Open Access Highly Accessed Research article

Antimicrobial resistance in urinary pathogens among Swedish nursing home residents remains low: a cross-sectional study comparing antimicrobial resistance from 2003 to 2012

Pär-Daniel Sundvall123*, Marie Elm4, Ronny Gunnarsson125, Sigvard Mölstad6, Nils Rodhe78, Lars Jonsson9 and Peter Ulleryd10

Author Affiliations

1 Research and Development Unit, Primary Health Care in Southern Älvsborg County, Sven Eriksonsplatsen 4, SE-503 38, Borås, Sweden

2 Department of Public Health and Community Medicine, Institute of Medicine, the Sahlgrenska Academy, University of Gothenburg, Box 100, SE-405 30 Gothenburg, Sweden

3 Sandared Primary Health Care Centre, Sandared, Sweden

4 Health Care Unit, Borås Municipality, Våglängdsgatan 21 B, SE-507 41 Borås, Sweden

5 Cairns Clinical School, School of Medicine and Dentistry, James Cook University, Cairns Base Hospital, PO Box 902, Cairns, QLD 4870, Australia

6 Department of Clinical Sciences, General Practice, Lund University, CRC, Hus 28, Plan 11, Jan Waldenströms gata 35, Malmö, SE-205 02, Sweden

7 Centre for Clinical Research, Dalarna, Sweden and Falu Vårdcentral, Södra Mariegatan 18, SE-791 70 Falun, Sweden

8 Department of Public Health and Caring Sciences, Family Medicine, Uppsala University, Uppsala, Sweden

9 Bio Imaging and Laboratory Medicine Unit, Södra Älvsborg Hospital, SE-501 82 Borås, SE-501 82, Sweden

10 Department of Infectious Diseases, Institute of Biomedicine, the Sahlgrenska Academy, University of Gothenburg, Sweden and Department of Communicable Disease Control, Västra Götalandsregionen, SE-501 82 Borås, Sweden

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BMC Geriatrics 2014, 14:30  doi:10.1186/1471-2318-14-30

Published: 13 March 2014



There are several risk factors for the colonisation, infection and spreading of antibiotic resistant bacteria among elderly residents of nursing homes. An updated estimate of the native prevalence of antimicrobial resistance in uropathogens among Swedish nursing home residents is needed.


Urine specimens were collected for culture and antimicrobial susceptibility testing against mecillinam, ampicillin, cefadroxil, trimethoprim, nitrofurantoin and quinolones from the residents of 32 and 22 nursing homes, respectively. The residents were capable of providing a voided urine sample in 2003 and 2012. In 2012 urine specimens were also collected from residents with urinary catheters. Any antibiotic treatment during the previous month was registered in 2003 as well as hospitalisation and any antibiotic treatment during the previous six months in 2012.


The proportion of positive urine cultures was 32% (207/651) in voided urine specimens in 2003, 35% (147/421) in 2012, and 46% (27/59) in urine samples from catheters in 2012. Escherichia coli (E. coli) was the most commonly occurring bacteria.

Resistance rates in E. coli (voided urine specimens) in 2012 were; ampicillin 21%, trimethoprim 12%, mecillinam 7.7%, ciprofloxacin 3.4%, cefadroxil 2.6% and nitrofurantoin 0.85%. There were no significant changes in the average resistance rates in E. coli for antibiotics tested 2003–2012.

In 2012, two isolates of E. coli produced extended spectrum beta-lactamase enzymes (ESBL) and one with plasmid mediated AmpC production.

Any antibiotic treatment during the previous month increased the risk for resistance in E. coli, adjusted for age and gender; for mecillinam with an odds ratio (OR) of 7.1 (2.4-21; p = 0.00049), ampicillin OR 5.2 (2.4-11; p = 0.000036), nalidixic acid OR 4.6 (1.4-16; p = 0.014) and trimethoprim OR 3.9 (1.6-9.2; p = 0.0023). Hospitalisation during the previous six months increased the risk for antibiotic resistance in E. coli to ampicillin, ciprofloxacin and any antimicrobial tested, adjusted for age, gender and antibiotic treatments during the previous six months.


The average rates of antimicrobial resistance were low and did not increase between 2003 and 2012 in E. coli urinary isolates among Swedish nursing home residents. Antibiotic treatment during the previous month and hospitalisation during the previous six months predicted higher resistance rates.

Drug resistance; Bacterial; Bacteriuria; Nursing homes; Homes for the aged; Urinary tract infections; Antibiotics