| 1. |
- Falkenstein-Hagander, Kathy, et al.
(författare)
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Viral aetiology and clinical outcomes in hospitalised infants presenting with respiratory distress.
- 2014
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Ingår i: Acta Pædiatrica. - : Wiley. - 1651-2227 .- 0803-5253. ; 103:6, s. 625-629
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Tidskriftsartikel (refereegranskat)abstract
- To determine the prevalence of various types of viruses in infants hospitalised due to respiratory distress, compare molecular diagnostic tests and evaluate symptom severity METHODS: All 136 nasopharyngeal aspirates from infants hospitalised for respiratory distress over a nine-month period were analysed for virus type by in-house respiratory syncytial virus (RSV) polymerase chain reaction (PCR) microarray-based and/or Luminex-based multiplex molecular tests. Medical records were reviewed retrospectively for clinical data.
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| 2. |
- Hellberg, Maria, et al.
(författare)
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Eradication of nasopharyngeal carriage of penicillin-non-susceptible Streptococcus pneumoniae-is it possible?
- 2012
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 1651-1980 .- 0036-5548. ; 44:12, s. 909-914
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Tidskriftsartikel (refereegranskat)abstract
- Background: The South Swedish Pneumococcal Intervention Project (SSPIP) was started in 1995 with the aim of limiting the spread of penicillin-non-susceptible pneumococci (PNSP) in Skåne County, Sweden. As part of the SSPIP, eradication therapy with rifampicin in combination with 1 more antibiotic was considered on a social indication after prolonged carriage of 2-3 months. Methods: In this retrospective study, 125 medical records were analyzed. Children aged 0-10 y referred for eradication therapy in Malmö and Lund, due to a prolonged nasopharyngeal carriage of PNSP with a penicillin G minimum inhibitory concentration of ≥ 0.5 mg/l, between the y 1997 and 2011 were included. Two consecutive negative cultures, with the second one no shorter than 7 days after treatment completion, were required for the carriage to be considered eradicated. Results: Out of 125 children, 71 received treatment with rifampicin in combination with amoxicillin (n = 44), erythromycin (n = 22), or clindamycin (n = 5) for 7 days. Eradication treatment was successful in 91.5% of the children. Six children (8.5%) had treatment failure with amoxicillin and rifampicin; 3 were found by late follow-up. There was a trend towards a better outcome with erythromycin and clindamycin combinations in comparison to amoxicillin. Conclusions: Eradication therapy was successful, but a proper follow-up is essential.
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| 5. |
- Nilsson Wimar, Percy, et al.
(författare)
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Carriage of penicillin-resistant Streptococcus pneumoniae by children in day-care centers during an intervention program in Malmo, Sweden
- 2001
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Ingår i: Pediatric Infectious Disease Journal. - 1532-0987. ; 20:12, s. 1144-1149
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: An increasing incidence of penicillin-resistant Streptococcus pneumoniae (PRP) was detected in Malmo in 1994. OBJECTIVE: To evaluate clonality and factors facilitating the spread of PRP among children in day-care centers (DCCs). METHODS: We used phenotypic and DNA-fingerprinting methods in conjunction with epidemiologic data from the South Swedish Pneumococcal Intervention Project's investigation of 63 DCCs during a 3-year period (1995 to 1997) in the Malmo region. RESULTS: A questionnaire about building and hygiene standards disclosed no statistically significant risk factor for carriage of pneumococci. However, age younger than the mean age at the DCC or in the child group was positively associated with carriage. Contrary to expectations no association with the number of children, either at the DCC or in the individual groups, was found. Of 2912 investigated children 1224 (42%) were carriers of S. pneumoniae, and 373 (12.8%) were PRP carriers (MIC > or = 0.1 microg/ml). Among isolates with MIC > or = 0.5 microg/ml 9 serogroups and 30 genetic types were found. Two clones in serogroups 9 (33%) and 19 (24%) were dominant in most municipality districts, and dominance was sustained during the whole study period. The previously internationally recognized serotype 9V clone seemed to be very stable, with a single DNA type and resistance pattern during the study period. In contrast the serogroup 19 isolates and other serogroups had diverse DNA types and resistance patterns, supporting the hypothesis that DCCs have a unique microenvironment facilitating the recombination of penicillin-binding protein genes among streptococci. In five DCCs we found PRP isolates with two different serogroups but an identical genetic type, indicating that serotype shift may be a common phenomenon in DCCs. CONCLUSION: Multivariate logistic regression of risk factors disclosed that young age of the children in the child groups was a significant risk factor for carriage of S. pneumoniae.
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| 6. |
- Nilsson Wimar, Percy, et al.
(författare)
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Children exposed to environmental smoking have a higher antibiotic consumption.
- 2007
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Ingår i: Vaccine. - : Elsevier BV. - 1873-2518 .- 0264-410X. ; 25:13, s. 2533-2535
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Tidskriftsartikel (refereegranskat)abstract
- In order to investigate what factors influence antibiotic prescribing, a questionnaire answered by 8700 parents to 4-year-old children in Malmö between 1999 and 2004 was analyzed. 51.3% of the 4-year-old children had been treated with antibiotics. Exposure to environmental smoking, attending day care centers, employment of parents and parents born in Sweden was found to be statistically significant risk factor for antibiotic prescribing. The association between environmental smoking and antibiotic treatment found in this study could be used in information campaigns which might not only lead to a decreased antibiotic prescribing among the children, but also future positive health effects for their parents.
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| 7. |
- Nilsson Wimar, Percy, et al.
(författare)
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Impact of socioeconomic factors and antibiotic prescribing on penicillin- non-susceptible Streptococcus pneumoniae in the city of Malmö.
- 2005
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Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 1651-1980 .- 0036-5548. ; 37:6, s. 436-441
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Tidskriftsartikel (refereegranskat)abstract
- Carriage or infection with penicillin-non-susceptible Streptococcus pneumoniae (PNSP) has been associated with antibiotic prescribing, socioeconomic factors, and attendance at day-care centres (DCCs). In the present study, linear regression was used to estimate the relation between these risk factors and the incidence of PNSP cases (non-susceptible defined as MIC >= 0.5 mu g/ml for penicillin) in 19 residential areas in Malmo. The number of PNSP cases was associated with the number of preschool children in the area (r=0.950, p<0.0001). The incidence of PNSP cases per 1000 children was positively correlated with antibiotic prescribing (r=0.614, p<0.01) but not with DCC attendance or any of the socioeconomic factors studied. Antibiotic prescribing was, however, positively correlated with per capita income (r=0.597, p<0.05). Thus, even if higher socioeconomic status alone had no apparent influence on the incidence of PNSP in Malmo, there was still an indirect relation between these 2 factors, since inhabitants in these areas consumed more antibiotics. Based on these results, the spread of antibiotic-resistant pneumococci seems to be most reliably restricted by pursuing a restrictive policy regarding antibiotic prescription.
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| 8. |
- Nilsson Wimar, Percy
(författare)
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Penicillin-Nonsusceptible Streptococcus pneumoniae in Malmö, Sweden. Aspects of Epidemiology, Microbiology and Genetics.
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- S. pneumoniae is a major cause of common diseases such as acute otitis media and pneumonia, as well as more serious illnesses like septicemia and meningitis. The increasing level of resistance in pneumococci threatens to change the tradition of treating common respiratory infections with narrow-spectrum penicillin. In the city of Malmö the proportion of penicillin nonsusceptible S. Pneumoniae (PNSP) increased to about 10% at the beginning of the 1990s. In Paper 1 we showed that the emergence of PNSP in Malmö in 1994?1995 was caused by several different clones. Many studies have suggested that day care centers constitute an ecological reservoir of PNSP clones. Among children attending DCCs in the Malmö region, 42% were carriers of S. pneumoniae, and 13% of those children carried PNSP (Paper 2). We found no evidence that the minor variations observed in building or hygiene standards at the DCCs had a significant impact on pneumococcal carriage, but younger age of the children was significantly associated with carriage of pneumococci. The incidence of PNSP cases per 1,000 children was positively correlated with the prescribing of antibiotics in Malmö (Paper 3). Prescribing of antibiotics was positively correlated with the level of income in different residential areas in Malmö. We also observed relatedness of pbp genes in both susceptible and nonsusceptible pneumococci, and horizontal transfer of pbp genes may be one explanation for the spread of resistance to penicillin in pneumococci in Malmö (Paper 5). In conclusion, the proportion of PNSP in Malmö has remained stable since the rapid increase in these bacteria seen in the mid 1990s, despite a steady decrease in the prescribing of antibiotics and an ongoing intervention program (Paper 4).
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| 9. |
- Nilsson Wimar, Percy, et al.
(författare)
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Several different clones present during the penetration phase of resistant Streptococcus pneumoniae in the city of Malmo, Sweden
- 1999
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Ingår i: Microbial Drug Resistance. - 1076-6294. ; 5:1, s. 37-43
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Tidskriftsartikel (refereegranskat)abstract
- A rapid increase in the prevalence of Streptococcus pneumoniae with reduced sensitivity to penicillin (MIC > or = 0.12 microgram/mL) was noted among clinical isolates during a 15-month period in 1994-1995 in the city of Malmo, Sweden. All first-time clinical isolates (n = 178) were consecutively collected and investigated for genetic relatedness with BOX-A PCR and arbitrarily primed (AP) PCR. An improved method for chromosomal DNA extraction and the use of three reliable discriminatory primers for AP-PCR of S. pneumoniae are described. Using molecular fingerprinting, 30 different genotypes were discerned among the 178 isolates. The majority (87%) of isolates belonged to serogroups 6, 9, 15, 19, and 23. Resistance patterns and serogrouping indicated the presence of at least three major phenotypic clones. DNA fingerprinting in conjunction with minimum inhibitory concentration (MIC) values, resistance patterns, and epidemiological data confirmed the existence of two clones belonging to serogroups 6 and 9. Of the 178 isolates, 82% were from children of preschool age, most of whom attended day-care centers. We conclude that abundant S. pneumoniae strains with MICs > or = 0.12 microgram/mL for penicillin were present in the city of Malmo during the study period. At least two genetically discrete clones causing clinical illness were identified, and attendance at day-care centers may be a major factor in the spread of these strains.
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