007, MRSA was diagnosed in 7 more dogs that had been treated in 3 different small animal hospitals, located 150–200 km apart, in different counties of Sweden. Screening of the animal hospital staff and environment in these small animal hospitals showed 20 of 152 staff to be positive for MRSA, with rates between 2% and 18% in the different hospitals, while all 128 environmental samples were negative. All MRSA isolates from dogs and staff belonged to spa type t032, were Panton–Valentine leukocidin (PVL)-negative, and had indistinguishable pulsed-field gel electrophoresis patterns, except for 2 isolates with closely related patterns. To our knowledge, this is the first report of multiple outbreaks of MRSA in dogs caused by the same strain within a short time frame, and appearing in a country with low prevalence of MRSA in both humans and dogs. This highlights the importance of infection control programs in animal hospitals and in animal health care. Awareness of MRSA as an occupational risk for veterinary personnel is essential.