Prevalence of antibiotic-resistant bacteria in residents of nursing homes in a Swedish municipality: healthcare staff knowledge of and adherence to principles of basic infection prevention

Scand J Infect Dis. 2012 Sep;44(9):641-9. doi: 10.3109/00365548.2012.671956. Epub 2012 Jun 10.


Background: The aims of this study were to investigate the prevalence of methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE) and extended-spectrum β-lactamase (ESBL)-producing Enterobacteriaceae in residents living in Swedish nursing homes, and if carriage of resistant bacteria was related to antibiotic treatment, other risk factors, and/or staff's adherence to guidelines for infection control.

Methods: Five hundred and sixty residents from 9 nursing homes on a total of 67 wards participated in the study and had microbiological cultures taken. Faecal samples were obtained from 495 residents (88.3%). ESBL-positive residents were followed for 2 y with repeated sampling. Two hundred and ninety-six [corrected] staff members were interviewed and observed regarding familiarity with and adherence to infection control guidelines.

Results: No resident was positive for MRSA or VRE. Fifteen of the residents were found to be ESBL-positive. Residents living on wards where ESBL-positive residents were identified had been treated more frequently with antibiotics (42%), compared to those on wards where no residents with ESBL were found (28%; p = 0.02). ESBL-positive Escherichia coli isolates from residents living in adjacent rooms were found to be closely genetically related when analysed by pulsed-field gel electrophoresis, indicating transmission between residents. Staff adherence to infection control guidelines sometimes revealed shortcomings, but no significant differences regarding compliance to the guidelines could be found.

Conclusion: Carriage of resistant bacteria was uncommon and only ESBL-producing Enterobacteriaceae were identified in Swedish nursing homes. Usage of antibiotics was higher on wards where ESBL-positive residents were detected and there was an indication of transmission of ESBL between residents.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Aged, 80 and over
  • Anti-Bacterial Agents / pharmacology
  • Bacteria / drug effects
  • Bacteria / genetics
  • Bacteria / isolation & purification
  • Bacterial Infections / epidemiology*
  • Bacterial Infections / microbiology*
  • Carrier State / epidemiology*
  • Carrier State / microbiology*
  • Drug Resistance, Bacterial
  • Electrophoresis, Gel, Pulsed-Field
  • Feces / microbiology
  • Female
  • Guideline Adherence
  • Health Knowledge, Attitudes, Practice*
  • Humans
  • Infection Control / standards
  • Infection Control / statistics & numerical data*
  • Male
  • Middle Aged
  • Nursing Homes / statistics & numerical data*
  • Nursing Staff
  • Prevalence
  • Risk Factors
  • Sweden / epidemiology


  • Anti-Bacterial Agents