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- Edman-Wallér, Jon
(författare)
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Clostridioides difficile infections: Preventive strategies
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Clostridioides difficile infections primarily affect elderly, hospitalised patients treated with antibiotics and are among the most common healthcare-related infections. This thesis aimed to improve the understanding of the best prevention strategies for this disease, particularly in a Swedish setting. In Paper I, we evaluated the effects of an antibiotic stewardship programme. C. difficile infection incidence fell after a substantial reduction of cephalosporin use at the hospital. No significant change in incidence was seen at a comparable hospital where no stewardship programme was implemented. In Paper II, we evaluated two surveillance algorithms intended to detect outbreaks. None of these could accurately discriminate transmission events. We combined different typing methods with epidemiological links to determine the frequency of intrahospital disease transmission. Transmissions occurred infrequently in our setting. In Paper III, we constructed a mathematical, compartmental model of C. difficile transmission dynamics, where the environmental reservoir of C. difficile spores was modelled alongside patient compartments. Antibiotic stewardship had the largest potential for decreasing infections, while improved cleaning and disinfection practices could best decrease colonisations and environmental spores. Improved isolation had modest effects overall. In conclusion, antibiotic stewardship, directed primarily at cephalosporins, is effective to reduce C. difficile infections in a real-life as well as a modelled Swedish setting. For optimal surveillance and outbreak detection, there is a need to further develop and validate methods. Improved general cleaning and disinfection in hospitals can potentially prevent colonisation and infections if a substantially increased rate of spore reduction is achieved. Such measures may be more important than isolation of infected patients.
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| 2. |
- Edman-Wallér, Jon, et al.
(författare)
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Clostridioides difficile outbreak detection: Evaluation by ribotyping and whole-genome sequencing of a surveillance algorithm based on ward-specific cutoffs
- 2023
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Ingår i: Infection control and hospital epidemiology. - 0899-823X. ; 44:12, s. 1948-1952
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Tidskriftsartikel (refereegranskat)abstract
- Objective:We evaluated the performance of an early-warning algorithm, based on ward-specific incidence cutoffs for detecting Clostridioides difficile transmission in hospitals. We also sought to determine the frequency of intrahospital Clostridioides difficile transmission in our setting. Design:Diagnostic performance of the algorithm was tested with confirmed transmission events as the comparison criterion. Transmission events were identified by a combination of high-molecular-weight typing, ward history, ribotyping, and whole-genome sequencing (WGS). Setting:The study was conducted in 2 major and 2 minor secondary-care hospitals with adjacent catchment areas in western Sweden, comprising a total population of & SIM;480,000 and & SIM;1,000 hospital beds. Patients:All patients with a positive PCR test for Clostridioides difficile toxin B during 2020 and 2021. Methods:We conducted culturing and high-molecular-weight typing of all positive clinical samples. Ward history was determined for each patient to find possible epidemiological links between patients with the same type. Transmission events were determined by PCR ribotyping followed by WGS. Results:We identified 4 clusters comprising a total of 10 patients (1.5%) among 673 positive samples that were able to be cultured and then typed by high-molecular-weight typing. The early-warning algorithm performed no better than chance; patient diagnoses were made at wards other than those where the transmission events likely occurred. Conclusions:In surveillance of potential transmission, it is insufficient to consider only the ward where diagnosis is made, especially in settings with high strain diversity. Transmission within wards occurs sporadically in our setting.
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| 3. |
- Edman-Wallér, Jon, et al.
(författare)
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Results of PCR Analysis of Mpox Clinical Samples, Sweden, 2022
- 2023
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Ingår i: Emerging Infectious Diseases. - : CENTERS DISEASE CONTROL & PREVENTION. - 1080-6040 .- 1080-6059. ; 29:6, s. 1220-1222
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Tidskriftsartikel (refereegranskat)abstract
- We compared cycle thresholds from mpox skin lesions with other specimen sites and over time from onset of clinical signs among 104 patients in Sweden. Cycle thresholds differed by anatomic site. We identified 2 ear-ly mpox cases from anorectal swab specimens after skin samples were negative, indicating necessity of sampling multiple sites.
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| 4. |
- Edman-Wallér, Jon, et al.
(författare)
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Systemic symptoms predict presence or development of severe sepsis and septic shock
- 2016
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Ingår i: Infectious Diseases. - : Informa UK Limited. - 2374-4235 .- 2374-4243. ; 48:3, s. 209-214
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Tidskriftsartikel (refereegranskat)abstract
- Severe sepsis is a major cause of mortality and morbidity globally. As the time to adequate treatment is directly linked to outcome, early recognition is of critical importance. Early, accessible markers for severe sepsis are desirable. The systemic inflammatory response in sepsis leads to changes in vital signs and biomarkers and to symptoms unrelated to the focus of infection. This study investigated whether the occurrence of any of six systemic symptoms could predict severe sepsis in a cohort of patients admitted to hospital for suspected bacterial infections. Methods: A retrospective, consecutive study was conducted. All adult patients admitted during 1 month to a 550-bed secondary care hospital in western Sweden and given intravenous antibiotics for suspected community-acquired infection were included (n=289). Symptoms (fever/chills, muscle weakness, localised pain, dyspnea, altered mental status and gastrointestinal symptoms) were registered along with age, sex, vital signs and laboratory values. Patients who fulfilled criteria of severe sepsis within 48 h were compared with patients who did not. Odds ratios for severe sepsis were calculated, adjusted for age, sex and comorbidities. Results: Criteria for severe sepsis were fulfilled by 90/289 patients (31.1%). Altered mental status (OR=4.29, 95% CI=2.03–9.08), dyspnea (OR=2.92, 95% CI=1.69–5.02), gastrointestinal symptoms (OR=2.31, 95% CI=1.14–4.69) and muscle weakness (OR=2.24, 95% CI=1.06–4.75) were more common in patients who had or later developed severe sepsis. Conclusions: Systemic symptoms in combination with other signs of infection should be considered warning signs of severe sepsis.
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| 5. |
- Karp, Johan, et al.
(författare)
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Clostridioides difficile incidence related to in-hospital cephalosporin use: a tale of two highly comparable hospitals.
- 2019
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Ingår i: The Journal of antimicrobial chemotherapy. - : Oxford University Press (OUP). - 1460-2091 .- 0305-7453. ; 74:1, s. 182-189
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Tidskriftsartikel (refereegranskat)abstract
- Antibiotic treatment is a well-known risk factor for healthcare facility-associated Clostridioides (Clostridium) difficile infection (HCF-CDI). Antibiotic stewardship programmes (ASPs) targeting high-risk antibiotics have been shown to decrease HCF-CDI incidence. HCF-CDI incidence is high in Nordic countries despite relatively low antibiotic use in hospital.To determine if HCF-CDI incidence was modified by a hospital ASP that restricted cephalosporin use.The effects of an ASP on HCF-CDI incidence were evaluated in a two-centre setting using a retrospective design. We exploited a strategy of both individual case ascertainment based on chart reviews and aggregated data from the hospitals. Cases were attributed to the antibiotics given prior to disease onset, in proportion to the number of DDDs used. Three periods were studied: 2007 (before the ASP), 2012 and 2015.At the ASP hospital, cephalosporin use decreased by 87% and the number of HCF-CDI/1000 hospital admissions decreased significantly from 2.25 (2007) to 1.16 (2015) (P=0.0014). The corresponding results at the non-ASP hospital showed a non-significant increase from 2.09 to 2.38. A high number of cases could be attributed to cephalosporins at both hospitals. The increased use of other broad-spectrum antibiotics, e.g. piperacillin/tazobactam, at the ASP hospital was not associated with offsetting increases in attributable HCF-CDI cases.Decreased use of cephalosporins is an effective strategy to decrease HCF-CDI incidence over time in a setting with high incidence and low antibiotic use.
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| 6. |
- Karp, Johan, et al.
(författare)
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Risk factors for recurrent healthcare-facility associated Clostridioides difficile infection in a Swedish setting
- 2023
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Ingår i: Anaerobe. - 1075-9964. ; 81
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: The objectives were to determine the risk factors for recurrent healthcare facility-associated Clostridioides difficile infection (HCF-CDI) in a high CDI incidence, low antibiotic use setting and to determine if length of cefotaxime exposure is a risk factor for recurrent HCF-CDI.Methods: The risk factors for recurrent HCF-CDI were evaluated with a retrospective nested case control study based on chart reading. The risk factors were evaluated univariately and multivariately. Length of risk antibiotic exposure was evaluated further in a subanalysis.Results: Risk factors for recurrent HCF-CDI were renal insufficiency (25.4% of cases compared to 15.4% of controls p = 0.006) and metronidazole treatment of initial CDI episode (88.4% compared to 71.7% p = 0.01). Exposure to cefotaxime and risk for recurrent CDI showed a dose-dependent relationship (linear by linear p = 0.028).Conclusions: Renal insufficiency and metronidazole treatment were independent risk factors for recur-rent HCF-CDI in our setting. The relationship between cefotaxime exposure and risk for recurrent HCF-CDI, dose-dependent, could be evaluated further in a setting with high cefotaxime use.& COPY; 2023 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/).
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