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Biliary microflora in patients undergoing cholecystectomy.

https://arctichealth.org/en/permalink/ahliterature260257
Source
Surg Infect (Larchmt). 2014 Jun;15(3):262-5
Publication Type
Article
Date
Jun-2014
Author
Bahman Darkahi
Gabriel Sandblom
Håkan Liljeholm
Per Videhult
Åsa Melhus
Ib Christian Rasmussen
Source
Surg Infect (Larchmt). 2014 Jun;15(3):262-5
Date
Jun-2014
Language
English
Publication Type
Article
Keywords
Aged
Bacteria - classification - isolation & purification
Bacterial Infections - epidemiology - microbiology
Bile - microbiology
Cholecystectomy
Female
Gallbladder - microbiology
Humans
Male
Middle Aged
Prevalence
Sweden
Abstract
The management of acute cholecystitis requires a sound knowledge of the biliary microflora.
Bile samples were taken for culture according to a standard routine during all cholecystectomies performed from April 2007 to February 2009 in the Department of Surgery at Enköping Hospital. The use of antibiotics within the 3-mo period before surgery, indication for surgery, prophylactic antibiotics, and post-operative complications were recorded prospectively.
Altogether, 246 procedures were performed during the study period, of which 149 (62%) were done on women. The mean (±SD) age of the study subjects was 49±16?y. Bacterial growth was seen in cultures from 34 (14%) of the subjects. The mean age of subjects with positive cultures was 64?y and that of subjects with negative cultures was 47?y (p
PubMed ID
24801654 View in PubMed
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A case-control study of risk factors for urinary acquisition of Klebsiella pneumoniae producing CTX-M-15 in an outbreak situation in Sweden.

https://arctichealth.org/en/permalink/ahliterature145253
Source
Scand J Infect Dis. 2010 Jul;42(6-7):439-44
Publication Type
Article
Date
Jul-2010
Author
Birgitta Lytsy
Johan Lindbäck
Erik Torell
Staffan Sylvan
Inga Velicko
Asa Melhus
Author Affiliation
Department of Clinical Microbiology, Uppsala University Hospital, Uppsala, Sweden. birgitta.lytsy@akademiska.se
Source
Scand J Infect Dis. 2010 Jul;42(6-7):439-44
Date
Jul-2010
Language
English
Publication Type
Article
Keywords
Aged
Aged, 80 and over
Disease Outbreaks
Drug Resistance, Multiple, Bacterial
Female
Humans
Klebsiella Infections - epidemiology - microbiology - urine
Klebsiella pneumoniae - enzymology - isolation & purification
Logistic Models
Male
Microbial Sensitivity Tests
Middle Aged
Odds Ratio
Polymerase Chain Reaction
Retrospective Studies
Risk factors
Sweden - epidemiology
Urine - microbiology
beta-Lactamases - biosynthesis - genetics - metabolism
Abstract
A retrospective case-control study was initiated at Uppsala University Hospital in 2006 during a major outbreak caused by a Klebsiella pneumoniae strain producing CTX-M-15. To identify risk factors associated with acquisition of the outbreak strain in the urinary tract, 52 case patients with a urine culture positive for the outbreak strain between 1 May and 31 December 2005 were enrolled. Case patients were matched 1:2 with concurrently hospitalized control patients with significant growth of susceptible Escherichia coli in a urine sample. Conditional logistic regression analyses identified hospital stay >or=9 days (odds ratio (OR) 18.8, 95% confidence interval (CI) 5.74-61.2), nasogastric feeding tube (OR 18.0, 95% CI 2.28-142) and diarrhoea (OR 9.62, 95% CI 3.30-28.1) as risk factors with high ORs. The odds of previous use of cephalosporins were 7.58 (95% CI 3.13-18.4) times higher in case patients compared with the controls. Several multivariable models were evaluated to reduce bias from confounding. These models identified prolonged period of hospitalization, diarrhoea, malignancy and antibiotic use as the most important risk factors for acquisition of the outbreak strain, factors that are often found in elderly patients with a poor functional status.
PubMed ID
20180680 View in PubMed
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Effect of pneumococcal conjugate vaccination on nasopharyngeal carriage in children with early onset of acute otitis media - a randomized controlled trial.

https://arctichealth.org/en/permalink/ahliterature266292
Source
Acta Otolaryngol. 2015 Jan;135(1):7-13
Publication Type
Article
Date
Jan-2015
Author
Marie Gisselsson-Solén
Gunnel Henriksson
Ann Hermansson
Asa Melhus
Source
Acta Otolaryngol. 2015 Jan;135(1):7-13
Date
Jan-2015
Language
English
Publication Type
Article
Keywords
Acute Disease
Age Factors
Carrier State - microbiology - prevention & control
Female
Haemophilus influenzae - isolation & purification
Humans
Infant
Male
Moraxella (Branhamella) catarrhalis - isolation & purification
Nasopharynx - microbiology
Otitis Media - microbiology - prevention & control
Pneumococcal Vaccines
Recurrence
Risk factors
Streptococcus pneumoniae - isolation & purification
Streptococcus pyogenes - isolation & purification
Sweden
Abstract
Although children vaccinated with heptavalent pneumococcal conjugate vaccine (PCV) had fewer episodes of acute otitis media (AOM), this trial was unable to prove a simultaneous decrease in nasopharyngeal carriage.
Carriage rates of AOM pathogens in the nasopharynx are high among children, and colonization is the first step towards infection. The possible impact of PCV on carriage is therefore of interest, particularly in children with recurrent AOM. The aims of this study were to examine the effect of heptavalent PCV on carriage of AOM pathogens in children at high risk of developing recurrent disease, and to monitor carriage of resistant pathogens in vaccinated and unvaccinated children.
A total of 109 children with an onset of AOM before 6 months of age, 89 of whom developed recurrent disease, were enrolled in a trial. Fifty-two children were vaccinated and all were closely monitored for 3 years.
There was no difference statistically between vaccinated children and controls concerning the carriage of any of the major AOM pathogens. There was evidence of within-child clustering for S. pneumoniae (p = 0.002) and H. influenzae (p
PubMed ID
25496176 View in PubMed
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First documented case of Aeromonas veronii biovar sobria infection in northern Europe.

https://arctichealth.org/en/permalink/ahliterature190051
Source
Scand J Infect Dis. 2002;34(3):218-9
Publication Type
Article
Date
2002
Author
Asa Melhus
Author Affiliation
Department of Medical Microbiology, Malmö University Hospital, Sweden. asa.melhus@mikrobiol.mas.lu.se
Source
Scand J Infect Dis. 2002;34(3):218-9
Date
2002
Language
English
Publication Type
Article
Keywords
Aeromonas - isolation & purification
Aged
Anti-Bacterial Agents - therapeutic use
Appendiceal Neoplasms - complications
Cefuroxime - therapeutic use
Gram-Negative Bacterial Infections - complications - drug therapy - microbiology - surgery
Humans
Liver Cirrhosis - complications
Male
Metronidazole - therapeutic use
Peritonitis - complications - drug therapy - microbiology - surgery
Scandinavia
Abstract
The first Scandinavian case of Aeromonas veronii biovar sobria infection, an episode of peritonitis in a patient suffering from a cirrhotic liver and an earlier unrecognized appendiceal cancer, is described.
PubMed ID
12030401 View in PubMed
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The first major extended-spectrum beta-lactamase outbreak in Scandinavia was caused by clonal spread of a multiresistant Klebsiella pneumoniae producing CTX-M-15.

https://arctichealth.org/en/permalink/ahliterature157845
Source
APMIS. 2008 Apr;116(4):302-8
Publication Type
Article
Date
Apr-2008
Author
Birgitta Lytsy
Linus Sandegren
Eva Tano
Erik Torell
Dan I Andersson
Asa Melhus
Author Affiliation
Department of Clinical Microbiology, Uppsala University Hospital, Uppsala, Sweden. birgitta.lytsy@lul.se
Source
APMIS. 2008 Apr;116(4):302-8
Date
Apr-2008
Language
English
Publication Type
Article
Keywords
Bacteriological Techniques - methods
Clavulanic Acid
DNA, Bacterial - genetics
Disease Outbreaks
Drug Resistance, Microbial
Drug Resistance, Multiple, Bacterial
Electrophoresis, Gel, Pulsed-Field
Humans
Klebsiella Infections - epidemiology
Klebsiella pneumoniae - classification - drug effects - enzymology - isolation & purification
Microbial Sensitivity Tests
Polymerase Chain Reaction
Sweden - epidemiology
beta-Lactamases - metabolism
Abstract
Between May and December 2005, 64 multidrug-resistant isolates of Klebsiella pneumoniae were detected from patients admitted to Uppsala University Hospital. This represented a dramatic increase in ESBL-producing K. pneumoniae compared to previous years. To investigate the epidemiology and to characterize the resistance mechanisms of the isolates, a study was initiated. Antibiotic susceptibility was determined by means of the Etest and the disc diffusion method. Extended-spectrum beta-lactamase (ESBL) production was identified by clavulanic acid synergy test and confirmed with PCR amplification followed by DNA sequencing. DNA profiles of the isolates were examined with pulsed-field gel electrophoresis (PFGE). All isolates were resistant or exhibited reduced susceptibility to cefadroxil, cefuroxime, cefotaxime, ceftazidime, aztreonam, piperacillin/tazobactam, ciprofloxacin, tobramycin, and trimethoprim-sulfamethoxazole. They produced ESBL of the CTX-M-15 type, and the involvement of a single K. pneumoniae clone was shown. This is the first major clonal outbreak of multiresistant ESBL-producing K. pneumoniae in Scandinavia. The outbreak demonstrates the epidemic potential of enterobacteria containing ESBLs of the CTX-M type, even in a country with a relatively low selective pressure and a low prevalence of multiresistant bacteria.
PubMed ID
18397465 View in PubMed
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Fluoroquinolones and tendon disorders.

https://arctichealth.org/en/permalink/ahliterature29804
Source
Expert Opin Drug Saf. 2005 Mar;4(2):299-309
Publication Type
Article
Date
Mar-2005
Author
Asa Melhus
Author Affiliation
Lund University, Department of Medical Microbiology, Malmö University Hospital, S-205 02 Malmö, Sweden. asa.melhus@mikrobiol.mas.lu.se
Source
Expert Opin Drug Saf. 2005 Mar;4(2):299-309
Date
Mar-2005
Language
English
Publication Type
Article
Keywords
Achilles Tendon - drug effects
Adult
Aged
Animals
Child
Disease Models, Animal
Drug Resistance, Bacterial
Female
Fluoroquinolones - adverse effects - pharmacokinetics
Humans
Incidence
Male
Middle Aged
Musculoskeletal Diseases - chemically induced - epidemiology
Risk factors
Rupture, Spontaneous
Sweden - epidemiology
Tendinopathy - chemically induced - epidemiology
Tendons - drug effects
Abstract
Fluoroquinolones are the most potent oral antibiotics in clinical use today. Increasingly, these drugs are being prescribed for relatively benign infections and for new categories of patients, including paediatric patients. As their use becomes more frequent, so will the adverse events. This review focuses on a rare but debilitating adverse reaction, the fluoroquinolone-associated tendinopathy. Despite many published case reports and approximately 3500 cases reported to the World Health Organization Collaborating Centre for Drug Monitoring, little is known about the mechanisms behind this fluoroquinolone-specific toxicity. Data on chemical properties, mode of action, pharmacokinetic features, clinical presentation and risk factors in relation to tendon toxicity are discussed and the literature reviewed. As long as the musculoskeletal toxicity cannot be predicted by in vitro or in vivo models and this class of antibiotics is one of the most commonly linked to selection of resistant bacteria, a more prudent use of fluoroquinolones is warranted.
PubMed ID
15794721 View in PubMed
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Foreign travel is a major risk factor for colonization with Escherichia coli producing CTX-M-type extended-spectrum beta-lactamases: a prospective study with Swedish volunteers.

https://arctichealth.org/en/permalink/ahliterature100575
Source
Antimicrob Agents Chemother. 2010 Sep;54(9):3564-8
Publication Type
Article
Date
Sep-2010
Author
Thomas Tängdén
Otto Cars
Asa Melhus
Elisabeth Löwdin
Author Affiliation
Section of Infectious Diseases, Department of Medical Sciences, Uppsala University, Uppsala, Sweden. thomas.tangden@gmail.com
Source
Antimicrob Agents Chemother. 2010 Sep;54(9):3564-8
Date
Sep-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Child
Child, Preschool
Escherichia coli - enzymology - pathogenicity
Escherichia coli Infections - epidemiology - microbiology
European Continental Ancestry Group
Female
Humans
Male
Middle Aged
Prospective Studies
Risk factors
Sweden
Travel
Young Adult
beta-Lactamases - metabolism
Abstract
Foreign travel has been suggested to be a risk factor for the acquisition of extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae. To our knowledge, this has not previously been demonstrated in a prospective study. Healthy volunteers traveling outside Northern Europe were enrolled. Rectal swabs and data on potential travel-associated risk factors were collected before and after traveling. A total of 105 volunteers were enrolled. Four of them did not complete the study, and one participant carried ESBL-producing Escherichia coli before travel. Twenty-four of 100 participants with negative pretravel samples were colonized with ESBL-producing Escherichia coli after the trip. All strains produced CTX-M enzymes, mostly CTX-M-15, and some coproduced TEM or SHV enzymes. Coresistance to several antibiotic subclasses was common. Travel to India was associated with the highest risk for the acquisition of ESBLs (88%; n = 7). Gastroenteritis during the trip was an additional risk factor (P = 0.003). Five of 21 volunteers who completed the follow-up after 6 months had persistent colonization with ESBLs. This is the first prospective study demonstrating that international travel is a major risk factor for colonization with ESBL-producing Enterobacteriaceae. Considering the high acquisition rate of 24%, it is obvious that global efforts are needed to meet the emergence and spread of CTX-M enzymes and other antimicrobial resistances.
PubMed ID
20547788 View in PubMed
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Inadequate adherence to Swedish guidelines for uncomplicated lower urinary tract infections among adults in general practice.

https://arctichealth.org/en/permalink/ahliterature285494
Source
APMIS. 2017 Sep;125(9):816-821
Publication Type
Article
Date
Sep-2017
Author
Heidi Lindbäck
Johan Lindbäck
Åsa Melhus
Source
APMIS. 2017 Sep;125(9):816-821
Date
Sep-2017
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Amdinocillin Pivoxil - therapeutic use
Anti-Bacterial Agents - therapeutic use
Female
General Practitioners - statistics & numerical data
Guideline Adherence - statistics & numerical data
Humans
Inappropriate Prescribing - statistics & numerical data
Male
Middle Aged
Point-of-Care Systems
Practice Patterns, Physicians' - statistics & numerical data
Quinolones - therapeutic use
Sweden
Urinary Tract Infections - diagnosis - drug therapy - microbiology
Young Adult
Abstract
In a primary care study of urinary tract infections (UTIs) performed 2008 in Uppsala County, Sweden, 43% of the patients were culture negative. In order to investigate the background to the observed overdiagnosis of UTI, study invitations were sent to the previously included patients. A total of 256 patients (88% women) approved to participate. Patient charts and recorded laboratory data were reviewed. Two or more of the cardinal symptoms were reported in 53% of the women and in 19% of the men. A dipstick test was performed in 93% of the consultations. The highest positive predicted values in women had a positive nitrite test (95%, 95% CI 87; 99) and dysuria in combination with urgency (81%, 95% CI 72; 88). Seventy-one percent of the women who fulfilled the symptom criteria received an antibiotic prescription directly, 87% of these had a positive culture. The drug of choice was pivmecillinam for women (51%) and quinolones (50%) for men. The treatment duration was too long for the women; 68% were treated for =7 days. In conclusion, the adherence to national guidelines/recommendations was inadequate. To reduce the selection of multiresistant bacteria, an improvement of the use of diagnostic criteria/tools and antibiotic drugs in primary care is necessary.
PubMed ID
28585332 View in PubMed
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Low frequency of antibiotic resistance among urine isolates of Escherichia coli in the community, despite a major hospital outbreak with Klebsiella pneumoniae producing CTX-M-15 in Uppsala County.

https://arctichealth.org/en/permalink/ahliterature98327
Source
Scand J Infect Dis. 2010 Apr;42(4):243-8
Publication Type
Article
Date
Apr-2010
Author
Heidi Lindbäck
Johan Lindbäck
Staffan Sylvan
Asa Melhus
Author Affiliation
Primary Health Care Centre, Knivsta vårdcentral Uppsala County, Sweden. heidi.lindback@lul.se
Source
Scand J Infect Dis. 2010 Apr;42(4):243-8
Date
Apr-2010
Language
English
Publication Type
Article
Keywords
Adolescent
Adult
Aged
Aged, 80 and over
Anti-Bacterial Agents - pharmacology
Child
Child, Preschool
Community-Acquired Infections - microbiology
Cross Infection - epidemiology - microbiology
Disease Outbreaks
Drug Resistance, Bacterial
Escherichia coli Infections - microbiology
Female
Humans
Infant
Klebsiella Infections - epidemiology - microbiology
Klebsiella pneumoniae - enzymology - isolation & purification
Male
Microbial Sensitivity Tests
Middle Aged
Sweden - epidemiology
Urinary Tract Infections - microbiology
Urine - microbiology
Uropathogenic Escherichia coli - drug effects - isolation & purification
Young Adult
beta-Lactamases - biosynthesis
Abstract
A screening programme introduced during a major outbreak of a Klebsiella pneumoniae strain producing extended spectrum beta-lactamase (ESBL), indicated a dissemination of ESBL-producing Escherichia coli in the community. A total of 360 urine samples, yielding 205 isolates, were therefore collected from primary care patients with lower urinary tract infections (UTI) in Uppsala County. The susceptibility pattern of the isolates was investigated with the disk diffusion method. The majority of the positive cultures contained E. coli (76%). Of the members of the Enterobacteriaceae family, only 2 E. coli isolates were resistant to cefpodoxime, of which one produced ESBL. The antibiotic resistance for E. coli isolates was as follows: ampicillin 29.5%, trimethoprim 18.6%, nalidixic acid 7.7%, mecillinam 1.3%, nitrofurantoin 1.3%, and cefpodoxime 1.3%. Approximately 5% of the E. coli isolates showed a combined resistance to 3 or more antibiotic drugs. Negative cultures were common, especially in men, and it was obvious that there were difficulties with the definition of both uncomplicated and lower UTI. In conclusion, a dissemination of ESBL-producing E. coli in the primary care population of Uppsala County could not be confirmed when using urine samples. The antibiotic resistance in E. coli isolates was low overall, with the exception of ampicillin and trimethoprim.
PubMed ID
20085420 View in PubMed
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Outbreak of Methicillin-resistant Staphylococcus aureus in a Hospital Center for Children's and Women's Health in a Swedish County.

https://arctichealth.org/en/permalink/ahliterature299076
Source
APMIS. 2019 Apr; 127(4):181-186
Publication Type
Journal Article
Date
Apr-2019
Author
Maria Gideskog
Åsa Melhus
Author Affiliation
Department of Infection Control and Hygiene, Linköping University Hospital, Linköping, Sweden.
Source
APMIS. 2019 Apr; 127(4):181-186
Date
Apr-2019
Language
English
Publication Type
Journal Article
Keywords
Bacterial Proteins - genetics
Cross Infection - epidemiology - microbiology - transmission
Disease Outbreaks
Disease Transmission, Infectious
Drug Resistance, Multiple, Bacterial
Epidemiologic Studies
Female
Hospitals, Maternity
Humans
Infant, Newborn
Male
Methicillin-Resistant Staphylococcus aureus - classification - drug effects - genetics - isolation & purification
Microbial Sensitivity Tests
Molecular Epidemiology
Molecular Typing
Penicillin-Binding Proteins - genetics
Staphylococcal Infections - epidemiology - microbiology - transmission
Sweden - epidemiology
Whole Genome Sequencing
Abstract
The objective of this study was to investigate a sudden increase in methicillin-resistant Staphylococcus aureus (MRSA) cases primarily in one maternity ward at the Center for Children's and Women's Health at Linköping University Hospital, Sweden. Approximately 300 individuals including patients, their family members, and healthcare workers were screened for MRSA. The antibiotic susceptibility was tested and isolates polymerase chain reaction (PCR)-positive for the mecA gene were spa typed. Isolates with the same antibiogram and spa type were further whole genome sequenced. Compliance to current cleaning and hygiene routines was also controlled, and environmental samples collected. The results showed that a total of 13 individuals were involved in the outbreak. It was caused by a t386 MRSA strain (ST-1, NCBI-accession AB505628) with additional resistance to erythromycin and clindamycin. All cases were epidemiologically connected to the index patient, who had recently emigrated from a high-endemic area for MRSA. With improved cleaning and better compliance to basic hygiene routines, no further cases were reported. This study demonstrates how rapid an MRSA strain can disseminate in a ward with susceptible patients and insufficient cleaning and hygiene. For a better control of MRSA, clinical cultures and screening samples need to be obtained early and more extensively than according to the current recommendations.
PubMed ID
30908773 View in PubMed
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13 records – page 1 of 2.