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Dave N, Sjöholm D, Hedberg P, Ternhag A, Granath F, Verberk JDM, Johansson AF, van der Werff SD, Nauclér P. Nosocomial SARS-CoV-2 Infections and Mortality During Unique COVID-19 Epidemic Waves. JAMA Netw Open 2023; 6:e2341936. [PMID: 37948082 PMCID: PMC10638644 DOI: 10.1001/jamanetworkopen.2023.41936] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/08/2023] [Indexed: 11/12/2023] Open
Abstract
Importance Quantifying the burden of nosocomial SARS-CoV-2 infections and associated mortality is necessary to assess the need for infection prevention and control measures. Objective To investigate the occurrence of nosocomial SARS-CoV-2 infections and associated 30-day mortality among patients admitted to hospitals in Region Stockholm, Sweden. Design, Setting, and Participants A retrospective, matched cohort study divided the period from March 1, 2020, until September 15, 2022, into a prevaccination period, early vaccination and pre-Omicron (period 1), and late vaccination and Omicron (period 2). From among 303 898 patients 18 years or older living in Region Stockholm, 538 951 hospital admissions across all hospitals were included. Hospitalized admissions with nosocomial SARS-CoV-2 infections were matched to as many as 5 hospitalized admissions without nosocomial SARS-CoV-2 by age, sex, length of stay, admission time, and hospital unit. Exposure Nosocomial SARS-CoV-2 infection defined as the first positive polymerase chain reaction test result at least 8 days after hospital admission or within 2 days after discharge. Main Outcomes and Measures Primary outcome of 30-day mortality was analyzed using time-to-event analyses with a Cox proportional hazards regression model adjusted for age, sex, educational level, and comorbidities. Results Among 2193 patients with SARS-CoV-2 infections or reinfections (1107 women [50.5%]; median age, 80 [IQR, 71-87] years), 2203 nosocomial SARS-CoV-2 infections were identified. The incidence rate of nosocomial SARS-CoV-2 infections was 1.57 (95% CI, 1.51-1.64) per 1000 patient-days. In the matched cohort, 1487 hospital admissions with nosocomial SARS-CoV-2 infections were matched to 5044 hospital admissions without nosocomial SARS-CoV-2 infections. Thirty-day mortality was higher in the prevaccination period (adjusted hazard ratio [AHR], 2.97 [95% CI, 2.50-3.53]) compared with period 1 (AHR, 2.08 [95% CI, 1.50-2.88]) or period 2 (AHR, 1.22 [95% CI, 0.92-1.60]). Among patients with nosocomial SARS-CoV-2 infections, 30-day AHR comparing those with 2 or more doses of SARS-CoV-2 vaccination and those with less than 2 doses was 0.64 (95% CI, 0.46-0.88). Conclusions and Relevance In this matched cohort study, nosocomial SARS-CoV-2 infections were associated with higher 30-day mortality during the early phases of the pandemic and lower mortality during the Omicron variant wave and after the introduction of vaccinations. Mitigation of excess mortality risk from nosocomial transmission should be a strong focus when population immunity is low through implementation of adequate infection prevention and control measures.
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Affiliation(s)
- Nishi Dave
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Daniel Sjöholm
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Pontus Hedberg
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ternhag
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Fredrik Granath
- Department of Medicine, Clinical Epidemiology Division, Karolinska Institutet, Stockholm, Sweden
| | - Janneke D. M. Verberk
- Department of Medical Microbiology and Infection Prevention, University Medical Centre Utrecht, Utrecht, the Netherlands
- Department of Epidemiology, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands
| | - Anders F. Johansson
- Department of Clinical Microbiology and Laboratory for Molecular Infection Medicine Sweden, Umeå University, Umeå, Sweden
| | - Suzanne D. van der Werff
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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Valik JK, Ternhag A, Nauclér P. Immortal Time Bias Possibly Affecting Fludrocortisone-Hydrocortisone Findings. JAMA Intern Med 2023; 183:1178. [PMID: 37669041 DOI: 10.1001/jamainternmed.2023.4378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/06/2023]
Affiliation(s)
- John Karlsson Valik
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ternhag
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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Vähäsarja N, Lund B, Ternhag A, Götrick B, Olaison L, Hultin M, Krüger Weiner C, Naimi-Akbar A. Oral streptococcal infective endocarditis among individuals at high risk following dental treatment: a nested case-crossover and case-control study. EClinicalMedicine 2023; 63:102184. [PMID: 37680946 PMCID: PMC10480552 DOI: 10.1016/j.eclinm.2023.102184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 08/10/2023] [Accepted: 08/14/2023] [Indexed: 09/09/2023] Open
Abstract
Background It is not clear whether Viridans Group Streptococcal Infective Endocarditis (VGS-IE) among individuals at high risk is more frequent following bacteraemia caused by invasive dental procedures (IDPs) than after daily bacteraemia caused by chewing and tooth brushing. The aim of this nested study was to assess if VGS-IE was temporally associated with IDPs in a national cohort of individuals at high risk. Methods This nested case-control and case-crossover study was based on a Swedish national cohort study of 76,762 individuals at high risk of IE due to complex congenital heart disease, prosthetic heart valve or previous IE. Participants were living in Sweden between July 1st, 2008 and January 1st, 2018. The frequency of IDPs during the 3 months before VGS-IE was calculated and compared to controls (sampled 1:10). A case-crossover study was conducted to account for residual confounders. Participants were identified using the national patient register, and IDPs were identified using the national dental health register. Findings 98,247 IDPs were carried out in the cohort during the study period: 624 occasions of oral surgery, 44,190 extractions and 53,433 sessions of subgingival scaling. The study could not confirm that IDPs were more common among cases (4.6%) than controls (4.1%), OR = 1.22 [95% Confidence Interval (CI) 0.64-2.3], or during case- (3.3%) than reference periods (3.8%), OR = 0.89 [95% CI: 0.68-1.17]. Restricting the analysis to the period when cessation of antibiotic prophylaxis for the prevention of IE in Swedish dentistry was recommended, from the 1st of October 2012 to the 1st of January 2018, did not alter the results of the case-control study: OR 0.64, 95% CI: 0.20-2.09, or the case-crossover study: OR 0.58, 95% CI: 0.15-2.19. Interpretation The study could not confirm that VGS-IE is associated with IDPs among individuals at high risk. A study with larger sample size could clarify whether there is a lack of association. The finding of a small (<5%) proportion of cases temporally associated with IDPs is similar to that of the previous large-scale study on IDPs and VGS-IE. Funding Funding was provided by the Board of doctoral education at Karolinska Institutet, the Public Health Agency of Sweden, Folktandvården Stockholm AB, Steering Group for Collaborative Odontological Research at Karolinska Institutet and Stockholm City County, and the Swedish Dental Association.
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Affiliation(s)
- Niko Vähäsarja
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Oral and Maxillofacial Surgery, Eastmaninstitutet, Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet, Stockholm, Sweden
| | - Bodil Lund
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Medical Unit of Plastic Surgery and Oral and Maxillofacial Surgery, Department for Oral and Maxillofacial Surgery and Jaw Orthopedics, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ternhag
- Division of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm 171 77, Sweden
| | - Bengt Götrick
- Department of Oral Diagnostics Faculty of Odontology, Malmö University, Malmö 205 06, Sweden
| | - Lars Olaison
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska University Hospital, Blå Stråket 5, Göteborg 413 45, Sweden
| | - Margareta Hultin
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Carina Krüger Weiner
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Aron Naimi-Akbar
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden
- Department of Oral and Maxillofacial Surgery, Eastmaninstitutet, Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet, Stockholm, Sweden
- Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö 205 06, Sweden
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Larsson S, Edlund C, Nauclér P, Svensson M, Ternhag A. Cost-Effectiveness Analysis of Temocillin Treatment in Patients with Febrile UTI Accounting for the Emergence of Antibiotic Resistance. Appl Health Econ Health Policy 2022; 20:835-843. [PMID: 35989360 PMCID: PMC9596505 DOI: 10.1007/s40258-022-00748-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/11/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND Antibiotic resistance has been listed as one of the biggest threats to global health today. A recent study has shown that treating febrile urinary tract infections with temocillin instead of cefotaxime leads to a reduced selection of antibiotic-resistant bacteria. However, a potential challenge with prioritizing temocillin over cefotaxime is the cost consequences. OBJECTIVE This study aimed to assess the cost effectiveness of using temocillin compared to cefotaxime in treating febrile urinary tract infections in a model that takes the emergence of antibiotic resistance into account. METHODS We used a Markov cohort model to estimate the costs and health effects of temocillin and cefotaxime treatment in febrile urinary tract infections in a Swedish setting. Health effects were assessed in terms of quality-adjusted life-years, and the primary outcome was the cost per quality-adjusted life-year gained with temocillin compared to cefotaxime. We used a 5-year time horizon. RESULTS The model results showed that temocillin treatment led to better health outcomes at a higher total cost. The cost per quality-adjusted life-year gained was approximately 38,400 EUR. Results from the sensitivity analysis suggested a 63% probability of temocillin being cost effective at a threshold of 50,000 EUR. Furthermore, results showed that the cost effectiveness of temocillin in febrile urinary tract infections is highly dependent on the drug cost. CONCLUSIONS As antibiotic consumption is a driving force of resistance, it is essential to consider the development of resistance when studying the health economic consequences of antibiotic treatments. In doing so, this study found temocillin to be cost effective for febrile urinary tract infections.
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Affiliation(s)
- Sofie Larsson
- Public Health Agency of Sweden, Solna, Sweden.
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | | | - Pontus Nauclér
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Mikael Svensson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anders Ternhag
- Public Health Agency of Sweden, Solna, Sweden
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
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5
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Dahlén E, Collin J, Hellman J, Norman C, Nauclér P, Ternhag A. The effect of absent or deferred antibiotic treatment on complications of common infections in primary care. Int J Infect Dis 2022; 124:181-186. [DOI: 10.1016/j.ijid.2022.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 09/08/2022] [Accepted: 09/30/2022] [Indexed: 10/31/2022] Open
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Vähäsarja N, Lund B, Ternhag A, Götrick B, Olaison L, Hultin M, Warnqvist A, Krüger Weiner C, Naimi-Akbar A. Infective Endocarditis Among High-risk Individuals Before and After the Cessation of Antibiotic Prophylaxis in Dentistry: A National Cohort Study. Clin Infect Dis 2022; 75:1171-1178. [PMID: 35134867 PMCID: PMC9525079 DOI: 10.1093/cid/ciac095] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A few years after the publication of the British guidelines, national recommendations were published by the Swedish Medical Products Agency in October 2012, promoting the cessation of antibiotic prophylaxis in dentistry for the prevention of infective endocarditis (IE). The aim of this study was to evaluate whether the incidence of oral streptococcal IE increased among high-risk individuals after October 2012. METHODS This nationwide cohort study included all adult individuals (>17 years) living in Sweden from January 2008 to January 2018, with a diagnose code or surgical procedure code indicating high risk of IE. Cox proportional hazard models were performed to calculate adjusted ratios of oral streptococcal IE before and after October 2012 between high-risk individuals and references. RESULTS This study found no increased incidence of oral streptococcal IE among high-risk individuals during the 5 years after the cessation, compared with before. Hazard rate ratios were 15.4 (95% confidence interval [CI]: 8.3-28.5) before and 20.7 (95% CI: 10.0-42.7) after October 2012 for prevalent high-risk individuals. Corresponding ratios for incident high-risk individuals were 66.8 (95% CI: 28.7-155.6) and 44.6 (95% CI: 22.9-86.9). Point estimates for interaction with time period were 1.4 (95% CI: .6-3.5) and 0.8 (95% CI: .5-1.3) for prevalent and incident high-risk individuals, respectively. CONCLUSION The results suggest that the current Swedish recommendation not to administer antibiotic prophylaxis for the prevention of IE in dentistry has not led to an increased incidence of oral streptococcal IE among high-risk individuals.
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Affiliation(s)
- Niko Vähäsarja
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Oral and Maxillofacial Surgery, Eastmaninstitutet, Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet, Stockholm, Sweden
| | - Bodil Lund
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Medical Unit for Reconstructive Plastic- and Craniofacial Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ternhag
- Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Bengt Götrick
- Department of Oral Diagnostics Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Lars Olaison
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Margareta Hultin
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Anna Warnqvist
- Division of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Solna, Sweden
| | - Carina Krüger Weiner
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Oral and Maxillofacial Surgery, Eastmaninstitutet, Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet, Stockholm, Sweden
| | - Aron Naimi-Akbar
- Division of Oral Diagnostics and Rehabilitation, Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Oral and Maxillofacial Surgery, Eastmaninstitutet, Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet, Stockholm, Sweden.,Health Technology Assessment-Odontology (HTA-O), Faculty of Odontology, Malmö University, Malmö, Sweden
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Tellapragada C, Ydsten KA, Ternhag A, Giske CG. Evaluation of a pneumonia multiplex PCR panel for detection of bacterial respiratory tract pathogens from serial specimens collected from hospitalized COVID-19 patients. Eur J Clin Microbiol Infect Dis 2022; 41:1093-1098. [PMID: 35727430 PMCID: PMC9210330 DOI: 10.1007/s10096-022-04466-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/09/2022] [Indexed: 11/24/2022]
Abstract
We investigated the concordance between the Unyvero Hospitalized Pneumonia (HPN) application and quantitative culture for detection of bacterial pathogens from serial lower respiratory tract (LRT) specimens collected from the same subject. Comparison of results from HPN application and culture was evaluated using 69 LRT samples from 27 subjects, using two evaluation approaches. False positive detections by the HPN application was 29% (20/69) in Evaluation I vs 10% (7/68) in Evaluation II. Additional pathogens detected by the HPN application could be confirmed in many instances by culture positivity for the same organism from previous or subsequent samples from the same subject.
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Affiliation(s)
- Chaitanya Tellapragada
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Alfred Nobels Allé 8, 14183, Stockholm, Sweden.
| | | | - Anders Ternhag
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden
| | - Christian G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Alfred Nobels Allé 8, 14183, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
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Larsson S, Svensson M, Ternhag A. Production loss and sick leave caused by antibiotic resistance: a register-based cohort study. BMC Public Health 2022; 22:527. [PMID: 35300650 PMCID: PMC8932015 DOI: 10.1186/s12889-022-12947-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 03/09/2022] [Indexed: 11/10/2022] Open
Abstract
Background Adverse economic consequences of antibiotic resistance, both in health care systems and in society at large, have been estimated to emerge and significantly affect the global economy. To date, most studies of the societal costs of antibiotic resistance have had a macroeconomic perspective, using the number of attributable deaths as a quantifier for production loss. In contrast, there have been few studies of the consequences of antibiotic resistance in terms of the length of sick leave and hence the impact of morbidity on production loss. The aim of our study was to estimate the production loss from ill health caused by antibiotic resistance. Method To estimate additional production loss due to antibiotic resistance, we used Swedish register-based cohort data to determine days of long-term sick leave (LTSL) for episodes of infection caused by resistant and susceptible bacteria respectively. We collected patient data for four common infection types (bloodstream infection, urinary tract infection, skin and soft tissue infection, and pneumonia), as well as, antibiotic susceptibility test data, and total days of LTSL. We used a two-part model to estimate the number of LTSL days attributable to resistance, and controlled for comorbidities and demographic variables such as age and gender. Results The results show that antibiotic resistance adds an additional 8.19 days of LTSL compared with a similar infection caused by susceptible bacteria, independent of infection type and resistance type. Furthermore, the results suggest that production loss due to temporary sick leave caused by antibiotic resistance in a working-age population amounts to about 7% of total health care costs attributable to antibiotic resistance in Sweden. Conclusion Estimating the effect of antibiotic resistance in terms of temporary production loss is important to gain a better understanding of the economic consequences of antibiotic resistance in society and, by extension, enable more effective resource allocation to combat further emergence of resistance. Society’s economic costs of antibiotic resistance are, however, probably much greater than those of sick leave due to disease alone. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12947-x.
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Affiliation(s)
- Sofie Larsson
- Public Health Agency of Sweden, SE-171 82, Solna, Sweden. .,School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
| | - Mikael Svensson
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Anders Ternhag
- Public Health Agency of Sweden, SE-171 82, Solna, Sweden.,Department of Medicine, Solna, Karolinska Institute, Stockholm, Sweden
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Norman C, Svensson M, Schmidt I, Bergfeldt VS, Obeid R, Ternhag A, Struwe JL. Reduced dispensing of prescribed antibiotics during the Covid-19 pandemic has not increased severe complications from common infections. BMC Public Health 2022; 22:252. [PMID: 35135517 PMCID: PMC8822723 DOI: 10.1186/s12889-022-12692-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Sweden has seen an accelerated decline in the number of dispensed antibiotic prescriptions from an already low level during the Covid-19 pandemic. This prompted us to explore whether the decrease in antibiotic prescriptions has reached a critically low level and resulted in an increase in treatment of severe complications from common infections. The aim was to study if the accelerated decrease in antibiotic sales has led to an increase in complications in outpatients with common infections. Method A population-based nationwide registry study based on the Swedish Prescribed Drug Register and the National Patient Register. Results The total number of dispensed antibiotic prescriptions decreased by 17% during 2020 compared to 2019. The decrease was most pronounced in younger age groups and for antibiotics targeting respiratory tract infections. The number of hospital admissions and visits to open specialist care due to pneumonia or complications related to otitis, tonsillitis, or sinusitis decreased by 4–44%. Prescriptions and numbers of visits or admissions due to urinary tract infections and skin infections remained largely unchanged compared to previous years. Conclusion No increase in complications due to common bacterial infections could be detected despite an unprecedented decline in dispensed antibiotic prescriptions in outpatient care in 2020. The decrease in dispensed antibiotic prescriptions from pharmacies was probably primarily related to a general decrease in the incidence of respiratory infections due to the recommendations and restrictions implemented to mitigate the Covid-19 pandemic in Sweden. This in return led to fewer doctors’ visits and consequently to fewer occasions to prescribe antibiotics, be they warranted or not. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12692-1.
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Affiliation(s)
| | | | | | | | - Ragda Obeid
- Public Health Agency of Sweden, Solna, Sweden
| | - Anders Ternhag
- Public Health Agency of Sweden, Solna, Sweden. .,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
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Hedberg P, Johansson N, Ternhag A, Abdel-Halim L, Hedlund J, Nauclér P. Bacterial co-infections in community-acquired pneumonia caused by SARS-CoV-2, influenza virus and respiratory syncytial virus. BMC Infect Dis 2022; 22:108. [PMID: 35100984 PMCID: PMC8802536 DOI: 10.1186/s12879-022-07089-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Accepted: 01/25/2022] [Indexed: 01/19/2023] Open
Abstract
Background A mismatch between a widespread use of broad-spectrum antibiotic agents and a low prevalence of reported bacterial co-infections in patients with SARS-CoV-2 infections has been observed. Herein, we sought to characterize and compare bacterial co-infections at admission in hospitalized patients with SARS-CoV-2, influenza or respiratory syncytial virus (RSV) positive community-acquired pneumonia (CAP). Methods A retrospective cohort study of bacterial co-infections at admission in SARS-CoV-2, influenza or RSV-positive adult patients with CAP admitted to Karolinska University Hospital in Stockholm, Sweden, from year 2011 to 2020. The prevalence of bacterial co-infections was investigated and compared between the three virus groups. In each virus group, length of stay, ICU-admission and 30-day mortality was compared in patients with and without bacterial co-infection, adjusting for age, sex and co-morbidities. In the SARS-CoV-2 group, risk factors for bacterial co-infection, were assessed using logistic regression models and creation of two scoring systems based on disease severity, age, co-morbidities and inflammatory markers with assessment of concordance statistics. Results Compared to influenza and RSV, the bacterial co-infection testing frequency in SARS-CoV-2 was lower for all included test modalities. Four percent [46/1243 (95% CI 3–5)] of all SARS-CoV-2 patients had a bacterial co-infection at admission, whereas the proportion was 27% [209/775 (95% CI 24–30)] and 29% [69/242 (95% CI 23–35)] in influenza and RSV, respectively. S. pneumoniae and S. aureus constituted the most common bacterial findings for all three virus groups. Comparing SARS-CoV-2 positive patients with and without bacterial co-infection at admission, a relevant association could not be demonstrated nor excluded with regards to risk of ICU-admission (aHR 1.53, 95% CI 0.87–2.69) or 30-day mortality (aHR 1.28, 95% CI 0.66–2.46) in adjusted analyses. Bacterial co-infection was associated with increased inflammatory markers, but the diagnostic accuracy was not substantially different in a scoring system based on disease severity, age, co-morbidities and inflammatory parameters [C statistic 0.66 (95% CI 0.59–0.74)], compared to using disease severity, age and co-morbidities only [C statistic 0.63 (95% CI 0.56–0.70)]. Conclusions The prevalence of bacterial co-infections was significantly lower in patients with community-acquired SARS-CoV-2 positive pneumonia as compared to influenza and RSV positive pneumonia. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07089-9.
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Affiliation(s)
- Pontus Hedberg
- Department of Medicine Solna, Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Niclas Johansson
- Department of Medicine Solna, Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ternhag
- Department of Medicine Solna, Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Lina Abdel-Halim
- Department of Medicine Solna, Karolinska Institutet, 171 77, Stockholm, Sweden
| | - Jonas Hedlund
- Department of Medicine Solna, Karolinska Institutet, 171 77, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Department of Medicine Solna, Karolinska Institutet, 171 77, Stockholm, Sweden. .,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
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Edlund C, Ternhag A, Skoog Ståhlgren G, Edquist P, Östholm Balkhed Å, Athlin S, Månsson E, Tempé M, Bergström J, Giske CG, Hanberger H. The clinical and microbiological efficacy of temocillin versus cefotaxime in adults with febrile urinary tract infection, and its effects on the intestinal microbiota: a randomised multicentre clinical trial in Sweden. Lancet Infect Dis 2021; 22:390-400. [PMID: 34756180 DOI: 10.1016/s1473-3099(21)00407-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 06/17/2021] [Accepted: 07/05/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND Use of third-generation cephalosporins, such as cefotaxime, is associated with an increased risk of selection for antimicrobial resistance, so alternative antibiotics need to be considered. The aim of the present study was to evaluate intestinal colonisation with third-generation cephalosporin-resistant pathogens following use of temocillin-an alternative antibiotic to cefotaxime that is potentially less prone to disturbing the intestinal microbiota-in empirical treatment of febrile urinary tract infection (UTI). METHODS We did a randomised, multicentre, superiority, open-label phase 4 trial in patients who had been admitted to inpatient care in 12 Swedish hospitals with suspected or diagnosed febrile UTI (complicated or uncomplicated). To meet inclusion criteria, a patient was required to have at least one sign or symptom of pyelonephritis (ie, flank pain; costovertebral angle tenderness; and changes to urinary frequency or urgency or dysuria), a fever of 38·0°C or higher, and a positive urine dipstick (for nitrites, white blood cells, or both). Participants were also required to have an indication for intravenous antibiotic treatment. Participants were randomly assigned (1:1) to receive either 2 g temocillin or 1-2 g cefotaxime, by local investigators opening consecutive sealed randomisation envelopes that were generated centrally in advance. Both drugs were administered intravenously every 8 h. The trial was open label for investigators and patients, but those doing the microbiological analyses were masked to the groups. Participants were treated with antibiotics for 7-10 days (or up to 14 days if they had bacteraemia), at least 3 days of which were on the study drug; at day 4 and later, participants who were showing improvement could be given an oral antibiotic (ciprofloxacin, ceftibuten, cefixime, or co-trimoxazole). Patients not showing improvement were regarded as having treatment failures. Rectal swabs were collected at three timepoints: at baseline (before the first dose), after the last dose of study drug, and 7-10 days after treatment stopped. The composite primary outcome was colonisation with Enterobacterales with reduced susceptibility to third-generation cephalosporins, or colonisation with toxin-producing Clostridioides difficile, or both, to evaluate disturbance of the intestinal microbiota. The study is registered in the EU Clinical Trials Register (EudraCT 2015-003898-15). FINDINGS Between May 20, 2016, and July 31, 2019, 207 patients were screened for eligibility, of whom 55 patients were excluded. 152 participants were randomly assigned to groups: 77 (51%) patients received temocillin, 75 (49%) patients received cefotaxime. The composite primary endpoint was met by 18 (26%) of 68 participants receiving temocillin versus 30 (48%) of 62 patients receiving cefotaxime (risk difference -22% [95% CI -42% to -3%]), showing superiority of temocillin versus cefotaxime (ie, less disturbance of the intestinal microbiota). 43 adverse events were reported in 40 (52%) of 77 patients in the temocillin group, versus 46 adverse events in 34 (45%) of 75 patients in the cefotaxime group. Most events were of mild to moderate severity. 21 (27%) patients in the temocillin and 17 (23%) patients in the cefotaxime group had an adverse event that was considered to be associated with the study drug. INTERPRETATION Temocillin was found to be less selective than cefotaxime of Enterobacterales with reduced susceptibility to third-generation cephalosporins, and it could therefore be a favourable alternative in the empirical treatment of febrile UTI. Use of this antibiotic could reduce hospital transmission and health-care-associated infections by these pathogens. FUNDING Public Health Agency of Sweden.
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Affiliation(s)
| | - Anders Ternhag
- The Public Health Agency of Sweden, Solna, Sweden; Division of Infectious Diseases, Department of Medicine, Karolinska Institutet, Solna, Sweden
| | | | | | - Åse Östholm Balkhed
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Simon Athlin
- Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Emeli Månsson
- Department of Infectious Diseases and Centre of Clinical Research, Västmanland Hospital, Västerås, Sweden
| | - Maria Tempé
- Sundsvall Härnösand Regional Hospital, Sundsvall, Sweden
| | | | - Christian G Giske
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Solna, Sweden; Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Håkan Hanberger
- Division of Infectious Diseases, Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden.
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12
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Bådholm M, Blixt J, Glimåker M, Ternhag A, Hedlund J, Nelson DW. Cerebrospinal fluid cell count variability is a major confounding factor in external ventricular drain-associated infection surveillance diagnostics: a prospective observational study. Crit Care 2021; 25:291. [PMID: 34380543 PMCID: PMC8359042 DOI: 10.1186/s13054-021-03715-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 07/29/2021] [Indexed: 11/20/2022] Open
Abstract
Background External ventricular drain (EVD)-related infections (EVDIs) are feared complications that are difficult to rapidly and correctly diagnose, which can lead to unnecessary treatment with broad-spectrum antibiotics. No readily available diagnostic parameters have been identified to reliably predict or identify EVDIs. Moreover, intraventricular hemorrhage is common and affect cerebrospinal fluid (CSF) cellularity. The relationship between leukocytes and erythrocytes is often used to identify suspected infection and triggers the use of antibiotics pending results of cultures, which may take days. Cell count based surveillance diagnostics assumes a homogeneous distribution of cells in the CSF. Given the intraventricular sedimentation of erythrocytes on computed tomography scans this assumption may be erroneous and could affect diagnostics. Aims To evaluate the consistency of cell counts in serially sampled CSF from EVDs, with and without patient repositioning, to assess the effect on infection diagnostics. Methods We performed a prospective single-center study where routine CSF sampling was followed by a second sample after 10 min, allocated around a standard patient repositioning, or not. Changes in absolute and pairwise cell counts and ratios were analyzed, including mixed regression models. Results Data from 51 patients and 162 paired samples were analyzed. We observed substantial changes in CSF cellularity as the result of both resampling and repositioning, with repositioning found to be an independent predictor of bidirectional cellular change. Glucose and lactate levels were affected, however clinically non-significant. No positive CSF cultures were seen during the study. Thirty percent (30%) of patients changed suspected EVDI status, as defined by the cell component of local and national guidelines, when resampling after repositioning. Conclusions CSF cell counts are not consistent and are affected by patient movement suggesting a heterogeneity in the intraventricular space. The relationship between leukocytes and erythrocytes was less affected than absolute changes. Importantly, cell changes are found to increase with increased cellularity, often leading to changes in suspected EVDI status. Faster and more precise diagnostics are needed, and methods such as emerging next generation sequencing techniques my provide tools to more timely and accurately guide antibiotic treatment. Trial Registration NCT04736407, Clinicaltrials.gov, retrospectively registered 2nd February 2021. Supplementary Information The online version contains supplementary material available at 10.1186/s13054-021-03715-1.
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Affiliation(s)
- Marcus Bådholm
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden. .,Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.
| | - Jonas Blixt
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Martin Glimåker
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ternhag
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Division of Infectious Diseases, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Jonas Hedlund
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Division of Infectious Diseases, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - David W Nelson
- Function Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.,Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
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13
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Hedberg P, Karlsson Valik J, van der Werff S, Tanushi H, Requena Mendez A, Granath F, Bell M, Mårtensson J, Dyrdak R, Hertting O, Färnert A, Ternhag A, Naucler P. Clinical phenotypes and outcomes of SARS-CoV-2, influenza, RSV and seven other respiratory viruses: a retrospective study using complete hospital data. Thorax 2021; 77:154-163. [PMID: 34226206 PMCID: PMC8260304 DOI: 10.1136/thoraxjnl-2021-216949] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 05/25/2021] [Indexed: 12/29/2022]
Abstract
Background An understanding of differences in clinical phenotypes and outcomes COVID-19 compared with other respiratory viral infections is important to optimise the management of patients and plan healthcare. Herein we sought to investigate such differences in patients positive for SARS-CoV-2 compared with influenza, respiratory syncytial virus (RSV) and other respiratory viruses. Methods We performed a retrospective cohort study of hospitalised adults and children (≤15 years) who tested positive for SARS-CoV-2, influenza virus A/B, RSV, rhinovirus, enterovirus, parainfluenza viruses, metapneumovirus, seasonal coronaviruses, adenovirus or bocavirus in a respiratory sample at admission between 2011 and 2020. Results A total of 6321 adult (1721 SARS-CoV-2) and 6379 paediatric (101 SARS-CoV-2) healthcare episodes were included in the study. In adults, SARS-CoV-2 positivity was independently associated with younger age, male sex, overweight/obesity, diabetes and hypertension, tachypnoea as well as better haemodynamic measurements, white cell count, platelet count and creatinine values. Furthermore, SARS-CoV-2 was associated with higher 30-day mortality as compared with influenza (adjusted HR (aHR) 4.43, 95% CI 3.51 to 5.59), RSV (aHR 3.81, 95% CI 2.72 to 5.34) and other respiratory viruses (aHR 3.46, 95% CI 2.61 to 4.60), as well as higher 90-day mortality, ICU admission, ICU mortality and pulmonary embolism in adults. In children, patients with SARS-CoV-2 were older and had lower prevalence of chronic cardiac and respiratory diseases compared with other viruses. Conclusions SARS-CoV-2 is associated with more severe outcomes compared with other respiratory viruses, and although associated with specific patient and clinical characteristics at admission, a substantial overlap precludes discrimination based on these characteristics.
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Affiliation(s)
- Pontus Hedberg
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden .,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - John Karlsson Valik
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Suzanne van der Werff
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Hideyuki Tanushi
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Ana Requena Mendez
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Fredrik Granath
- Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Max Bell
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Johan Mårtensson
- Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden.,Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden
| | - Robert Dyrdak
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institute, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Olof Hertting
- Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden.,Department of Paediatric Infectious Diseases, Astrid Lindgren's Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Färnert
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Anders Ternhag
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
| | - Pontus Naucler
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.,Department of Medicine Solna, Karolinska Institute, Stockholm, Sweden
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14
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van der Werff SD, Thiman E, Tanushi H, Valik JK, Henriksson A, Ul Alam M, Dalianis H, Ternhag A, Nauclér P. The accuracy of fully automated algorithms for surveillance of healthcare-associated urinary tract infections in hospitalized patients. J Hosp Infect 2021; 110:139-147. [PMID: 33548370 DOI: 10.1016/j.jhin.2021.01.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 01/27/2021] [Accepted: 01/27/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Surveillance for healthcare-associated infections such as healthcare-associated urinary tract infections (HA-UTI) is important for directing resources and evaluating interventions. However, traditional surveillance methods are resource-intensive and subject to bias. AIM To develop and validate a fully automated surveillance algorithm for HA-UTI using electronic health record (EHR) data. METHODS Five algorithms were developed using EHR data from 2979 admissions at Karolinska University Hospital from 2010 to 2011: (1) positive urine culture (UCx); (2) positive UCx + UTI codes (International Statistical Classification of Diseases and Related Health Problems, 10th revision); (3) positive UCx + UTI-specific antibiotics; (4) positive UCx + fever and/or UTI symptoms; (5) algorithm 4 with negation for fever without UTI symptoms. Natural language processing (NLP) was used for processing free-text medical notes. The algorithms were validated in 1258 potential UTI episodes from January to March 2012 and results extrapolated to all UTI episodes within this period (N = 16,712). The reference standard for HA-UTIs was manual record review according to the European Centre for Disease Prevention and Control (and US Centers for Disease Control and Prevention) definitions by trained healthcare personnel. FINDINGS Of the 1258 UTI episodes, 163 fulfilled the ECDC HA-UTI definition and the algorithms classified 391, 150, 189, 194, and 153 UTI episodes, respectively, as HA-UTI. Algorithms 1, 2, and 3 had insufficient performances. Algorithm 4 achieved better performance and algorithm 5 performed best for surveillance purposes with sensitivity 0.667 (95% confidence interval: 0.594-0.733), specificity 0.997 (0.996-0.998), positive predictive value 0.719 (0.624-0.807) and negative predictive value 0.997 (0.996-0.997). CONCLUSION A fully automated surveillance algorithm based on NLP to find UTI symptoms in free-text had acceptable performance to detect HA-UTI compared to manual record review. Algorithms based on administrative and microbiology data only were not sufficient.
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Affiliation(s)
- S D van der Werff
- Department of Medicine Solna, Division of Infectious Disease, Karolinska Institutet, Stockholm, Sweden.
| | - E Thiman
- Department of Medicine Solna, Division of Infectious Disease, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - H Tanushi
- Department of Medicine Solna, Division of Infectious Disease, Karolinska Institutet, Stockholm, Sweden; Department of Data Processing & Analysis, Karolinska University Hospital, Stockholm, Sweden
| | - J K Valik
- Department of Medicine Solna, Division of Infectious Disease, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - A Henriksson
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - M Ul Alam
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - H Dalianis
- Department of Computer and Systems Sciences, Stockholm University, Stockholm, Sweden
| | - A Ternhag
- Department of Medicine Solna, Division of Infectious Disease, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - P Nauclér
- Department of Medicine Solna, Division of Infectious Disease, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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15
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Larsson S, Prioux M, Fasth T, Ternhag A, Struwe J, Dohnhammar U, Brouwers L. A microsimulation model projecting the health care costs for resistance to antibacterial drugs in Sweden. Eur J Public Health 2020; 29:392-396. [PMID: 30304449 PMCID: PMC6532827 DOI: 10.1093/eurpub/cky209] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies have shown that increasing antibacterial resistance (ABR) globally will cause extensive morbidity, deaths and escalated health care costs. METHODS To project economic consequences of resistance to antibacterial drugs for the Swedish health care sector, we used an individual-based microsimulation model, SESIM. Health care consumption was represented as increased numbers of hospital days, outpatient visits and contact tracing for individuals getting clinical infections or becoming asymptomatic carriers. The risk of contracting a resistant bacterium was calculated using the incidence of mandatorily notifiable ABR in Sweden. RESULTS We estimate accumulated additional health care costs attributable to notifiable ABR from 2018 until 2030 to EUR 406 million and EUR 1, 503 million until 2050. Until 2030 the largest proportion, more than EUR 247 million (EUR 958 million until 2050), was due to ESBL, followed by methicillin resistant Staphylococcus aureus, carbapenemase-producing Enterobacteriaceae, vancomycin-resistant Enterococci and penicillin non-susceptible Pneumococci which incurred costs of EUR 128 million (EUR 453 million, 2050), EUR 15 million (EUR 58 million, 2050), EUR 13 million (EUR 28 million, 2050) and EUR 2 million (EUR 6 million, 2050), respectively. CONCLUSIONS Projections concerning the future costs of ABR can be used to guide priorities and distribution of limited health care resources. Our estimates imply that costs in Sweden will have doubled by 2030 and increased more than 4-fold by 2050 if present trends continue and infection control practices remain unchanged. Still, indirect societal costs and costs for non-notifiable resistance remain to be added.
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Affiliation(s)
- Sofie Larsson
- Public Health Agency of Sweden, Solna, Sweden.,Health Metrics unit, Department of Publich Health and Community Medicine, Sahlgrenska Academy at University of Gothenburg, Gothenburg, Sweden
| | | | | | - Anders Ternhag
- Public Health Agency of Sweden, Solna, Sweden.,Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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16
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Vähäsarja N, Lund B, Ternhag A, Götrick B, Olaison L, Hultin M, Krüger Weiner C, Naimi-Akbar A. Incidence of infective endocarditis caused by viridans group streptococci in Sweden - effect of cessation of antibiotic prophylaxis in dentistry for risk individuals. J Oral Microbiol 2020; 12:1768342. [PMID: 33014311 PMCID: PMC7520904 DOI: 10.1080/20002297.2020.1768342] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Introduction In October 2012, the Swedish Medical Products Agency published new recommendations for the cessation of prophylactic antibiotics in dentistry for the prevention of infective endocarditis (IE). Previously, 2 g of amoxicillin per os would be administered 1 h before invasive dental procedures to patients with valve prosthesis, complicated heart valve disease, and to those with previous endocarditis. Objectives The aim of this study was to evaluate whether the total incidence of IE caused by oral viridans group streptococci (VGS) or IE caused by staphylococci, increased in Sweden after the introduction of the new recommendations. Methods The incidence of IE in Sweden before and after October 2012 was calculated and compared using an interrupted time series analysis. Separate analyses were conducted for the total incidence of IE, and IE caused by VGS or Staphylococcus aureus. Cases of IE were identified using the Swedish national registry of IE, which has existed since 1995 and contains data from all Swedish hospital clinics specialising in infectious disease. All cases with hospital admission date from the 1st of Jan 2008, to the 31st of Dec 2017 were included. The incidence calculations were corrected for annual changes in population size using data from the Swedish government agency Statistics Sweden. Results The results show no statistically significant increase in the slope of the trend line of the total incidence of IE, IE caused by VGS or S. aureus in the Swedish general population after October 2012, compared to before. Conclusion The results suggest that the recommended cessation of prophylactic antibiotics for the prevention of IE in dentistry has not led to an increased incidence of IE caused by oral streptococci among the Swedish population.
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Affiliation(s)
- Niko Vähäsarja
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet
| | - Bodil Lund
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Department of Clinical Dentistry, University of Bergen, Bergen, Norway.,Department of Oral and Maxillofacial Surgery, Haukelands University Hospital, Bergen, Norway
| | - Anders Ternhag
- Department of Medicine Solna, Karolinska Institutet, Unit for Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Bengt Götrick
- Department of Oral Diagnostics Faculty of Odontology, Malmö University, Malmö, Sweden
| | - Lars Olaison
- Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska University Hospital, Sweden
| | - Margareta Hultin
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden
| | - Carina Krüger Weiner
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet
| | - Aron Naimi-Akbar
- Department of Dental Medicine, Karolinska Institutet, Huddinge, Sweden.,Folktandvården Stockholms Län AB, Folktandvården Eastmaninstitutet.,Health Technology Assessment-Odontology (HTA-O), Malmö University, Malmö, Sweden
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17
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Smith AJ, Palmer NOA, Seaton RA, Ternhag A. Letter to the Editor: "Risk of Adverse Reactions to Oral Antibiotics Prescribed by Dentists". J Dent Res 2020; 99:863. [PMID: 32282275 DOI: 10.1177/0022034520917143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- A J Smith
- Scottish Antimicrobial Prescribing Group-Dental, University of Glasgow, UK
| | - N O A Palmer
- Health Education England-North West, Liverpool, UK.,University of Liverpool, Liverpool, UK
| | - R A Seaton
- Queen Elizabeth University Hospital, Glasgow, UK
| | - A Ternhag
- Department of Medicine Solna, Infectious Diseases Unit, Karolinska Institutet, Stockholm, Sweden
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18
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Isendahl J, Giske CG, Hammar U, Sparen P, Tegmark Wisell K, Ternhag A, Nauclér P. Temporal Dynamics and Risk Factors for Bloodstream Infection With Extended-spectrum β-Lactamase-producing Bacteria in Previously-colonized Individuals: National Population-based Cohort Study. Clin Infect Dis 2020; 68:641-649. [PMID: 29961883 DOI: 10.1093/cid/ciy539] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Accepted: 06/28/2018] [Indexed: 12/11/2022] Open
Abstract
Background Little is known of the long-term risks of bloodstream infection (BSI) with extended spectrum β-lactamase-producing Enterobacteriaceae (EPE) in previously-colonized individuals. We investigated EPE-BSI risks and associated risk factors during 6 years following EPE colonization. Methods We performed a population-based cohort study in Sweden using national health registers. Subjects were followed from their first EPE finding in feces (n = 5513) or urine (n = 17189). The effects of co-morbidity, sociodemography, and outpatient antibiotic dispensation on EPE-BSI risks were assessed. The EPE-BSI risks were compared to those of 45161 matched population-based reference subjects. Results The cumulative 6-year EPE-BSI incidences were 3.8%, 1.6%, and 0.02% in the urine, feces, and reference cohorts, respectively. The incidences decreased exponentially during the first 6-12 months. Among EPE-exposed subjects, urological disorders were associated with the highest adjusted cause-specific hazard ratio (aCSHR) for subsequent EPE-BSIs (3.40, 95% confidence interval 2.47-4.69). The aCSHRs were between 1.62-2.20 for male sex, immunosuppression, diabetes, malignancy, lung disease, baseline urine source, and Klebsiella pneumoniae, compared to the Escherichia coli baseline sample. Antibiotics with selective activity against gram-negative bacilli-but mostly not EPE (trimethoprim-sulfamethoxazole, fluoroquinolones, oral cephalosporins, and penicillins with extended spectrums)-and pivmecillinam were associated with doubled EPE BSI risk during the 3 months after antibiotic dispensation in EPE-colonized subjects. Conclusions EPE in urine or feces is a substantial risk factor for subsequent EPE-BSIs, but the risk declines rapidly during the first year after detection. In EPE-colonized individuals, specific risk factors can be used to identify subgroups for targeted interventions, such as eradication therapy.
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Affiliation(s)
- Joakim Isendahl
- Department of Medicine Solna, Unit for Infectious Diseases, Karolinska University Hospital
| | - Christian G Giske
- Department of Laboratory Medicine, Laboratory Building L2:02, Karolinska University Hospital Laboratory
| | - Ulf Hammar
- Institute of Environmental Medicine, C6, Biostatistics
| | - Pär Sparen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm
| | | | - Anders Ternhag
- Department of Medicine Solna, Unit for Infectious Diseases, Karolinska University Hospital.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Pontus Nauclér
- Department of Medicine Solna, Unit for Infectious Diseases, Karolinska University Hospital.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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19
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Abstract
A child with pre-B acute lymphoblastic leukaemia (ALL) developed fatal encephalitis associated with human coronavirus OC43 (HCoV-OC43). During chemotherapy the child had a persistent HCoV-OC43 respiratory infection and later developed progressive encephalitis. Cerebrospinal fluid was negative for pathogens including HCoV-OC43, but a brain biopsy was HCoV-OC43-positive by metagenomic next-generation sequencing.
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Affiliation(s)
- Anna Nilsson
- Department of Women's and Children's Health, Childhood Cancer Research Unit, Astrid Lindgren Children's Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Niklas Edner
- Department of Microbiology, Public Health Agency of Sweden, Solna, Sweden
| | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden.,Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ternhag
- Department of Medicine Solna, Unit for Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
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20
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Valik JK, Ward L, Tanushi H, Müllersdorf K, Ternhag A, Aufwerber E, Färnert A, Johansson AF, Mogensen ML, Pickering B, Dalianis H, Henriksson A, Herasevich V, Nauclér P. Validation of automated sepsis surveillance based on the Sepsis-3 clinical criteria against physician record review in a general hospital population: observational study using electronic health records data. BMJ Qual Saf 2020; 29:735-745. [PMID: 32029574 PMCID: PMC7467502 DOI: 10.1136/bmjqs-2019-010123] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Revised: 01/19/2020] [Accepted: 01/21/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND Surveillance of sepsis incidence is important for directing resources and evaluating quality-of-care interventions. The aim was to develop and validate a fully-automated Sepsis-3 based surveillance system in non-intensive care wards using electronic health record (EHR) data, and demonstrate utility by determining the burden of hospital-onset sepsis and variations between wards. METHODS A rule-based algorithm was developed using EHR data from a cohort of all adult patients admitted at an academic centre between July 2012 and December 2013. Time in intensive care units was censored. To validate algorithm performance, a stratified random sample of 1000 hospital admissions (674 with and 326 without suspected infection) was classified according to the Sepsis-3 clinical criteria (suspected infection defined as having any culture taken and at least two doses of antimicrobials administered, and an increase in Sequential Organ Failure Assessment (SOFA) score by >2 points) and the likelihood of infection by physician medical record review. RESULTS In total 82 653 hospital admissions were included. The Sepsis-3 clinical criteria determined by physician review were met in 343 of 1000 episodes. Among them, 313 (91%) had possible, probable or definite infection. Based on this reference, the algorithm achieved sensitivity 0.887 (95% CI: 0.799 to 0.964), specificity 0.985 (95% CI: 0.978 to 0.991), positive predictive value 0.881 (95% CI: 0.833 to 0.926) and negative predictive value 0.986 (95% CI: 0.973 to 0.996). When applied to the total cohort taking into account the sampling proportions of those with and without suspected infection, the algorithm identified 8599 (10.4%) sepsis episodes. The burden of hospital-onset sepsis (>48 hour after admission) and related in-hospital mortality varied between wards. CONCLUSIONS A fully-automated Sepsis-3 based surveillance algorithm using EHR data performed well compared with physician medical record review in non-intensive care wards, and exposed variations in hospital-onset sepsis incidence between wards.
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Affiliation(s)
- John Karlsson Valik
- Division of Infectious Diseases, Department of Medicine, Solna (MedS), Karolinska Institutet, Stockholm, Sweden .,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Logan Ward
- Treat Systems ApS, Aalborg, Denmark.,Center for Model-based Medical Decision Support, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Hideyuki Tanushi
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Kajsa Müllersdorf
- Division of Infectious Diseases, Department of Medicine, Solna (MedS), Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anders Ternhag
- Division of Infectious Diseases, Department of Medicine, Solna (MedS), Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Ewa Aufwerber
- Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Färnert
- Division of Infectious Diseases, Department of Medicine, Solna (MedS), Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Anders F Johansson
- Department of Clinical microbiology and the Laboratory for Molecular Infection Medicine (MIMS), Umeå University, Umeå, Sweden
| | | | - Brian Pickering
- Department of Anesthesiology and Perioperative medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hercules Dalianis
- Department of Computer and Systems Sciences, Stockholm University, Kista, Sweden
| | - Aron Henriksson
- Department of Computer and Systems Sciences, Stockholm University, Kista, Sweden
| | - Vitaly Herasevich
- Department of Anesthesiology and Perioperative medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Pontus Nauclér
- Division of Infectious Diseases, Department of Medicine, Solna (MedS), Karolinska Institutet, Stockholm, Sweden.,Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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Isendahl J, Giske CG, Tegmark Wisell K, Ternhag A, Nauclér P. Risk factors for community-onset bloodstream infection with extended-spectrum β-lactamase-producing Enterobacteriaceae: national population-based case-control study. Clin Microbiol Infect 2019; 25:1408-1414. [PMID: 30986557 DOI: 10.1016/j.cmi.2019.04.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Revised: 02/24/2019] [Accepted: 04/03/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVES The aim was to investigate risk factors for community-onset bloodstream infections with extended-spectrum β-lactamase-producing Enterobacteriaceae (EPE BSI). METHODS It is mandatory to report EPE BSI to a national register at the Public Health Agency of Sweden. Using this register, we performed a population-based case-control study from 2007 to 2012 of 945 cases and 9390 controls. Exposure data on comorbidity, hospitalization, in- and outpatient antibiotic consumption and socio-economic status were collected from hospital and health registers. RESULTS The overall incidence of EPE BSI was 1.7 per 100 000 person-years. The 30-day mortality was 11.3%. Urological disorders inferred the highest EPE BSI risk, adjusted odds ratio (aOR) 4.32 (95% Confidence Interval (CI) 3.41-5.47), followed by immunological disorders, aOR 3.54 (CI 2.01-6.23), haematological malignancy, aOR 2.77 (CI 1.57-4.87), solid tumours, aOR 2.28 (1.76-2.94) and diabetes, aOR 2.03 (1.58-2.61). Consumption of fluoroquinolones or mostly non-EPE-active antibiotics with selective Gram-negative spectrum of activity within the previous 3 months was associated with EPE BSI, aORs 5.52 (CI 2.8-11.0) and 3.8, CI 1.9-7.7) respectively. There was a dose-response relationship in EPE BSI risk with increasing number of consecutive regimens. Antibiotic consumption >3 months before EPE BSI was not associated with increased risk. Higher age, malignancies and education ≤12 years (aORs >2) were associated with increased 30-day mortality. CONCLUSIONS Targeted interventions should be directed towards improving care for patients with immunosuppression, urological disorders and subjects with lower socio-economic status. Antibiotic stewardship should focus on reduction of fluoroquinolones.
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Affiliation(s)
- J Isendahl
- Department of Medicine Solna, Unit for Infectious Diseases, Karolinska Institutet, Stockholm, Sweden.
| | - C G Giske
- Department of Clinical Microbiology, Karolinska Institutet, Karolinska University Hospital Laboratory, Stockholm, Sweden
| | | | - A Ternhag
- Department of Medicine Solna, Unit for Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - P Nauclér
- Department of Medicine Solna, Unit for Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
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Ternhag A, Nauclér P. [Not Available]. Lakartidningen 2018; 115:EWPI. [PMID: 29337340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Affiliation(s)
- Anders Ternhag
- Karolinska Universitetssjukhuset - Infektion Stockholm, Sweden Karolinska Universitetssjukhuset - Infektion Stockholm, Sweden
| | - Pontus Nauclér
- Karolinska Universitetssjukhuset - Infektion Stockholm, Sweden Karolinska Universitetssjukhuset - Infektion Stockholm, Sweden
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Cars T, Eriksson I, Granath A, Wettermark B, Hellman J, Norman C, Ternhag A. Antibiotic use and bacterial complications following upper respiratory tract infections: a population-based study. BMJ Open 2017; 7:e016221. [PMID: 29146635 PMCID: PMC5695332 DOI: 10.1136/bmjopen-2017-016221] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVES To investigate if use of antibiotics was associated with bacterial complications following upper respiratory tract infections (URTIs). DESIGN Ecological time-trend analysis and a prospective cohort study. SETTING Primary, outpatient specialist and inpatient care in Stockholm County, Sweden. All analyses were based on administrative healthcare data on consultations, diagnoses and dispensed antibiotics from January 2006 to January 2016. MAIN OUTCOME MEASURES Ecological time-trend analysis: 10-year trend analyses of the incidence of URTIs, bacterial infections/complications and respiratory antibiotic use. Prospective cohort study: Incidence of bacterial complications following URTIs in antibiotic-exposed and non-exposed patients. RESULTS The utilisation of respiratory tract antibiotics decreased by 22% from 2006 to 2015, but no increased trend for mastoiditis (p=0.0933), peritonsillar abscess (p=0.0544), invasive group A streptococcal disease (p=0.3991), orbital abscess (p=0.9637), extradural and subdural abscesses (p=0.4790) and pansinusitis (p=0.3971) was observed. For meningitis and acute ethmoidal sinusitis, a decrease in the numbers of infections from 2006 to 2015 was observed (p=0.0038 and p=0.0003, respectively), and for retropharyngeal and parapharyngeal abscesses, an increase was observed (p=0.0214). Bacterial complications following URTIs were uncommon in both antibiotic-exposed (less than 1.5 per 10 000 episodes) and non-exposed patients (less than 1.3 per 10 000 episodes) with the exception of peritonsillar abscess after tonsillitis (risk per 10 000 tonsillitis episodes: 32.4 and 41.1 in patients with no antibiotic treatment and patients treated with antibiotics, respectively). CONCLUSIONS Bacterial complications following URTIs are rare, and antibiotics may lack protective effect in preventing bacterial complications. Analyses of routinely collected administrative healthcare data can provide valuable information on the number of URTIs, antibiotic use and bacterial complications to patients, prescribers and policy-makers.
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Affiliation(s)
- Thomas Cars
- Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
| | - Irene Eriksson
- Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Anna Granath
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Ear, Nose and Throat Clinic, Karolinska University Hospital, Stockholm, Sweden
| | - Björn Wettermark
- Department of Healthcare Development, Public Healthcare Services Committee, Stockholm County Council, Stockholm, Sweden
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Anders Ternhag
- Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
- Public Health Agency of Sweden, Solna, Sweden
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Grün N, Mbuya W, Ternhag A, Ramqvist T, Ahlberg A, Jangard M, Dalianis T, Hammarstedt-Nordenvall L. Human papillomavirus prevalence in mouthwashes of patients undergoing tonsillectomy shows dominance of HPV69, without the corresponding finding in the tonsils. Infect Dis (Lond) 2017; 49:588-593. [PMID: 28293975 DOI: 10.1080/23744235.2017.1300319] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND The role of human papillomavirus (HPV) in tonsillar squamous cell carcinomas (TSCC) is of interest, since a considerable proportion of TSCC in Sweden and other Western countries is HPV positive. Nevertheless, the natural history of HPV in normal tonsils, and the progression from localized infection to pre-malignant lesion to cancer are poorly understood. The aim of this study was to investigate whether HPV types found in mouthwash samples correlated to those in tonsillar tissue from the same individuals undergoing tonsillectomy. METHODS Mouthwash samples from 232 patients, aged 3-56 years, undergoing tonsillectomy, the majority with chronic tonsillitis, were collected at the time of surgery and analysed for the presence of 27 HPV types by a bead based multiplex assay. RESULTS An HPV prevalence of 10.3% (24/232) was observed in mouthwash samples, with HPV 69 being the dominant type (10/24). Ten patients were positive for high risk HPV (HPV 16, 33, 35, 45, 56, 59). None of the tonsils resected from patients with HPV-positive mouthwash samples were positive for HPV. CONCLUSIONS Despite an oral HPV prevalence of 10.3% in mouthwash samples from tonsillectomized patients, with dominance of HPV 69, none of the corresponding tonsillar samples exhibited the presence of HPV.
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Affiliation(s)
- Nathalie Grün
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden
| | - Wilbert Mbuya
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden
| | - Anders Ternhag
- b Department of Medicine Solna , Karolinska Institutet , Stockholm , Sweden
| | - Torbjörn Ramqvist
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden
| | - Alexander Ahlberg
- c Capio ENT Globen and CFTK , Capio Specialist Clinics , Stockholm , Sweden
| | - Mattias Jangard
- d ENT Unit, Research Laboratory , Sophiahemmet University , Stockholm , Sweden
| | - Tina Dalianis
- a Department of Oncology-Pathology , Karolinska Institutet , Stockholm , Sweden
| | - Lalle Hammarstedt-Nordenvall
- e Department of Clinical Sciences and Technology , Karolinska Institutet , Stockholm , Sweden.,f Department of ENT , Karolinska University Hospital , Stockholm , Sweden
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Prioux M, Brouwers L, Dohnhammar U, Fasth T, Larsson S, Struwe J, Ternhag A. A microsimulation model forecasting the health care costs associated with increasing MRSA infections. Eur J Public Health 2016. [DOI: 10.1093/eurpub/ckw165.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Hellman J, Grape M, Ternhag A. Antibiotic consumption among a Swedish cohort of children born in 2006. Acta Paediatr 2015; 104:1035-8. [PMID: 26109274 DOI: 10.1111/apa.13097] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Revised: 06/01/2015] [Accepted: 06/18/2015] [Indexed: 11/29/2022]
Abstract
AIM It is important to measure antibiotic consumption because it contributes to antimicrobial resistance. Our objective was to follow all children born in 2006 in Sweden and to analyse antibiotic consumption during each month of life for the first two years and thereafter for every year during their third to fifth years of life. METHODS This was a register-based, open-cohort study where we used the Swedish Prescribed Drug Register, which covers the whole population, to identify the type and date of purchase of antibiotics for the children in the cohort. RESULTS During the first one-year follow-up period, 101 555 children up to one year of age were living in Sweden, of which 50 135 were boys and 49 420 were girls. Children consumed the largest amount of antibiotics during their second year of life. In our cohort, 51% received antibiotics at some point during the second year and 24% received multiple treatments. The consumption then dropped with every year of life during the follow-up. CONCLUSION This study suggests that actions against overprescribing of antibiotics to children should be targeted towards the second year of life in order to have the greatest effect on consumption.
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Affiliation(s)
| | - Malin Grape
- Public Health Agency of Sweden; Solna Sweden
| | - Anders Ternhag
- Public Health Agency of Sweden; Solna Sweden
- Department of Medicine; Karolinska Institutet; Solna Sweden
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Abstract
BACKGROUND Patients undergoing endovascular aneurysm repair (EVAR) due to abdominal aortic aneurysm often develop an inflammatory response, postimplantation syndrome (PIS) where fever and leukocytosis are common. Previous studies suggest that type of stent graft material (polyester or polytetrafluoroethylene [PTFE]) plays a role. OBJECTIVES To investigate the effect of stent graft material on the inflammatory response and length of hospital stay in patients undergoing standard elective EVAR. METHODS Sixty-nine elective EVAR patients were included in this observational study. To avoid comparing patients with a different graft location and stent graft burden, 12 cases were excluded as well as cases with complication or simultaneous open surgical procedures, leaving 45 patients (32 with polyester and 13 with PTFE graft) for final analysis. Tympanic temperature, C-reactive protein (CRP), white blood cell (WBC), and procalcitonin (PCT) were measured on days -1 and +1 and +3. Duration of in-hospital stay and frequency of PIS were recorded. RESULTS The PIS was diagnosed in 9 (28.1%) of the 32 polyester cases and in 1 (7.7%) of the 13 cases in the PTFE group (P = .24). Median (interquartile range) in-hospital stay was 5 (5-6) days in the polyester group and 4 (4-5) days in the PTFE group (P = .009). On day +3, in the polyester group, mean CRP was 154 (95% confidence interval: 127-182) mg/L, WBC 9.5 (8.4-10.5) ×10(9)/L, and PCT 0.17 (0.12-0.21) ng/mL. In the PTFE group, mean CRP was 70 (32-109) mg/L (P = .001), WBC 8.8 (6.4-11.1) ×10(9)/L (P = .37), and PCT 0.09 (0.06-0.13) ng/mL (P = .009) on day +3. CONCLUSION Standard EVAR with polyester stent grafts appears to result in a trend toward a more pronounced inflammatory reaction than similar EVAR using PTFE and is associated with a longer in-hospital stay.
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Affiliation(s)
- Fredrik Sartipy
- Section of Vascular Surgery, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - David Lindström
- Department of Vascular Surgery, Karolinska University Hospital, Stockholm, Sweden Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
| | - Peter Gillgren
- Section of Vascular Surgery, Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset, Stockholm, Sweden
| | - Anders Ternhag
- Department of Medicine Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
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Ternhag A, Grünewald M, Nauclér P, Tegmark Wisell K. Antibiotic consumption in relation to socio-demographic factors, co-morbidity, and accessibility of primary health care. ACTA ACUST UNITED AC 2014; 46:888-96. [DOI: 10.3109/00365548.2014.954264] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Abstract
BACKGROUND The aim of this paper was to describe and analyze the effect of antibiotic policy changes on antibiotic consumption in Swedish hospitals and to review antibiotic stewardship in Swedish hospitals. RESULTS The main findings were: 1) Antibiotic consumption has significantly increased in Swedish hospitals over the last decade. The consumption of cephalosporins has decreased, whereas that of most other drugs including piperacillin-tazobactam, carbapenems, and penicillinase-sensitive and -resistant penicillins has increased and replaced cephalosporins. 2) Invasive infections caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae have increased, but the proportion of pathogens resistant to third-generation cephalosporins causing invasive infections is still very low in a European and international perspective. Furthermore, the following gaps in knowledge were identified: 1) lack of national, regional, and local data on the incidence of antibiotic resistance among bacteria causing hospital-acquired infections e.g. bloodstream infections and hospital-acquired pneumonia-data on which standard treatment guidelines should be based; 2) lack of data on the incidence of Clostridium difficile infections and the effect of change of antibiotic policies on the incidence of C. difficile infections and infections caused by antibiotic-resistant pathogens; and 3) lack of prospective surveillance programs regarding appropriate antibiotic treatment, including selection of optimal antimicrobial drug regimens, dosage, duration of therapy, and adverse ecological effects such as increases in C. difficile infections and emergence of antibiotic-resistant pathogens. CONCLUSIONS Evidence-based actions to improve antibiotic use and to slow down the problem of antibiotic resistance need to be strengthened. The effect of such actions should be analyzed, and standard treatment guidelines should be continuously updated at national, regional, and local levels.
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Affiliation(s)
- Håkan Hanberger
- Division of Infectious Diseases, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden
- County Council of Östergötland, Linköping, Sweden
| | | | - Anders Ternhag
- The Public Health Agency of Sweden, Solna, Sweden
- Department of Medicine, Division of Infectious Diseases, Karolinska Institute, Stockholm, Sweden
| | - Christian G. Giske
- The Department of Clinical Microbiology, Karolinska Institute MTC, Karolinska University Hospital, Stockholm, Sweden
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Norberg S, Struwe J, Grunewald M, Ternhag A. A pilot study of risk adjustment for benchmarking antibiotic use between hospitals in Sweden. J Glob Antimicrob Resist 2014; 2:39-42. [PMID: 27873636 DOI: 10.1016/j.jgar.2013.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 07/23/2013] [Accepted: 08/08/2013] [Indexed: 11/16/2022] Open
Abstract
There is no established standard for comparing overall antibiotic use between hospitals taking patient characteristics into account. The objective of this study was to investigate whether there is a correlation between surrogate markers for patient morbidity, namely case mix index (CMI), mean length of hospital stay (LoS) and mean cost per admission, and antibiotic use in a sample of Swedish hospitals. All primary and secondary hospitals in three counties with high and three counties with low consumption of antibiotics were selected. Data from 16 hospitals were included. A regression analysis was used to evaluate whether there was a linear trend between defined daily doses (DDD) of antibiotics per 100 bed-days and the surrogate markers for morbidity. No correlation could be found between any of the measures of morbidity and total antibiotic consumption. However, a correlation was found between CMI and the proportion of narrow-spectrum antibiotics: the higher the CMI, the lower the proportional use of β-lactamase-sensitive penicillins. In conclusion, it was found that CMI, mean LoS and mean cost per admission did not appears to be useful factors to adjust for when comparing antibiotic use in this subset of primary and secondary care hospitals. Based on this limited study, we suggest that DDD/100 bed-days can still be used as an appropriate metric to benchmark antibiotic use in primary and secondary hospitals until a better marker for variation of patients and activities is identified.
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Affiliation(s)
- Signe Norberg
- Karolinska Institutet, Department of Medicine, Solna, Sweden; Swedish Institute for Communicable Disease Control, Solna, Sweden
| | - Johan Struwe
- Swedish Institute for Communicable Disease Control, Solna, Sweden; Strama Stockholm, Karolinska Institutet, Department of Medicine, Huddinge, Sweden
| | - Maria Grunewald
- Swedish Institute for Communicable Disease Control, Solna, Sweden
| | - Anders Ternhag
- Karolinska Institutet, Department of Medicine, Solna, Sweden; Swedish Institute for Communicable Disease Control, Solna, Sweden.
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Ternhag A, Giske CG, Hanberger H. [Aminoglycosides are effective--but oto- and nephrotoxic. Knowledge base from the reference group for antibiotic issues on benefit-risk with aminoglycosides]. Lakartidningen 2014; 111:268-269. [PMID: 24669487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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Ternhag A, Cederström A, Törner A, Westling K. A nationwide cohort study of mortality risk and long-term prognosis in infective endocarditis in Sweden. PLoS One 2013; 8:e67519. [PMID: 23861768 PMCID: PMC3704638 DOI: 10.1371/journal.pone.0067519] [Citation(s) in RCA: 70] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2013] [Accepted: 05/24/2013] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Infective endocarditis (IE) remains a serious disease with substantial mortality. In this study we investigated the incidence of IE, as well as its associated short and long term mortality rates. METHODS The IE cases were identified in the Swedish national inpatient register using ICD-10 codes, and then linked to the population register in order to identify deaths in the cohort. Crude mortality rates among IE patients were obtained for different time intervals. These rates were directly standardized using sex- and age-matched mortality in the general population. RESULTS The cohort consisted of 7603 individuals and 7817 episodes of IE during 1997-2007. The 30 days all-cause crude mortality rate was 10.4% and the standardized mortality ratio (SMR) was 33.7 (95% confidence interval [CI]: 31.0-36.6). Excluding the first year of follow-up, the long term mortality (1-5 years) showed an increased SMR of 2.2 (95% CI: 2.0-2.3) compared to the general population. Significantly higher SMR was found for cases of IE younger than 65 years of age with a 1-5 year SMR of 6.3, and intravenous drug-users with a SMR of 19.1. Native valve IE cases, in which surgery was performed had lower crude mortality rates and Mantel-Haenzel odds ratios of less than one compared to those with medical therapy alone during 30-day and 5-years follow-up. CONCLUSIONS The 30-days crude mortality rate for IE was 10.4% and long-term relative mortality risk remains increased even up to 5 years of follow-up, therefore a close monitoring of these patients would be of value.
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Affiliation(s)
- Anders Ternhag
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
- * E-mail:
| | - Agneta Cederström
- Department of Medicine, Solna, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
| | - Anna Törner
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Katarina Westling
- Department of Medicine, Huddinge, Division of Infectious Diseases, Karolinska Institutet, Stockholm, Sweden
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Hanberger H, Edlund C, Furebring M, G Giske C, Melhus A, Nilsson LE, Petersson J, Sjölin J, Ternhag A, Werner M, Eliasson E. Rational use of aminoglycosides--review and recommendations by the Swedish Reference Group for Antibiotics (SRGA). ACTA ACUST UNITED AC 2012; 45:161-75. [PMID: 23270477 DOI: 10.3109/00365548.2012.747694] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
The Swedish Reference Group for Antibiotics (SRGA) has carried out a risk-benefit analysis of aminoglycoside treatment based on clinical efficacy, antibacterial spectrum, and synergistic effect with beta-lactam antibiotics, endotoxin release, toxicity, and side effects. In addition, SRGA has considered optimal dosage schedules and advice on serum concentration monitoring, with respect to variability in volume of drug distribution and renal clearance. SRGA recommends that aminoglycoside therapy should be considered in the following situations: (1) progressive severe sepsis and septic shock, in combination with broad-spectrum beta-lactam antibiotics, (2) sepsis without shock, in combination with broad-spectrum beta-lactam antibiotics if the infection is suspected to be caused by multi-resistant Gram-negative pathogens, (3) pyelonephritis, in combination with a beta-lactam or quinolone until culture and susceptibility results are obtained, or as monotherapy if a serious allergy to beta-lactam or quinolone antibiotics exists, (4) serious infections caused by multi-resistant Gram-negative bacteria when other alternatives are lacking, and (5) endocarditis caused by difficult-to-treat pathogens when monotherapy with beta-lactam antibiotics is not sufficient. Amikacin is generally more active against extended-spectrum beta-lactamase (ESBL)-producing and quinolone-resistant Escherichia coli than other aminoglycosides, making it a better option in cases of suspected infection caused by multidrug-resistant Enterobacteriaceae. Based on their resistance data, local drug committees should decide on the choice of first-line aminoglycoside. Unfortunately, aminoglycoside use is rarely followed up with audiometry, and in Sweden we currently have no systematic surveillance of adverse events after aminoglycoside treatment. We recommend routine assessment of adverse effects, including hearing loss and impairment of renal function, if possible at the start and after treatment with aminoglycosides, and that these data should be included in hospital patient safety surveillance and national quality registries.
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Affiliation(s)
- Håkan Hanberger
- Department of Clinical and Experimental Medicine, Infectious Diseases, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
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Eriksson A, Giske CG, Ternhag A. The relative importance ofStaphylococcus saprophyticusas a urinary tract pathogen: distribution of bacteria among urinary samples analysed during 1 year at a major Swedish laboratory. APMIS 2012; 121:72-8. [DOI: 10.1111/j.1600-0463.2012.02937.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2011] [Accepted: 05/23/2012] [Indexed: 11/27/2022]
Affiliation(s)
- Andreas Eriksson
- Section of Infectious Diseases; Department of Medicine; Karolinska Institutet; Solna; Sweden
| | - Christian G. Giske
- Clinical Microbiology; MTC; Karolinska Institutet; Karolinska University Hospital; Solna; Sweden
| | - Anders Ternhag
- Section of Infectious Diseases; Department of Medicine; Karolinska Institutet; Solna; Sweden
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Linde A, Ternhag A, Törner A, Claesson BE. Antibiotic prescriptions and laboratory-confirmed cases of Mycoplasma pneumoniae during the epidemic in Sweden in 2011. Euro Surveill 2012. [DOI: 10.2807/ese.17.06.20082-en] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Binary file ES_Abstracts_Final_ECDC.txt matches
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Affiliation(s)
- A Linde
- Department of Analysis and Prevention, Swedish Institute for Communicable Disease Control, Sweden
| | - A Ternhag
- Department of Analysis and Prevention, Swedish Institute for Communicable Disease Control, Sweden
| | - A Törner
- Department of Analysis and Prevention, Swedish Institute for Communicable Disease Control, Sweden
| | - B E Claesson
- Department of Clinical Microbiology, Unilabs AB, Kärnsjukhuset, Skövde, Sweden
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Linde A, Ternhag A, Torner A, Claesson B. Antibiotic prescriptions and laboratory-confirmed cases of Mycoplasma pneumoniae during the epidemic in Sweden in 2011. Euro Surveill 2012; 17:20082. [PMID: 22340974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
Swedish laboratories reported an increase of Mycoplasma pneumoniae during the autumn 2011. Data from the laboratory in Skövde, covering 12.9% of the Swedish population, indicate an approximate increase in the number of laboratory-confirmed cases in the whole country, from around 3,500 in 2009 to 11,100 in 2011. Antibiotics are recommended only for pneumonia, not bronchitis, but compared with the autumn 2009, 42,652 more prescriptions of doxycycline and macrolides were registered in the autumn 2011.
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Affiliation(s)
- A Linde
- Department of Analysis and Prevention, Swedish Institute for Communicable Disease Control, Sweden.
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Cars O, Mölstad S, Norman C, Ternhag A, André M, Erntell M. [National recommendations for the treatment of pharyngotonsillitis are valid]. Lakartidningen 2012; 109:108-109. [PMID: 22451987] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Ternhag A, Cars O, Norman C, Struwe J. [Antibiotics or not--procalcitonin can guide therapeutic choices. At least at the emergency department for adults with lower respiratory tract infection]. Lakartidningen 2010; 107:985-988. [PMID: 20464915] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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40
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Ternhag A. Larval therapy for leg ulcers. Compression may be key. BMJ 2009; 338:b2064. [PMID: 19474009 DOI: 10.1136/bmj.b2064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
Bacterial gastrointestinal infections are associated with short- and long-term complications from several organ systems. During 1997–2004, microbiologically confirmed gastrointestinal infections were reported for 101,855 patients in Sweden. Among patients who had Salmonella infection (n = 34,664), we found an increased risk for aortic aneurysm (standardized incidence ratio [SIR] 6.4, 95% confidence interval [CI] 3.1–11.8) within 3 months after infection and an elevated risk for ulcerative colitis (SIR 3.2, 95% CI 2.2–4.6) within 1 year after infection. We also found this elevated risk for ulcerative colitis among Campylobacter infections (n = 57,425; SIR 2.8, 95% CI 2.0–3.8). Within 1 year, we found an increased risk for reactive arthritis among patients with Yersinia enteritis (n = 5,133; SIR 47.0, 95% CI 21.5–89.2), Salmonella infection (SIR 18.2, 95% CI 12.0–26.5), and Campylobacter infection (SIR 6.3, 95% CI 3.5–10.4). Acute gastroenteritis is sometimes associated with disease manifestations from several organ systems that may require hospitalization of patients.
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Affiliation(s)
- Anders Ternhag
- Department of Medical Epidemiology and Biostatistics, Karolinska Institute, Stockholm, Sweden.
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Ternhag A, Asikainen T, Giesecke J, Ekdahl K. A meta-analysis on the effects of antibiotic treatment on duration of symptoms caused by infection with Campylobacter species. Clin Infect Dis 2007; 44:696-700. [PMID: 17278062 DOI: 10.1086/509924] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2006] [Accepted: 08/21/2006] [Indexed: 12/13/2022] Open
Abstract
Eleven randomized, controlled trials of antibiotic treatment versus placebo in patients with Campylobacter species infection were pooled in a meta-analysis. Antibiotic treatment shortened the duration of intestinal symptoms by 1.32 days (95% confidence interval, 0.64-1.99; P<.0001). Because of problems with drug resistance, a restrictive attitude towards the administration of antibiotics in uncomplicated cases is advised.
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Affiliation(s)
- Anders Ternhag
- Karolinska Institutet, Department of Medical Epidemiology and Biostatistics, Stockholm, Sweden.
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Abstract
We examined excess deaths after infection with Salmonella in a registry-based matched cohort study of 25,060 persons infected abroad and 5,139 infected within Sweden. The domestically infected have an increased standardized mortality ratio, whereas those who acquired Salmonella infection abroad had no excess risk of death.
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Affiliation(s)
- Anders Ternhag
- Swedish Institute for Infectious Disease Control, Solna, Sweden.
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Abstract
Patient organisations serve their members with information and support concerning a specific disease. In many cases they also contribute to research funding and lobby to improve the situation for their members. The larger group of patients an organisation claims to represent, the bigger their potential influence. Our hypothesis is that patient organisations exaggerate the number of persons affected with a specific disease. Prevalence figures from patient organisations in Sweden were collected via their own web sites. About 93 patient organisations were identified, 29 of which presented the estimates of disease occurrence used in this study. We calculated the probability for a person to have at least one disease and the proportion of the population not having any of the diseases listed. About 60% of the Swedish population have at least one disease covered by our sample of patient organisations. Nine tenths (87%) of the population would be ill if one assumes that an individual could only have one disease. Our rough estimates suggest that patient organisations exaggerate the number of ill persons. To render other messages on their agenda more trustworthy, we propose that some patient organisations moderate their prevalence and/or incidence figures.
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Affiliation(s)
- Anders Ternhag
- Department of Epidemiology, Swedish Institute for Infectious Disease Control, SE-171 82 Solna, Sweden.
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Ternhag A, Törner A, Svensson Å, Giesecke J, Ekdahl K. Mortality following Campylobacter infection: a registry-based linkage study. BMC Infect Dis 2005; 5:70. [PMID: 16162289 PMCID: PMC1236927 DOI: 10.1186/1471-2334-5-70] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2005] [Accepted: 09/14/2005] [Indexed: 12/02/2022] Open
Abstract
Background Campylobacteriosis is one of the most commonly identified causes of bacterial diarrheal disease and a common cause of gastroenteritis in travellers from developed nations. Despite the widespread occurrence, there is little information on Campylobacter mortality. Methods Mortality among a cohort of Campylobacter cases were compared with the general population 0–1, 1–3, 3–12 and more than 12 month after the onset of the illness. The cases were sub-grouped according to if they had been infected domestically or abroad. Results The standardized mortality ratio for cases infected domestically was 2.9 (95% CI: 1.9–4.0) within the first month following the illness. The risk then gradually diminished and approached 1.0 after one year or more have passed since the illness. This initial excess risk was not attributable to any particular age group (such as the oldest). In contrast, for those infected abroad, a lower standardized mortality ratio 0.3 (95% CI: 0.04–0.8) was shown for the first month after diagnosis compared to what would be expected in the general population. Conclusion Infection with Campylobacter is associated with an increased short-term risk of death among those who were infected domestically. On the contrary, for those infected abroad a lower than expected risk of death was evident. We suggest that the explanation behind this is a "healthy traveler effect" among imported cases, and effects of a more frail than average population among domestic cases.
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Affiliation(s)
- Anders Ternhag
- Department of Epidemiology, Swedish Institute for Infectious Disease Control, Solna, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Törner
- Department of Epidemiology, Swedish Institute for Infectious Disease Control, Solna, Sweden
| | - Åke Svensson
- Department of Epidemiology, Swedish Institute for Infectious Disease Control, Solna, Sweden
- Division of Mathematical Statistics, Stockholm University, Sweden
| | - Johan Giesecke
- Department of Epidemiology, Swedish Institute for Infectious Disease Control, Solna, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Karl Ekdahl
- Department of Epidemiology, Swedish Institute for Infectious Disease Control, Solna, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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Ternhag A, Penttinen P. [Nipah virus--another product from the Asian "virus factory"]. Lakartidningen 2005; 102:1046-7. [PMID: 15892474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
Affiliation(s)
- Anders Ternhag
- Avdelningen för epidemiologi, Smittskyddsinstitutet, Solna.
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Ternhag A, Tegnell A, Lesko B, Skaerlund K, Penttinen P. Basic Surveillance Network, a European database for surveillance data on infectious diseases. Euro Surveill 2004; 9:19-22. [PMID: 15318006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023] Open
Abstract
The Basic Surveillance Network was started in 2000 and is one of the networks on infectious diseases funded by the European Commission. The network collects and makes readily available basic surveillance data on infectious diseases from all the 'old' (pre-2004) European Union member states. The aim is to provide easy access to descriptive data that already exist in national databases, so that it is possible to monitor and compare incidence trends for infectious diseases in the EU member states. The list of diseases covered by the network has recently been expanded from 10 initial 'pilot' diseases to over 40 diseases listed by the EU to be under surveillance. In the near future, the new member states will be invited to participate in the network. Data are case-based and comprise date of onset of disease, age and sex. Only a very short list of disease specific additional variables, such as country of infection or immunisation status, is collected. Classification of cases (possible, probable, confirmed) is specified according to EU case definitions. The participants of the network have access to an internal web site were all the data is presented in tables and graphs. An open website is available for the public at https://www.eubsn.org./BSN/
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Affiliation(s)
- A Ternhag
- Swedish Institute for Infectious Disease Control, Stockholm, Sweden
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Ternhag A, Tegnell A, Lesko B, Skaerlund K, Penttinen P. Basic Surveillance Network, a European database for surveillance data on infectious diseases. Euro Surveill 2004; 9:1-2. [DOI: 10.2807/esm.09.07.00472-en] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The Basic Surveillance Network was started in 2000 and is one of the networks on infectious diseases funded by the European Commission. The network collects and makes readily available basic surveillance data on infectious diseases from all the 'old' (pre-2004) European Union member states. The aim is to provide easy access to descriptive data that already exist in national databases, so that it is possible to monitor and compare incidence trends for infectious diseases in the EU member states. The list of diseases covered by the network has recently been expanded from 10 initial 'pilot' diseases to over 40 diseases listed by the EU to be under surveillance. In the near future, the new member states will be invited to participate in the network. Data are case-based and comprise date of onset of disease, age and sex. Only a very short list of disease specific additional variables, such as country of infection or immunisation status, is collected. Classification of cases ( possible, probable, confirmed) is specified according to EU case definitions. The participants of the network have access to an internal web site were all the data is presented in tables and graphs. An open website is available for the public at https://www.eubsn.org./BSN/
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Affiliation(s)
- A Ternhag
- Swedish Institute for Infectious Disease Control, Stockholm, Sweden
| | - A Tegnell
- Swedish Institute for Infectious Disease Control, Stockholm, Sweden
| | - B Lesko
- Swedish Institute for Infectious Disease Control, Stockholm, Sweden
| | - K Skaerlund
- Swedish Institute for Infectious Disease Control, Stockholm, Sweden
| | - P Penttinen
- Swedish Institute for Infectious Disease Control, Stockholm, Sweden
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Ternhag A, Janzon R, Ekdahl K, Giesecke J. [Good guideline compliance among patients and health services when it comes to suspected SARS infection]. Lakartidningen 2004; 101:686-7. [PMID: 15024943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
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50
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Ekdahl K, Penttinen P, Ternhag A, Linde A, Giesecke J. [Avian influenza--next global infection threat from Asia]. Lakartidningen 2004; 101:683-5. [PMID: 15024942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/29/2023]
Affiliation(s)
- Karl Ekdahl
- Avdelningen för epidemiologi, Smittskyddsinstitutet, Solna.
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