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14-Year Survey in a Swedish County Reveals a Pronounced Increase in Bloodstream Infections (BSI). Comorbidity - An Independent Risk Factor for Both BSI and Mortality.

https://arctichealth.org/en/permalink/ahliterature283680
Source
PLoS One. 2016;11(11):e0166527
Publication Type
Article
Date
2016
Author
Martin Holmbom
Christian G Giske
Mats Fredrikson
Åse Östholm Balkhed
Carina Claesson
Lennart E Nilsson
Mikael Hoffmann
Håkan Hanberger
Source
PLoS One. 2016;11(11):e0166527
Date
2016
Language
English
Publication Type
Article
Keywords
Aged
Anti-Bacterial Agents - therapeutic use
Bacteremia - drug therapy - epidemiology - microbiology - mortality
Candidiasis - drug therapy - epidemiology - microbiology - mortality
Community-Acquired Infections
Comorbidity
Cross Infection - epidemiology - microbiology
Female
Fungemia - drug therapy - epidemiology - microbiology - mortality
Gram-Negative Bacterial Infections - drug therapy - epidemiology - microbiology - mortality
Gram-Positive Bacterial Infections - drug therapy - epidemiology - microbiology - mortality
Health Surveys
Humans
Male
Middle Aged
Multivariate Analysis
Retrospective Studies
Risk factors
Survival Analysis
Sweden - epidemiology
Abstract
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.
Notes
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PubMed ID
27835663 View in PubMed
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Alarming spread of vancomycin resistant enterococci in Sweden since 2007.

https://arctichealth.org/en/permalink/ahliterature141857
Source
Euro Surveill. 2010;15(29)
Publication Type
Article
Date
2010
Author
T. Soderblom
O. Aspevall
M. Erntell
G. Hedin
D. Heimer
I. Hokeberg
K. Kidd-Ljunggren
A. Melhus
B. Olsson-Liljequist
I. Sjogren
J. Smedjegard
J. Struwe
S. Sylvan
K. Tegmark-Wisell
M. Thore
Author Affiliation
Swedish Institute for Infectious Disease Control, Solna, Sweden.
Source
Euro Surveill. 2010;15(29)
Date
2010
Language
English
Publication Type
Article
Keywords
Drug Resistance, Bacterial
Enterococcus - drug effects
Gram-Positive Bacterial Infections - drug therapy - epidemiology
Humans
Population Surveillance
Sweden - epidemiology
Vancomycin - pharmacology - therapeutic use
Abstract
The total number of persons infected or colonised with vancomycin-resistant enterococci mandatorily reported to the Swedish Institute for Infectious Disease Control increased dramatically during 2007 and 2008. During a period of twenty months from 1 July 2007 to 28 February 2009, a total of 760 cases were reported compared with 194 cases reported during the entire period from 2000 to 2006. This rise was mainly attributed to a wide dissemination of vancomycin resistant enterococci which started in a number of hospitals in Stockholm in the autumn of 2007 and was followed by dissemination in various healthcare facilities (hospitals and homes for the elderly) in a further two Swedish counties in 2008. The majority of the cases (97%) were acquired in Sweden and among these, healthcare-acquired E. faecium vanB dominated (n=634). The majority of these isolates had identical or closely related pulsed-field gel electrophoresis patterns indicating clonal dissemination in the affected counties. The median minimum inhibitory concentration of vancomycin was 32 mg/L (ranging from 4 to >128 mg/L) and of teichoplanin 0.12 mg/L (ranging from 0.06 to 0.25 mg/L). Particular emphasis was placed on countermeasures such as screening, contact tracing, cleaning procedures, education in accurate use of infection control practices as well as increasing awareness of hygiene among patients and visitors. With these measures the dissemination rate decreased substantially, but new infections with the E. faecium vanB strain were still detected.
PubMed ID
20667301 View in PubMed
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[Aminoglycoside-resistant enterococci a new bacterial hazard].

https://arctichealth.org/en/permalink/ahliterature202302
Source
Lakartidningen. 1999 Apr 7;96(14):1694-5
Publication Type
Article
Date
Apr-7-1999
Author
A. Melhus
Author Affiliation
Kliniskt mikrobiologiska laboratoriet, Universitetssjukhuset MAS, Malmö. asa.melhus@mikrobiol.mas.lu.se
Source
Lakartidningen. 1999 Apr 7;96(14):1694-5
Date
Apr-7-1999
Language
Swedish
Publication Type
Article
Keywords
Aminoglycosides
Anti-Bacterial Agents - administration & dosage
Cross Infection - drug therapy - microbiology - prevention & control
Drug Resistance, Microbial
Drug Resistance, Multiple
Enterococcus - drug effects - genetics - pathogenicity
Enterococcus faecalis - drug effects - genetics - pathogenicity
Gram-Positive Bacterial Infections - drug therapy - prevention & control - transmission
Humans
Infection Control
Prevalence
Sweden - epidemiology
Virulence
Abstract
Enterococci are common causative agents in a broad range of human infections. Although formerly considered to be of low virulence, in recent years they have emerged as important pathogens, particularly in the hospital environment. Enterococci are not only intrinsically resistant to several antibiotics, but are also characterised by a potent and unique ability to exchange genetic material. With the increasing prevalence of strains resistant to ampicillin, aminoglycosides and glycopeptides, serious therapeutic difficulties have become more common. Epidemiological aspects, the mechanisms of action, the detection of antibiotic resistance, and the situation of enterococci in Sweden are discussed in the article.
PubMed ID
10222683 View in PubMed
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Antibiotic resistance patterns among blood culture isolates in a Danish county 1981-1995.

https://arctichealth.org/en/permalink/ahliterature203319
Source
J Med Microbiol. 1999 Jan;48(1):67-71
Publication Type
Article
Date
Jan-1999
Author
B. Kristensen
H H Smedegaard
H M Pedersen
M F Andersen
J F Dahlerup
H T Sørensen
B. Korsager
H C Schønheyder
Author Affiliation
Department of Clinical Microbiology, Aalborg Hospital, Denmark.
Source
J Med Microbiol. 1999 Jan;48(1):67-71
Date
Jan-1999
Language
English
Publication Type
Article
Keywords
Aminoglycosides
Ampicillin - therapeutic use
Anti-Bacterial Agents - therapeutic use
Bacteremia - drug therapy - epidemiology - microbiology
Denmark - epidemiology
Drug Resistance, Microbial
Drug Resistance, Multiple
Drug Therapy, Combination - therapeutic use
Escherichia coli - drug effects - isolation & purification
Gram-Negative Bacteria - drug effects - isolation & purification
Gram-Negative Bacterial Infections - drug therapy - microbiology
Gram-Positive Bacteria - drug effects - isolation & purification
Gram-Positive Bacterial Infections - drug therapy - microbiology
Humans
Penicillin G - therapeutic use
Abstract
All episodes of bacteraemia during a 15-year period (1981-1995) in the County of Northern Jutland, Denmark, were analysed with regard to antibiotic resistance. A total of 8840 isolates from 7938 episodes of bacteraemia was identified. Over time, no changes in bacterial aetiology were noted. Three isolates of Staphylococcus aureus were methicillin resistant (0.2%) and six were gentamicin resistant (0.4%). Among coagulase-negative staphylococci a 14% increase in resistance to penicillin was observed (95% confidence intervals, CI: 2-26%). Likewise, the frequency of resistance to methicillin, gentamicin and erythromycin increased, the corresponding figures being 38% (CI: 26-50%), 26% (CI: 14-38%) and 32% (CI: 16-50%), respectively, whereas a 14% decrease in resistance to streptomycin was recorded (CI: 4-24%). A 20% (CI: 2-37%) increase of coagulase-negative staphylococci resistant to three or more antibiotics was observed. The frequency of ampicillin resistance increased by 9% among Escherichia coli (CI: 4-13%) and by 10% (CI: 6-14%) in all Enterobacteriaceae. Among Enterobacteriaceae the level of resistance to third-generation cephalosporins, carbapenems, aminoglycosides and fluoroquinolones remained low (
PubMed ID
9920127 View in PubMed
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Antimicrobial susceptibility in bacterial isolates from Norwegian cats with lower urinary tract disease.

https://arctichealth.org/en/permalink/ahliterature267978
Source
J Feline Med Surg. 2015 Jun;17(6):507-15
Publication Type
Article
Date
Jun-2015
Author
Heidi Sjetne Lund
Gaute Skogtun
Henning Sørum
Anna Vigdís Eggertsdóttir
Source
J Feline Med Surg. 2015 Jun;17(6):507-15
Date
Jun-2015
Language
English
Publication Type
Article
Keywords
Animals
Anti-Bacterial Agents - pharmacology
Anti-Infective Agents - pharmacology
Cat Diseases - drug therapy - microbiology - urine
Cats
Drug Resistance, Microbial
Gram-Positive Bacterial Infections - drug therapy - microbiology - urine - veterinary
Microbial Sensitivity Tests - veterinary
Norway
Urinary Tract Infections - drug therapy - microbiology - urine - veterinary
Urine - microbiology
Abstract
Studies of feline lower urinary tract disease (FLUTD) among Norwegian cats have shown higher prevalences of bacterial cystitis than most previously published reports. The aims of the present study were to identify bacterial isolates obtained from the urine of Norwegian cats with FLUTD and their susceptibility to antimicrobial agents. Eighty-two bacterial isolates from 72 urine cultures obtained from 71 different cats were included. Escherichia coli, Staphylococcus species, Enterococcus species and Streptococcus species were the most frequently detected. The percentages of isolates susceptible to the included antimicrobial agents were as follows: enrofloxacin - 92%; trimethoprim/sulfonamide - 91%; nitrofurantoin - 89%; tetracycline - 78%; ampicillin - 73%; amoxicillin/clavulanic acid - 72%; trimethoprim - 68%; amoxicillin - 58%; cephalexin - 51%; spiramycin - 39%; penicillin - 34%; fucidic acid - 34%; lincomycin - 27%. Although several tendencies towards increasing antimicrobial resistance were detected among the isolates included, the species of bacteria isolated and their patterns of antimicrobial resistance were, in general, in concurrence with the existing literature. Thus, the results do not fully explain the higher prevalence of bacterial cystitis found in Norwegian cats. Moreover, additional explanatory factors beside the inclusion of primary accession cases rather than referred cases were not found.
PubMed ID
25216729 View in PubMed
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Clinical and epidemiological significance of enterococci intrinsically resistant to vancomycin (possessing the vanC genotype)

https://arctichealth.org/en/permalink/ahliterature207176
Source
J Clin Microbiol. 1997 Dec;35(12):3166-70
Publication Type
Article
Date
Dec-1997
Author
B. Toye
J. Shymanski
M. Bobrowska
W. Woods
K. Ramotar
Author Affiliation
Department of Pathology and Laboratory Medicine, Ottawa General Hospital, University of Ottawa, Ontario, Canada. btoye@ogh.on.ca
Source
J Clin Microbiol. 1997 Dec;35(12):3166-70
Date
Dec-1997
Language
English
Publication Type
Article
Keywords
Adult
Aged
Anti-Bacterial Agents - pharmacology
Bacterial Proteins - genetics
Base Sequence
Carrier State - epidemiology - microbiology
Case-Control Studies
Cross Infection - drug therapy - epidemiology - microbiology
DNA Primers - genetics
DNA, Bacterial - genetics - isolation & purification
Drug Resistance, Microbial - genetics
Electrophoresis, Gel, Pulsed-Field
Enterococcus - drug effects - genetics - isolation & purification
Female
Genes, Bacterial
Genotype
Gram-Positive Bacterial Infections - drug therapy - epidemiology - microbiology
Humans
Male
Middle Aged
Molecular Epidemiology
Ontario - epidemiology
Polymerase Chain Reaction
Prospective Studies
Vancomycin - pharmacology
Abstract
Constitutive low-level vancomycin resistance is found intrinsically in certain enterococcal species and is encoded by vanC ligase genes. These intrinsically vancomycin-resistant enterococci (VRE) will be referred to as VANC VRE. A prospective study to determine the clinical and epidemiologic significance of VANC VRE was conducted. VANC VRE were recovered from the stools of 34 of 601 (5.7%) patients, a rate similar to that obtained for the stools of 100 outpatients in the community (5%). VANC VRE were also isolated from the nonstool specimens of 9 of 538 patients (1.7%), including two patients with bacteremia. No VRE of the vanA or vanB genotypes were detected in nonstool specimens. Eighty-two hospital contacts of the first 23 patients found to be colonized or infected with VANC VRE were screened, and 6 contacts were found to be gastrointestinal carriers of VANC VRE. However, typing of isolates from these 6 contacts by pulsed-field gel electrophoresis with SmaI showed the isolates to be unique and different from those recovered from the index patients. In fact, all VANC VRE isolates from different patients in this study were unique. A case-control study with patients who were negative when screened for VANC VRE as controls failed to identify any risk factor associated with colonization or infection with this organism. VANC VRE were infrequently recovered from clinical specimens but were occasionally found as part of the normal stool flora. Since no transmission between patients was documented, additional isolation procedures may not be necessary for patients colonized or infected with VANC VRE.
Notes
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Erratum In: J Clin Microbiol 1998 May;36(5):1469
PubMed ID
9399514 View in PubMed
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Clonality and anatomic distribution on the skin of antibiotic resistant and sensitive Propionibacterium acnes.

https://arctichealth.org/en/permalink/ahliterature267635
Source
Acta Derm Venereol. 2014 Sep;94(5):534-8
Publication Type
Article
Date
Sep-2014
Author
Hans B Lomholt
Mogens Kilian
Source
Acta Derm Venereol. 2014 Sep;94(5):534-8
Date
Sep-2014
Language
English
Publication Type
Article
Keywords
Acne Vulgaris - drug therapy - microbiology
Anti-Bacterial Agents - therapeutic use
Case-Control Studies
Denmark
Drug Resistance, Multiple, Bacterial
Gram-Positive Bacterial Infections - drug therapy - genetics
Humans
Propionibacterium acnes - genetics - isolation & purification
Abstract
Increasing antibiotic resistance in the population of Propionibacterium acnes is a major concern. Our aims were to examine the clonal relationships and anatomical distribution of resistant and sensitive P. acnes. A collection of 350 P. acnes isolates was therefore used to determine the minimum inhibitory concentration of tetracycline, erythro-mycin and clindamycin, multilocus sequence type, and the identity of genetic resistance markers. Two hitherto unknown resistance mutations were detected. Resistant P. acnes mainly belonged to clonal clusters in division I-1a frequently isolated from skin and associated with moderate to severe acne. All high-level tetracycline resistant strains were members of a single clone. Multiple isolates from distinct anatomic areas of surface skin and follicles of 2 acne patients revealed substantial clonal diversity between areas and co-existence of resistant and sensitive clones. Fifty-two percent of Danish acne patients and 43% of controls carried at least one resistant P. acnes strain, resistance to clindamycin being most frequent followed by tetracycline and erythromycin. Resistance to tetracycline was detected exclusively among isolates from acne patients. In conclusion, antibiotic resistance is associated with particular evolutionary clades of P. acnes and a substantial part is due to a single geographically widespread clone (ST3). Individuals carry a strikingly complex population of P. acnes with distinct virulence potential and antibiotic resistance.
PubMed ID
24577497 View in PubMed
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Clustering of polyclonal VanB-type vancomycin-resistant Enterococcus faecium in a low-endemic area was associated with CC17-genogroup strains harbouring transferable vanB2-Tn5382 and pRUM-like repA containing plasmids with axe-txe plasmid addiction systems.

https://arctichealth.org/en/permalink/ahliterature135292
Source
APMIS. 2011 Apr;119(4-5):247-58
Publication Type
Article
Date
Apr-2011
Author
Eva Bjørkeng
Gunlög Rasmussen
Arnfinn Sundsfjord
Lennart Sjöberg
Kristin Hegstad
Bo Söderquist
Author Affiliation
Research Group for Host-Microbe Interactions, Department of Medical Biology, University of Tromsø, Norway.
Source
APMIS. 2011 Apr;119(4-5):247-58
Date
Apr-2011
Language
English
Publication Type
Article
Keywords
Adult
Aged
Aged, 80 and over
Bacterial Proteins - genetics
Bacterial Typing Techniques
Base Sequence
Cluster analysis
Conjugation, Genetic
DNA Transposable Elements
DNA, Bacterial - genetics
Electrophoresis, Gel, Pulsed-Field
Endemic Diseases
Enterococcus faecium - classification - drug effects - genetics - isolation & purification
Female
Genes, Bacterial
Gram-Positive Bacterial Infections - drug therapy - epidemiology - microbiology
Humans
Male
Middle Aged
Plasmids - genetics
Sweden - epidemiology
Vancomycin Resistance - genetics
Virulence - genetics
Abstract
VanB-type vancomycin-resistant Enterococcus faecium isolates (n = 17) from 15 patients at the Örebro University hospital in Sweden during a span of 18 months was characterized. All patients had underlying disorders and received broad-spectrum antimicrobial therapy. Pulsed-field gel electrophoresis (PFGE) grouped 14 isolates in three PFGE types and three isolates in unique PFGE patterns. All isolates had multi-locus sequence types [ST17 (n = 5); ST18 (n = 3); ST125 (n = 7); ST262 (n = 1); ST460 (n = 1)] belonging to the successful hospital-adapted clonal complex 17 (CC17), harboured CC17-associated virulence genes, were vanB2-positive and expressed diverse vancomycin minimum inhibitory concentration (MICs; 8 to > 256 mg/L). Isolate 1 had a unique PFGE type and a chromosomal transferable vanB2-Tn5382 element. Interestingly, the other five PFGE types had Tn5382 located on plasmids containing pRUM-like repA and a plasmid addiction system (axe-txe) shown by co-hybridization analysis of PFGE-separated S1-nuclease digested total DNA. The resistance plasmids were mainly of 120-kb and supported intraspecies vanB transfer. Two strains were isolated from patient 6 and we observed a possible transfer of the vanB2-resistance genes from PFGE type III ST460 to a more successful PFGE type I ST125. This latter PFGE type I ST125 became the predominant type afterwards. Our observations support the notion that vanB-type vancomycin-resistant Enterococcus faecium can persist in a low-endemic area through successful clones and plasmids with stability functions in hospital patients with known risk factors.
PubMed ID
21492224 View in PubMed
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Emergence of resistance of vancomycin-resistant Enterococcus faecium in a thermal injury patient treated with quinupristin-dalfopristin and cultured epithelial autografts for wound closure.

https://arctichealth.org/en/permalink/ahliterature187898
Source
Burns. 2002 Nov;28(7):696-8
Publication Type
Article
Date
Nov-2002
Author
Christina M Rose
Kathleen J Reilly
Linwood R Haith
Mary L Patton
Robert J Guilday
Michael J Cawley
Bruce H Ackerman
Author Affiliation
Health System/Medical College of Virginia Hospitals, Virginia Commonwealth University, Richmond, VA, USA.
Source
Burns. 2002 Nov;28(7):696-8
Date
Nov-2002
Language
English
Publication Type
Article
Keywords
Adult
Burns - therapy
Chloramphenicol - therapeutic use
Cross Infection - drug therapy
Drug Resistance, Multiple, Bacterial
Enterococcus faecium - drug effects
Graft Survival
Gram-Positive Bacterial Infections - drug therapy
Humans
Male
Skin Transplantation
Vancomycin Resistance
Virginiamycin - pharmacology
Abstract
Vancomycin-resistant Enterococcus faecium and faecalis (VRE) remains a major complication among critically ill patients. A 26-year-old patient with 65% total body surface area burns (TBSA) was infected with several E. faecium strains during his admission that were resistant to vancomycin. Because chloramphenicol was the standard treatment at this time, this drug was initiated until, the organism was identified as E. faecium and reported as susceptible to quinupristin-dalfopristin. Given these data, it was then decided to discontinue the chloramphenicol therapy. Quinupristin-dalfopristin therapy resulted in initial reduction of fever and white blood cell counts that continued over the next 5 days. However, on day 7 of quinupristin-dalfopristin therapy, a return of fever and elevation of the white blood cell count was noted and a repeated E. faecium blood culture demonstrated sudden resistance to quinupristin-dalfopristin (Bauer-Kirby zone size
PubMed ID
12417169 View in PubMed
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34 records – page 1 of 4.