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Bager P, Kähler J, Andersson M, Holzknecht BJ, Kjær Hansen SG, Schønning K, Nielsen KL, Koch K, Pinholt M, Voldstedlund M, Larsen AR, Kristensen B, Mølbak K, Sönksen UW, Skovgaard S, Skov R, Hammerum AM. Comparison of morbidity and mortality after bloodstream infection with vancomycin-resistant versus -susceptible Enterococcus faecium: a nationwide cohort study in Denmark, 2010-2019. Emerg Microbes Infect 2024; 13:2309969. [PMID: 38258968 DOI: 10.1080/22221751.2024.2309969] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Accepted: 01/19/2024] [Indexed: 01/24/2024]
Abstract
The emergence of bloodstream infections (BSI) caused by vancomycin-resistant Enterococci (VRE) has caused concern. Nonetheless, it remains unclear whether these types are associated with an excess risk of severe outcomes when compared with infections caused by vancomycin-susceptible Enterococci (VSE). This cohort study included hospitalized patients in Denmark with Enterococcus faecium-positive blood cultures collected between 2010 and 2019 identified in the Danish Microbiology Database. We estimated 30-day hazard ratio (HR) of death or discharge among VRE compared to VSE patients adjusted for age, sex, and comorbidity. The cohort included 6071 patients with E. faecium BSI (335 VRE, 5736 VSE) among whom VRE increased (2010-13, 2.6%; 2014-16, 6.3%; 2017-19; 9.4%). Mortality (HR 1.08, 95%CI 0.90-1.29; 126 VRE, 37.6%; 2223 VSE, 37.0%) or discharge (HR 0.89, 95%CI 0.75-1.06; 126 VRE, 37.6%; 2386 VSE, 41.6%) was not different between VRE and VSE except in 2014 (HR 1.87, 95% CI 1.18-2.96). There was no interaction between time from admission to BSI (1-2, 3-14, and >14 days) and HR of death (P = 0.14) or discharge (P = 0.45) after VRE compared to VSE, despite longer time for VRE patients (17 vs. 10 days for VSE, P < 0.0001). In conclusion, VRE BSI was not associated with excess morbidity and mortality. The excess mortality in 2014 only may be attributed to improved diagnostic- and patient-management practices after 2014, reducing time to appropriate antibiotic therapy. The high level of mortality after E. faecium BSI warrants further study.
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Affiliation(s)
- Peter Bager
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Jonas Kähler
- Department of Dataintegration and -Analysis, Statens Serum Institut, Copenhagen, Denmark
| | - Mikael Andersson
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Barbara Juliane Holzknecht
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Kristian Schønning
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Karen Leth Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Kristoffer Koch
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Mette Pinholt
- Department of Clinical Microbiology, Copenhagen University Hospital - Amager and Hvidovre, Copenhagen, Denmark
| | - Marianne Voldstedlund
- Department of Dataintegration and -Analysis, Statens Serum Institut, Copenhagen, Denmark
- Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Anders Rhod Larsen
- National Reference Laboratory for Antimicrobial Resistance, Statens Serum Institut, Copenhagen, Denmark
| | - Brian Kristensen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Kåre Mølbak
- Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
- Department of Veterinary and Animal Sciences, Faculty of Health, University of Copenhagen, Denmark
| | - Ute Wolff Sönksen
- National Reference Laboratory for Antimicrobial Resistance, Statens Serum Institut, Copenhagen, Denmark
| | - Sissel Skovgaard
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev and Gentofte, Herlev, Denmark
- National Reference Laboratory for Antimicrobial Resistance, Statens Serum Institut, Copenhagen, Denmark
| | - Robert Skov
- Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
- Department of Bacteria, Parasites, and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Anette M Hammerum
- National Reference Laboratory for Antimicrobial Resistance, Statens Serum Institut, Copenhagen, Denmark
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Årdal C, Baraldi E, Busse R, Castro R, Ciabuschi F, Cisneros JM, Gyssens IC, Harbarth S, Kostyanev T, Lacotte Y, Magrini N, McDonnell A, Monnier AA, Moon S, Mossialos E, Peñalva G, Ploy MC, Radulović M, Ruiz AA, Røttingen JA, Sharland M, Tacconelli E, Theuretzbacher U, Vogler S, Sönksen UW, Åkerfeldt K, Cars O, O'Neill J. Transferable exclusivity voucher: a flawed incentive to stimulate antibiotic innovation. Lancet 2024; 403:e2-e4. [PMID: 36774936 DOI: 10.1016/s0140-6736(23)00282-9] [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] [Received: 01/12/2023] [Accepted: 01/31/2023] [Indexed: 02/11/2023]
Affiliation(s)
- Christine Årdal
- Antimicrobial Resistance Centre, Norwegian Institute of Public Health, Oslo 0213, Norway.
| | - Enrico Baraldi
- Department of Engineering Sciences, Industrial Engineering and Management, Uppsala University, Uppsala, Sweden
| | - Reinhard Busse
- Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | - Rosa Castro
- European Public Health Alliance, Brussels, Belgium
| | | | - José Miguel Cisneros
- Department of Infectious Diseases, University Hospital Virgen del Rocio, IBiS, CIBERINFEC, Seville, Spain
| | - Inge C Gyssens
- Department of Internal Medicine, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | | | | | - Yohann Lacotte
- University of Limoges, INSERM, CHU Limoges, RESINFIT, Limoges, France
| | | | | | - Annelie A Monnier
- Department of Medical Microbiology, Radboudumc Center for Infectious Diseases, Radboud University Medical Center, Nijmegen, Netherlands
| | - Suerie Moon
- Graduate Institute of International and Development Studies, Geneva, Switzerland
| | - Elias Mossialos
- London School of Economics and Political Science, London, UK
| | - Germán Peñalva
- Institute of Biomedicine of Seville (IBiS), University of Seville/CSIC/University Hospital Virgen del Rocio, Seville, Spain
| | - Marie-Cécile Ploy
- University of Limoges, INSERM, CHU Limoges, RESINFIT, Limoges, France
| | - Momir Radulović
- Agency for Medicinal Products and Medical Devices of the Republic of Slovenia, Ljubljana, Slovenia
| | - Adrián Alonso Ruiz
- Graduate Institute of International and Development Studies, Geneva, Switzerland
| | | | - Michael Sharland
- Centre for Neonatal and Paediatric Infection, St George's University of London, London, UK
| | | | | | - Sabine Vogler
- Austrian National Public Health Institute, Vienna, Austria; Department of Health Care Management, Berlin University of Technology, Berlin, Germany
| | | | | | - Otto Cars
- ReAct Europe, Uppsala University, Uppsala, Sweden
| | - Jim O'Neill
- The Review on Antimicrobial Resistance, London, UK
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Moura P, Borck Høg B, Alban L, Sönksen UW, Ribeiro Duarte AS, Sandberg M. Evaluating the OH-EpiCap tool using the Danish integrated surveillance program for AMU and AMR as a case study. Front Public Health 2023; 11:1127701. [PMID: 38054067 PMCID: PMC10694429 DOI: 10.3389/fpubh.2023.1127701] [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] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 10/31/2023] [Indexed: 12/07/2023] Open
Abstract
Antimicrobial resistance (AMR) is considered a One Health (OH) challenge, ideally demanding concerted efforts from the animal, human and environmental side. DANMAP, the Danish Integrated Antimicrobial Resistance Monitoring and Research Program, is monitoring AMR and antimicrobial use in animals and humans. OH-EpiCap is an evaluation tool, developed to address essential elements in OH surveillance systems, such as the dimensions of the organization, operational activities and the impact of the surveillance activities. We aimed to evaluate DANMAP using OH-EpiCap and hereby assessed the suitability of OH-EpiCap to evaluate integrated AMR surveillance systems. During the evaluation, the strengths and weaknesses of DANMAP concerning the "OH-ness" of the program were discussed. Furthermore, possible adaptations of the standard operating procedures and governance structure were addressed. Attention was paid to the ability and easiness of DANMAP to cope with current and future challenges connected to integrated AMR surveillance. It was concluded that DANMAP has a strong OH approach covering relevant aspects for humans and animals, whereas environmental aspects are missing. OH-EpiCap proved to be straightforward to use and provided valuable insights. The authors recommend OH-EpiCap to be used by health authorities and stakeholders. It is not suitable for the technical evaluation of a surveillance program.
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Affiliation(s)
- Pedro Moura
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Birgitte Borck Høg
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
| | - Lis Alban
- Department for Food Safety, Veterinary Issues and Risk Analysis, Danish Agriculture and Food Council, Copenhagen, Denmark
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | | | | | - Marianne Sandberg
- National Food Institute, Technical University of Denmark, Lyngby, Denmark
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Mwatondo A, Rahman-Shepherd A, Hollmann L, Chiossi S, Maina J, Kurup KK, Hassan OA, Coates B, Khan M, Spencer J, Mutono N, Thumbi SM, Muturi M, Mutunga M, Arruda LB, Akhbari M, Ettehad D, Ntoumi F, Scott TP, Nel LH, Ellis-Iversen J, Sönksen UW, Onyango D, Ismail Z, Simachew K, Wolking D, Kazwala R, Sijali Z, Bett B, Heymann D, Kock R, Zumla A, Dar O. A global analysis of One Health Networks and the proliferation of One Health collaborations. Lancet 2023; 401:605-616. [PMID: 36682370 DOI: 10.1016/s0140-6736(22)01596-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 07/14/2022] [Accepted: 08/11/2022] [Indexed: 01/21/2023]
Abstract
There has been a renewed focus on threats to the human-animal-environment interface as a result of the COVID-19 pandemic, and investments in One Health collaborations are expected to increase. Efforts to monitor the development of One Health Networks (OHNs) are essential to avoid duplication or misalignment of investments. This Series paper shows the global distribution of existing OHNs and assesses their collective characteristics to identify potential deficits in the ways OHNs have formed and to help increase the effectiveness of investments. We searched PubMed, Google, Google Scholar, and relevant conference websites for potential OHNs and identified 184 worldwide for further analysis. We developed four case studies to show important findings from our research and exemplify best practices in One Health operationalisation. Our findings show that, although more OHNs were formed in the past 10 years than in the preceding decade, investment in OHNs has not been equitably distributed; more OHNs are formed and headquartered in Europe than in any other region, and emerging infections and novel pathogens were the priority focus area for most OHNs, with fewer OHNs focusing on other important hazards and pressing threats to health security. We found substantial deficits in the OHNs collaboration model regarding the diversity of stakeholder and sector representation, which we argue impedes effective and equitable OHN formation and contributes to other imbalances in OHN distribution and priorities. These findings are supported by previous evidence that shows the skewed investment in One Health thus far. The increased attention to One Health after the COVID-19 pandemic is an opportunity to focus efforts and resources to areas that need them most. Analyses, such as this Series paper, should be used to establish databases and repositories of OHNs worldwide. Increased attention should then be given to understanding existing resource allocation and distribution patterns, establish more egalitarian networks that encompass the breadth of One Health issues, and serve communities most affected by emerging, re-emerging, or endemic threats at the human-animal-environment interface.
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Affiliation(s)
- Athman Mwatondo
- Zoonotic Disease Unit, Ministry of Health, Nairobi, Kenya; International Livestock Research Institute, Nairobi, Kenya; Royal Institute of International Affairs, London, UK.
| | - Afifah Rahman-Shepherd
- London School of Hygiene & Tropical Medicine, London, UK; Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore; Royal Institute of International Affairs, London, UK
| | - Lara Hollmann
- Royal Institute of International Affairs, London, UK
| | - Scott Chiossi
- Royal Institute of International Affairs, London, UK
| | - Josphat Maina
- Zoonotic Disease Unit, Ministry of Health, Nairobi, Kenya; International Livestock Research Institute, Nairobi, Kenya
| | | | | | | | - Mishal Khan
- London School of Hygiene & Tropical Medicine, London, UK; Department of Community Health Sciences and Department of Pathology, Aga Khan University, Karachi, Pakistan; Royal Institute of International Affairs, London, UK
| | - Julia Spencer
- London School of Hygiene & Tropical Medicine, London, UK
| | - Nyamai Mutono
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya
| | - Samuel M Thumbi
- Paul G Allen School for Global Animal Health, Washington State University, Pullman, WA, USA; Center for Epidemiological Modelling and Analysis, University of Nairobi, Nairobi, Kenya; Institute of Immunology and Infection Research, University of Edinburgh, Edinburgh, UK
| | - Mathew Muturi
- Zoonotic Disease Unit, Ministry of Agriculture, Livestock, and Fisheries, Nairobi, Kenya; International Livestock Research Institute, Nairobi, Kenya
| | - Mumbua Mutunga
- Institute of Tropical and Infectious Diseases, University of Nairobi, Nairobi, Kenya
| | - Liã Bárbara Arruda
- Centre for Clinical Microbiology, Division of Infection and Immunity, University College London, London, UK
| | - Melika Akhbari
- Clinical Academic Training Office, University of Cambridge, Cambridge, UK
| | - Dena Ettehad
- Academic Foundation Programme, Faculty of Medicine, Imperial College London, Imperial College Healthcare NHS Trust, London, UK
| | - Francine Ntoumi
- Fondation Congolaise pour la Recherche Médicale, Brazzaville, Democratic Republic of the Congo; Institute for Tropical Medicine, University of Tübingen, Tübingen, Germany
| | | | - Louis H Nel
- Department of Biochemistry, Genetics, and Microbiology, University of Pretoria, Pretoria, South Africa
| | | | - Ute Wolff Sönksen
- National Centre for Antimicrobials and Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Diana Onyango
- The One Health for Humans, Environment, Animals and Livelihoods Project, Addis Ababa, Ethiopia
| | - Zuleka Ismail
- The One Health for Humans, Environment, Animals and Livelihoods Project, Addis Ababa, Ethiopia
| | - Kebadu Simachew
- The One Health for Humans, Environment, Animals and Livelihoods Project, Addis Ababa, Ethiopia
| | - David Wolking
- One Health Institute, University of California, Davis, CA, USA
| | - Rudovick Kazwala
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Zikankuba Sijali
- Department of Veterinary Medicine and Public Health, Sokoine University of Agriculture, Morogoro, Tanzania
| | - Bernard Bett
- International Livestock Research Institute, Nairobi, Kenya
| | - David Heymann
- Department of Infectious Disease Epidemiology, London, UK
| | - Richard Kock
- Royal Veterinary College, University of London, London, UK
| | - Alimuddin Zumla
- Department of Infection, Division of Infection and Immunity, University College London, London, UK; National Institute for Health and Care Research Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Osman Dar
- Global Health Programme, Royal Institute of International Affairs, London, UK; Global Operations, UK Health Security Agency, London, UK
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Krogsgaard LW, Espenhain L, Tribler S, Sværke Jørgensen C, Hansen CH, Møller FT, Glode Helmuth I, Sönksen UW, Vangsted AM, Ullum H, Ethelberg S. Seroprevalence of SARS-CoV-2 Antibodies in Denmark: Results of Two Nationwide Population-Based Surveys, February and May 2021. Infect Drug Resist 2023; 16:301-312. [PMID: 36683911 PMCID: PMC9851711 DOI: 10.2147/idr.s383491] [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] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Accepted: 12/14/2022] [Indexed: 01/15/2023] Open
Abstract
Background Seroprevalence studies can be used to measure the progression of national COVID-19 epidemics. The Danish National Seroprevalence Survey of SARS-CoV-2 infections (DSS) was conducted as five separate surveys between May 2020 and May 2021. Here, we present results from the two last surveys conducted in February and May 2021. Methods Persons aged 12 or older were randomly selected from the Danish Population Register and those having received COVID-19 vaccination subsequently excluded. Invitations to have blood drawn in local test centers were sent by mail. Samples were analyzed for whole Immunoglobulin by ELISA. Seroprevalence was estimated by sex, age and geography. Comparisons to vaccination uptake and RT-PCR test results were made. Results In February 2021, we found detectable antibodies in 7.2% (95% CI: 6.3-7.9%) of the invited participants (participation rate 25%) and in May 2021 in 8.6% (95% CI: 7.6-9.5%) of the invited (participation rate: 14%). Seroprevalence did not differ by sex, but by age group, generally being higher among the <50 than 50+ year-olds. In May 2021, levels of seroprevalence varied from an estimated 13% (95% CI: 12-15%) in the capital to 5.2% (95% CI: 3.4-7.4%) in rural areas. Combining seroprevalence results with vaccine coverage, estimates of protection against infection in May 2021 varied from 95% among 65+ year-olds down to 10-20% among 12-40 year-olds. In March-May 2021, an estimated 80% of all community SARS-CoV-2 infections were diagnosed by RT-PCR and captured by surveillance. Conclusion Seroprevalence estimates doubled during the 2020-21 winter wave of SARS-CoV-2 infections and then stabilized as vaccinations were rolled out. The epidemic affected large cities and younger people the most. Denmark saw comparatively low infections rates, but high test coverage; an estimated four out of five infections were detected by RT-PCR in March-May 2021.
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Affiliation(s)
- Lene Wulff Krogsgaard
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Laura Espenhain
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Siri Tribler
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | | | - Christian Holm Hansen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Frederik Trier Møller
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Ida Glode Helmuth
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Ute Wolff Sönksen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark,TestCentre Denmark, Statens Serum Institut, Copenhagen, Denmark
| | | | - Henrik Ullum
- Division of Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Steen Ethelberg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark,Correspondence: Steen Ethelberg, Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, 5 Artillerivej, 2300 Copenhagen, Denmark, Tel +45 3268 3545, Email
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Skajaa N, Gehrt L, Nieminen H, Laake I, Englund H, Sönksen UW, Feiring B, Benn CS, Trogstad L, Palmu AA, Sørup S. Trends in Antibiotic Use in Danish, Finnish, Norwegian and Swedish Children. Clin Epidemiol 2022; 14:937-947. [PMID: 35966903 PMCID: PMC9369097 DOI: 10.2147/clep.s362262] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2022] [Accepted: 06/30/2022] [Indexed: 11/23/2022] Open
Abstract
Objective To compare the use of antibiotics in children in four Northern European countries. Methods We conducted a register-based study based on individual-level prescription data from national prescription registers. We identified all redeemed outpatient prescriptions for systemic antibiotics in children aged 0–14 years from July 2006 to June 2017 in Denmark, Finland, Norway, and Sweden. We computed incidence rates and incidence rate ratios of treatment episodes with any antibiotic and different antibiotic classes. Results In 2016/2017, the rates of antibiotic treatment episodes per 1000 person-years in children aged 0–14 years were 429, 284, 219, and 184 in Finland, Denmark, Sweden, and Norway, respectively, and the rate ratios (95% confidence intervals) compared with Norway were 2.33 (2.33–2.34), 1.54 (1.54–1.55), and 1.19 (1.19–1.20) in Finland, Denmark, and Sweden, respectively. The rate of antibiotic treatment episodes declined over time in all countries. The relative reductions in 2016/2017 compared with 2006/2007 were 36% in Finland, 40% in Denmark, 49% in Sweden, and 29% in Norway. Treatment episodes peaked between age 12 and 18 months. The most used antibiotic class was beta-lactamase sensitive penicillins among all children in Norway and Sweden and among children above two years in Denmark, while penicillins with extended spectrum were most used in Finland and among the youngest children in Denmark. Conclusion In all countries, the use of antibiotics in children declined between 2006 and 2017. However, there were still considerable differences in antibiotic use between otherwise quite similar Nordic countries, with a more than 2-fold difference between the countries with the lowest and highest rates. Interventions to reduce the number of antibiotic treatment episodes in the countries with higher rates could reduce the total antibiotic use.
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Affiliation(s)
- Nils Skajaa
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, Open Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Lise Gehrt
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, Open Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
| | - Heta Nieminen
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland
| | - Ida Laake
- Division of Infection Control and Environmental Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Hélène Englund
- Unit for Vaccination Programmes, Public Health Agency of Sweden, Solna, Sweden
| | - Ute Wolff Sönksen
- Reference Laboratory for Antimicrobial Resistance, Infection Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Berit Feiring
- Division of Infection Control and Environmental Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Christine Stabell Benn
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Bandim Health Project, Open Patient Data Explorative Network, Odense University Hospital/Department of Clinical Research, University of Southern Denmark, Odense C, Denmark
- Danish Institute for Advanced Study, University of Southern Denmark, Odense C, Denmark
| | - Lill Trogstad
- Division of Infection Control and Environmental Health, The Norwegian Institute of Public Health, Oslo, Norway
| | - Arto A Palmu
- Department of Public Health and Welfare, Finnish Institute for Health and Welfare, Tampere, Finland
| | - Signe Sørup
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Research Center for Vitamins and Vaccines, Statens Serum Institut, Copenhagen, Denmark
- Correspondence: Signe Sørup, Department of Clinical Epidemiology, Aarhus University Hospital, Olof Palmes Allé 43-45, Aarhus N, 8200, Denmark, Email
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7
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Fogh K, Strange JE, Scharff BFSS, Eriksen ARR, Hasselbalch RB, Bundgaard H, Nielsen SD, Jørgensen CS, Erikstrup C, Norsk J, Nielsen PB, Kristensen JH, Østergaard L, Ellermann-Eriksen S, Andersen B, Nielsen H, Johansen IS, Wiese L, Simonsen L, Fischer TK, Folke F, Lippert F, Ostrowski SR, Benfield T, Mølbak K, Ethelberg S, Koch A, Sönksen UW, Vangsted AM, Krause TG, Fomsgaard A, Ullum H, Skov R, Iversen K. Testing Denmark: a Danish Nationwide Surveillance Study of COVID-19. Microbiol Spectr 2021; 9:e0133021. [PMID: 34908473 PMCID: PMC8672904 DOI: 10.1128/spectrum.01330-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [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] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022] Open
Abstract
"Testing Denmark" is a national, large-scale, epidemiological surveillance study of SARS-CoV-2 in the Danish population. Between September and October 2020, approximately 1.3 million people (age >15 years) were randomly invited to fill in an electronic questionnaire covering COVID-19 exposures and symptoms. The prevalence of SARS-CoV-2 antibodies was determined by point-of care rapid test (POCT) distributed to participants' home addresses. In total, 318,552 participants (24.5% invitees) completed the study and 2,519 (0.79%) were seropositive. Of the participants with a prior positive PCR test (n = 1,828), 29.1% were seropositive in the POCT. Although seropositivity increased with age, participants 61 years and over reported fewer symptoms and were tested less frequently. Seropositivity was associated with physical contact with SARS-CoV-2 infected individuals (risk ratio [RR] 7.43, 95% CI: 6.57-8.41), particular in household members (RR 17.70, 95% CI: 15.60-20.10). A greater risk of seropositivity was seen in home care workers (RR 2.09, 95% CI: 1.58-2.78) compared to office workers. A high degree of adherence with national preventive recommendations was reported (e.g., >80% use of face masks), but no difference were found between seropositive and seronegative participants. The seroprevalence result was somewhat hampered by a lower-than-expected performance of the POCT. This is likely due to a low sensitivity of the POCT or problems reading the test results, and the main findings therefore relate to risk associations. More emphasis should be placed on age, occupation, and exposure in local communities. IMPORTANCE To date, including 318,522 participants, this is the largest population-based study with broad national participation where tests and questionnaires have been sent to participants' homes. We found that more emphasis from national and local authorities toward the risk of infection should be placed on age of tested individuals, type of occupation, as well as exposure in local communities and households. To meet the challenge that broad nationwide information can be difficult to gather. This study design sets the stage for a novel way of conducting studies. Additionally, this study design can be used as a supplementary model in future general test strategy for ongoing monitoring of COVID-19 immunity in the population, both from past infection and from vaccination against SARS-CoV-2, however, with attention to the complexity of performing and reading the POCT at home.
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Affiliation(s)
- Kamille Fogh
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jarl E Strange
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bibi F S S Scharff
- Department of Clinical Immunology, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alexandra R R Eriksen
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus B Hasselbalch
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne D Nielsen
- Department of Infectious Diseases, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Christian Erikstrup
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Infectious Diseases, Aarhus University Hospitalgrid.154185.c, Aarhus, Denmark
| | - Jakob Norsk
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Brok Nielsen
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jonas H Kristensen
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Østergaard
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Infectious Diseases, Aarhus University Hospitalgrid.154185.c, Aarhus, Denmark
| | - Svend Ellermann-Eriksen
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Clinical Microbiology, Aarhus University Hospitalgrid.154185.c, Aarhus, Denmark
| | - Berit Andersen
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Odense, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospitalgrid.7143.1, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Lone Simonsen
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Thea K Fischer
- Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark
- Department of Public health, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospitalgrid.4973.9, Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kåre Mølbak
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Steen Ethelberg
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Public health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Koch
- Department of Infectious Diseases, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Henrik Ullum
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
| | - Robert Skov
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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8
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Umair M, Mohsin M, Sönksen UW, Walsh TR, Kreienbrock L, Laxminarayan R. Measuring Antimicrobial Use Needs Global Harmonization. Glob Chall 2021; 5:2100017. [PMID: 34631149 PMCID: PMC8495560 DOI: 10.1002/gch2.202100017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Revised: 05/12/2021] [Indexed: 06/13/2023]
Abstract
Global health and global economies are predicted to be severely affected by antimicrobial resistance (AMR). The three organizations World Health Organization/World Organisation for Animal Health/Food and Agriculture Organization (WHO/OIE/FAO) are working in their domains to prevent any future AMR crisis. Antimicrobial use (AMU), especially in food animals, is contributing to the development and dissemination of AMR bacteria and genes. AMU monitoring is a strategic objective of the global and national action plans on AMR. However, the AMU reporting metrics at different levels are not harmonized yet, posing difficulties in comparisons among AMU data from different sources. A tripartite WHO/OIE/FAO collaboration is urgently required to develop and implement a globally accepted AMU metric system to ensure reliable comparisons among various data sets.
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Affiliation(s)
- Muhammad Umair
- Institute of MicrobiologyUniversity of AgricultureFaisalabad38000Pakistan
| | - Mashkoor Mohsin
- Institute of MicrobiologyUniversity of AgricultureFaisalabad38000Pakistan
| | | | - Timothy Rutland Walsh
- Department of ZoologyINEOS Oxford Institute for AMR ResearchUniversity of OxfordOxfordOX1 3SZUK
| | - Lothar Kreienbrock
- Department for BiometryEpidemiology and Information ProcessingUniversity of Veterinary Medicine Hannover30559HannoverGermany
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9
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Espenhain L, Tribler S, Sværke Jørgensen C, Holm Hansen C, Wolff Sönksen U, Ethelberg S. Prevalence of SARS-CoV-2 antibodies in Denmark: nationwide, population-based seroepidemiological study. Eur J Epidemiol 2021; 36:715-725. [PMID: 34420152 PMCID: PMC8380416 DOI: 10.1007/s10654-021-00796-8] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [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] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 08/04/2021] [Indexed: 12/23/2022]
Abstract
Seroprevalence studies have proven an important tool to monitor the progression of the coronavirus disease 2019 (COVID-19) pandemic. We present results of consecutive population-based seroprevalence surveys performed in Denmark in 2020. In spring, late summer and autumn/winter of 2020, invitation letters including a questionnaire covering symptoms were sent to representative samples of the population above 12 years and to parents of children below 18 years in the sample. Blood samples were analysed for total Ig and seroprevalence estimates per population segment were calculated and compared to other surveillance parameters. Based on 34 081 participants (participation rate 33%), seroprevalence estimates increased from 1.2% (95%CI: 0.3-1.9%) in May to 4.1% (95%CI: 3.1-4.9%) in December 2020. Seroprevalence estimates were roughly three times higher in those aged 12-29 years compared to 65 + and higher in metropolitan municipalities. By December 2020, 1.5% of the population had tested positive by RT-PCR. Infected individuals in older age groups were hospitalised several fold more often than in younger. Amongst seropositives, loss of taste/smell were the more specific symptoms, 32-56% did not report any symptoms. In more than half of seroconverted families, we did not see evidence of transmission between generations. Seroprevalence increased during 2020; adolescents were primarily infected in the autumn/winter. Denmark has a high per capita test rate; roughly one undiagnosed infection of SARS-CoV-2 were estimated to occur for each diagnosed case. Approximately half were asymptomatically infected. The epidemic appears to have progressed relatively modestly during 2020 in Denmark.
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Affiliation(s)
- Laura Espenhain
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark.
| | - Siri Tribler
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - Charlotte Sværke Jørgensen
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - Christian Holm Hansen
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - Ute Wolff Sönksen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark
| | - Steen Ethelberg
- Department of Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen S, Denmark
- Department of Public Health, Global Health Section, University of Copenhagen, Øster Farimagsgade 5, 1014, Copenhagen K, Denmark
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10
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Möller V, Östholm-Balkhed Å, Berild D, Fredriksson M, Gottfredsson M, Holmbom M, Järvinen A, Kristjansson M, Rydell U, Sönksen UW, Kolmos HJ, Hanberger H. Antibiotic resistance among major pathogens compared to hospital treatment guidelines and antibiotic use in Nordic hospitals 2010-2018. Infect Dis (Lond) 2021; 53:607-618. [PMID: 33970737 DOI: 10.1080/23744235.2021.1910338] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 12/12/2022] Open
Abstract
BACKGROUND The Nordic countries have comparable nationwide antibiotic resistance surveillance systems and individual antibiotic stewardship programmes. The aim of this study was to assess antibiotic resistance among major pathogens in relation to practice guidelines for hospital antibiotic treatment and antibiotic use in Nordic countries 2010-2018. METHODS Antibiotic resistance among invasive isolates from 2010-2018 and aggregated antibiotic use were obtained from the European Centre for Disease Prevention and Control. Hospital practice guidelines were obtained from national or regional guidelines. RESULTS Antibiotic resistance levels among Escherichia coli and Klebsiella pneumoniae were similar in all Nordic countries in 2018 and low compared to the European mean. Guidelines for acute pyelonephritis varied; 2nd generation cephalosporin (Finland), 3rd generation cephalosporins (Sweden, Norway), ampicillin with an aminoglycoside or aminoglycoside monotherapy (Denmark, Iceland and Norway). Corresponding guidelines for sepsis of unknown origin were 2nd (Finland) or 3rd (Sweden, Norway, Iceland) generation cephalosporins, carbapenems, (Sweden) combinations of penicillin with an aminoglycoside (Norway, Denmark), or piperacillin-tazobactam (all Nordic countries). Methicillin-resistant Staphylococcus aureus rates were 0-2% and empirical treatment with anti-MRSA antibiotics was not recommended in any country. Rates of penicillin non-susceptibility among Streptococcus pneumoniae were low (<10%) except in Finland and Iceland (<15%), but benzylpenicillin was recommended for community-acquired pneumonia in all countries. CONCLUSION Despite similar resistance rates among Enterobacteriaceae there were differences in practice guidelines for pyelonephritis and sepsis. National surveillance of antibiotic resistance can be used for comparison and optimization of guidelines and stewardship interventions to preserve the low levels of antibiotic resistance in Nordic countries.
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Affiliation(s)
- Vidar Möller
- Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Åse Östholm-Balkhed
- Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Dag Berild
- Department of Infectious Diseases, Oslo University Hospital, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mats Fredriksson
- Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Magnus Gottfredsson
- Landspitali University Hospital, Reykjavik, Iceland.,University of Iceland, Reykjavik, Iceland
| | - Martin Holmbom
- Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | - Asko Järvinen
- Division of Infectious Diseases, Helsinki University Hospital and Helsinki University, Helsinki, Finland
| | - Mar Kristjansson
- Landspitali University Hospital, Reykjavik, Iceland.,University of Iceland, Reykjavik, Iceland
| | - Ulf Rydell
- Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
| | | | | | - Håkan Hanberger
- Department of Biomedical and Clinical Sciences, Faculty of Medicine, Linköping University, Linköping, Sweden
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11
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Larsen HD, Fonager J, Lomholt FK, Dalby T, Benedetti G, Kristensen B, Urth TR, Rasmussen M, Lassaunière R, Rasmussen TB, Strandbygaard B, Lohse L, Chaine M, Møller KL, Berthelsen ASN, Nørgaard SK, Sönksen UW, Boklund AE, Hammer AS, Belsham GJ, Krause TG, Mortensen S, Bøtner A, Fomsgaard A, Mølbak K. Preliminary report of an outbreak of SARS-CoV-2 in mink and mink farmers associated with community spread, Denmark, June to November 2020. ACTA ACUST UNITED AC 2021; 26. [PMID: 33541485 PMCID: PMC7863232 DOI: 10.2807/1560-7917.es.2021.26.5.210009] [Citation(s) in RCA: 92] [Impact Index Per Article: 30.7] [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] [Indexed: 01/05/2023]
Abstract
In June–November 2020, SARS-CoV-2-infected mink were detected in 290 of 1,147 Danish mink farms. In North Denmark Region, 30% (324/1,092) of people found connected to mink farms tested SARS-CoV-2-PCR-positive and approximately 27% (95% confidence interval (CI): 25–30) of SARS-CoV-2-strains from humans in the community were mink-associated. Measures proved insufficient to mitigate spread. On 4 November, the government ordered culling of all Danish mink. Farmed mink constitute a potential virus reservoir challenging pandemic control.
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Affiliation(s)
| | | | | | - Tine Dalby
- Statens Serum Institut, Copenhagen, Denmark
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - Anette Ella Boklund
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne Sofie Hammer
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Graham J Belsham
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Sten Mortensen
- Department of Animal Health, Danish Veterinary and Food administration, Copenhagen, Denmark
| | - Anette Bøtner
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Statens Serum Institut, Copenhagen, Denmark
| | | | - Kåre Mølbak
- Department of Veterinary and Animal Sciences, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Statens Serum Institut, Copenhagen, Denmark
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12
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Belkessa S, Ait-Salem E, Laatamna A, Houali K, Sönksen UW, Hakem A, Bouchene Z, Ghalmi F, Stensvold CR. Prevalence and Clinical Manifestations of Giardia intestinalis and Other Intestinal Parasites in Children and Adults in Algeria. Am J Trop Med Hyg 2021; 104:910-916. [PMID: 33534771 DOI: 10.4269/ajtmh.20-0187] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2020] [Accepted: 09/06/2020] [Indexed: 11/07/2022] Open
Abstract
Giardia intestinalis is one of the most common causes of parasite-induced diarrhea, abdominal pain, flatulence, and malabsorption. Yet, data on the epidemiology of G. intestinalis infections in North Africa are limited. The purpose of this study was to carry out a retrospective survey on the level of intestinal parasitism with a particular emphasis on G. intestinalis in children and adults in Algiers, Algeria. A total of 2,054 individuals from outpatient clinics or hospitalized at Beni-Messous University Hospital of Algiers undergoing stool microscopy for ova and parasites were included. The overall parasite infection rate was 28%. In the 567 parasite-positive samples, Blastocystis was found most frequently (57.3%), followed in frequency by Endolimax nana (41.0%), Entamoeba histolytica/dispar (19.6%), G. intestinalis (17.1%), Entamoeba coli (13.9%), Chilomastix mesnili (1.0%), Iodamoeba bütschlii (0.7%), Entamoeba hartmanni (0.5%), and Cryptosporidium spp. (0.2%). Intestinal parasites were generally more common in adults than in children, except for Giardia, which was more common in children (P = 0.0001). Giardia infection was independent of gender (P = 0.94). Compared with other intestinal parasitic infections, clinical manifestations, such as abdominal pain (P = 0.28) and diarrhea (P = 0.82), were found not to be significantly linked to Giardia infection. In conclusion, G. intestinalis is common in individuals referred to the University Hospital of Beni-Messous with digestive symptoms, particularly so in children. However, in our study, intestinal symptoms appeared not to be more linked to Giardia than to other intestinal parasites.
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Affiliation(s)
- Salem Belkessa
- 1Department of Biochemistry and Microbiology, Laboratory of Analytical Biochemistry and Biotechnology (LABAB), Faculty of Biological and Agronomic Sciences, Mouloud Mammeri University of Tizi Ouzou, Tizi Ouzou, Algeria.,2Department of Natural and Life Sciences, Faculty of Exact Sciences and Natural and Life Sciences, Mohamed Khider University of Biskra, Biskra, Algeria.,3Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Elhosseyn Ait-Salem
- 1Department of Biochemistry and Microbiology, Laboratory of Analytical Biochemistry and Biotechnology (LABAB), Faculty of Biological and Agronomic Sciences, Mouloud Mammeri University of Tizi Ouzou, Tizi Ouzou, Algeria
| | - AbdElkarim Laatamna
- 4Laboratory of Exploration and Valorisation of Steppe Ecosystems, Faculty of Nature and Life Sciences, University of Djelfa, Djelfa, Algeria
| | - Karim Houali
- 1Department of Biochemistry and Microbiology, Laboratory of Analytical Biochemistry and Biotechnology (LABAB), Faculty of Biological and Agronomic Sciences, Mouloud Mammeri University of Tizi Ouzou, Tizi Ouzou, Algeria
| | - Ute Wolff Sönksen
- 3Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Ahcene Hakem
- 4Laboratory of Exploration and Valorisation of Steppe Ecosystems, Faculty of Nature and Life Sciences, University of Djelfa, Djelfa, Algeria.,5Center Research in Agropastoralism, Djelfa, Algeria
| | - Zahida Bouchene
- 6Faculty of Medicine, University of Algiers, Algiers, Algeria
| | - Farida Ghalmi
- 7Higher National Veterinary School of Algiers, Algiers, Algeria
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13
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Vandenbroucke-Grauls CMJE, Kahlmeter G, Kluytmans J, Kluytmans-van den Bergh M, Monnet DL, Simonsen GS, Skov RL, Wolff Sönksen U, Voss A. The proposed Drug Resistance Index (DRI) is not a good measure of antibiotic effectiveness in relation to drug resistance. BMJ Glob Health 2019; 4:e001838. [PMID: 31543998 PMCID: PMC6730578 DOI: 10.1136/bmjgh-2019-001838] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2019] [Revised: 07/24/2019] [Accepted: 07/27/2019] [Indexed: 02/01/2023] Open
Affiliation(s)
| | - Gunnar Kahlmeter
- The EUCAST Development Laboratory and Clinical Microbiology, Central Hospital in Vaxjo, Vaxjo, Sweden
| | - Jan Kluytmans
- Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands.,Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | - Marjolein Kluytmans-van den Bergh
- Julius Center for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands.,Department of Infection Control, Amphia Hospital, Breda, The Netherlands
| | - Dominique L Monnet
- Office of the Chief Scientist, European Centre for Disease Prevention and Control, Solna, Sweden
| | - Gunnar Skov Simonsen
- Department of Clinical Microbiology, University Hospital of North Norway, UiT Arctic University of Norway, Tromso, Norway
| | - Robert L Skov
- Division of Infectious Disease Preparedness, Statens Serum Institut, Kobenhavn, Denmark
| | - Ute Wolff Sönksen
- Reference Laboratory for Antimicrobial Resistance, Infection Preparedness, Statens Serum Institut, Kobenhavn, Denmark
| | - Andreas Voss
- Department of Medical Microbiology, Radboudumc, Nijmegen, The Netherlands.,Canisius Wilhelmina Hospital, Nijmegen, The Netherlands
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14
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Roer L, Hansen F, Stegger M, Sönksen UW, Hasman H, Hammerum AM. Novel mcr-3 variant, encoding mobile colistin resistance, in an ST131 Escherichia coli isolate from bloodstream infection, Denmark, 2014. Euro Surveill 2017; 22. [PMID: 28797324] [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] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Indexed: 06/07/2023] Open
Abstract
A novel variant of the plasmid-borne colistin resistance gene mcr-3 was detected on an IncHI2 plasmid in an ST131 CTX-M-55-producing Escherichia coli isolate from a Danish patient with bloodstream infection in 2014. The discovery of novel plasmid-borne genes conferring resistance to colistin is of special interest since colistin has reemerged as an important drug in the treatment of infections with multidrug-resistant Gram-negative bacteria.
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Affiliation(s)
- Louise Roer
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Frank Hansen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Marc Stegger
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Ute Wolff Sönksen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Henrik Hasman
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Anette M Hammerum
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
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15
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Roer L, Hansen F, Stegger M, Sönksen UW, Hasman H, Hammerum AM. Novel mcr-3 variant, encoding mobile colistin resistance, in an ST131 Escherichia coli isolate from bloodstream infection, Denmark, 2014. Euro Surveill 2017. [PMCID: PMC5553058 DOI: 10.2807/1560-7917.es.2017.22.31.30584] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
A novel variant of the plasmid-borne colistin resistance gene mcr-3 was detected on an IncHI2 plasmid in an ST131 CTX-M-55-producing Escherichia coli isolate from a Danish patient with bloodstream infection in 2014. The discovery of novel plasmid-borne genes conferring resistance to colistin is of special interest since colistin has reemerged as an important drug in the treatment of infections with multidrug-resistant Gram-negative bacteria.
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Affiliation(s)
- Louise Roer
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Frank Hansen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Marc Stegger
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Ute Wolff Sönksen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Henrik Hasman
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Anette M Hammerum
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
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16
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Wang M, Ellermann-Eriksen S, Hansen DS, Kjerulf A, Fuglsang-Damgaard D, Holm A, Østergaard C, Røder B, Sönksen UW, Detlefsen M, Hansen F, Hasman H, Hammerum A, Skov RL. [Epidemic increase in the incidence of carbapenemase-producing Enterobacteriaceae in Denmark]. Ugeskr Laeger 2016; 178:V06160422. [PMID: 27855770] [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: 06/06/2023]
Abstract
Carbapenemase-producing Enterobacteriaceae (CPE) are extremely multiresistant bacteria with few or no treatment options. Infections with CPE are associated with a mortality of 40-50%. In Denmark, CPE were first detected in 2008. Prior to 2013 the CPE incidence was low, but since then the incidence has increased significantly. Seven outbreaks have occurred, and at least 25 patients have been infected or colonized. The rise in CPE incidence emphasizes the need for a national intervention to reduce the spread. This can be obtained through systematic surveillance, infection control and reduction of antibiotic consumption.
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17
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Sönksen UW, Christensen JJ, Nielsen L, Hesselbjerg A, Hansen DS, Bruun B. Fastidious Gram-Negatives: Identification by the Vitek 2 Neisseria-Haemophilus Card and by Partial 16S rRNA Gene Sequencing Analysis. Open Microbiol J 2010; 4:123-31. [PMID: 21347215 PMCID: PMC3043276 DOI: 10.2174/1874285801004010123] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2010] [Revised: 10/31/2010] [Accepted: 11/02/2010] [Indexed: 11/22/2022] Open
Abstract
Taxonomy and identification of fastidious Gram negatives are evolving and challenging. We compared identifications achieved with the Vitek 2 Neisseria-Haemophilus (NH) card and partial 16S rRNA gene sequence (526 bp stretch) analysis with identifications obtained with extensive phenotypic characterization using 100 fastidious Gram negative bacteria. Seventy-five strains represented 21 of the 26 taxa included in the Vitek 2 NH database and 25 strains represented related species not included in the database. Of the 100 strains, 31 were the type strains of the species. Vitek 2 NH identification results: 48 of 75 database strains were correctly identified, 11 strains gave `low discrimination´, seven strains were unidentified, and nine strains were misidentified. Identification of 25 non-database strains resulted in 14 strains incorrectly identified as belonging to species in the database. Partial 16S rRNA gene sequence analysis results: For 76 strains phenotypic and sequencing identifications were identical, for 23 strains the sequencing identifications were either probable or possible, and for one strain only the genus was confirmed. Thus, the Vitek 2 NH system identifies most of the commonly occurring species included in the database. Some strains of rarely occurring species and strains of non-database species closely related to database species cause problems. Partial 16S rRNA gene sequence analysis performs well, but does not always suffice, additional phenotypical characterization being useful for final identification.
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Affiliation(s)
- Ute Wolff Sönksen
- Department of Clinical Microbiology, Hillerød Hospital, Hillerød, Denmark
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Ibler K, Truberg Jensen K, Ostergaard C, Sönksen UW, Bruun B, Schønheyder HC, Kemp M, Dargis R, Andresen K, Christensen JJ. Six cases of Aerococcus sanguinicola infection: clinical relevance and bacterial identification. ACTA ACUST UNITED AC 2009; 40:761-5. [PMID: 19086249 DOI: 10.1080/00365540802078059] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Aerococcus sanguinicola is a Gram-positive coccus first described in 2001. Infections in humans are rare but the use of 16S rRNA gene sequencing and improved phenotypic methods has facilitated the identification of A. sanguinicola. We report here 6 cases of A. sanguinicola bacteraemia, 2 of which were associated with infective endocarditis. Most patients were elderly (median age 70 y) and had underlying neurological disorders including dementia, cerebral degeneration, and myelomeningocele. The primary focus of infection was the urinary tract in 3 cases and the gallbladder in 1; no focus was detected in 2 cases. Long-term prognosis was poor reflecting the frailty of the patients. All strains were susceptible to penicillin, ampicillin, cefuroxime, vancomycin, erythromycin, and rifampicin. The optimal treatment of infection with A. sanguinicola has yet to be determined.
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Affiliation(s)
- Kristina Ibler
- Department of Bacteriology, Mycology and Parasitology, Statens Serum Institute, Copenhagen, Denmark.
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Abstract
Erysipelas and bacteraemia with what initially was diagnosed as a non-haemolytic streptococcus is reported. As neither colony morphology nor clinical picture was characteristic of non-haemolytic streptococci, the isolate was sent to a reference laboratory. 16S rRNA sequencing and phenotypic characterization identified the strain as a streptolysin S-deficient S. pyogenes..
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Affiliation(s)
- Ute Wolff Sönksen
- Department of Clinical Microbiology, Hillerød Sygehus, Copenhagen, Denmark.
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