ABSTRACT
By collecting and analyzing diapers, we identified a >6-fold increase in carriage of extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae for healthy preschool children in Sweden (p<0.0001). For 6 of the 50 participating preschools, the carriage rate was >40%. We analyzed samples from 334 children and found 56 containing >1 ESBL producer. The prevalence in the study population increased from 2.6% in 2010 to 16.8% in 2016 (p<0.0001), and for 6 of the 50 participating preschools, the carriage rate was >40%. Furthermore, 58% of the ESBL producers were multidrug resistant, and transmission of ESBL-producing and non-ESBL-producing strains was observed at several of the preschools. Toddlers appear to be major carriers of ESBL producers in Sweden.
Subject(s)
Carrier State , Enterobacteriaceae Infections/epidemiology , Enterobacteriaceae Infections/microbiology , Enterobacteriaceae , beta-Lactamases/metabolism , Anti-Bacterial Agents/pharmacology , Child, Preschool , Enterobacteriaceae/classification , Enterobacteriaceae/drug effects , Enterobacteriaceae/genetics , Enterobacteriaceae/metabolism , Enterobacteriaceae Infections/transmission , Female , Follow-Up Studies , Genome, Bacterial , Humans , Infant , Male , Microbial Sensitivity Tests , Population Surveillance , Prevalence , Sweden/epidemiology , beta-Lactamases/geneticsABSTRACT
OBJECTIVES: Enterococci are a natural part of the bacterial flora of humans, animals, and insects and are frequently found in the community. Vancomycin-resistant enterococci (VRE) have emerged as a growing problem, associated with high morbidity and mortality. The aim of this study was to investigate the prevalence of VRE among healthy Swedish preschool children and ascertain whether they constitute a reservoir for the bacteria. METHODS: In total, 313 individual diapers were collected from preschools in Uppsala, Sweden. Fecal samples were screened by analyzing the color change in a broth followed by polymerase chain reaction for vanA and vanB genes, which are associated with vancomycin resistance. RESULTS: Neither vanA nor vanB genes could be detected from the samples. CONCLUSIONS: Preschool children in Uppsala do not constitute a reservoir for VRE. The zero prevalence is consistent with the overall decline in VRE prevalence in Sweden during the last years.
Subject(s)
Child, Preschool , Vancomycin-Resistant Enterococci/isolation & purification , Bacterial Proteins/genetics , Carbon-Oxygen Ligases/genetics , Disease Reservoirs , Feces/microbiology , Humans , Prevalence , Real-Time Polymerase Chain Reaction , Specimen Handling , Sweden , Vancomycin-Resistant Enterococci/geneticsABSTRACT
AIM: The objective was to determine the prevalence of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae in faeces from healthy Swedish preschool children and to establish whether transmission took place between children in preschools. METHODS: Diapers from children attending preschools in Uppsala city were collected during September to October 2010, and the faeces was cultured. Antibiotic profiles and carriage of CTX-M, TEM, SHV and AmpC type enzymes were determined. PCR-positive isolates were further characterized by sequencing and epidemiological typing. Statistics on antibiotic use and ESBL producers in paediatric patients at Uppsala University Hospital were extracted for comparison. RESULTS: A total of 313 stool specimens were obtained, representing 24.5% of all preschool children in Uppsala city. The carriage rate of ESBL-producing Enterobacteriaceae was 2.9% among these healthy children. The corresponding figure for patients in the same age group was 8.4%. Escherichia coli with CTX-M type enzymes predominated, and only one E. coli isolate carried genes-encoding CMY. CTX-M-producing E. coli isolates with identical genotypes were found in children with no familial relation at two different preschools. CONCLUSIONS: Using diapers, the prevalence of ESBL-producing Enterobacteriaceae in children was quickly established, and, most likely, a transmission of ESBL-producing E. coli was for the first time documented between children at the same preschool.
