| 1. |
- Larsson, Marie C., et al.
(author)
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Rapid identification of pneumococci, enterococci, beta-haemolytic streptococci and S. aureus from positive blood cultures enabling early reports
- 2014
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In: BMC Infectious Diseases. - : BioMed Central. - 1471-2334. ; 14:146
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Journal article (peer-reviewed)abstract
- BACKGROUND:The aim of this study was to evaluate diagnostic tests in order to introduce a diagnostic strategy to identify the most common gram-positive bacteria (pneumococci, enterococci, β-haemolytic streptococci and S. aureus) found in blood cultures within 6 hours after signalling growth.METHODS:The tube coagulase test was optimized and several latex agglutination tests were compared and evaluated before a validation period of 11 months was performed on consecutive positive blood culture patient samples from Kalmar County Hospital, Sweden.RESULTS:During the validation period 150 (91%) of a total of 166 gram-positive cocci (119 in clusters, 45 in chains or pairs and 2 undefined morphology) were correctly identified as S. aureus, CoNS, Pneumococci, Enterococci or group A streptococci (GAS), group B streptococci (GBS), group G streptococci (GGS) within 6 hours with a minimal increase in work-load and costs. The remaining samples (9%) were correctly identified during the next day. No samples were incorrectly grouped with this diagnostic strategy and no patient came to risk by early reporting.CONCLUSION:A simple strategy gives reliable and cost-effective reporting of >90% of the most common gram-positive cocci within 6 hours after a blood cultures become positive. The high specificity of the tests used makes preliminary reports reliable. The reports can be used to indicate the focus of infection and not the least, support faster administration of proper antimicrobial treatment for patients with serious bacterial infections.
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| 2. |
- Lindqvist, Maria, et al.
(author)
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Genetic relatedness of multi-resistant methicillin-susceptible Staphylococcus aureus in southeast Sweden
- 2014
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Other publication (other academic/artistic)abstract
- Background: A high exchange of patients occurs between the hospitals in southeast Sweden, resulting in a possible transmission of nosocomial pathogens. The objective of this study was to investigate the incidence and possible genetic relatedness of multi-resistant methicillinsusceptible Staphylococcus aureus (MSSA) in the region in general, and in particular the possible persistence and transmission of the ECT-R clone (t002) showing resistance to erythromycin, clindamycin and tobramycin previously found in Östergötland County.Methods: Three groups of S. aureus isolates with different antibiotic resistance profiles, including the ECT-R profile, were collected from the three County Councils in southeast Sweden and investigated with spa typing, real-time PCR targeting the staphylococcal cassette chromosome (SCC) mec right extremity junction (MREJ), and microarray.Results: All isolates with the ECT-R resistance profile (n = 12) from Östergötland County and two additional isolates with another antibiotic resistance profile were designated spa type t002, MREJ type ii, and were clustered in the same clonal cluster (CC) (i.e. CC5) by the microarray result, indicating the persistence of the ECT-R clone. In addition, 60 % of the isolates belonged to CC15 from newborns, with 94 % sharing spa type t084, indicating interhospital transmission.Conclusions: The persistence of the ECT-R clone and the possible transmission of the t084 strain indicate that there is still an insufficiency in the maintenance of basic hygiene guidelines. The ECT-R clone probably possesses mechanisms of virulence and transmission that make it so successful.
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| 3. |
- Schon, Thomas, et al.
(author)
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A comparative study of three methods to evaluate an intervention to improve empirical antibiotic therapy for acute bacterial infections in hospitalized patients
- 2011
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In: SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES. - : Informa Healthcare. - 0036-5548 .- 1651-1980. ; 43:4, s. 251-257
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Journal article (peer-reviewed)abstract
- Background: In order to limit the use of broad-spectrum antibiotics, standardized empirical therapy against acute bacterial infections has been advocated. Methods: Guidelines for acute bacterial infections recommending increased usage of benzylpenicillin and restricted use of fluoroquinolones and cephalosporins have been implemented in Kalmar County, Sweden. We evaluated this strategy by recording therapy in patients with bacteraemia, antibiotic requisition, and point prevalence surveys prior to this intervention and at 6 and 12 months after. Results: Comparing the methods simultaneously, there was good agreement between them and an overall significant change in antibiotic usage. There was a significant shift from cefuroxime to cefotaxime and a borderline significant increase in the use of benzylpenicillin (p == 0.057). Based on the defined daily dose (DDD), a highly significant decrease in total cefotaxime and cefuroxime usage was observed that was not detected when applying the prescribed daily dose (PDD), which is adapted to local treatment practices. No change was found in mortality in Staphylococcus aureus bacteraemia or the incidence of Clostridium difficile infection. Conclusions: We conclude that the implementation of the new guidelines has resulted in a significant change in antibiotic usage, which could be conveniently monitored by antibiotic requisition if PDD is used in addition to DDD.
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