Colonization and Resistance Patterns of Gram-Positive and Gram-Negative Bacteria in Patients Had No Recent History of Hospitalization Behice Kurtaran, MD,* Yesim Tasova,MD,* Filiz Kibar, MD,Þ Aslihan Candevir, MD,* Gu ¨l zah Seydao ?lu, MD,þ Ozay Akyildiz, MD,* Ayse Seza Inal, MD,* and Hasan Salih Zeki Aksu, MD* Objectives: The aims of this study were to evaluate colonization with resistant gram-positive and gram-negative microorganisms and the results of antibiotic susceptibility of patients who had no history of hospitalization at least within the last 3 months and also to evaluate the risk factors of antibiotic resistance in bacterial isolates. Methods: A cross-sectional study was designed in a university hos- pital. Patients admitted to hospital between January 1, and December 31, 2008, was included in the study. A total of 653 isolates of nasal and rectal swab cultures were obtained from 248 patients. Risk factors and demo- graphic data were determined with a prospective surveillance. Logistic regression models were performed to evaluate the independent risk factors for resistance. Results: Methicillin resistant Staphylococcus aureus rate in Staphylo- coccus aureus was 3.9%, and methicillin resistance rate in coagulase- negative staphylococci was 60.6%. Extended-spectrum A-lactamase (ESBL) production rate of Escherichia coli and Klebsiella pneumoniae isolates was 15%, quinolone resistance rate in Enterobactericeae was 20.7%, and vancomycin resistance rate in Enterococcus species was 10.8%. Univariate analyses were shown that antibiotic use was found to be risk factors associated with the recovery of a resistant organism for ESBL production (odds ratio [OR], 6.2; 95% confidence interval [CI], 2.8Y13.8), quinolone (OR, 3.5; 95% CI, 1.9Y6.6), and methicillin resis- tance (OR, 3.3; 95% CI, 1.7Y6.2). In multivariate analysis, independent risk factors associated with the recovery of a resistant organism were found to be use of antibiotics. Previous hospitalization was also found to be an independent risk factor for methicillin resistance (OR, 2.4; 95% CI, 1.2Y4.6). Conclusions: Resistance rates of isolates were found to be high. An especially high rate of quinolone resistance and production of ESBL in colonized Enterobacteriacea species and vancomycin resistance in colonized Enterococcus species in community are starting to attract attention. Key Words: community, resistant bacteria, risk factor (Infect Dis Clin Pract 2011;19: 105Y110) C olonized pathogens have the potential to cause infection if they spread to a different site on the same patient (eg, from the skin to the urinary tract) or to another person. Depending on the microorganism, colonized pathogens can be transmitted from person to person and via inanimate objects. Person-to-person transmission is the major route of colonization within health care facilities. Although a person can become infected as soon as a pathogen invades, in many cases, colonization without signs and symptoms of infection takes place before infection occurs. Nowadays, multiresistant bacteria have become an in- creasing problem in both hospitals and the community. Notable problem between gram-positive pathogens are methicillin- resistant Staphylococcus aureus, coagulase-negative staphylococci (CNS), glycopeptide-resistant enterococci, and penicillin-resistant Streptococcus pneumoniae. Like quinolone, resistance in En- terobacteriacea and extended-spectrum A-lactamase (ESBL) production in Escherichia coli and Klebsiella pneumoniae between gram-negative pathogens are also problem for man- agement infections in all settings. Numerous studies have documented the relationship between antibiotic use and the emergence of antibiotic resistance, particularly in E. coli. 1,2 However, a few studies have assessed the impact of hospital stay and antibiotic use on gastrointestinal colonization with resistant Enterobacteriaceae. However, the precise epidemiology and frequency of each drug-resistant pathogen depend on geographical location, the patient group involved, and previous antibiotic use. Active measures need to be taken to reduce the spread of these patho- gens and thus preserve the efficacy of available antibiotics. 3 Because of difficulty of epidemiological studies, evaluation of the patients who administrated to the hospitals and had no recent history of hospitalization may reflect situation of the community and community-acquired infections. The aims of this study were to evaluate colonization with resistant gram-positive and gram-negative microorganisms and the results of antibiotic susceptibility of patients who had no history of hospitalization within the last 3 months and also to evaluate the risk factors of antibiotic resistance in bacterial isolates. MATERIALS AND METHODS Patient Population Consecutive new admissions to Infectious Diseases De- partment of Cukurova University, between January 2008 and December 2008 with no history of hospitalization within the last 3 month were included in this study prospectively. Cukurova University Hospital is in Adana City (with 2 million population) in the south of Turkey. It has 1200 beds. The records of all 248 patients were reviewed for demo- graphical and clinical data, including patient age, sex, length of hospital stay, administration of corticosteroids or cytotoxic agents, admission to the hospital within 12 months, transfer from another hospital, surgery and trauma in the preceding month, administration of oral or parenteral antimicrobial agents in the month before admission, and medical history (eg, diabetes, chronic respiratory disease, cancer). Hepatic dis- ease was defined to have chronic hepatitis B and hepatitis C, acute hepatitis, and end-stage hepatic disease cirrhosis. Chronic renal failure was defined as the presence of objective kidney ORIGINAL ARTICLE Infectious Diseases in Clinical Practice & Volume 19, Number 2, March 2011 www.infectdis.com 105 From the Faculty of Medicine, Departments of *Infectious Diseases, †Microbiology, and ‡Biostatistic, Cukurova University, Adana, Turkey. Correspondence to: Behice Kurtaran, MD, Faculty of Medicine, Department of Infectious Diseases, Cukurova University, Adana, Turkey. E-mail: behicekurtaran@gmail.com. The authors have no funding or conflicts of interest to disclose. Copyright * 2011 by Lippincott Williams & Wilkins ISSN: 1056-9103 Copyright © 2011 Lippincott Williams & Wilkins. Unauthorized reproduction of this article is prohibited.