Yersiniosis is a zoonosis that is transmitted from pigs to humans. In January 2006 more cases of Yersinia enterocolitica enterocolitis than expected were reported in Norway. The fact that the isolates belonged to the O:9 serogroup, which is rare in Norway, and the geographical and temporal clustering of the cases, pointed to an outbreak. We have conducted a retrospective study of 11 patients who were diagnosed during this outbreak.
The material is based upon applicants' information, patient journals and a questionnaire. In order to disclose the source of infection, a case-control survey was performed.
Nine of the 11 patients had enterocolitis and two had septicaemia, both of whom died following a few days of treatment. One patient presented with pseudo- appendicitis while another developed monoarthritis, which persisted for more than three months after the debut of symptoms Treatment with antibiotics was offered in six cases. The case-control analysis indicated that brawn was the probable source of infection.
This is the first reported Norwegian outbreak of Y. enterocolitica O:9 disease. The incubation time, disease duration and frequency of intestinal and immunological complications corresponds with previously published data. The frequency of septicaemia exceeds several previously reported outbreaks and retrospective studies of sporadic cases.
Antibiotic resistance is a problem in nursing homes. Presumed urinary tract infections (UTI) are the most common infection. This study examines urine culture results from elderly patients to see if specific guidelines based on gender or whether the patient resides in a nursing home (NH) are warranted.
This is a cross sectional observation study comparing urine cultures from NH patients with urine cultures from patients in the same age group living in the community.
There were 232 positive urine cultures in the NH group and 3554 in the community group. Escherichia coli was isolated in 145 urines in the NH group (64%) and 2275 (64%) in the community group. There were no clinically significant differences in resistance. Combined, there were 3016 positive urine cultures from females and 770 from males. Escherichia coli was significantly more common in females 2120 (70%) than in males 303 (39%) (p?
Cites: Intern Med J. 2012 Jul;42(7):e157-6421241444
Optimising the diagnostic work-up and treatment of genital chlamydia infection requires knowledge of the sampling patterns of those who order chlamydia tests. We wished to determine which groups of doctors collect specimens for chlamydia testing, and to examine the sex and age distribution of patients tested, and the proportion of positive tests, from general practitioners, gynaecologists in private practice, and youth health services.
The study includes 43 465 specimens analysed for genital infection with Chlamydia trachomatis at Vestfold Hospital Trust over the period 1 January 2007 to 31 December 2011. Data from the laboratory information system were used to classify the test requisitioners.
General practitioners requisitioned 60 % of all chlamydia tests and 63 % of all positive tests. Youth health services requisitioned 13 % of all tests and 22 % of positive tests; gynaecologists in private practice, 12 % of all tests and 5 % of positive tests. Overall, 26 % of specimens were from women over the age of 30 with 2.2 % testing positive, and 82 % of these specimens were submitted by general practitioners or gynaecologists in private practice. Twenty-three per cent of specimens were from men, and 78 % of these were collected in general practice.
Knowledge of who requisitions chlamydia testing and of whom is important for planning and improving chlamydia diagnosis, treatment and contact tracing. In this study from Norway, we found that doctors in general practice play a key role in diagnosing and treating chlamydia. The testing of women over the age of 30 by general practitioners and gynaecologists in private practice probably leads to unnecessary use of resources and should be reduced.
Beta-lactam resistance in Haemophilus influenzae due to ftsI mutations causing altered penicillin-binding protein 3 (PBP3) is increasing worldwide. Low-level resistant isolates with the N526K substitution (group II low-rPBP3) predominate in most geographical regions, while high-level resistant isolates with the additional S385T substitution (group III high-rPBP3) are common in Japan and South Korea.Knowledge about the molecular epidemiology of rPBP3 strains is limited. We combined multilocus sequence typing (MLST) and ftsI/PBP3 typing to study the emergence and spread of rPBP3 in nontypeable H. influenzae (NTHi) in Norway.
The prevalence of rPBP3 in a population of 795 eye, ear and respiratory isolates (99% NTHi) from 2007 was 15%. The prevalence of clinical PBP3-mediated resistance to ampicillin was 9%, compared to 2.5% three years earlier. Group II low-rPBP3 predominated (96%), with significant proportions of isolates non-susceptible to cefotaxime (6%) and meropenem (20%). Group III high-rPBP3 was identified for the first time in Northern Europe.Four MLST sequence types (ST) with characteristic, highly diverging ftsI alleles accounted for 61% of the rPBP3 isolates. The most prevalent substitution pattern (PBP3 type A) was present in 41% of rPBP3 isolates, mainly carried by ST367 and ST14. Several unrelated STs possessed identical copies of the ftsI allele encoding PBP3 type A.Infection sites, age groups, hospitalization rates and rPBP3 frequencies differed between STs and phylogenetic groups.
This study is the first to link ftsI alleles to STs in H. influenzae. The results indicate that horizontal gene transfer contributes to the emergence of rPBP3 by phylogeny restricted transformation.Clonally related virulent rPBP3 strains are widely disseminated and high-level resistant isolates emerge in new geographical regions, threatening current empiric antibiotic treatment. The need of continuous monitoring of beta-lactam susceptibility and a global system for molecular surveillance of rPBP3 strains is underlined. Combining MLST and ftsI/PBP3 typing is a powerful tool for this purpose.
The 2011 Mycoplasma pneumoniae epidemic in Norway resulted in many GP consultations and significantly increased the prescription of macrolide antibiotics.
To investigate the signs, symptoms, course, and prescription patterns of antibiotics in patients positive for M. pneumoniae compared with patients negative for M. pneumoniae.
A retrospective case-control study using questionnaires collected from GPs in a county in Norway. A total of 212 M. pneumoniae positive and 202 control patients were included.
Descriptive statistics and logistic regression analyses were performed on the reported findings.
Forty-eight per cent of patients positive for M. pneumoniae received an antibiotic at first consultation. Another 45% in the same group received antibiotics after the polymerase chain reaction (PCR) result was known, although these patients were not clinically different from all other patients not receiving an antibiotic at first consultation. Logistic regression analysis to evaluate independent predictors for prescription of antibiotics at first consultation showed that the following factors were significantly associated: elevated C-reactive protein (CRP) level, temperature >38.0°C, pathological findings on pulmonary auscultation, and impaired general condition. Elevated CRP level, younger age, temperature >38.0°C, short duration of symptoms, and absence of rhinitis were found to be positive predictors for M. pneumoniae infection.
A positive PCR test for M. pneumoniae tends to trigger an antibiotic prescription, irrespective of the severity of the patient's condition at first consultation. New guidelines for treatment and possibly PCR testing should be established.
Mycoplasma genitalium and Ureaplasma urealyticum cause sexually transmitted infections. While M. genitalium is an established aetiological agent, U. urealyticum is still controversial as a pathogen. Testing for these microbes is not yet widely available in Norway, and knowledge of their prevalence is limited. In this study we have investigated the prevalence of M. genitalium and U. urealyticum in a heterogeneous population from Vestfold and Telemark.
Urine samples (n = 4,665) received by the laboratory for testing for Chlamydia trachomatis in the period from February 2011 to January 2012 were subsequently tested for M. genitalium and U. urealyticum. Samples were analysed using an in-house PCR protocol.
The prevalence of C. trachomatis, M. genitalium and U. urealyticum was 11.9%, 3.6% and 17.9% respectively. M. genitalium was found most frequently in women aged 20-24 years (5.1%), while the proportion of samples positive for U. urealyticum was greatest in persons aged 15-24 years (22.8%).
M. genitalium was highly prevalent in urine samples submitted for C. trachomatis testing. M. genitalium testing was requested for only a minority of the samples analysed, suggesting limited knowledge of this microbe. U. urealyticum was the most predominant microbe in the study, which may indicate that it is largely non-pathogenic.
Comment In: Tidsskr Nor Laegeforen. 2016 Jan 26;136(2):10426813809