| 1. |
- Almroth, Gabriel, 1953-, et al.
(författare)
-
Perspectives on hepatitis B infections and the efficacy of vaccination (hepatitis B and pneumococci) in dialysis patients.
- 2003
-
Ingår i: Upsala journal of medical sciences. - : Uppsala Medical Society. - 0300-9734 .- 2000-1967. ; 108:1, s. 61-74
-
Tidskriftsartikel (refereegranskat)abstract
- Hepatitis B is a well known problem in dialysis units. We therefore examined the historical frequency of hepatitis B carriers in our unit, our vaccination program to hepatitis B virus (HBV), the response to hepatitis B vaccine, the IgG subclass response of anti-HBs and the response and IgG subclass response to pneumococcal vaccination (another vaccine) in dialysis patients. From 1970 and onwards 23 HBV carriers were found, but no new cases of hepatitis B occurred during the study period, i.e. from 1980 and onwards. Only one of the carriers was alive by the end of 2001. In four patients liver disease (in one of them liver cirrhosis) may have been a concomitant cause of death. The antibody response to hepatitis B vaccine was significantly lower in patients than in staff. In four patients a fourth injection was cancelled due to transplantation and bad health, while such data were lacking in 8 cases. In anti-HBs positive patients and controls a significant difference in the response of healthy adults was observed in anti-HBs IgG1 (p < 0.001) vs all other IgG subclasses. Dialysis patients had low levels, or negative findings, in all cases, with IgG1 as the highest proportion found (3/11 patients). An antibody response to pneumococcal vaccination was registered in 25 out of 29 dialysis patients (in all 86%). The IgG-subclass vaccination response to pneumococci in 28 dialysis patients was mainly IgG2 and IgG1 but also occurred in IgG3 and IgG4. Prevaccination antibody levels of the controls were higher in IgG1 and IgG2 (p < 0.01) (n = 21) than in dialysis patients (n = 28). Hepatitis B is nowadays a rare, but still dangerous disease in nephrology units. Dialysis patients have a reduced response to hepatitis B vaccine and vaccination schedules should be started early as some patients otherwise may not receive a fourth injection. The adequate antibody response to pneumococcal vaccination mainly due to IgG2 and IgG1 antibodies indicates that the antigen involved is important in vaccination responses in dialysis patients.
|
|
| 2. |
- Hällgren, Anita, 1963-, et al.
(författare)
-
Genetic relatedness among Enterococcus faecalis with transposon-mediated high-level gentamicin resistance in Swedish intensive care units
- 2003
-
Ingår i: Journal of Antimicrobial Chemotherapy. - : Oxford University Press (OUP). - 0305-7453 .- 1460-2091. ; 52:2, s. 162-167
-
Tidskriftsartikel (refereegranskat)abstract
- We studied 45 isolates of Enterococcus faecalis with high-level gentamicin resistance (HLGR), all but one concomitantly resistant to ciprofloxacin, and 25 ciprofloxacin-resistant isolates without HLGR for genetic relatedness using pulsed-field gel electrophoresis (PFGE). E. faecalis were isolated from patients admitted to intensive care units at eight hospitals in southern Sweden from December 1996 through December 1998. Genomic analysis by PFGE resulted in three clusters of genetically related isolates (designated clusters I, II and III) and 23 unique clones. Cluster I was found predominantly in the eastern and central parts of southern Sweden and clusters II and III in south-western Sweden. Among the 45 isolates with HLGR, 69% belonged to cluster I, 20% to cluster II, and 11% had unique PFGE patterns, which suggests that the majority of isolates with HLGR are closely related. Among the 25 ciprofloxacin-resistant isolates without HLGR, 68% had unique PFGE patterns, 12% belonged to cluster I and 20% to cluster III, which suggests the ciprofloxacin-resistant isolates are not related. All isolates with HLGR contained the aac(6′)Ie-aph(2″)Ia gene, which was carried on a Tn5281-like transposon in all isolates except one. We conclude that HLGR in E. faecalis was mainly due to dissemination of genetically related clones during the time studied, and that HLGR in these isolates was due to the presence of the aac(6′)Ie-aph(2″)Ia gene.
|
|
| 3. |
- Isaksson, Barbro, 1947-
(författare)
-
MRSA och andra multiresistenta bakterier.
- 2003
-
Ingår i: Smittnytt : information från smittskyddet och mikrobiologen. - Linköping : Smittskyddsenheten. ; 36, s. 24-25
-
Tidskriftsartikel (populärvet., debatt m.m.)
|
|
| 4. |
- Lymer, Ulla-Britt, et al.
(författare)
-
Health care workers' action strategies in situations that involve a risk of blood exposure
- 2003
-
Ingår i: Journal of Clinical Nursing. - 0962-1067 .- 1365-2702. ; 12:5, s. 660-667
-
Tidskriftsartikel (refereegranskat)abstract
- A mapping of fatigue crack growth rates in thick plates of a high strength aluminium alloy has been done. The plate thicknesses investigated was 100, 150 and 200 mm. In this work, material from near edge at near surface and mid-thickness has been investigated. Measurements of crack length has been performed using DC potential drop. Cyclic condensation is used in order to reveal crack growth behaviour for stage I and the earlier part of stage II crack growth. Influence of crack closure, crack branching and slow growing side cracks on fatigue crack growth rate of S-L and L-T oriented specimens are discussed. Variation of difference in growth rate in the upper part of the stage II growth between near surface and mid thickness positioned L-T specimens are found to vary with plate thickness.
|
|
| 5. |
- Lymer, Ulla-Britt, 1943-, et al.
(författare)
-
Health care workers' action strategies in situations that involve a risk of blood exposure
- 2003
-
Ingår i: Journal of Clinical Nursing. - : Wiley. - 0962-1067 .- 1365-2702. ; 12:5, s. 660-667
-
Tidskriftsartikel (refereegranskat)abstract
- • Previous research shows that health care workers (HCWs) often act in a risky way in blood-exposure situations, and thereby run the risk of becoming infected by blood-borne pathogens.• A qualitative study was conducted in order to describe factors that influence HCWs' actions in such situations. Nurses and nursing assistants were interviewed.• The analysis shows that HCWs perceive that there is a conflict among different demands. These demands are protecting the patient's privacy, protecting themselves from being infected and respecting the norms of the department.• The process of managing this conflict is labelled `balancing', which most often results in the choice of a diagnosis-related strategy.
|
|
| 6. |
- Samuelsson, A, et al.
(författare)
-
Clustering of enterococcal infections in a general intensive care unit
- 2003
-
Ingår i: Journal of Hospital Infection. - 0195-6701 .- 1532-2939. ; 54:3, s. 188-195
-
Tidskriftsartikel (refereegranskat)abstract
- This is a retrospective study comparing patients' characteristics, antibiotic consumption and environmental contamination before the impact of a new regimen of intensified infection control measures in a general intensive care unit (ICU) at a university-affiliated tertiary-care teaching hospital. The new regimen consisted of (1) reorganization of patient rooms (2) improved hygienic measures including strict hygiene barrier nursing (3) more isolated patient care and (4) more restrictive use of antibiotics. The regimen was introduced after a cluster of enterococcal infections. All patients admitted to the ICU from 1 March 1995 to 28 february 1997 were included. A study period of 12 months after reorganization of the ward was compared with the 12 months immediately before it. The antibiotic consumption, the individual patient's severity of disease (APACHE score), and the extent of therapeutic interventions (TISS score) were recorded. Enterococci were typed biochemically, antibiograms were established and the relation between the isolates was investigated with pulsed-field gel electrophoresis. The bacteriological results and the patient data suggested a hospital-acquired spread as the cause of the ICU enterococcal outbreak. After implementation of the new regimen, we observed a reduction in the rate of enterococcal bloodstream infections from 3.1 to 1.8%. The consumption of antibiotics fell from 6.11 to 4.24 defined daily doses per patient.The introduction of strict hygiene and barrier nursing, more restrictive use of antibiotics, isolation of infected patients, thorough cleaning and disinfection of the unit was followed by an absence of enterococcal infection clustering and reduction in incidence of enterococcal bacteraemia. We were not able to determine whether the reduction in antibiotic consumption was due to the intervention programme. ⌐ 2003 The Hospital Infection Society. Published by Elsevier Science Ltd. All rights reserved.
|
|
