Finnish Hospital Infection Program (SIRO), National Public Health Institute, Department of Infectious Disease Epidemiology, and Department of Medicine, Helsinki University Central Hospital, Finland. firstname.lastname@example.org
In Finland, use of antimicrobials in ambulatory care is moderate, but some reports suggest that hospital use is higher than in other European countries. We evaluated the amount and type of antimicrobials administered in Finnish acute care hospitals.
We analysed data collected in the national prevalence survey of nosocomial infections (NIs) during February-March 2005 in all tertiary care, all secondary care and 25% of other acute care hospitals. All inpatients present on the study day in acute care wards for adults were included (n=8234). The names and use-days of antimicrobials in Anatomical Therapeutic Class groups J01-J05 were collected on the study day and retrospectively for the previous 6 days.
On the study day, 39% of patients had received at least one, 14% at least two and 3% at least three antimicrobials; patients with NI represented 21%, 29% and 45% of these groups, respectively. The prevalence of patients receiving any antimicrobial was 53% in intensive care patients and varied in other specialties from 0% in ophthalmology to 63% in dental and oral surgery. Within a 7 day period, the total use of antibacterial agents (J01) was 64 use-days per 100 patient-days. Cephalosporins were the most frequently used antimicrobials, followed by quinolones and metronidazole.
The prevalence and spectrum of antimicrobial use in Finnish acute care hospitals were high. NI patients contributed markedly to the total usage. The NI survey with a 7 day data collection period provided insights into the use-density of antimicrobials.
Of all residents (n = 12,784) for whom a minimum data set 2.0 form was completed in long-term care facilities (n = 253) using a Resident Assessment Instrument in April and September 2011 in Finland, 16% received antimicrobials, most commonly methenamine (42%) and trimethoprim (24%). The prevalence of urinary tract infections was 8%, wound infection 2%, and pneumonia 2%. Minimum data set form provides a feasible tool for collecting data on antibiotic use and infections in long-term care facilities.
To describe the incidence and nature of bloodstream infections (BSI) among children with juvenile idiopathic arthritis (JIA) followed-up prospectively from disease onset.
The Social Insurance Institution's (SII) national register on individuals with reimbursement for medication of chronic diseases was used to identify children with JIA from 2004 through 2011 and their medications. The National Infectious Disease Register (NIDR) collects data of all blood culture positive samples from all microbiology laboratories in Finland. We combined the NIDR and SII registers to identify JIA patients with BSI. Clinical and laboratory data of each JIA-BSI patient were collected from hospital records.
There were 1604 JIA patients and 6630 person-years of follow-up. Five patients had BSI. During the first 5 years after diagnosis the cumulative emergence of BSI was 0.38% [95% confidence interval (CI) 0.16% to 0.92%]. The incidence rates were 7.5/10 000 follow-up years for JIA (95% CI 2.4-17.6) and 2.8/10 000 follow-up years for the age-matched general population (95% CI 2.7-2.9). The standardised incidence ratio was 3.0 (95% CI 1.2 to 7.2). The causative bacteria were Streptococcus pneumoniae, Staphylococcus aureus, Escherichia coli and Fusobacterium necrophorum. Three patients were on anti-rheumatic drugs, including two on TNF inhibitors. All patients responded rapidly to antimicrobial therapy and recovered uneventfully.
Although BSI is rare among children with JIA, the incidence is 3-fold higher than among the general population.
A notable portion of deaths in bloodstream infections (BSI) have previously been shown to occur within 2 days after taking the first positive blood culture specimen. The aim of this study was to analyse patients' characteristics and causative pathogens of BSIs, leading to early deaths in order to explore possibilities for prevention. Patients with BSI in Helsinki and Uusimaa region (population = 1.5 million) in 2007 were identified from the National Infectious Disease Register (n = 2181) and their deaths within 2 days after the first positive blood culture from the Population Information System (n = 76). Of the early fatal BSIs, 42 (55%) were community-acquired (CA-BSI) and 34 (45%) healthcare-associated (HA-BSI). Charlson comorbidity index was moderate-to-high (index = 3) in 71% of HA-BSIs and 60% of CA-BSIs. The most common pathogens in CA-BSIs were Streptococcus pneumoniae (29%) and Escherichia coli (24%) and in HA-BSIs Pseudomonas aeruginosa (24%) and Staphylococcus aureus (18%). The respiratory tract (50%) was the most common focus of infection. Empiric antimicrobial treatment was more often appropriate in CA-BSIs vs HA-BSIs (81% vs 41%, p
Few systematically collected multi-centre surveillance data on nosocomial bloodstream infections (BSI) caused by extended-spectrum ß-lactamase (ESBL) producing Escherichia coli or Klebsiella pneumoniae have been published.
To evaluate trends, patient characteristics and mortality of such infections, nosocomial BSI data reported by the 4-17 hospitals participating in the prospective laboratory-based surveillance during 1999-2013 were analysed.
Data were collected by local infection control nurses, patient-days were obtained from the hospital's administrative database, and dates of deaths from the population registry. Resistance to third-generation cephalosporins was further examined in the national reference laboratory.
A total of 16 028 nosocomial BSIs were identified; 2217 (14%) were caused by E. coli and 661 (4%) by K. pneumoniae; 207 (7%) were non-susceptible to third-generation cephalosporins, with an increasing trend from 0% in 1999 to 17% in 2013. Patient characteristics did not differ significantly between BSIs caused by third-generation susceptible and resistant E. coli and K. pneumonia, but the case fatality tended to be higher. Most (88%) of the isolates reported as non-susceptible to third-generation cephalosporins had ESBL phenotype, CTX-M (79%) being the most common enzyme.
A sharp increase in nosocomial BSIs caused by ESBL producing bacteria was observed. Identification of patients for screening pose a challenge, emphasising the role of infection control guidelines and antibiotic policy in prevention.
A multidisciplinary team visited all long-term care facilities (n = 123) for elderly persons in the Central Finland health care district (population, 265,000) during 2004-2005. Use of alcohol-based hand rubs and ongoing systematic antimicrobials were assessed. Thereafter, regional guidelines for prudent use of antimicrobials were published. One year after the visits, a significant increase in the mean amount of alcohol-based hand rubs used was detected while usage of antimicrobials for the prevention of urinary tract reinfections had decreased.
Urinary tract infection (UTI) is the most common diagnosis made in prescribing antimicrobials in long-term care facilities (LTCF). The diagnostic criteria for UTI vary among institutions and prescribers. Our aim was to reduce the inappropriate use of antimicrobials in LTCFs.
A team comprising infectious disease consultant, infection control nurse, and geriatrician visited all LTCFs for older persons (2,321 patients in 25 primary care hospitals and 39 nursing homes and dementia units) in the Central Finland Healthcare District (population 267,000) during 2004-2005. The site visits consisted of a structured interview concerning patients, ongoing systematic antimicrobials, and diagnostic practices for UTI. Following the visits, regional guidelines for prudent use of antimicrobials in LTCFs were published, and the use of antimicrobials was followed up by an annual questionnaire.
The proportions of patients receiving antimicrobials in 2005, 2006, 2007, and 2008 were 19.9%, 16.9%, 16.2%, and 15.4%, respectively. Most of the antibiotics were used for UTI (range by year, 66.6%-81.1%). From 2005 through 2008, the proportion of patients on antibiotic prophylaxis for UTI decreased from 13% to 6%. The decrease was statistically significant in both types of settings.
The visits and guidelines were associated with a reduction in the usage of antimicrobials. To sustain this, UTI surveillance and close collaboration between infection control experts and LTCFs are crucial.
In December 2015, an asylum seeker originating from Afghanistan was diagnosed with respiratory diphtheria in Finland. He arrived in Finland from Sweden where he had already been clinically suspected and tested for diphtheria. Corynebacterium diphtheriae was confirmed in Sweden and shown to be genotypically and phenotypically toxigenic. The event highlights the importance of early case detection, rapid communication within the country and internationally as well as preparedness plans of diphtheria antitoxin availability.
The 30-day prevalence of urinary tract infection (UTI) among Finnish home care clients (N?=?6,887) estimated by the Resident Assessment Instrument was 4.5%, and 5.9% of the clients received antimicrobial agents, most commonly for UTI prophylaxis. Urinary catheter and female gender were the strongest factors independently associated with antimicrobial use and UTI. The Resident Assessment Instrument provides data that could be used when training home care providers and primary health care workers in the appropriate use of antimicrobial agents and UTI prevention.