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1.	Andreasson, Thomas, et al. (författare) Evaluation of anamnestic criteria for the identification of patients with acute community onset viral gastroenteritis in the emergency department-A prospective observational study. 2014 Ingår i: Scandinavian journal of infectious diseases. - : Informa UK Limited. - 1651-1980 .- 0036-5548. ; 46:8, s. 561-565 Tidskriftsartikel (refereegranskat)abstract Background: To our knowledge no clinical criteria for the identification of community onset viral gastroenteritis in individual patients have been evaluated systematically with modern PCR-based diagnostic assays as gold standard. Objective: The aim of this study was to identify factors independently associated with the detection of virus by PCR in rectal swab samples from patients with acute community onset gastroenteritis. Methods: A prospective observational study was conducted from December 2010 through March 2011 at the emergency department (ED) of a large teaching hospital. All patients who reported vomiting and/or diarrhoea up to 48 h prior to their visit to the ED were asked to participate. A rectal swab sample was obtained from each patient. Symptoms, date of onset, and epidemiological data were recorded. Samples were analysed with a multiple real-time PCR targeting 6 viral agents (astrovirus, adenovirus, rotavirus, sapovirus, and norovirus GI and GII). Results: Two hundred and five patients fulfilled the inclusion criteria, of whom 66 agreed to participate; their median (IQR) age was 65 (38-84) y and 43 (65%) were females. Thirty-one (47%) were positive by PCR for at least 1 of the agents examined (26 norovirus, 2 sapovirus, 2 rotavirus, and 1 adenovirus). Diarrhoea and a short duration of symptoms (≤ 2 days) were independently associated with a positive rectal swab sample, with odds ratios of 7.5 (95% confidence interval (CI) 2.0-28) and 10.4 (95% CI 1.9-56), respectively (p < 0.01 for both). A multivariate model including these 2 variables had a sensitivity of 81% (25/31) and a specificity of 69% (24/35). Conclusions: Diarrhoea and a short duration of symptoms were the only anamnestic criteria independently associated with acute community onset viral gastroenteritis confirmed by PCR.
2.	Helldal, Lisa, et al. (författare) Evaluation of MLVA for epidemiological typing and outbreak detection of ESBL-producing Escherichia coli in Sweden 2017 Ingår i: Bmc Microbiology. - : Springer Science and Business Media LLC. - 1471-2180. ; 17 Tidskriftsartikel (refereegranskat)abstract Background: To identify the spread of nosocomial infections and halt outbreak development caused by Escherichia coli that carry multiple antibiotic resistance factors, such as extended-spectrum beta-lactamases (ESBLs) and carbapenemases, is becoming demanding challenges due to the rapid global increase and constant and increasing influx of these bacteria from the community to the hospital setting. Our aim was to assess a reliable and rapid typing protocol for ESBL-E. coli, with the primary focus to screen for possible clonal relatedness between isolates. All clinical ESBL-E. coli isolates, collected from hospitals (n = 63) and the community (n = 41), within a single geographical region over a 6 months period, were included, as well as clinical isolates from a polyclonal outbreak (ST131, n = 9, and ST1444, n = 3). The sporadic cases represented 36 STs, of which eight STs dominated i.e. ST131 (n = 33 isolates), ST648 (n = 10), ST38 (n = 9), ST12 and 69 (each n = 4), ST 167, 405 and 372 (each n = 3). The efficacy of multiple-locus variable number tandem repeat analysis (MLVA) was evaluated using three, seven or ten loci, in comparison with that of pulsed-field gel electrophoresis (PFGE) and multi locus sequence typing (MLST). Results: MLVA detected 39, 55 and 60 distinct types, respectively, using three (GECM-3), seven (GECM-7) or ten (GECM-10) loci. For GECM-7 and -10, 26 STs included one type and eleven STs each included several types, the corresponding numbers for GECM-3 were 29 and 8. The highest numbers were seen for ST131 (7,7 and 8 types, respectively), ST38 (5,5,8) and ST648 (4,5,5). Good concordance was observed with PFGE and GECM-7 and -10, despite fewer types being identified with MLVA; 78 as compared to 55 and 60 types. The lower discriminatory power of MLVA was primarily seen within the O25b-ST131 lineage (n = 34) and its H30-Rx subclone (n = 21). Epidemiologically unrelated O25b-ST131 isolates were clustered with O25b-ST131 outbreak isolates by MLVA, whereas the ST1444 outbreak isolates were accurately distinguished from unrelated isolates. Conclusion: MLVA, even when using only three loci, represents an easy initial typing tool for epidemiological screening of ESBL-E. coli. For the ST131-O25b linage, complementary methods may be needed to obtain sufficient resolution.
3.	Helldal, Lisa, et al. (författare) Increasing prevalence of ESBL but not AmpC in Escherichia coli and Klebsiella pneumoniae, in Göteborg, 2004-2008 2009 Ingår i: Scandinavian Society for Antimicrobial Chemotherapy - 2009, September 3, Tromsø, Norway. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Introduction: The increasing prevalence of transferable broad-spectrum resistance to beta-lactams, such as Extended Spectrum Beta Lactamases (ESBL) and AmpC, is troublesome, since they confer resistance to cephalosporins and penicillins, and often also are associated with additional resistance. Materials and methods: Resistance for E. coli and Klebsiella pneumoniae isolated from urine (~10.000 isolates/year) and blood (~xxx isolates/year), during 2004-2008 were determined. Cephalosporin resistant isolates were examined for presence of ESBL with a double-disk-assay using clavulanic acid as inhibitory substance. Cefoxitine-resistant strains were analyzed for presence of AmpC with a second double-disk-assay using cloxacillin as inhibitory substance. Positive strains where further tested with PCR assays for ESBL and plasmid AmpC. Results: During 2004-2008 presence of ESBL increased from 0,3–1,5% in urinary and 0,0–1,4 % in blood E. coli. For Klebsiella the corresponding figures were 0,08–0,68% and 0%, respectively. For ESBL-producing E. coli, 60–80% were resistant also to quinolones and trimetoprime. In 2008, the vast a majority of the ESBL-isolates carried CTX-M subtype 1. Approximately 50 % is community-acquired isolates. 0,15-0,23% of the urinary E. coli-strains had phenotypical characteristics indicating AmpC-production. Presence of plasmid-mediated AmpC will be tested. Approximately 50% of these were multidrug resistant. In blood E coli isolates as well as in Klebsiella from urine and blood AmpC was rarely detected (0-2 isolates/year). Discussion and Conclusion: There is a steady increase in ESBL-producing bacteria in our region. However, the frequency of isolates with AmpC is still low. In addition, a majority of these strains are multidrug resistant which is particularly alarming.
4.	Helldal, Lisa, et al. (författare) Shift of CTX-M genotypes has determined the increased prevalence of extended-spectrum beta-lactamase-producing Escherichia coli in south-western Sweden 2013 Ingår i: Clinical Microbiology and Infection. - : Elsevier BV. - 1198-743X .- 1469-0691. ; 19:2 Tidskriftsartikel (refereegranskat)abstract The prevalence of Escherichia coli producing extended-spectrum β-lactamases (ESBLs) markedly increased during 2004-2008 in south-western Sweden, with a greater increase in urinary isolates in hospitals (0.2-2.5%) than in the community (0.2-1.6%). ESBLs of genotype CTX-M predominated, with a significant (p<0.02) shift from the CTX-M-9 to CTX-M-1 phylogroup occurring among urinary ESBL-producing E.coli isolated early (n=41) as compared with late (n=221) in the study period. The increase in ESBL-producing E.coli was polyclonal, and only partly attributable to an increase (0-24%) in the number of O25b-ST131 isolates carrying CTX-M-15. The increase was prominent in men and in elderly patients, and warrants continued surveillance.
5.	Helldal, Lisa, et al. (författare) Shifts in Extended-Spectrum Beta-Lactamase types with increasing prevalence of Escherichia coli producing ESBL 2010 Ingår i: 20th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), Vienna, Austria. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Objectives: Contrary to other multidrug-resistant pathogens, the prevalence of bacteria producing extended-spectrum beta-lactamase (ESBL) is increasing rapidly in Sweden. In Europe, ESBL of CTX-M-, TEM-, OXA- and SHV-types are generally associated with E. coli infections, CTX-M being the most predominant. We have investigated how the prevalence of these types has changed during the last five years in the low endemic setting of western Sweden. Methods: Yearly resistance in urinary (approximately 10,000 isolates/year) and blood (approximately 250 isolates/year) E. coli during 2004-2008 were determined. Cephalosporin-resistant isolates were screened for ESBL, using a double-disk assay with clavulanic acid as the inhibitory agent. All ESBL-E. coli isolated in the region during the periods Sept 2003-April 2005 (n=46) and April 2008-March 2009 (n=256) were typed by multiplex-PCR, detecting CTX-M, TEM, OXA and SHV. CTX-M-positive isolates were sub-typed by real time Q-PCR for CTX-M-1, CTX-M-2 and CTXM-9 groups. Results: During 2004-2008, ESBL-producing E. coli strains increased from 0.3-1.5% in urinary and 0-1.4% in blood isolates. Resistance to quinolones and trimethoprim was observed in 60-80% of strains, as compared to less than 8% in non-ESBL-producing E. coli. The majority of the ESBL-E. coli strains possessed the CTX-M gene-type, increasing from 78% (36/46) in 2003-2005 to 93% (238/256) in 2008-2009. Between these time-periods, a marked shift occurred in the distribution of CTX-M types, in that strains with the CTX-M-9 group decreased from 42% (15/36) of isolates to 21% (51/238, p=0.01) and, simultaneously, strains with the CTX-M-1 group increased from 58% (21/36) to 78% (185/238, p= 0.02). Furthermore, strains of CTX-M-type exhibiting also TEM- and/or OXA increased to comprise 86% of cases, as compared to 75% previously. Similar trends were seen for community and hospital detected isolates and with no differences associated with age in affected patients. Conclusion: A steady increase in multidrug-resistant ESBL-E. coli, possessing the genes for multiple ESBL-types, was observed in western Sweden, contrary to the patterns of other multidrug-resistant bacteria. As ESBL has increased during the five-year study period, we detected a shift in the prevalence of ESBL-types, currently dominated by the CTX-M-1 group. These observations suggest that a novel ESBL-producing E. coli clone may have emerged in the area, which will be further investigated and presented.
6.	Karami, Nahid, 1959, et al. (författare) Sub-Typing of Extended-Spectrum-beta-Lactamase-Producing Isolates from a Nosocomial Outbreak: Application of a 10-Loci Generic Escherichia coli Multi-Locus Variable Number Tandem Repeat Analysis 2013 Ingår i: Plos One. - : Public Library of Science (PLoS). - 1932-6203. ; 8:12 Tidskriftsartikel (refereegranskat)abstract Extended-spectrum beta-lactamase producing Escherichia coli (ESBL-E. coli) were isolated from infants hospitalized in a neonatal, post-surgery ward during a four-month-long nosocomial outbreak and six-month follow-up period. A multi-locus variable number tandem repeat analysis (MLVA), using 10 loci (GECM-10), for 'generic' (i.e., non-STEC) E. coli was applied for sub-species-level (i.e., sub-typing) delineation and characterization of the bacterial isolates. Ten distinct GECM-10 types were detected among 50 isolates, correlating with the types defined by pulsed-field gel electrophoresis (PFGE), which is recognized to be the 'gold-standard' method for clinical epidemiological analyses. Multi-locus sequence typing (MLST), multiplex PCR genotyping of bla(CTX-M), bla(TEM), bla(OXA) and bla(SHV) genes and antibiotic resistance profiling, as well as a PCR assay specific for detecting isolates of the pandemic O25b-ST131 strain, further characterized the outbreak isolates. Two clusters of isolates with distinct GECM-10 types (G06-04 and G07-02), corresponding to two major PFGE types and the MLST-based sequence types (STs) 131 and 1444, respectively, were confirmed to be responsible for the outbreak. The application of GECM-10 sub-typing provided reliable, rapid and cost-effective epidemiological characterizations of the ESBL-producing isolates from a nosocomial outbreak that correlated with and may be used to replace the laborious PFGE protocol for analyzing generic E. coli.
7.	Nowrouzian, Forough, 1957, et al. (författare) Virulence gene typing of methicillin-resistant Staphylococcus aureus as a complement in epidemiological typing 2013 Ingår i: Journal of Microbiological Methods. - : Elsevier BV. - 0167-7012. ; 93:3, s. 173-176 Tidskriftsartikel (refereegranskat)abstract Methicillin-resistant Staphylococcus aureus (MRSA) has widely spread to all parts of the world. For
8.	Åhrén, Christina, et al. (författare) Outbreak with ESBL (CTX-M)-producing Escherichia coli in a pediatric surgical ward 2009 Ingår i: Scandinavian Society for Antimicrobial Chemotherapy 2009, September 3, Tromsø, Norway. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Introduction: Nosocomial outbreaks with ESBL-producing bacteria in Scandinavia are still rare. In a surgical ward carrying mainly for small children with congenital gastrointestinal disorders spread with ESBL-producing bacteria most likely had been ongoing for three months when we detected the outbreak in December 2008. Five children with ESBL-infections had been cared for since September. Four had septicaemia as compared to no E.coli isolated in blood the previous year. Materials and methods: ESBL-detection has been performed according to routine methods. Positive isolates from patients hospitalised in the ward since 2007 were typed with pulse field gel electrophoresis (PFGE) and the PhP-phenplate method. Results: Altogether 125/169 children hospitalised during September-December were screened and 23 were positive for ESBL-producing bacteria (~50 available isolates), of which15 were only positive in stool. They had been hospitalised for a few days to several months. Four children probably constituted the infection pool. Twenty children carried the likely outbreak strain, but ESBL-producing E coli with four additional PFGE-types as well as Klebsiella pneumonie of one type were identified. Each type demonstrated up to three different resistance-patterns against trimetoprim, ciprofloxacin and tobramycin. Six children had multiple types. Discussion and Conclusion: Spread of ESBL-producing bacteria may go undetected for a long time when only clinical isolates are available. By comparing resistance pattern we missed this outbreak by more than a month. PFGE has been an invaluable tool in the investigation. Through cohorting, enforced hygiene routines, including food handling, for personnel, parents and siblings no new child has been infected (uninfected children are screened twice weekly) since the outbreak was detected.
9.	Alsterholm, M., et al. (författare) Variation in Staphylococcus aureus Colonization in Relation to Disease Severity in Adults with Atopic Dermatitis during a Five-month Follow-up 2017 Ingår i: Acta Dermato-Venereologica. - : Medical Journals Sweden AB. - 0001-5555. ; 97:7, s. 802-807 Tidskriftsartikel (refereegranskat)abstract The aim of this study was to monitor Staphylococcus aureus colonization and disease severity in adults with atopic dermatitis (AD) during 5 months. Twenty-one patients attended 3 visits each for severity SCORing of Atopic Dermatitis (SCORAD) assessment, quantitative cultures from the skin and conventional cultures from the anterior nares, tonsils and perineum. S. aureus isolates were typed for strain identity with pulsed-field gel electrophoresis (PFGE). Seventy-one percent of patients were colonized with S. aureus on lesional skin at least once. Density (colony-forming units (CFU)/cm(2)) was higher on lesional skin than on non-lesional skin (p < 0.05). Density on lesional skin and number of colonized body sites were positively correlated with SCORAD (p = 0.0003 and p = 0.007, respectively). Persistent carriers of the same strain on lesional skin had higher mean SCORAD index than intermittent/noncarriers (36.3 and 17.1, respectively, p = 0.002). The results show a temporal correlation between several aspects of S. aureus colonization and disease severity in AD raising the question of the importance of this in pathogenesis and treatment.
10.	Andelid, Kristina, 1953, et al. (författare) Systemic cytokine signaling via IL-17 in smokers with obstructive pulmonary disease: a link to bacterial colonization? 2015 Ingår i: International Journal of Chronic Obstructive Pulmonary Disease. - : Informa UK Limited. - 1178-2005. ; 10, s. 689-702 Tidskriftsartikel (refereegranskat)abstract We examined whether systemic cytokine signaling via interleukin (IL)-17 and growth-related oncogene-alpha (GRO-alpha) is impaired in smokers with obstructive pulmonary disease including chronic bronchitis (OPD-CB). We also examined how this systemic cytokine signaling relates to bacterial colonization in the airways of the smokers with OPD-CB. Currently smoking OPD-CB patients (n=60, corresponding to Global initiative for chronic Obstructive Lung Disease [ GOLD] stage I-IV) underwent recurrent blood and sputum sampling over 60 weeks, during stable conditions and at exacerbations. We characterized cytokine protein concentrations in blood and bacterial growth in sputum. Asymptomatic smokers (n=10) and never-smokers (n=10) were included as control groups. During stable clinical conditions, the protein concentrations of IL-17 and GRO-alpha were markedly lower among OPD-CB patients compared with never-smoker controls, whereas the asymptomatic smoker controls displayed intermediate concentrations. Notably, among OPD-CB patients, colonization by opportunistic pathogens was associated with markedly lower IL-17 and GRO-alpha, compared with colonization by common respiratory pathogens or oropharyngeal flora. During exacerbations in the OPD-CB patients, GRO-alpha and neutrophil concentrations were increased, whereas protein concentrations and messenger RNA for IL-17 were not detectable in a reproducible manner. In smokers with OPD-CB, systemic cytokine signaling via IL-17 and GRO-alpha is impaired and this alteration may be linked to colonization by opportunistic pathogens in the airways. Given the potential pathogenic and therapeutic implications, these findings deserve to be validated in new and larger patient cohorts.
11.	Andelid, Kristina, 1953, et al. (författare) Systemic signs of neutrophil mobilization during clinically stable periods and during exacerbations in smokers with obstructive pulmonary disease 2015 Ingår i: International Journal of Chronic Obstructive Pulmonary Disease. - : Informa UK Limited. - 1178-2005. ; 10, s. 1253-1263 Tidskriftsartikel (refereegranskat)abstract Background: It is still unclear whether signs of neutrophil mobilization in the blood of patients with chronic obstructive pulmonary disease represent true systemic events and how these relate to bacterial colonization in the airways. In this study, we evaluated these issues during clinically stable periods and during exacerbations in smokers with obstructive pulmonary disease and chronic bronchitis (OPD-CB). Methods: Over a period of 60 weeks for each subject, blood samples were repeatedly collected from 60 smokers with OPD-CB during clinically stable periods, as well as during and after exacerbations. Myeloperoxidase (MPO) and neutrophil elastase (NE) protein and mRNA, growth of bacteria in sputum, and clinical parameters were analyzed. Ten asymptomatic smokers and ten never-smokers were included as controls. Results: We found that, during clinically stable periods, neutrophil and NE protein concentrations were increased in smokers with OPD-CB and in the asymptomatic smokers when compared with never-smokers. During exacerbations, neutrophil and MPO protein concentrations were further increased in smokers with OPD-CB, without a detectable increase in the corresponding mRNA during exacerbations. However, MPO and NE protein and mRNA displayed positive correlations. During exacerbations, only increased neutrophil concentrations were associated with growth of bacteria in sputum. Among patients with low transcutaneous oxygen saturation during exacerbations, PaO2 (partial oxygen pressure) correlated with concentrations of MPO and NE protein and neutrophils in a negative manner. Conclusion: There are signs of systemic neutrophil mobilization during clinically stable periods and even more so during exacerbations in chronic obstructive pulmonary disease. In this condition, MPO and NE may share a cellular origin, but its location remains uncertain. Factors other than local bacteria, including hypoxemia, may be important for driving systemic signs of neutrophil mobilization.
12.	Flach, Carl-Fredrik, 1977, et al. (författare) Monitoring of hospital sewage shows both promise and limitations as an early-warning system for carbapenemase-producing Enterobacterales in a low-prevalence setting 2021 Ingår i: Water Research. - : Elsevier BV. - 0043-1354 .- 1879-2448. ; 200 Tidskriftsartikel (refereegranskat)abstract Carbapenemase-producing Enterobacterales (CPE) constitute a significant threat to healthcare systems. Continuous surveillance is important for the management and early warning of these bacteria. Sewage monitoring has been suggested as a possible resource-efficient complement to traditional clinical surveillance. It should not least be suitable for rare forms of resistance since a single sewage sample contains bacteria from a large number of individuals. Here, the value of sewage monitoring in early warning of CPE was assessed at the Sahlgrenska University Hospital in Gothenburg, Sweden, a setting with low prevalence of CPE. Twenty composite hospital sewage samples were collected during a two-year period. Carbapenemase genes in the complex samples were analyzed by quantitative PCR and the CPE loads were assessed through cultures on CPE-selective agar followed by species determination as well as phenotypic and genotypic tests targeting carbapenemases of presumed CPE. The findings were related to CPE detected in hospitalized patients. A subset of CPE isolates from sewage and patients were subjected to whole genome sequencing. For three of the investigated carbapenemase genes, bla(NDM), bla(OXA-48-like) and bla(KPC), there was concordance between gene levels and abundance of corresponding CPE in sewage. For the other two analyzed genes, bla(VIM) and bla(IMP), there was no such concordance, most likely due to the presence of those genes in non-Enterobacterales populating the sewage samples. In line with the detection of OXA-48-like- and NDM-producing CPE in sewage, these were also the most commonly detected CPE in patients. NDM-producing CPE were detected on a single occasion in sewage and isolated strains were shown to match strains detected in a patient. A marked peak in CPE producing OXA-48-like enzymes was observed in sewage during a few months. When levels started to increase there were no known cases of such CPE at the hospital but soon after a few cases were detected in samples from patients. The OXA-48-like-producing CPE from sewage and patients represented different strains, but they carried similar bla(OXA-48-like)-harbouring mobile genetic elements. In conclusion, sewage analyses show both promise and limitations as a complement to traditional clinical resistance surveillance for early warning of rare forms of resistance. Further evaluation and careful interpretation are needed to fully assess the value of such a sewage monitoring system. (C) 2021 The Authors. Published by Elsevier Ltd.
13.	Heltveit-Olsen, Silje Rebekka, et al. (författare) Methenamine hippurate to prevent recurrent urinary tract infections in older women: protocol for a randomised, placebo-controlled trial (ImpresU) 2022 Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 12:11 Tidskriftsartikel (refereegranskat)abstract Introduction Methenamine hippurate is a urinary antiseptic used as preventive treatment for recurrent urinary tract infections (UTIs) in some Scandinavian countries. However, the scientific evidence for the preventive effect and safety for longer-term use is limited. The aim of this study is to assess whether methenamine hippurate can reduce the incidence of UTIs in older women with recurrent UTIs. Methods and analysis The ImpresU consortium is a collaboration between Norway, Sweden, Poland and the Netherlands. The study is a randomised, controlled, triple-blind phase IV clinical trial. Women ≥70 years with recurrent UTIs are screened for eligibility in a general practice setting. We aim to include 400 women in total, with 100 recruited from each collaborating country. The participants are randomised to treatment with methenamine hippurate 1 g or placebo tablets two times per day for a treatment period of 6 months, followed by a drug-free follow-up period of 6 months. The primary outcome is number of antibiotic treatments for UTIs during the treatment period. The secondary outcomes include number of antibiotic treatments for UTIs during the follow-up period and self-reported symptom of severity and duration of UTI episodes. Differences in complications between the treatment groups are measured as safety outcomes. We also aim to investigate whether strain characteristics or phylogenetic subgroups of Escherichia coli present in the urine culture at inclusion have a modifying effect on the outcomes. Ethics and dissemination Ethical approvals are obtained in all participating countries. The results will be communicated in peer-reviewed journals and at scientific conferences. Trial registration number ClinicalTrials.gov Registry (NCT04077580); EudraCT: 2018-002235-15.
14.	Hutinel, Marion, et al. (författare) Population-level surveillance of antibiotic resistance in Escherichia coli through sewage analysis. 2019 Ingår i: Eurosurveillance. - : European Centre for Disease Prevention and Control. - 1025-496X .- 1560-7917. ; 24:37 Tidskriftsartikel (refereegranskat)abstract IntroductionThe occurrence of antibiotic resistance in faecal bacteria in sewage is likely to reflect the current local clinical resistance situation.AimThis observational study investigated the relationship between Escherichia coli resistance rates in sewage and clinical samples representing the same human populations.MethodsE. coli were isolated from eight hospital (n = 721 isolates) and six municipal (n = 531 isolates) sewage samples, over 1 year in Gothenburg, Sweden. An inexpensive broth screening method was validated against disk diffusion and applied to determine resistance against 11 antibiotics in sewage isolates. Resistance data on E. coli isolated from clinical samples from corresponding local hospital and primary care patients were collected during the same year and compared with those of the sewage isolates by linear regression.ResultsE. coli resistance rates derived from hospital sewage and hospital patients strongly correlated (r2 = 0.95 for urine and 0.89 for blood samples), as did resistance rates in E. coli from municipal sewage and primary care urine samples (r2 = 0.82). Resistance rates in hospital sewage isolates were close to those in hospital clinical isolates while resistance rates in municipal sewage isolates were about half of those measured in primary care isolates. Resistance rates in municipal sewage isolates were more stable between sampling occasions than those from hospital sewage.ConclusionOur findings provide support for development of a low-cost, sewage-based surveillance system for antibiotic resistance in E. coli, which could complement current monitoring systems and provide clinically relevant antibiotic resistance data for countries and regions where surveillance is lacking.
15.	Jaén-Luchoro, Daniel, et al. (författare) Comparative Genomic Analysis of ST131 Subclade C2 of ESBL-Producing E. coli Isolates from Patients with Recurrent and Sporadic Urinary Tract Infections 2023 Ingår i: Microorganisms. - 2076-2607. ; 11:7 Tidskriftsartikel (refereegranskat)abstract The global emergence of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-E. coli), mainly causing urinary tract infections (UTI), is a major threat to human health. ESBL-E. coli sequence type (ST) 131 is the dominating clone worldwide, especially its subclade C2. Patients developing recurrent UTI (RUTI) due to ST131 subclade C2 appear to have an increased risk of recurrent infections. We have thus compared the whole genome of ST131 subclade C2 isolates from 14 patients with RUTI to those from 14 patients with sporadic UTI (SUTI). We aimed to elucidate if isolates causing RUTI can be associated with specific genomic features. Paired isolates from patients with RUTI were identical, presenting 2-18 single nucleotide polymorphism (SNP) differences for all six patients investigated. Comparative genomic analyses, including virulence factors, antibiotic resistance, pangenome and SNP analyses did not find any pattern associated with isolates causing RUTI. Despite extensive whole genome analyses, an increased risk of recurrences seen in patients with UTI due to ST131 subclade C2 isolates could not be explained by bacterial genetic differences in the two groups of isolates. Hence, additional factors that could aid in identifying bacterial properties contributing to the increased risk of RUTI due to ESBL-E. coli ST131 subclade C2 remains to be explored.
16.	Jaen-Luchoro, Daniel, et al. (författare) Genomic and Proteomic Characterization of the Extended-Spectrum beta-Lactamase (ESBL)-Producing Escherichia coli Strain CCUG 73778: A Virulent, Nosocomial Outbreak Strain 2020 Ingår i: Microorganisms. - : MDPI AG. - 2076-2607. ; 8:6 Tidskriftsartikel (refereegranskat)abstract Escherichia colistrain CCUG 78773 is a virulent extended-spectrum beta-lactamase (ESBL)-producing ST131-O25b type strain isolated during an outbreak at a regional university hospital. The complete and closed genome sequence, comprising one chromosome (5,076,638 bp) and six plasmids (1718-161,372 bp), is presented. Characterization of the genomic features detected the presence of 59 potential antibiotic resistance factors, including three prevalent beta-lactamases. Several virulence associated elements were determined, mainly related with adherence, invasion, biofilm formation and antiphagocytosis. Twenty-eight putative type II toxin-antitoxin systems were found. The plasmids were characterized, through in silico analyses, confirming the two beta-lactamase-encoding plasmids to be conjugative, while the remaining plasmids were mobilizable. BLAST analysis of the plasmid sequences showed high similarity with plasmids inE. colifrom around the world. Expression of many of the described virulence and AMR factors was confirmed by proteomic analyses, using bottom-up, liquid chromatography-tandem mass spectrometry (LC-MS/MS). The detailed characterization ofE. colistrain CCUG 78773 provides a reference for the relevance of genetic elements, as well as the characterization of antibiotic resistance and the spread of bacteria harboring ESBL genes in the hospital environment.
17.	Johnning, Anna, 1985, et al. (författare) Draft genome sequence of extended-spectrum-β-lactamase-producing Escherichia coli strain CCUG 62462, isolated from a urine sample 2016 Ingår i: Genome Announcements. - 2169-8287. ; 4:6, s. e01382-16 Tidskriftsartikel (refereegranskat)abstract The draft genome sequence has been determined for an extended-spectrum-β-lactamase (ESBL)-producing (blaCTX-M-15) Escherichia coli strain (CCUG 62462), composed of 119 contigs and a total size of 5.27 Mb. This E. coli is serotype O25b and sequence type 131, a pandemic clonal group, causing worldwide antimicrobial-resistant infections.
18.	Karami, Nahid, 1959, et al. (författare) ESBL- producing E. coli of O25b-ST131 clone as a cause of recurrent urinary tract infections in comparison to other ESBL-producing E. coli 2016 Ingår i: 26th ECCMID 2016, 9 - 12 April 2016, Amsterdam, Netherlands. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Background: Microbial resistance to antibiotics is unfolding worldwide and this sets the treatment and control of infections at risk. Great concern has been directed towards the emergence of multi-resistant ESBL-producing E. coli (ESBL-E. coli). Certain virulent clones of ESBL- E. coli, such as O25b-ST131 clone (including the fimH30Rx–ST131 subclone), increasingly cause extra-intestinal infections and are of particular concern. Since they are greatly responsible for the global emerge of ESBL- E. coli, we compared the frequency of this clone to the other ESBL- E. coli types in patients with recurring urinary tract infections (UTI). Material/methods: Isolates from patients with repeated clinical UTIs due to ESBL-E. coli in Western Sweden from June 2008 to October 2010 were investigated. Patients with an initial UTI caused by ESBL-E. coli of O25b-ST131 clone (n=31) were compared with patients with ESBL-E.coli that tested negative for this clone (n=20). Presence of ESBL was confirmed with the double-disk diffusion test and with a multiplex PCR; PCR assays were used to detect the O25b-ST131 clone. In addition, the phylogenetic groups of E. coli strains were analysed and, for the non-O25b-ST131 isolates, PFGE-types were determined to verify possible strain identity. Results: For all patients in this study, the recurrent UTI was caused by the same E coli type as for the initial UTI, regardless of the E. coli strain type. Only one patient from non-O25b-ST131 group was infected by a different E. coli type, compared to the initial UTI isolate. All O25b-ST131 isolates belonged to the phylogenetic group, B2. The non-O25b-ST131 group was more heterogeneous; 36 % belonged to phylogenetic group A, 22 % to F, 16 % to B2, 10 % to D, 9 % to C and 7 % to group B1 and 21 distinct PFGE types were noted. The patients with previous O25b-ST131 infections exhibited a longer period of recurring infections. The maximum range of months was 25 for the O25b-ST131 group and 11 for the non-O25b-ST131, (mean: seven months versus four months, respectively) and almost twice as many episodes of UTI during the study period, compared to those caused by the non-O25b-ST131 isolates. Conclusions: Patients with recurring UTI caused by ESBL- E. coli were repeatedly infected with their initially isolated strain, which is of concern regarding those infected initially with E. coli O25b-ST131 isolates of known virulence potential. These patients also had more recurrences and for longer time-periods than those with UTI caused by other types. Further attention and consideration should be taken in patients infected by ESBL- E. coli of O25b-ST131 clone.
19.	Karami, Nahid, 1959, et al. (författare) Genotypisk detektion av ESBL (Extended-Spectrum Betalactamase)-gener och artbestämning av ESBL-producerande Enterobacteriacea med dnaJ. En pilot-studie från Göteborg 2008 Ingår i: Svenska Läkaresällskapet Medicinska Riksstämman 2008, November 26, Göteborg, Sweden. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Sedan några år tillbaka har antalet resistenta Gram-negativa tarmbakterier som producerar extended spectrum beta-lactamase (ESBL)-enzym ökat kraftigt både i sjukhus miljön och i samhället. ESBL påvisades först hos Escherichia coli och Klebsiella pneumoniae, men har även detekterats hos Salmonella, Proteus, Enterobacter, Serratia och Pseudomonas spp. ESBL-producerande bakterier förekommer allt oftare vid allvarliga infektioner och även dödsfall har rapporteras. Det finns fyra huvudgrupper av ESBL enzymer; TEM, SHV, OXA och CTX-M där det sistnämnda är det mest vanligt förekommande. dnaJ är en mycket konserverad ”housekeeping gene” som deltar i syntesen av ”heat shock protein” och förekommer i alla mikroorganismer. Med partiell sekvensering av dnaJ kan man få en högre upplösning mellan arterna inom Enterobactericea-familjen än med 16S rDNA. Mellan november 2007 och mars 2008 analyserades 50 gramnegativa isolat med ESBL-fenotyp från Bakteriologiska laboratoriet i Göteborg. Proverna kom huvudsakligen från urinvägarna. Alla isolat med nedsatt känslighet för cefotaxim eller ceftazidim i diskdiffusion bekräftades med E-test för cefotaxim eller ceftazidim med och utan klavulansyra. All isolat analyserades med dnaJ för artbestämning och screenades med en multiplex PCR för olika ESBL gener. CTX-M positiva isolat analyserades med PCR för CTX-M subgrupper; CTX-M-1, CTX-M-2 och CTX-M-9. dnaJ-sekvensering kunde artbestämma all isolat till E. coli (n= 48) eller K. pneumonia (n=2). Fyrtiosju isolat (94%) bar CTX-M genen, varav 83 % (39/47) hade genen tillhörande CTX-M-grupp 1 och 17% CTX-M-grupp 9. Inget E. coli isolat tillhörde CTX-M-grupp 2. En av K. pneumonia tillhörde CTX-M-grupp 1 och den andra grupp 2. Mer än två tredjedelar av CTX-M positiva hade antingen TEM eller OXA gener. Femton procent hade CTX-M i kombination med TEM och OXA. Med hjälp av genotypisk analyse kunde vi artbestämma alla isolat och även dela in alla E. coli -isolat i 5 dnaJ types. ESBL isolat med CTX-M typ var den mest vanligt förekommande och en stor del av dessa tillhörde CTX-M grupp 1.
20.	Karami, Nahid, 1959, et al. (författare) Identity of bla ctx-m carrying plasmids in sequential esbl-e. Coli isolates from patients with recurrent urinary tract infections 2021 Ingår i: Microorganisms. - : MDPI AG. - 2076-2607. ; 9:6 Tidskriftsartikel (refereegranskat)abstract Plasmid-mediated multidrug resistance in E. coli is becoming increasingly prevalent. Considering this global threat to human health, it is important to understand how plasmid-mediated resistance spreads. From a cohort of 123 patients with recurrent urinary tract infections (RUTI) due to extended spectrum beta-lactamase (ESBL)-producing Escherichia coli (ESBL E. coli), only five events with a change of ESBL E. coli strain between RUTI episodes were identified. Their blaCTX-M encoding plasmids were compared within each pair of isolates using optical DNA mapping (ODM) and PCR-based replicon typing. Despite similar blaCTX-M genes and replicon types, ODM detected only one case with identical plasmids in the sequential ESBL E. coli strains, indicating that plasmid transfer could have occurred. For comparison, plasmids from seven patients with the same ESBL E. coli strain reoccurring in both episodes were analyzed. These plasmids (encoding blaCTX-M-3, blaCTX-M-14, and blaCTX-M-15 ) were unaltered for up to six months between recurrent infections. Thus, transmission of blaCTX-M plasmids appears to be a rare event during the course of RUTI. Despite the limited number (n = 23) of plasmids investigated, similar blaCTX-M-15 plasmids in unrelated isolates from different patients were detected, suggesting that some successful plasmids could be associated with specific strains, or are more easily transmitted.
21.	Karami, Nahid, 1959, et al. (författare) Investigation of an outbreak of CTX-M-15-producing Escherichia coli of sequence types 131 and 1441 in a neonatal surgical ward: comparison of typing methods 2010 Ingår i: 20th European Congress of Clinical Microbiology and Infectious Diseases (ECCMID), Vienna, Austria. Konferensbidrag (refereegranskat)abstract Objectives: In a surgical ward caring mainly for newborns spread of CTX-M-15-producing E.coli had been ongoing at least since September 2008 when we finally recognized the outbreak in late December. We have compared various typing methods with pulsed-field gel electrophoresis (PFGE) to verify the actual outbreak and subsequently to determine number of affected children. Methods: In addition to clinical sampling 125 children hospitalized between Sept-Dec were screened for extended-spectrum beta-lactamase (ESBL)-producing bacteria in stool during Dec-Feb. From Jan-June 2009 newly admitted children were screened at admission and twice weekly. Fifty-one E coli isolates with ESBL from 27 children were found. These isolates have been typed with PFGE, multiple-locus-variable number tandem repeat analysis (MLVA), a mini multiple-locus-sequence typing (MLST) method (dnaJ, purA and fumC genes) as well as with the Phene Plate (PhP) biochemical fingerprinting system. Results: When the outbreak was revealed five children had developed infections with ESBL-producing E. coli that were of two PFGE-types (A and B) later considered to be the outbreak strains. One or both were spread to 21 children. Six children had multiple types. Altogether 38 isolates (20 children) were of type A (ST 131), 7 isolates (5 children) of type B (ST 1441). In addition E coli of six distinct PFGE-types (C-?) were found in one child each. MLVA gave identical discriminatory results as PFGE for all isolates tested. Mini-MLST could not differentiate ST 131 isolates of to distinct PFGE-types (type A and C) but accurately predicted the ST-types of each PFGE-type when confirmed with standard MLST according to http://mlst.ucc.ie/mlst/dbs/Ecoli. By comparing resistance pattern we thus missed the outbreak by a month. PhP indicated that all initial isolates were singletons and there was hardly any correlation with PFGE. Conclusion: If transmission has been ongoing for a long time several types of ESBL-producing bacteria may be found in an outbreak and all isolates including repeat and screening isolates need to be typed to identify affected patients. Only genetic typing, gave satisfactory results in this outbreak. MLVA gave identical results to PFGE and is thus attractive being faster, cheaper and easier to communicate. Our mini-MLST was somewhat less discriminatory but despite using only three house keeping genes accurately predicted the ST-types.
22.	Karami, Nahid, 1959, et al. (författare) Multi-locus sequence typing of extended-spectrum β-lactamase-producing Escherichia coli based on dnaJ, purA and fumC and correlation with ESBL types 2009 Ingår i: FEMS 2009 - 3rd Congress of European Microbiologists. Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract Background: Four extended-spectrum β-lactamase (ESBL) types: CTXM; TEM; OXA; and SHV; are associated with most ESBL Escherichia coli infections in Europe, CTXM being the most predominant. Prevalence of ESBL-E. coli has increased dramatically in hospital- and community-acquired infections in the past 5 years in Sweden. Objectives: Adapt a multi-locus sequence typing (MLST) analysis for ESBL-E. coli isolates and to correlate MLST data to the prevalence of ESBL types. Methods: Forty-eight isolates from urinary tract samples were collected from November 2007 to March 2008 at Sahlgrenska University Hospital, Göteborg. E. coli were identified by standard methods and screening for ESBL was performed by the double disk assay and ESBL Etest strips. The diversity and prevalence of ESBL-types: CTXM; TEM; OXA; and SHV; were determined by a multiplex PCR assay. CTXM-positive isolates were further typed by PCR, for CTXM sub-types: CTXM-1; CTXM-2; and CTXM-9. MLST of ESBL-E. coli, using house-keeping gene sequences for dnaJ, encoding heat shock protein 40, as well as purA (adenylosuccinate dehydrogenase) and fumC (fumarate hydratase) sequences. Results: Among all isolates analysed, 94% of ESBL-E. coli strains were CTXM-positive. Combinations of ESBL-genes were observed in 90% of strains: CTXM+TEM (36%); and CTXM+OXA (33%). Among CTXM-positive E. coli, 76% were observed to be CTXM-1 sub-type. MLST of strains detected eighteen different MLST sequence types, with 38% of strains belonging to one sequence type. Among strains of the most prevalent MLST sequence type, 46% exhibited CTXM+TEM and 39% exhibited CTXM+OXA combinations. Conclusions: A clear predominance of CTXM-ESBL in combination with TEM or OXA was observed in ESBL-E. coli recovered from Swedish patients. No clear correlation could be determined between MLST sequence types and ESBL types, although two MLST-ESBL types were observed to be distinctly prevalent among ESBL-E. coli analysed.
23.	Karami, Nahid, 1959, et al. (författare) Recurrence of urinary tract infections with extended-spectrum beta-lactamase-producing Escherichia coli caused by homologous strains among which clone ST131-O25b is dominant 2020 Ingår i: Journal of Global Antimicrobial Resistance. - : Elsevier BV. - 2213-7165. ; 22, s. 126-132 Tidskriftsartikel (refereegranskat)abstract Objectives: Bacterial features associated with recurrent urinary tract infections (RUTIs) due to extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-E. coli) are not well understood. In this study, phylogenetic groups and ST131 subclones were investigated to assess strain homology of ESBL-E. coli isolates in patients with RUTIs in inpatient and outpatient settings in western Sweden. Methods: Almost all isolates (319/356) from 123 patients with 2-7 episodes (median 2 episodes) of ESBL-E. coli UTI within 1 year were examined for seven E. coli phylogroups, the ST131-O25b clone and its subclonefimH30-Rx. Antimicrobial resistance and ESBL genes were determined for the index isolates. A subset of isolates was typed using pulsed-field gel electrophoresis (PFGE). Results: The same phylogroup and ST131 subclones were seen for all recurrences in 119/123 patients, and PFGE confirmed strain homology in recurrences for 43/44 patients tested. Phylogroup B2 dominated (56%), followed by D (19%) and F (10%). ST131-O25b andfimH30-Rx isolates were detected in 44% and 30%, respectively. CTX-M group 1 (71%) predominated. Elderly patients were in the majority. There were no associations between patient demographics or time to recurrence and bacterial characteristics. The fimH30-Rx subclone was associated with a higher number of recurrences (P= 0.015) compared with the remaining B2 isolates. Conclusion: In ESBL-E. coli RUTI, most recurrences were caused by the initial infecting strain. The high frequency of the multidrug-resistant fimH30-Rx subclone and its association with multiple recurrences warrants further attention and early detection of this subclone in patients at risk of developing RUTI with ESBL-E. coli. (C) 2020 The Authors. Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.
24.	Lampi, Elina, 1967, et al. (författare) Interventions for prudent antibiotic use in primary healthcare: an econometric analysis 2020 Ingår i: BMC Health Services Research. - : Springer Science and Business Media LLC. - 1472-6963. ; 20:1 Tidskriftsartikel (refereegranskat)abstract Background Rational antibiotic prescribing is crucial to combat antibiotic resistance. Optimal strategies to improve antibiotic use are not known. Strama, the Swedish strategic program against antibiotic resistance, has been successful in reducing antibiotic prescription rates. This study investigates whether two specific interventions directed toward healthcare centers, an informational visit and a self-evaluation meeting, played a role in observed reduction in rates of antibiotic prescriptions in primary healthcare. Methods The study was a retrospective, observational, empirical analysis exploiting the variation in the timing of the interventions and considering past prescriptions through use of estimations from dynamic panel data models. Primary healthcare data from 2011 to 2014 were examined. Data were from public and private primary healthcare centers in western Sweden. The key variables were prescription of antibiotics and indicator variables for the two interventions. Results The first intervention, an educational information intervention, decreased the number of prescriptions among public healthcare centers, but this effect was only temporary. We found no proof that the second intervention, a self-evaluation meeting at the healthcare center, had an impact on the reduction of prescriptions. Conclusions Single educational interventions aimed at influencing rates of antibiotic prescriptions have limited impact. A multifaceted approach is needed in efforts to reduce the use of antibiotics in primary health care.
25.	Letara, N., et al. (författare) Prevalence and patient related factors associated with Extended-Spectrum Beta-Lactamase producing Escherichia coli and Klebsiella pneumoniae carriage and infection among pediatric patients in Tanzania 2021 Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 11:1 Tidskriftsartikel (refereegranskat)abstract Extended-Spectrum Beta-Lactamase (ESBL) producing Enterobacteriaceae (EPE) is increasing worldwide, though less documented in low-income settings. Here we determined the prevalence of EPE infection and carriage, and patient factors associated with EPE-carriage among pediatric patients in three health care levels in Tanzania. Between January and April 2016, 350 febrile children (median age 21 months) seeking care at a university or a regional referral hospital, or a health centre in Moshi municipality, Tanzania, were included. Socio-demographic characteristics were collected using a questionnaire. Rectal swabs and blood cultures were collected from all children (n = 350) and urinary samples from 259 children at admission. ESBL-phenotype and antimicrobial susceptibility were determined for Klebsiella pneumoniae (K. pneumoniae) and Escherichia coli (E. coli) isolates. Only one EPE case (E. coli) in blood and four in urine (one E. coli and three K. pneumoniae) were found, whereas (n = 90, 26%) of the children were colonized in feces (ESBL-E. coli; n = 76, ESBL-K. pneumoniae, n = 14). High resistance rates were seen in fecal ESBL-E. coli (n = 76) against trimethoprim-sulfamethoxazole (n = 69, 91%), gentamicin (n = 51, 67%), ciprofloxacin (n = 39, 51%) and chloramphenicol (n = 27, 35%) whereas most isolates were sensitive to amikacin (n = 71, 93%). Similar rates were seen for fecal ESBL-K. pneumoniae. Resistance to first line antibiotics were also very high in fecal E. coli not producing ESBL. No sociodemographic factor was associated with EPE-carriage. Children colonized with EPE were younger than 12 months (n = 43, 48%) and often treated with antibiotics (n = 40, 44%) in the previous two months. After adjustment for age children admitted to the intensive care unit had higher odds of EPE fecal carriage compared with those in the general wards (OR = 3.9, 95%CI = 1.4-10.4). Despite comparatively high rates of fecal EPE-carriage and previous antibiotic treatment, clinical EPE cases were rare in the febrile children. The very high resistant rates for the EPE and the non-ESBL producing E. coli to commonly used antibiotics are worrying and demand implementation of antibiotic stewardship programs in all levels of health care in Tanzania.
26.	Lindblom, Anna, et al. (författare) Interspecies plasmid transfer appears rare in sequential infections with extended-spectrum beta-lactamase (ESBL)-producing Enterobacteriaceae 2019 Ingår i: Diagnostic Microbiology and Infectious Disease. - : Elsevier BV. - 0732-8893 .- 1879-0070. ; 93:4, s. 380-385 Tidskriftsartikel (refereegranskat)abstract From a cohort of 1836 Swedish patients infected with ESBL-producing Enterobacteriaceae (EPE) during 2004-2014, 513 patients with recurrent EPE infection were identified. Only in 14 of the 513 patients was a change of species (ESBL-E. coli to ESBL-K. pneumoniae or vice versa) found between the index and subsequent infection. Eleven sequential urine isolates from 5 of the 14 patients were available for further analysis of possible transfer of ESBL-carrying plasmids. The plasmid content was studied using optical DNA mapping (ODM), PCR-based replicon typing, and ESBL gene sequencing. ODM allowed us to directly compare whole plasmids between isolates and found similar ESBL-carrying plasmids in 3 out of the 5 patients. The ODM results and the rarity in shift of species between ESBL-E. coli and ESBL-K. pneumoniae imply that in recurrent EPE infections interspecies plasmid transfer is uncommon. (C) 2018 Elsevier Inc. All rights reserved.
27.	Lindblom, Anna, et al. (författare) Subsequent infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae in patients with prior infection or fecal colonization 2018 Ingår i: European Journal of Clinical Microbiology & Infectious Diseases. - : Springer Science and Business Media LLC. - 0934-9723 .- 1435-4373. ; 37:8, s. 1491-1497 Tidskriftsartikel (refereegranskat)abstract In clinical practice, there is a growing need to assess the impact of prior colonization or infection with extended-spectrum beta-lactamase-producing Enterobacteriaceae (EPE) on new EPE infections. We have investigated the frequency of, and duration to, a subsequent EPE infection in patients with prior fecal carriage or infection with EPE. Culture data for 3272 EPE-positive patients in Western Sweden during 2004-2014 were evaluated. The median follow-up time was 3.7 years. The first recorded EPE-positive fecal screen, or clinical (urine, blood) culture, and subsequent EPE-positive clinical samples were analyzed, focusing on the first and last recurrence of EPE infection. ESBL Escherichia coli dominated (95%). Almost all (94%) patients initially positive in fecal screen (n = 1436) and 72 and 71% of those initially positive in urine (n = 1717) and blood (n = 119) had no further EPE clinical isolates. Subsequent EPE bacteremia was only detected in 0.7, 1.6, and 4.2% of the respective patient group. Recurrent EPE-positive urine cultures occurred in 27% (460/1717), most (75%) within 6 months, and rarely (13%) after 1 year. Repeated EPE-positive clinical samples were significantly (p < 0.01) more common in patients > 65 years and in men with ESBL Klebsiella pneumoniae. In our low-endemic setting, subsequent EPE infections in previously colonized patients were rare. On the other hand, in patients previously EPE-positive in urine or blood, subsequent EPE urinary tract infections were common, especially within 6 months and in patients > 65 years old.
28.	Lindblom, Anna, et al. (författare) The impact of the ST131 clone on recurrent ESBL-producing E. coli urinary tract infection: a prospective comparative study 2022 Ingår i: Scientific Reports. - : Springer Science and Business Media LLC. - 2045-2322. ; 12:1 Tidskriftsartikel (refereegranskat)abstract The global emergence of extended-spectrum beta-lactamase-producing Escherichia coli (ESBL-E. coli), mainly causing urinary tract infections (UTI), is of great concern. Almost one third of patients with UTI, develop recurrent UTI (RUTI). We followed 297 patients for one year after their first episode of UTI due to ESBL-E. coli. Our aim was to evaluate the impact of the globally dominant sequence type (ST)131 clone and its clades, on the risk of subsequent recurrences with ESBL-E. coli. Isolates from patients developing RUTI (68/297) were compared with those from patients with sporadic UTI (SUTI, 229/297). No association was found between RUTI and the two most prevalent phylogroups B2 and D, bla(CTX-M) genes, or resistance profile. Half of the patients with RUTI were infected with ST131 isolates. Clade C2 were in dominance (50/119) among ST131 isolates. They were more common in patients with RUTI than SUTI (28% vs 13%) and multivariate analysis showed an increased odds-ratio (OR = 2.21, p = 0.033) for recurrences in patients infected with these isolates as compared to non-ST131 isolates. Detecting specific biomarkers, as ST131 clade C2, in ESBL-E. coli UTI isolates may aid in prediction of RUTI and improve diagnostics and care of patients with a risk of ESBL-E. coli recurrences.
29.	Lindgren, Åsa, 1979, et al. (författare) Development of a rapid MALDI-TOF MS based epidemiological screening method using MRSA as a model organism 2018 Ingår i: European Journal of Clinical Microbiology & Infectious Diseases. - : Springer Science and Business Media LLC. - 0934-9723 .- 1435-4373. ; 37:1, s. 57-68 Tidskriftsartikel (refereegranskat)abstract In this study we present a method using whole cell MALDI-TOF MS and VITEK MS RUO/SARAMIS as a rapid epidemiological screening tool. MRSA was used as a model organism for setting up the screening strategy. A collection of well-characterised MRSA strains representing the 19 most common Pulsed-Field Gel Electrophoresis (PFGE)-types in the region of South-West Sweden for the past 20 years was analysed with MALDI-TOF MS. A total of 111 MRSA strains were used for creating 19 PFGE-specific Superspectra using VITEK MS RUO/SARAMIS. Prior to performing the final analysis, the 19 Superspectra were combined into ten groups displaying similar peak patterns, hereafter named "MALDI-types". Two-hundred fifty-five MRSA strains were analysed to test the constructed Superspectra/MALDI-type database. Matches to the Superspectra above a threshold of 65% (corresponding to the number of matched peaks in the Superspectrum) were considered as positive assignment of a strain to a MALDI-type. The median peak matching value for correct assignment of a strain to a MALDI-type was 78% (range 65.3-100%). In total, 172 strains (67.4%) were assigned to the correct MALDI-type and only 5.5% of the strains were incorrectly assigned to another MALDI-type than the expected based on the PFGE-type of the strain. We envision this methodology as a cost-efficient step to be used as a first screening strategy in the typing scheme of MRSA isolates, to exclude epidemiological relatedness of isolates or to identify the need for further typing.
30.	Lindqvist, Maria, 1983- (författare) Epidemiological and molecular biological studies of multi-resistant methicillin-susceptible Staphylococcus aureus 2014 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract Antibiotic resistance is increasingly recognised as a major problem and threat. During the last decades Gram-positive bacteria in general, and methicillin-resistant Staphylococcus aureus (MRSA) in particular, have been in focus both concerning matters of antibiotic resistance and as pathogens causing health care-associated (nosocomial) infections. In contrast to MRSA, studies on clonal distribution of methicillin-susceptible S. aureus (MSSA) are scarce. However, interest in MSSA has increased since it was shown that MRSA emerges from susceptible backgrounds by acquisition of a staphylococcal cassette chromosome element, carrying the mecA gene encoding methicillin-resistance (SCCmec).In an outbreak investigation of MRSA in Östergötland County, Sweden, in 2005, a high incidence of MSSA isolates with concomitant resistance to erythromycin, clindamycin and tobramycin (ECT-R) was detected. Analysis showed that 91 % of the investigated isolates were genetically related (clonal). The ECT-R clone was divided into four different but closely related patterns with pulsed-field gel electrophoresis (PFGE), and was designated spa type t002. Whole genome sequencing revealed that the ECT-R clone carried a pseudo-SCC element estimated to be 12 kb in size, showing a resemblance of more than 99 % with the SCCmec type II element of MRSA strain N315 (New York/Japan clone). This suggested a probable derivation from a highly successful MRSA strain, which had partially excised its SCCmec. The clonal outbreak was concentrated in eight hospital departments and two primary care centres, all located in the city of Linköping. Despite a high exchange of patients with the hospitals in the neighbouring counties in southeast Sweden (Jönköping- and Kalmar County), the ECT-R clone seemed to be limited to Östergötland County. However, a tobramycin-resistant clone predominated by isolates of spa type t084 was found in all three counties in southeast Sweden, and in particular among newborns, suggesting inter-hospital transmission.The ECT-R clone has survived as an abundant MSSA clone for a decade in Östergötland County, which indicates an insufficiency in the maintenance of basic hygiene guidelines, and that the clone probably possesses mechanisms of virulence and transmission that are yet to be discovered.
31.	Müller, Vilhelm, 1990, et al. (författare) Rapid Tracing of Resistance Plasmids in a Nosocomial Outbreak Using Optical DNA Mapping 2016 Ingår i: Acs Infectious Diseases. - : American Chemical Society (ACS). - 2373-8227. ; 2:5, s. 322-328 Tidskriftsartikel (refereegranskat)abstract Resistance to life-saving antibiotics increases rapidly worldwide, and multiresistant bacteria have become a global threat to human health. Presently, the most serious threat is the increasing spread of Enterobacteriaceae carrying genes coding for extended spectrum beta-lactamases (ESBL) and carbapenemases on highly mobile plasmids. We here demonstrate how optical DNA maps of single plasmids can be used as fingerprints to trace plasmids, for example, during resistance outbreaks. We use the assay to demonstrate a potential transmission route of an ESBL-carrying plasmid between bacterial strains/species and between patients, during a polyclonal outbreak at a neonatal ward at Sahlgrenska University Hospital (Gothenburg, Sweden). Our results demonstrate that optical DNA mapping is an easy and rapid method for detecting the spread of plasmids mediating resistance. With the increasing prevalence of multiresistant bacteria, diagnostic tools that can aid in solving ongoing routes of transmission, in particular in hospital settings, will be of paramount importance.
32.	Mölstad, Sigvard, et al. (författare) Lessons learnt during 20 years of the swedish strategic programme against antibiotic resistance 2017 Ingår i: Bulletin of the World Health Organization. - : WORLD HEALTH ORGANIZATION. - 0042-9686 .- 1564-0604. ; 95:11, s. 764-773 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract Increasing use of antibiotics and rising levels of bacterial resistance to antibiotics are a challenge to global health and development. Successful initiatives for containing the problem need to be communicated and disseminated. In Sweden, a rapid spread of resistant pneumococci in the southern part of the country triggered the formation of the Swedish strategic programme against antibiotic resistance, also known as Strama, in 1995. The creation of the programme was an important starting point for long-term coordinated efforts to tackle antibiotic resistance in the country. This paper describes the main strategies of the programme: committed work at the local and national levels; monitoring of antibiotic use for informed decision-making; a national target for antibiotic prescriptions; surveillance of antibiotic resistance for local, national and global action; tracking resistance trends; infection control to limit spread of resistance; and communication to raise awareness for action and behavioural change. A key element for achieving long-term changes has been the bottom-up approach, including working closely with prescribers at the local level. The work described here and the lessons learnt could inform countries implementing their own national action plans against antibiotic resistance.
33.	Nijsingh, Niels, 1977, et al. (författare) Screening for multi-drug-resistant Gram-negative bacteria: what is effective and justifiable? 2020 Ingår i: Monash Bioethics Review. - : Springer Science and Business Media LLC. - 1321-2753 .- 1836-6716. ; 38:supplement 1 Tidskriftsartikel (refereegranskat)abstract Effectiveness is a key criterion in assessing the justification of antibiotic resistance interventions. Depending on an intervention’s effectiveness, burdens and costs will be more or less justified, which is especially important for large scale population-level interventions with high running costs and pronounced risks to individuals in terms of wellbeing, integrity and autonomy. In this paper, we assess the case of routine hospital screening for multi-drug-resistant Gram-negative bacteria (MDRGN) from this perspective. Utilizing a comparison to screening programs for Methicillin-Resistant Staphylococcus aureus (MRSA) we argue that current screening programmes for MDRGN in low endemic settings should be reconsidered, as its effectiveness is in doubt, while general downsides to screening programs remain. To accomplish justifiable antibiotic stewardship, MDRGN screening should not be viewed as a separate measure, but rather as part of a comprehensive approach. The program should be redesigned to focus on those at risk of developing symptomatic infections with MDRGN rather than merely detecting those colonised.
34.	Roos, Kristian, et al. (författare) Can probiotic lactobacilli eradicate persistent carriage of meticillin-resistant Staphylococcus aureus? 2011 Ingår i: Journal of Hospital Infection. - : Elsevier BV. - 0195-6701 .- 1532-2939. ; 78:1, s. 77-78 Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
35.	Shehata, Adam, 1981, et al. (författare) Same News Frames, Different Issues: Issue Familiarity and Dynamic Framing Effects 2024 Ingår i: Communication Research. - : Sage Publications. - 0093-6502 .- 1552-3810. Tidskriftsartikel (refereegranskat)abstract This study addresses how issue familiarity conditions longitudinal news framing effect dynamics. Comparing how the economic consequences frame impacts interpretation of two global problems—antimicrobial resistance and climate change—we study longitudinal effects across two similar issues varying significantly in salience and politicization, focusing on how various effect dynamics (single, repetitive, and counter-framing exposure) influence citizens’ beliefs over time. A longitudinal experiment conducted with a probability-recruited sample in Sweden (N = 1,956) reveals (1) clear framing effects for both issues, (2) dynamics driven primarily by recency mechanisms, and (3) that individual differences in baseline belief certainty condition news framing effects. In sum, while the same news frame can have very similar effects on different issues, the findings suggest a “dual role” of issue familiarity, potentially conditioning the specific longitudinal effect dynamics, on the one hand, and effect susceptibility, on the other hand.
36.	Skovbjerg, Susann, 1973, et al. (författare) Low rate of pneumococci non-susceptible to penicillin in healthy Swedish toddlers. 2013 Ingår i: Scandinavian Journal of Infectious Diseases. - : Informa UK Limited. - 0036-5548 .- 1651-1980. ; 45:4, s. 279-284 Tidskriftsartikel (refereegranskat)abstract Background: Infection caused by Streptococcus pneumoniae is the leading cause of mortality in children worldwide. The aim of this study was to determine if a noted increase in non-susceptibility to penicillin among pneumococcal clinical isolates from young children reflected a similar increase in healthy children. Methods: During 2004-2005, before the conjugate pneumococcal vaccine was introduced in Sweden, 663 healthy children (13-24 months of age) attending 17 child health centres in Gothenburg, Sweden, were cultured for bacteria in the nasopharynx. Social factors were identified through a parental questionnaire. Pneumococcal serotypes and antibiotic resistance rates were determined. Antibiotic resistance was also monitored in 162 simultaneously obtained nasopharyngeal pneumococci isolated from clinical samples. Results: The healthy children frequently carried pneumococci (45%), Moraxella catarrhalis (54%), and Haemophilus influenzae (22%). The carriage rates for all these pathogens were higher in children attending day care centres compared to children staying at home (p < 0.001). The dominating pneumococcal serotypes were 6B, 19F, 23F, and 6A. Non-susceptibility to penicillin was low (4.0%) and only exceeded by that to trimethoprim-sulfamethoxazole (9.8%). Both rates were higher in the clinical isolates (9.3% and 16.7%, respectively; p < 0.05). No relationships to geographic area, day care attendance, recent antibiotic use, or travel abroad were shown for any specific serotype or for the presence of penicillin-non-susceptible pneumococci in the healthy children. Conclusions: Pneumococcal resistance rates in the healthy child population were low and did not reflect the higher rates noted at the laboratory in clinical samples obtained before and during the study.
37.	Skyman, Eva, et al. (författare) Being Met as marked – patients’ experiences of beinginfected with community-acquired methicillin-resistantStaphylococcus aureus (MRSA) 2015 Ingår i: Scandinavian Journal of Caring Sciences. - : Wiley-Blackwell. - 0283-9318 .- 1471-6712. Tidskriftsartikel (refereegranskat)abstract Background: It is known that patients who acquiredmethicillin-resistant Staphylococcus aureus (MRSA) in hospitalssuffer and feel as plague. Moreover, the patientinteraction with nurses and physicians is described asfrightening. Little is known about patient experiencesafter having acquired CA-MRSA concerning care andeveryday life.Aim: To reveal and interpret otherwise healthy patients’lived experiences of receiving care and their everyday lifeafter having acquired community MRSA (CA-MRSA).Methods: A phenomenological hermeneutic approachguided by Ricouer was conducted. Interviews withtwelve patients were transcribed verbatim into a text.The text was analysed in three phases: naive understanding,structural analysis and comprehensive understandingto reveal a possible being in the world. In thisstudy, this referred to what it means to be infected withCA-MRSA.Results: The findings indicate that patients who acquiredMRSA experience a changed body image. They sufferfrom ignorant and frightened behavior from healthcareworkers, social contacts, and also of being bullied by colleagues.Despite this, patients assume great responsibilityfor protecting others. However, knowledgeable staff alleviatesuffering and bring peace of mind to the patients.Conclusions: Preventing patient’s feelings of being a pest,an outsider living with fear, requires urgent educationand understanding about resistant bacteria and how tomeet an infected patient. The results describing patients,affected with MRSA, may contribute and touch the readersto better understanding of patient’s changed bodyimage and suffering and how to mitigate these feelings.
38.	Skyman, Eva, et al. (författare) Notification card to alert for Methicillin-resistant Saphylococcus Aureus is stigmatizing from the patients' point of view 2014 Ingår i: Scandinavian Journal of Infectious Diseases. Supplementum. - : Informa UK Limited. - 0300-8878 .- 0036-5548 .- 1651-1980. ; 46:6, s. 440-6 Tidskriftsartikel (refereegranskat)abstract Scand J Infect Dis. 2014 Jun;46(6):440-6. doi: 10.3109/00365548.2014.896029. Epub 2014 Mar 26. Notification card to alert for methicillin-resistant Staphylococcus aureus is stigmatizing from the patient's point of view. Skyman E1, Bergbom I, Lindahl B, Larsson L, Lindqvist A, Thunberg Sjöström H, Ahrén C. Author information Abstract BACKGROUND: The importance of alerting health care systems of patients carrying multidrug-resistant bacteria (MRB) is highlighted in numerous guidelines. In the absence of electronic alert systems, notification cards are often recommended, but have rarely been evaluated. We evaluated patient experiences of receiving and using a methicillin-resistant Staphylococcus aureus (MRSA) notification card. METHODS: Two cohorts of patients given a card when identified for the first time as a carrier in 1999-2003 and 2008-2010, responded to questionnaires distributed in 2004 and 2011, respectively. The response rate in 2004 was 92 (38 females)/129 and in 2011 was 110 (55 females)/209. In addition, 63% and 49%, respectively, followed the encouragement to provide written comments to the questions. These were analysed using a qualitative method. RESULTS: The patients took responsibility not to infect others, reported high usage, and acknowledged the importance of the card to inform health care institutions about their carrier status, despite experiencing fear, disrespect, lack of knowledge, and unprofessional behaviour when presenting it to personnel. Alarmingly these stigmatizing experiences were more frequent in 2011. Professional behaviour was reported from the infectious disease clinic. A majority of the patients were unaware of how they had acquired MRSA. CONCLUSIONS: The MRSA notification card was felt to stigmatize the patient, which makes its use questionable. Other alert methods need to be developed. Most importantly, the study demonstrates the importance for these patients to meet staff educated about MRB. Thus, there is an urgent need to educate health care professionals at all levels.
39.	Sundvall, Pär-Daniel, et al. (författare) Rational antibiotic prescribing in primary care: qualitative study of opportunities and obstacles 2020 Ingår i: BJGP Open. - 2398-3795. ; 4:4 Tidskriftsartikel (refereegranskat)abstract Background: The Swedish strategic programme against antibiotic resistance (Strama) has worked towards rational use of antibiotics, and Swedish antibiotic prescribing is low. Aim: To explore how opportunities and obstacles for rational antibiotic prescribing were perceived by primary health care centres (PHCCs). Design & setting: A qualitative study of 50 randomly selected reports from approximately 200 PHCCs in 2013 and 2016 in Region Västra Götaland, Sweden. Method: One assigned GP at each PHCC reported yearly in an open-ended questionnaire on how the PHCC worked to improve antibiotic prescribing. The report included several antibiotic-related tasks and a summary of reflective meetings with the doctors, the head of the PHCC, and, preferably, also the nurses. The reports were qualitatively analysed using Malterud’s systematic text condensation (STC). Results: ‘Everyone wants to do right, but sometimes you do not know what’s right or wrong.’ Knowledge about diagnosis and treatment of infectious diseases was highlighted. Knowledge and skills had to be internalised by the clinician in order to bring about behavioural change. This could be achieved through reflective, collegial dialogues where consensus often was found. Structural factors at the PHCC could provide good conditions for ‘doing right’, but could also constitute obstacles. Teamwork involving all personnel was important to achieve rational antibiotic prescribing. Conclusion: Enablers for rational antibiotic prescribing were knowledge, reflective collegial dialogues, a well organised workplace, and a collaborating team. Obstacles were lack of knowledge, insufficient staffing, perceived lack of time, and overuse of laboratory tests. Patients’ attitudes and expectations could be both.
40.	Swerkersson, Svante, 1954, et al. (författare) Urinary tract infection in infants: the significance of low bacterial count. 2016 Ingår i: Pediatric nephrology (Berlin, Germany). - : Springer Science and Business Media LLC. - 1432-198X .- 0931-041X. ; 31:2, s. 239-245 Tidskriftsartikel (refereegranskat)abstract In national guidelines for urinary tract infection (UTI) in children, different cut-off levels for defining bacteriuria are used. In this study, the relationship between bacterial count in infant UTI and inflammatory parameters, frequency of vesicoureteral reflux (VUR), kidney damage, and recurrent UTI was analyzed.
41.	Swerkersson, Svante, 1954, et al. (författare) Urinary tract infection in small outpatient children: the influence of age and gender on resistance to oral antimicrobials. 2014 Ingår i: European journal of pediatrics. - : Springer Science and Business Media LLC. - 1432-1076 .- 0340-6199. ; 173:8, s. 1075-1081 Tidskriftsartikel (refereegranskat)abstract Urinary tract infection (UTI) is a common bacterial disease in small children in which treatment with antimicrobials is used. The worldwide increase of bacterial resistance to these drugs is threatening the efficacy of such treatment and may increase the risk for long-term damage. The aim of this retrospective study was to analyse the development of resistance to oral antimicrobials over a 10-year period in an unselected outpatient population of small children with first-time UTI. The patient material included 494 boys and 512 girls below 2years of age with community acquired symptomatic UTI. Escherichia coli bacteria were isolated in 96% of girls and 89% of boys (p<0.0001). The overall resistance of E. coli was 14% to trimethoprim and below 1% to cefadroxil and nitrofurantoin. Over the 10-year period, the trimethoprim resistance of E. coli increased from 5 to 17% but remained unchanged to cefadroxil and nitrofurantoin. E. coli resistance to trimethoprim was related to age: 11% below and 19% above 9months (p<0.01). The increase in resistance over time and with age was found only in girls. Conclusion: The increasing resistance of E. coli to trimethoprim makes this drug less suitable for empiric treatment of UTI. Young children with UTI seem predisposed to early development of resistance. Therefore, surveillance of resistance to antimicrobials with special regard to age and gender is recommended.
42.	Wranne, Moa, 1986, et al. (författare) Comparison of CTX-M encoding plasmids present during the early phase of the ESBL pandemic in western Sweden 2024 Ingår i: Scientific Reports. - 2045-2322 .- 2045-2322. ; 14:1, s. 11880- Tidskriftsartikel (refereegranskat)abstract Plasmids encoding blaCTX-M genes have greatly shaped the evolution of E. coli producing extended-spectrum beta-lactamases (ESBL-E. coli) and adds to the global threat of multiresistant bacteria by promoting horizontal gene transfer (HGT). Here we screened the similarity of 47 blaCTX-M -encoding plasmids, from 45 epidemiologically unrelated and disperse ESBL-E. coli strains, isolated during the early phase (2009-2014) of the ESBL pandemic in western Sweden. Using optical DNA mapping (ODM), both similar and rare plasmids were identified. As many as 57% of the plasmids formed five ODM-plasmid groups of at least three similar plasmids per group. The most prevalent type (28%, IncIl, pMLST37) encoded blaCTX-M-15 (n = 10), blaCTX-M-3 (n = 2) or blaCTX-M-55 (n = 1). It was found in isolates of various sequence types (STs), including ST131. This could indicate ongoing local HGT as whole-genome sequencing only revealed similarities with a rarely reported, IncIl plasmid. The second most prevalent type (IncFII/FIA/FIB, F1:A2:B20) harboring blaCTX-M-27, was detected in ST131-C1-M27 isolates, and was similar to plasmids previously reported for this subclade. The results also highlight the need for local surveillance of plasmids and the importance of temporospatial epidemiological links so that detection of a prevalent plasmid is not overestimated as a potential plasmid transmission event in outbreak investigations.
43.	Åhren, Christina (författare) Är jag en riktig same? : En etnologisk studie av unga samers identitetsarbete 2006 Licentiatavhandling (övrigt vetenskapligt/konstnärligt)
44.	Åhrén, Christina, 1975- (författare) Är jag en riktig same? : en etnologisk studie av unga samers identitetsarbete 2008 Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract This thesis is an ethnological study of young Sami living in Sweden. The aim is to describe and analyse different ways of being Sami today and discuss the historical terms of creating identities Reindeer grazing legislation have influenced the informants’ rights within the Sami people and their identity is based on their social and material terms. Membership in a reindeer herding district is important to the informants and they use different ethnic strategies to reach their memberships. Some informants use the political arena while other informants tries to obtain their membership by being invited by all ready existing members. Some informants are influenced by their alienation through the different legislative acts and their families have created a Sami culture based on other values and norms, different from the other informants in this study. They are acutely aware of their own history and use that history in all conversations. The symbolic side of ethnicity becomes more obvious within the reindeer herding communities. The informants of this group acquire the cultural competence which is necessary through their upbringing. The children of the reindeer herders participate and are included in the daily labour of reindeer husbandry and thus are incorporated in the group and learn which norms and values are important within their community. Difficulties occur when traditional terms collide with the modern society. What sometimes seems irrational within this group is explained by using Højrups Lifeform theory. Gender is also an important factor since the informants are expected to act differently and to choose different paths in their lives based upon gender. In a modern society increasingly more fragmented and where identity becomes a personal project can the ethnic togetherness with its clearly defined boundaries be tempting for searching individuals. But questions of who is Sami are brought to a head. An ethnocentrism becomes obvious where different Sami individuals are differently valued. The informants different Sami heritage have resulted in their sometimes being so apart from each other that it may be concluded that they are different kinds of Sami.
45.	Åkerlund, Anna, et al. (författare) Svarstiderna kan kortas vid mikrobiologisk diagnostik av sepsis: Bättre öppettider på laboratorier och aktiv rådgivning ger snabbare terapi 2015 Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 112:7 Tidskriftsartikel (refereegranskat)abstract Snabbt insatt adekvat antibiotikabehandling är livräddande vid allvarliga bakteriella infektioner. Snabb mikrobiologisk diagnostik krävs i och med ökande antibiotikaresistens och kommer att ge medicinska vinster.En enkät till landets mikrobiologiska laboratorier visar på stora skillnader avseende tillgänglighet, snabbhet och kommunikation med svarsmottagande enhet vad gäller positiva blododlingar.För snabbare svar krävs att mikrobiologiska laboratorier erbjuder mer generösa öppettider, effektivare transportsystem och patientnära blododlingsinkubatorer samt tidig och aktiv rådgivning till behandlande läkare.n/a
46.	Åkerlund, Anna, et al. (författare) Svarstiderna kan kortas vid mikrobiologisk diagnostik av sepsis [Response times can be shortened in microbiological diagnosis of sepsis] : Bättre öppettider på laboratorier och aktiv rådgivning ger snabbare terapi [Better opening hours in laboratories and active advice enables faster therapy] 2015 Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 112 Tidskriftsartikel (refereegranskat)abstract Early and adequate antimicrobial therapy is lifesaving in patients with bloodstream infections (BSI). Continuous incubation and 24h availability of microbial pathogen identification in clinical microbiology laboratories shortens the time to report. To describe the current status in Swedish clinical microbiology laboratories, a web-based survey was performed. The survey showed major differences in availability both regarding laboratory opening hours and ability to incubate blood culture bottles outside working hours. It also showed differences in what was conveyed verbally to the clinician and in time to report of the bacterial species. Based on this survey, we debate how Swedish healthcare can improve the care of patients with BSI by offering a more rapid diagnostic process. This could be achieved through longer opening hours of the laboratory, better transport systems and blood culture cabinets positioned closer to the patient.

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