During a 6-month period, 892 positive blood cultures were detected in the Copenhagen County hospitals. 302 (34%) were regarded as contaminations, and of the remaining cases 419 (71%) were community-acquired and 171 (29%) hospital-acquired, giving incidence rates of 6.8/1,000 admissions and 2.8/1,000 admissions, respectively. Both frequency and rate of hospital-acquired bacteremia were lower compared to most other studies. E. coli was more commonly found in community-acquired infections, while coagulase-negative staphylococci were the organisms most often considered as a contaminant. The main causative organisms in hospital-acquired infections were S. aureus (n = 37) and E. coli (n = 34). The proportion of polymicrobial bacteremias in this study was lower compared to most other studies (8%). E. coli from hospital-acquired infections were resistant to ampicillin in 42% of cases, but other Enterobacteriaceae showed higher percentage of resistance to beta-lactam antibiotics. S. aureus was penicillin-resistant in 92% of cases, but no methicillin-resistant strains were isolated. The frequency of antibiotic resistance was low compared to reports from other countries. A total of 136 hospital-acquired cases were followed prospectively. 61% of the patients were male and 46% were > or = 60 years of age. Most patients had predisposing diseases, 90% had foreign body and/or recent surgery performed, and 74 (54%) had an intraveneous catheter. The portal of entry was known in 132 (97%) of the cases, the most common being the urinary tract (42%), followed by an intravenous catheter (30%). The prevalence of urinary tract catheters gave an increased number of cases with E. coli bacteremia. The mortality was 16%.
This report describes a 12-month fever surveillance survey in a 258-bed veterans long-term care institution. There were 128 episodes of fever (one episode per 24 patient-months); 114 were studied. Lower respiratory tract infections were most frequent, 36 (32%), with 26 (23%) urinary tract infections. Streptococcus pneumoniae was the most common pathogen in the chest infections and Proteus mirabilis the most common of the urinary tract infections. In 40 (35%) there was no evidence of a lower respiratory tract, urinary tract, or other bacterial infection. Most recovered rapidly, many with no specific treatment. There was a 16% mortality associated with the febrile episodes.
During 1981-1993, 229 episodes of bacteraemia due to beta-haemolytic streptococci of groups A, B, C and G were diagnosed in the County of Northern Jutland, Denmark. The annual rates for bacteraemia were quite constant during the 13-year period for each streptococcal group. Group A streptococcal (GAS) bacteraemia was the most frequent, comprising 1.4% of all bacteraemias. The incidence of GAS bacteraemia was 1.8/100,000/year in children 60 years old. With the notable exception of group B streptococcal (GBS) bacteraemia in neonates, beta-haemolytic streptococci of groups B, C (GCS) and G (GGS) were isolated mostly from elderly patients. Except for GBS bacteraemia in neonates, approximately one-third of the bacteraemias in each group was nosocomially acquired. Predisposing factors included operative procedures in GAS and GCS bacteraemia, and diabetes mellitus in GBS bacteraemia. The skin was the most common primary focus in GAC, GCC and GGS bacteraemias, whereas the urinary tract was the commonest focus in GBS bacteraemia in adults. The mortality rates in GAS, GCS, GGS, and adult GBS bacteraemia were 23%, 16%, 17% and 19%, respectively. Of the 23 fatal cases of GAS bacteraemia, 57% died within 24 h after blood cultures had been obtained.
we assessed the incidence, risk factors and outcome of BSI over a 14-year period (2000-2013) in a Swedish county.
retrospective cohort study on culture confirmed BSI among patients in the county of Östergötland, Sweden, with approximately 440,000 inhabitants. A BSI was defined as either community-onset BSI (CO-BSI) or hospital-acquired BSI (HA-BSI).
of a total of 11,480 BSIs, 67% were CO-BSI and 33% HA-BSI. The incidence of BSI increased by 64% from 945 to 1,546 per 100,000 hospital admissions per year during the study period. The most prominent increase, 83% was observed within the CO-BSI cohort whilst HA-BSI increased by 32%. Prescriptions of antibiotics in outpatient care decreased with 24% from 422 to 322 prescriptions dispensed/1,000 inhabitants/year, whereas antibiotics prescribed in hospital increased by 67% (from 424 to 709 DDD per 1,000 days of care). The overall 30-day mortality for HA-BSIs was 17.2%, compared to 10.6% for CO-BSIs, with an average yearly increase per 100,000 hospital admissions of 2 and 5% respectively. The proportion of patients with one or more comorbidities, increased from 20.8 to 55.3%. In multivariate analyses, risk factors for mortality within 30 days were: HA-BSI (2.22); two or more comorbidities (1.89); single comorbidity (1.56); CO-BSI (1.21); male (1.05); and high age (1.04).
this survey revealed an alarming increase in the incidence of BSI over the 14-year study period. Interventions to decrease BSI in general should be considered together with robust antibiotic stewardship programmes to avoid both over- and underuse of antibiotics.
Cites: Infect Control Hosp Epidemiol. 2009 Nov;30(11):1036-4419780675
Cites: Am J Infect Control. 2016 Feb;44(2):167-7226577629
Between November 1 and 22, 1985, an outbreak of acute, nonbacterial gastroenteritis occurred in a 600-bed hospital in Toronto, Ontario, Canada. Illness in 635 of 2,379 (27%) staff was characterized by fatigue, nausea, diarrhea, and vomiting and had a median duration of 24-48 hours. The finding of virus-like particles measuring 25-30 nm in six stool specimens and low rates of seroresponse to Norwalk virus (3/39) and Snow Mountain agent (1/6) suggest that a Norwalk-like virus was responsible for the outbreak. The outbreak was of abrupt onset and high incidence, affecting 79 people in a single day. No common food or water exposure could be identified. The attack rate was greatest (69%) for staff who had worked in the Emergency Room. Of 100 patients and their companions who visited the Emergency Room on November 11-12 for unrelated problems, 33 (33%) developed gastroenteritis 24-48 hours after their visit, versus 0 of 18 who visited the Emergency Room on November 8 (p less than 0.001). An analysis of housekeepers who worked at least once during the period from November 9-13, which included those who became ill during the period of November 9-14, showed that the risk of becoming ill was four times greater for those who visited or walked through the Emergency Room than for those who did not (p = 0.028). These data are consistent with the possibility of the airborne spread of a virus.
Nosocomial transmission of Lassa virus (LASV) is reported to be low when care for the index patient includes proper barrier nursing methods. We investigated whether asymptomatic LASV infection occurred in healthcare workers who used standard barrier nursing methods during the first 15 days of caring for a patient with Lassa fever in Sweden. Of 76 persons who were defined as having been potentially exposed to LASV, 53 provided blood samples for detection of LASV IgG. These persons also responded to a detailed questionnaire to evaluate exposure to different body fluids from the index patient. LASV-specific IgG was not detected in any of the 53 persons. Five of 53 persons had not been using proper barrier nursing methods. Our results strengthen the argument for a low risk of secondary transmission of LASV in humans when standard barrier nursing methods are used and the patient has only mild symptoms.