Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments: a cross-sectional survey

BMJ Open. 2019 Jun 27;9(6):e029000. doi: 10.1136/bmjopen-2019-029000.


Objectives: The aim of this study was to describe the carrier prevalence and demographic variation of four different multiresistant bacteria (MRB) among acute patients in Danish emergency departments (EDs): methicillin-resistant Staphylococcus aureus (MRSA), carbapenemase-producing enterobacteria (CPE), extended-spectrum beta-lactamase-producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE), and to analyse the association of MRB carriage to a range of potential risk factors.

Design: Multicentre descriptive and analytic cross-sectional survey.

Setting: Eight EDs and four clinical microbiology departments in Denmark.

Participants: Adults visiting the ED.

Main outcome measures: Swabs from nose, throat and rectum were collected and analysed for MRSA, ESBL, VRE and CPE. The primary outcome was the prevalence of MRB carriage, and secondary outcomes relation to risk factors among ED patients.

Results: We included 5117 patients in the study. Median age was 68 years (54-77) and gender was equally distributed. In total, 266 (5.2%, 95% CI 4.6 to 5.8) were colonised with at least one MRB. No significant difference was observed between male and female patients, between age groups and between university and regional hospitals. Only 5 of the 266 patients with MRB were colonised with two of the included bacteria and none with more than two. CPE prevalence was 0.1% (95% CI 0.0 to 0.2), MRSA prevalence was 0.3% (95% CI 0.2 to 0.5), VRE prevalence was 0.4% (95% CI 0.3 to 0.6) and ESBL prevalence was 4.5% (95% CI 3.9 to 5.1). Risk factors for MRB carriage were previous antibiotic treatment, previous hospital stay, having chronic respiratory infections, use of urinary catheter and travel to Asia, Oceania or Africa.

Conclusion: Every 20th patient arriving to a Danish ED brings MRB to the hospital. ESBL is the most common MRB in the ED. The main risk factors for MRB carriage are recent antibiotic use and travel abroad.

Trial registration number: NCT03352167;Post-results.

Keywords: carbapenemase-producing enterobacteria; carrier prevalence; extended-spectrum beta-lactamase-producing enterobacteria; methicillin resistant staphylococcus aureus; risk factors; vancomycin resistant enterococci.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Anti-Bacterial Agents / therapeutic use*
  • Carbapenem-Resistant Enterobacteriaceae / isolation & purification
  • Carrier State* / diagnosis
  • Carrier State* / epidemiology
  • Carrier State* / microbiology
  • Cross-Sectional Studies
  • Denmark / epidemiology
  • Drug Resistance, Multiple, Bacterial*
  • Emergency Service, Hospital / statistics & numerical data*
  • Enterobacteriaceae Infections* / epidemiology
  • Enterobacteriaceae Infections* / prevention & control
  • Female
  • Humans
  • Infection Control / methods
  • Male
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification
  • Prevalence
  • Risk Assessment
  • Risk Factors
  • Staphylococcal Infections* / epidemiology
  • Staphylococcal Infections* / prevention & control
  • Streptococcal Infections* / epidemiology
  • Streptococcal Infections* / prevention & control
  • Travel
  • Vancomycin-Resistant Enterococci / isolation & purification


  • Anti-Bacterial Agents

Associated data