Carriage of ESBL (extended spectrum beta-lactamases) - producing bacteria - knowledge, emotional impact and risk assessment

Antibiotic-resistant bacteria, such as ESBL-producing Enterobacteriaceae, have become a growing public health threat. The overall aim of this thesis was to explore how the increasing prevalence of ESBL-producing bacteria affects different groups among the Swedish population. Paper I described the knowledge and understanding of antibiotic-resistant bacteria, and of the risk of becoming a carrier of such bacteria, among ninety-five Swedish travelers before travel to high-risk areas. A questionnaire was used for data sampling and qualitative content analysis for data analysis. The study shows that the travelers lacked knowledge of antibiotic resistance, that they perceived there to be no risk of acquiring such bacteria during the upcoming trip, and that they distanced themselves from the problem. In Paper II travelers’ risk behavior and risk-taking during their travel to a high-prevalence country for ESBL were described. Fifteen persons, who acquired a carriage of ESBL during their trip, were interviewed after homecoming. Grounded Theory was used for data analysis. The low knowledge level of antibiotic-resistant bacteria and transmission routes influenced the participants ́ behavior and risk-taking during their journey, resulting in most of them exposing themselves to risk situations of which they were mostly unaware. For the participants it was unclear why they had become carriers of ESBL, and they did not see that it could have been caused by their personal risk behavior. Paper III comprises the experiences of patients who have become carriers of ESBL, as patients in healthcare and the consequences for their daily life. Seven ESBL-patients were interviewed and Grounded Theory was used for the data analysis. The participants experienced that physicians and other healthcare staff had a poor knowledge of ESBL, resulting in them receiving insufficient and incorrect information, which in turn gave rise to many thoughts and various emotions among the informants. To cope with their daily lives they constructed their own strategies to handle the consequences of ESBL. In contact with healthcare they perceived staff as ignorant, disrespectful and with a nonchalant attitude, and they sometimes felt stigmatized. In Paper IV the consequences for staff in acute care settings and nursing homes caring for patients and residents with ESBL-producing bacteria were described. Interviews were conducted with five Registered Nurses (RNs), five Assistant Nurses (ANs) and three Physicians in acute care settings and five RNs and five RNs in nursing homes. Grounded Theory was used for data analysis. Some fear was present among healthcare staff and it was more frequent in nursing homes than in acute care settings. The fear most often concerned the risk of becoming personally infected or transmitting contagion at home to family and friends. The ESBL knowledge level was lower in nursing homes than in acute care settings. Fear and a lack of knowledge sometimes caused a lack of respect and empathy for ESBL-patients and residents. There was a lack of nurses and of single-rooms for ESBL-patients in acute care settings, resulting in staff being overworked and stressed, leading to guidelines sometimes not being followed. In conclusion: To prevent the spread of ESBL-producing Enterobacteriaceae across borders and back home to Sweden there is a need for improved pre-travel advice for Swedish travelers. It is important with correct information to enable persons with ESBL to be able to cope with their everyday lives. Increased knowledge among staff is important to preserve the dignity of ESBLpatients in healthcare. It is also necessary to provide good working conditions for the staff so that they can give high quality care to patients and residents with ESBL.