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Inghammar M, Kahn F. Immune evasiveness of SARS-CoV-2 variants and vaccine selection. Lancet Infect Dis 2024:S1473-3099(24)00286-X. [PMID: 38761805 DOI: 10.1016/s1473-3099(24)00286-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2024] [Accepted: 04/16/2024] [Indexed: 05/20/2024]
Affiliation(s)
- Malin Inghammar
- Infection Medicine, Department of Clinical Sciences Lund, Lund University, 22185 Lund, Sweden; Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden; Epidemiology, Population Studies and Infrastructures (EPI@LUND), Department of Laboratory Medicine, Lund University, Lund, Sweden.
| | - Fredrik Kahn
- Infection Medicine, Department of Clinical Sciences Lund, Lund University, 22185 Lund, Sweden; Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden; Epidemiology, Population Studies and Infrastructures (EPI@LUND), Department of Laboratory Medicine, Lund University, Lund, Sweden
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Kahn F, Bonander C, Moghaddassi M, Christiansen CB, Bennet L, Malmqvist U, Inghammar M, Björk J. Previous SARS-CoV-2 infections and their impact on the protection from reinfection during the Omicron BA.5 wave - a nested case-control study among vaccinated adults in Sweden. IJID Reg 2024; 10:235-239. [PMID: 38532742 PMCID: PMC10964055 DOI: 10.1016/j.ijregi.2024.02.004] [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] [Figures] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Revised: 02/23/2024] [Accepted: 02/23/2024] [Indexed: 03/28/2024]
Abstract
Objectives We evaluated the protection afforded by SARS-CoV-2 infection-induced immunity against reinfection among working-age vaccinated individuals during a calendar period from June to December 2022 when Omicron BA.5 was the dominating subvariant in Scania County, Sweden. Methods The study cohort (n = 71,592) mainly consisted of health care workers. We analyzed 4144 infected cases during the Omicron BA.5 dominance and 41,440 sex- and age-matched controls with conditional logistic regression. Results The average protection against reinfection was marginal (16%, 95% confidence interval [CI] 7-23%) during the study period but substantially higher for recent infections. Recent infection (3-6 months) with Omicron BA.2 and BA.5 offered strong protection (86%, 95% CI 68-94% and 78%, 95% CI 69-84%), whereas more distant infection (6-12 months) with Omicron BA.1, BA.2, and the variants before Omicron offered marginal or no protection. Conclusions These findings suggest that infection-induced immunity contributes to short-term population protection against infection with the subvariant BA.5 among working-age vaccinated individuals but wanes considerably with time, independent of the virus variant.
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Affiliation(s)
- Fredrik Kahn
- Department of Clinical Sciences Lund, Section for Infection Medicine, Lund University, Lund, Sweden
| | - Carl Bonander
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mahnaz Moghaddassi
- Department of Clinical Sciences Malmö, Section for Social Medicine and Global Health, Lund University, Malmö, Sweden
| | - Claus Bohn Christiansen
- Department of Clinical Microbiology and Infection Prevention and Control, Skåne University Hospital, Lund, Sweden
| | - Louise Bennet
- Department of Clinical Sciences Malmö, Section for Family Medicine, Lund University, Malmö, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Ulf Malmqvist
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Malin Inghammar
- Department of Clinical Sciences Lund, Section for Infection Medicine, Lund University, Lund, Sweden
| | - Jonas Björk
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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Nyström H, Ekström M, Berkius J, Ström A, Walther S, Inghammar M. Prognosis after Intensive Care for COPD Exacerbation in Relation to Long-Term Oxygen Therapy: A Nationwide Cohort Study. COPD 2023; 20:64-70. [PMID: 36656666 DOI: 10.1080/15412555.2022.2106840] [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] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Decisions to admit or refuse admission to intensive care for acute exacerbations of COPD (AECOPD) can be difficult, due to an uncertainty about prognosis. Few studies have evaluated outcomes after intensive care for AECOPD in patients with chronic respiratory failure requiring long-term oxygen therapy (LTOT). In this nationwide observational cohort study, we investigated survival after first-time admission for AECOPD in all patients aged ≥40 years admitted to Swedish intensive care units between January 2008 and December 2015, comparing patients with and without LTOT. Among the 4,648 patients enrolled in the study, 450 were on LTOT prior to inclusion. Respiratory support data was available for 2,631 patients; 73% of these were treated with noninvasive ventilation (NIV) only, 17% were treated with immediate invasive ventilation, and 10% were intubated after failed attempt with NIV. Compared to patients without LTOT, patients with LTOT had higher 30-day mortality (38% vs. 25%; p < 0.001) and one-year mortality (70% vs. 43%; p < 0.001). Multivariable logistic and Cox regression models adjusted for age, sex and SAPS3 score confirmed higher mortality in LTOT, odds ratio for 30-day mortality was 1.8 ([95% confidence interval] 1.5-2.3) and hazard ratio for one-year mortality was 1.8 (1.6-2.0). In summary, although need for LTOT is a negative prognostic marker for survival after AECOPD requiring intensive care, a majority of patients with LTOT survived the AECOPD and 30% were alive after one year.
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Affiliation(s)
- Helena Nyström
- Department of Surgical and Perioperative Sciences, Anesthesiology and Intensive Care Medicine, Umeå University, Umeå, Sweden.,Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Magnus Ekström
- Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Lund University, Lund, Sweden
| | - Johan Berkius
- Department of Anesthesia and Intensive Care, Västervik Hospital, Västervik, Sweden
| | - Axel Ström
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Sten Walther
- Department of Cardiothoracic and Vascular Surgery, Linköping University Hospital and Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Malin Inghammar
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
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Dietler D, Kahn F, Inghammar M, Björk J. Waning protection after vaccination and prior infection against COVID-19-related mortality over 18 months. Clin Microbiol Infect 2023; 29:1573-1580. [PMID: 37580016 DOI: 10.1016/j.cmi.2023.08.007] [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: 03/29/2023] [Revised: 08/04/2023] [Accepted: 08/07/2023] [Indexed: 08/16/2023]
Abstract
OBJECTIVES Evidence on waning patterns in protection from vaccine-induced, infection-induced, and hybrid immunity against death is scarce. The aim of this study is to assess the temporal trends in protection against mortality. METHODS Population-based case-control study nested in the total population of Scania Region, Sweden using individual-level registry data of COVID-19-related deaths (<30 days after positive SARS-CoV-2 test) between 27 December 2020 and 3 June 2022. Controls were matched for age, sex, and index date. Conditional logistic regression was used to estimate the preventable fraction (PF) from vaccination (PFvac corresponding to vaccine effectiveness; ≥2 vaccine doses vs. 0 doses), prior infection (PFinf), and hybrid immunity (PFhybrid). PF was calculated as one minus odds ratio. Models were adjusted for comorbidities, long-term care facility residence, prior infection (for PFvac), country of birth, socio-economic conditions, and time since last vaccination (for PFinf). RESULTS In total, 14 936 individuals (1440 COVID-19-related deaths and 13 496 controls) were included in the case-control analyses (45% females, median age: 84 years). PFvac was above 90% during the first month after vaccination, regardless of the number of vaccine doses. After 6 months, PFvac of two doses waned to 34% (95% CI: -30% to 66%). PFinf for people surviving a SARS-CoV-2 infection waned from 88% (-16% to 99%) 3 months after infection to 62% (34-79%) after 9 months. No differences in waning patterns in PFvac were seen between virus variants, gender, and age. DISCUSSION Given the waning of protection against death, continuous surveillance of population immunity status, particularly among the most vulnerable population groups, could help to further fine-tune vaccination recommendations.
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Affiliation(s)
- Dominik Dietler
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.
| | - Fredrik Kahn
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Malin Inghammar
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden; Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
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Öberg J, Inghammar M, Nilson B. Improved identification of Streptococcus bovis-Streptococcus equinus-complex species and subspecies by MALDI-TOF MS using a novel library. Diagn Microbiol Infect Dis 2023; 107:116045. [PMID: 37598592 DOI: 10.1016/j.diagmicrobio.2023.116045] [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: 02/14/2023] [Revised: 05/06/2023] [Accepted: 07/28/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVES To develop an in-house matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS) library for improved identification of species and subspecies of the Streptococcus bovis/Streptococcus equinus-complex (SBSEC). METHODS A total of 236 SBSEC isolates from blood stream infections and culture collections, determined by whole genome sequencing to subspecies level, were grown in brain heart infusion broth. Mass spectra were collected using the Bruker MALDI Biotyper system after ethanol-formic acid extraction. Main spectral profiles from 117 isolates were used to create the "SBSEC-CMRS library." The remaining 119 spectra were used for evaluation of Bruker MALDI Biotyper (MBT) Compass Library Revision K (2022) and the SBSEC-CMRS library. RESULTS The Bruker library correctly identified species and subspecies in 72 of 119 (61 %) isolates, while the SBSEC-CMRS library identified 116 of 119 (97 %), using a cutoff score of ≥2.0. CONCLUSIONS The SBSEC-CMRS library showed sufficient diagnostic accuracy, and can be implemented in clinical practice for SBSEC species and subspecies identification.
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Affiliation(s)
- Jonas Öberg
- Department of Clinical Sciences Lund, Section for Infection Medicine, Lund University, Lund, Sweden; Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden.
| | - Malin Inghammar
- Department of Clinical Sciences Lund, Section for Infection Medicine, Lund University, Lund, Sweden
| | - Bo Nilson
- Department of Laboratory Medicine Lund, Section of Medical Microbiology, Lund University, Lund, Sweden; Department of Clinical Microbiology, Infection Control and Prevention, Office for Medical Services, Region Skåne, Lund, Sweden
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Rothman E, Olsson O, Christiansen CB, Rööst M, Inghammar M, Karlsson U. Influenza A subtype H3N2 is associated with an increased risk of hospital dissemination - an observational study over six influenza seasons. J Hosp Infect 2023; 139:134-140. [PMID: 37419188 DOI: 10.1016/j.jhin.2023.06.024] [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: 05/23/2023] [Revised: 06/15/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023]
Abstract
BACKGROUND Previous studies on hospital-acquired influenza (HAI) have not systematically evaluated the possible impact of different influenza subtypes. HAI has historically been associated with high mortality, but clinical consequences may be less severe in a modern hospital setting. AIMS To identify and quantify HAI for each season, investigate possible associations with varying influenza subtypes, and to determine HAI-associated mortality. METHODS All influenza-PCR-positive adult patients (>18 years old) hospitalized in Skåne County during 2013-2019, were prospectively included in the study. Positive influenza samples were subtyped. Medical records of patients with suspected HAI were examined to confirm a nosocomial origin and to determine 30-day mortality. RESULTS Of 4110 hospitalized patients with a positive influenza PCR, 430 (10.5%) were HAI. Influenza A(H3N2) infections were more often HAI (15.1%) than influenza A(H1N1)pdm09, and influenza B (6.3% and 6.8% respectively, P<0.001). The majority of HAI caused by H3N2 were clustered (73.3 %) and were the cause of all 20 hospital outbreaks consisting of ≥4 affected patients. In contrast, the majority of HAI caused by influenza A(H1N1)pdm09 and influenza B were solitary cases (60% and 63.2%, respectively, P<0.001). Mortality associated with HAI was 9.3% and similar between subtypes. CONCLUSIONS HAI caused by influenza A(H3N2) was associated with an increased risk of hospital dissemination. Our study is relevant for future seasonal influenza infection control preparedness and shows that subtyping of influenza may help to define relevant infection control measures. Mortality in HAI remains substantial in a modern hospital setting.
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Affiliation(s)
- E Rothman
- Department of Clinical Microbiology and Infection Prevention and Control, Skåne University Hospital, Sweden; Department of Research and Development, Region Kronoberg, Växjö, Sweden
| | - O Olsson
- Clinical Infection Medicine, Department of Translational Medicine, Lund University, Malmö, Sweden; Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden
| | - C B Christiansen
- Department of Clinical Microbiology and Infection Prevention and Control, Skåne University Hospital, Sweden
| | - M Rööst
- Department of Research and Development, Region Kronoberg, Växjö, Sweden; Department of Clinical Sciences in Malmö, Family Medicine, Clinical Research Centre, Lund University, Malmö, Sweden
| | - M Inghammar
- Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden; Section for Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - U Karlsson
- Department of Clinical Microbiology and Infection Prevention and Control, Skåne University Hospital, Sweden; Section for Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden.
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Bonander C, Stranges D, Gustavsson J, Almgren M, Inghammar M, Moghaddassi M, Nilsson A, Capdevila Pujol J, Steves C, Franks PW, Gomez MF, Fall T, Björk J. A regression discontinuity analysis of the social distancing recommendations for older adults in Sweden during COVID-19. Eur J Public Health 2022; 32:799-806. [PMID: 35962987 PMCID: PMC9384721 DOI: 10.1093/eurpub/ckac101] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This article investigates the impact of a non-mandatory and age-specific social distancing recommendation on isolation behaviours and disease outcomes in Sweden during the first wave of the coronavirus disease 2019 (COVID-19) pandemic (March to July 2020). The policy stated that people aged 70 years or older should avoid crowded places and contact with people outside the household. METHODS We used a regression discontinuity design-in combination with self-reported isolation data from COVID Symptom Study Sweden (n = 96 053; age range: 39-79 years) and national register data (age range: 39-100+ years) on severe COVID-19 disease (hospitalization or death, n = 21 804) and confirmed cases (n = 48 984)-to estimate the effects of the policy. RESULTS Our primary analyses showed a sharp drop in the weekly number of visits to crowded places (-13%) and severe COVID-19 cases (-16%) at the 70-year threshold. These results imply that the age-specific recommendations prevented approximately 1800-2700 severe COVID-19 cases, depending on model specification. CONCLUSIONS It seems that the non-mandatory, age-specific recommendations helped control COVID-19 disease during the first wave of the pandemic in Sweden, as opposed to not implementing a social distancing policy aimed at older adults. Our study provides empirical data on how populations may react to non-mandatory, age-specific social distancing policies in the face of a novel virus.
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Affiliation(s)
- Carl Bonander
- Health Economics & Policy, School of Public Health & Community Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Debora Stranges
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Johanna Gustavsson
- Centre for Societal Risk Research, Faculty of Arts and Social Sciences, Karlstad University, Karlstad, Sweden
| | - Matilda Almgren
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Malin Inghammar
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Mahnaz Moghaddassi
- Department of Clinical Sciences Malmö, Social Medicine and Global Health, Lund University, Malmö, Sweden
| | - Anton Nilsson
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | | | - Claire Steves
- Department of Twin Research and Genetic Epidemiology, King’s College London, London, UK
| | - Paul W Franks
- Department of Clinical Sciences, Lund University Diabetes Center, Skåne University Hospital, Malmö, Sweden
- Department of Nutrition, Harvard Chan School of Public Health, Boston, MA, USA
| | - Maria F Gomez
- Department of Clinical Sciences in Malmö, Diabetic Complications Unit, Lund University Diabetes Centre, Lund, Sweden
| | - Tove Fall
- Department of Medical Sciences, Molecular Epidemiology, and Science for Life Laboratory, Uppsala University, Uppsala, Sweden
| | - Jonas Björk
- Department of Laboratory Medicine, Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
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de Lauzanne A, Sreng N, Foucaud E, Sok T, Chon T, Yem C, Hak V, Heng S, Soda M, Gouali M, Nadimpalli M, Inghammar M, Rabenandrasana MAN, Collard JM, Vray M, Hello SL, Kerleguer A, Piola P, Delarocque-Astagneau E, Guillemot D, Huynh BT, Borand L. Prevalence and factors associated with faecal carriage of extended-spectrum β-lactamase-producing Enterobacterales among peripartum women in the community in Cambodia. J Antimicrob Chemother 2022; 77:2658-2666. [PMID: 35794710 PMCID: PMC9525094 DOI: 10.1093/jac/dkac224] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 01/18/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background In Southeast-Asia, where many conditions associated with dissemination of ESBL-producing Enterobacterales (ESBL-E) in the community are met, data from the community are scarce but show high ESBL-E carriage prevalence. Maternal ESBL-E colonization is considered a risk factor for neonatal colonization, which is the first step towards developing neonatal sepsis. Despite this, ESBL-E carriage prevalence and its risk factors during pregnancy or postpartum remain undefined in Southeast-Asia. Objectives To estimate the prevalence of ESBL-E faecal colonization among peripartum women in the community of an urban and a rural area in Cambodia, to investigate ESBL-E genomic characteristics and to identify associated risk factors. Methods Epidemiological data and faecal samples from 423 peripartum women were collected in an urban and rural areas in Cambodia (2015–16). Bacterial cultures, antibiotic susceptibility tests and ESBL gene sequencing were performed. Risk factor analysis was conducted using logistic regression. Results The prevalence of ESBL-E faecal carriage was 79.2% (95% CI 75.0%–82.8%) among which Escherichia coli (n = 315/335, 94.0%) were most frequent. All isolates were multidrug resistant. Among 318 ESBL-E, the genes most frequently detected were blaCTX-M-15 (41.5%), blaCTX-M-55 (24.8%), and blaCTX-M-27 (15.1%). Low income, undernutrition, multiparity, regular consumption of pork, dried meat, and raw vegetables, were associated with ESBL-E faecal carriage. Conclusions The high prevalence of ESBL-E carriage observed among peripartum women in Southeast-Asia and the identified associated factors underline the urgent need for public health measures to address antimicrobial resistance, including a ‘One Health’ approach.
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Affiliation(s)
| | - Navin Sreng
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Elsa Foucaud
- Assistance Publique/Hôpitaux de Paris, Hôpital Jean Verdier, Paris, France
| | - Touch Sok
- Cambodian Communicable Disease Control Department, Phnom Penh, Cambodia
| | - Thida Chon
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Chhaily Yem
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Veasna Hak
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Sothada Heng
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Meng Soda
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | | | - Malin Inghammar
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia.,Lund University, Department of Clinical Sciences Lund, Section for Infection Medicine, Lund, Sweden
| | | | | | - Muriel Vray
- Institut Pasteur, Paris, France.,Institut Pasteur, Dakar, Senegal
| | | | | | | | - Elisabeth Delarocque-Astagneau
- Institut National de la Santé et de la Recherche Médicale, Université de Versailles Saint-Quentin-en-Yvelines and Université Paris-Saclay, Paris, France.,Assistance Publique/Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| | - Didier Guillemot
- Institut Pasteur, Paris, France.,Institut National de la Santé et de la Recherche Médicale, Université de Versailles Saint-Quentin-en-Yvelines and Université Paris-Saclay, Paris, France.,Assistance Publique/Hôpitaux de Paris, Hôpital Raymond-Poincaré, Garches, France
| | - Bich Tram Huynh
- Institut Pasteur, Paris, France.,Institut National de la Santé et de la Recherche Médicale, Université de Versailles Saint-Quentin-en-Yvelines and Université Paris-Saclay, Paris, France
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Nibell O, Inghammar M. Reply to Rezahosseini. Clin Infect Dis 2022; 74:2262. [PMID: 34918748 PMCID: PMC9258922 DOI: 10.1093/cid/ciab967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- Olof Nibell
- Section for Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Malin Inghammar
- Section for Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Blomquist A, Inghammar M, Al Shakirchi M, Ericson P, Krantz C, Svedberg M, Lindblad A, Påhlman LI. Persistent Aspergillus fumigatus infection in cystic fibrosis: impact on lung function and role of treatment of asymptomatic colonization-a registry-based case-control study. BMC Pulm Med 2022; 22:263. [PMID: 35790954 PMCID: PMC9258124 DOI: 10.1186/s12890-022-02054-3] [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] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 06/27/2022] [Indexed: 11/10/2022] Open
Abstract
Background Aspergillus fumigatus is the most common filamentous fungus isolated from the airways of people with cystic fibrosis (CF). The aim of this study was to investigate how chronic A. fumigatus colonization affects lung function in people with CF, to identify risk factors for colonization, and to evaluate antifungal treatment of asymptomatic Aspergillus colonization.
Methods Data from 2014–2018 was collected from the Swedish CF registry and medical records. Baseline data before the start of A. fumigatus colonization was compared with the two succeeding years to evaluate how colonization and treatment affected lung function and other clinical aspects.
Results A total of 437 patients were included, of which 64 (14.6%) became colonized with A. fumigatus during the study period. Inhaled antibiotics was associated with A. fumigatus colonization (adjusted OR 3.1, 95% CI 1.6–5.9, p < 0.05). Fungal colonization was not associated with a more rapid lung function decline or increased use of IV-antibiotics compared to the non-colonized group, but patients with A. fumigatus had more hospital days, a higher increase of total IgE, and higher eosinophil counts. In the Aspergillus group, 42 patients were considered to be asymptomatic. Of these, 19 patients received antifungal treatment. Over the follow up period, the treated group had a more pronounced decrease in percent predicted Forced Expiratory Volume in one second (ppFEV1) compared to untreated patients (− 8.7 vs − 1.4 percentage points, p < 0.05). Conclusion Inhaled antibiotics was associated with A. fumigatus colonization, but no association was found between persistent A. fumigatus and subsequent lung function decline. No obvious benefits of treating asymptomatic A. fumigatus colonization were demonstrated.
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Affiliation(s)
- Axel Blomquist
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, BMC B14, 221 84, Lund, Sweden
| | - Malin Inghammar
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, BMC B14, 221 84, Lund, Sweden
| | - Mahasin Al Shakirchi
- Stockholm Cystic Fibrosis Centre, Karolinska University Hospital Huddinge, Department of Clinical Science, Intervention and Technology, Division of Paediatrics, Karolinska Institute, Stockholm, Sweden
| | - Petrea Ericson
- Department of Respiratory Medicine, Sahlgrenska University Hospital, 413 45, Gothenburg, Sweden
| | - Christina Krantz
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Marcus Svedberg
- Department of Paediatrics, Institute of Clinical Science at The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Lindblad
- Department of Paediatrics, Institute of Clinical Science at The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Lisa I Påhlman
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, BMC B14, 221 84, Lund, Sweden. .,Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden.
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Öberg J, Nilson B, Gilje P, Rasmussen M, Inghammar M. Bacteraemia and infective endocarditis with Streptococcus bovis-Streptococcus equinus-complex: a retrospective cohort study. Infect Dis (Lond) 2022; 54:760-765. [PMID: 35730935 DOI: 10.1080/23744235.2022.2089730] [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] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Streptococcus bovis/equinus complex (SBSEC) comprise several species and subspecies and is a common cause of infective endocarditis (IE). S. gallolyticus subsp. gallolyticus (Sg gallolyticus) accounts for a majority of SBSEC IE, but the risk of IE for other subspecies is largely unknown. We aimed to investigate the clinical presentation of bacteraemia, and proportion of patients with IE in bacteraemia with the most common subspecies. METHODS A retrospective cohort study of SBSEC-bacteraemia identified in clinical laboratory databases, in Skåne Region, Sweden, 2003-2018. Bacteraemia with Sg gallolyticus, S. gallolyticus subsp. pasteurianus (Sg pasteurianus), S. lutetiensis and S. infantarius subsp. infantarius (Si infantarius) were included. Subspecies was identified by whole genome sequencing. Medical charts were reviewed according to a predetermined protocol, IE was defined by the criteria from European Society of Cardiology. RESULTS In total, 210 episodes of SBSEC-bacteraemia were included. Definite IE was identified in 28/210 (13%) episodes. Of these, 7/28 (25%) were prosthetic valve-IE, 1/28 (4%) related to a cardiovascular implantable electronic device and 10/28 (36%) required heart valve surgery. The proportions of IE among different subspecies were: Sg gallolyticus 17/52 (33%), Si infantarius 5/31 (16%), Sg pasteurianus 4/83 (5%) and S. lutetiensis 2/44 (5%) (p < 0.001). Sg pasteurianus and S. lutetiensis were more often associated with intra-abdominal- and polymicrobial infection. CONCLUSION The proportion of IE in SBSEC-bacteraemia varies substantially depending on subspecies. Echocardiography should always be considered in bacteraemia with Sg gallolyticus and Si infantarius, and can sometimes be omitted in bacteraemia with Sg pasteurianus and S. lutetiensis.
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Affiliation(s)
- Jonas Öberg
- Department of Clinical Sciences Lund, Section for Infection Medicine, Helsingborg Hospital, Lund University, Lund, Sweden
| | - Bo Nilson
- Department of Laboratory Medicine Lund, Division of Medical Microbiology, Office for Medical Services, Lund University, Region Skåne, Lund, Sweden.,Department of Clinical Microbiology, Infection Control and Prevention, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Patrik Gilje
- Department of Cardiology, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Malin Inghammar
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
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12
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Mortazavi SE, Inghammar M, Christiansen C, Pesola AK, Stenkilsson M, Paulsson M. A retrospective cohort study of the effect of SARS-CoV-2 point of care rapid RT-PCR at the Emergency Department on targeted admission. BMC Infect Dis 2022; 22:536. [PMID: 35692041 PMCID: PMC9188907 DOI: 10.1186/s12879-022-07497-x] [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: 01/12/2022] [Accepted: 05/25/2022] [Indexed: 12/02/2022] Open
Abstract
Background To prevent nosocomial transmission of SARS-CoV-2, infection prevention control (IPC) measures are implemented for patients with symptoms compatible with COVID-19 until reliable test results are available. This delays admission to the most appropriate ward based on the medical condition. SARS-CoV-2 rapid antigen detection (RAD) tests and point-of-care (POC) rapid RT-PCR (VitaPCR) were introduced at emergency department (ED) at Skåne University Hospital, Sweden in late 2020, but the consequence on patient flow and targeted admission is unknown. Methods Patients presenting at the emergency department of a referral hospital (N = 2940) between 13-Nov-2020 and 12-Jan-2021 were included. The study period was delimited into three periods by the introduction of RAD tests and the VitaPCR. Participant data was collected from hospital records, and outcome variables were Length-of-Stay (LoS), intrahospital transfers and targeted admission to COVID-19 ward. Results Compared to baseline (RT-PCR only), RAD tests reduced ED Length-of-Stay (LoS) for participants with positive tests. Negative VitaPCR results reduced mean hospital LoS by 1.5 (95% CI 0.3–2.7) days and admissions to COVID-19 wards from 34.5 (95% CI 28.9–40.5) to 14.7 (95% CI 11.1–19.1) per 100 admissions and reduced transfers between hospital wards in the first 5 days from 50.0 (95% CI 45.0–55.0) to 34.0 (95% CI 30.3–37.9) per 100 admissions. Conclusion RAD tests enabled prompt detection of SARS-CoV-2 infection which had pronounced effects on LoS at the ED. Negative VitaPCR enabled cessation of IPC measures and a negative test was associated with increased targeted admissions, reduced intrahospital transfers and shorter LoS at the hospital. Supplementary Information The online version contains supplementary material available at 10.1186/s12879-022-07497-x.
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Affiliation(s)
- Susanne E Mortazavi
- Division of Clinical Chemistry and Pharmacology, Department of Laboratory Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Malin Inghammar
- Section for Infection Medicine, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Claus Christiansen
- Clinical Microbiology, Laboratory Medicine Skåne, Region Skåne, Lund, Sweden
| | - Anne-Katrine Pesola
- Clinical Microbiology, Laboratory Medicine Skåne, Region Skåne, Lund, Sweden
| | - Mikael Stenkilsson
- Department of Emergency and Internal Medicine, Skåne University Hospital, Lund, Sweden
| | - Magnus Paulsson
- Section for Infection Medicine, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden.
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13
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Björk J, Bonander C, Moghaddassi M, Rasmussen M, Malmqvist U, Inghammar M, Kahn F. COVID-19 vaccine effectiveness against severe disease from SARS-CoV-2 Omicron BA.1 and BA.2 subvariants - surveillance results from southern Sweden, December 2021 to March 2022. Euro Surveill 2022; 27. [PMID: 35514304 PMCID: PMC9074397 DOI: 10.2807/1560-7917.es.2022.27.18.2200322] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
We compared vaccine effectiveness against severe COVID-19 between December 2021 and March 2022 when Omicron BA.1 and BA.2 were the dominating SARS-CoV-2 variants in Scania county, Sweden. Effectiveness remained above 80% after the transition from BA.1 to BA.2 among people with at least three vaccine doses but the point estimate decreased markedly to 54% among those with only two doses. Protection from prior infection was also lower after the transition to BA.2. Booster vaccination seems necessary to maintain sufficient protection.
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Affiliation(s)
- Jonas Björk
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden.,Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Carl Bonander
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mahnaz Moghaddassi
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ulf Malmqvist
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Malin Inghammar
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Fredrik Kahn
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
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14
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Björk J, Bonander C, Moghaddassi M, Rasmussen M, Malmqvist U, Inghammar M, Kahn F. COVID-19 vaccine effectiveness against severe disease from SARS-CoV-2 Omicron BA.1 and BA.2 subvariants - surveillance results from southern Sweden, December 2021 to March 2022. Euro Surveill 2022. [PMID: 35514304 DOI: 10.2807/1560-7917.es.2022.27.18.220032] [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] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/03/2023] Open
Abstract
We compared vaccine effectiveness against severe COVID-19 between December 2021 and March 2022 when Omicron BA.1 and BA.2 were the dominating SARS-CoV-2 variants in Scania county, Sweden. Effectiveness remained above 80% after the transition from BA.1 to BA.2 among people with at least three vaccine doses but the point estimate decreased markedly to 54% among those with only two doses. Protection from prior infection was also lower after the transition to BA.2. Booster vaccination seems necessary to maintain sufficient protection.
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Affiliation(s)
- Jonas Björk
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden.,Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Carl Bonander
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mahnaz Moghaddassi
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ulf Malmqvist
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Malin Inghammar
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Fredrik Kahn
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
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15
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Kahn F, Bonander C, Moghaddassi M, Rasmussen M, Malmqvist U, Inghammar M, Björk J. Risk of severe COVID-19 from the Delta and Omicron variants in relation to vaccination status, sex, age and comorbidities - surveillance results from southern Sweden, July 2021 to January 2022. Euro Surveill 2022; 27:2200121. [PMID: 35241215 PMCID: PMC8895467 DOI: 10.2807/1560-7917.es.2022.27.9.2200121] [Citation(s) in RCA: 53] [Impact Index Per Article: 26.5] [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] [Indexed: 12/29/2022] Open
Abstract
We compared the risk of severe COVID-19 during two periods 2021 and 2022 when Delta and Omicron, respectively, were the dominating virus variants in Scania county, Sweden. We adjusted for differences in sex, age, comorbidities, prior infection and vaccination. Risk of severe disease from Omicron was markedly lower among vaccinated cases. It was also lower among the unvaccinated but remained high (> 5%) for older people and middle-aged men with two or more comorbidities. Efforts to increase vaccination uptake should continue.
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Affiliation(s)
- Fredrik Kahn
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Carl Bonander
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mahnaz Moghaddassi
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ulf Malmqvist
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Malin Inghammar
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jonas Björk
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden,Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
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16
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Björk J, Bonander C, Moghaddassi M, Rasmussen M, Malmqvist U, Kahn F, Inghammar M. Surveillance of COVID-19 vaccine effectiveness - a real-time case-control study in southern Sweden. Epidemiol Infect 2022; 150:1-15. [PMID: 35232506 PMCID: PMC8924553 DOI: 10.1017/s0950268822000425] [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] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/20/2022] [Accepted: 02/23/2022] [Indexed: 11/25/2022] Open
Abstract
The extensive register infrastructure available for coronavirus disease 2019 surveillance in Scania county, Sweden, makes it possible to classify individual cases with respect to hospitalisation and disease severity, stratify on time since last dose and demographic factors, account for prior infection and extract data for population controls automatically. In the present study, we developed a case–control sampling design to surveil vaccine effectiveness (VE) in this ethnically and socioeconomically diverse population with more than 1.3 million inhabitants. The first surveillance results show that estimated VE against hospitalisation and severe disease 0–3 months after the last dose remained stable during the study period, but waned markedly 6 months after the last dose in persons aged 65 years or over.
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Affiliation(s)
- Jonas Björk
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden
| | - Carl Bonander
- School of Public Health and Community Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden
| | - Mahnaz Moghaddassi
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ulf Malmqvist
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Fredrik Kahn
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Malin Inghammar
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
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17
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Öberg J, Rasmussen M, Buchwald P, Nilson B, Inghammar M. Streptococcus bovis-bacteremia: subspecies distribution and association with colorectal cancer: a retrospective cohort study. Epidemiol Infect 2021; 150:e8. [PMID: 38751047 PMCID: PMC8753481 DOI: 10.1017/s0950268821002533] [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] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 11/06/2021] [Accepted: 11/16/2021] [Indexed: 12/03/2022] Open
Abstract
This study aimed to describe the incidence of Streptococcus bovis/Streptococcus equinus complex (SBSEC) bacteremia, distribution of the SBSEC subspecies, and their respective association with colorectal cancer (CRC). A population-based retrospective cohort study of all episodes of SBSEC-bacteremia from 2003 to 2018 in Skåne Region, Sweden. Subspecies was determined by whole-genome sequencing. Medical charts were reviewed. The association between subspecies and CRC were analysed using logistic regression. In total 266 episodes of SBSEC-bacteremia were identified and the average annual incidence was 2.0 per 100 000 inhabitants. Of the 236 isolates available for typing, the most common subspecies was S. gallolyticus subsp. pasteurianus 88/236 (37%) followed by S. gallolyticus subsp. gallolyticus 58/236 (25%). In order to determine the risk of cancer following bacteremia, an incidence cohort of 174 episodes without a prior diagnosis of CRC or metastasised cancer was followed for 560 person-years. CRC was found in 13/174 (7%), of which 9 (69%) had S. gallolyticus subsp. gallolyticus-bacteremia. In contrast to other European studies, S. gallolyticus subsp. pasteurianus was the most common cause of SBSEC-bacteremia. CRC diagnosis after bacteremia was strongly associated with S. gallolyticus subsp. gallolyticus-bacteremia. Identification of SBSEC subspecies can guide clinical decision-making regarding CRC work-up following bacteremia.
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Affiliation(s)
- Jonas Öberg
- Department of Clinical Sciences Lund, Section for Infection Medicine, Lund University, Lund,Sweden
- Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences Lund, Section for Infection Medicine, Lund University, Lund,Sweden
| | - Pamela Buchwald
- Department of Surgery, Skåne University Hospital Malmö, Malmö, Sweden
- Department of Clinical Sciences Malmö, Lund University, Lund, Sweden
| | - Bo Nilson
- Department of Laboratory Medicine Lund, Section of Medical Microbiology, Lund University, Lund, Sweden
- Department of Clinical Microbiology, Infection Control and Prevention, Office for Medical Services, Region Skåne, Lund, Sweden
| | - Malin Inghammar
- Department of Clinical Sciences Lund, Section for Infection Medicine, Lund University, Lund,Sweden
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18
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Björk J, Inghammar M, Moghaddassi M, Rasmussen M, Malmqvist U, Kahn F. High level of protection against COVID-19 after two doses of BNT162b2 vaccine in the working age population - first results from a cohort study in Southern Sweden. Infect Dis (Lond) 2021; 54:128-133. [PMID: 34586934 PMCID: PMC8500302 DOI: 10.1080/23744235.2021.1982144] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND Vaccine effectiveness against COVID-19 needs to be assessed in diverse real-world population settings. METHODS A cohort study of 805,741 residents in Skåne county, Southern Sweden, aged 18-64 years, of whom 26,587 received at least one dose of the BNT162b2 vaccine. Incidence rates of COVID-19 were estimated in sex- and age-adjusted analysis and stratified in two-week periods with substantial community spread of the disease. RESULTS The estimated vaccine effectiveness in preventing infection ≥7 days after second dose was 86% (95% CI 72-94%) but only 42% (95% CI 14-63%) ≥14 days after a single dose. No difference in vaccine effectiveness was observed between females and males. Having a prior positive test was associated with 91% (95% CI 85-94%) effectiveness against new infection among the unvaccinated. CONCLUSION A satisfactory effectiveness of BNT162b2 after the second dose was suggested, but with possibly substantially lower effect before the second dose.
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Affiliation(s)
- Jonas Björk
- Division of Occupational and Environmental Medicine, Lund University, Lund, Sweden.,Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Malin Inghammar
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Mahnaz Moghaddassi
- Social Medicine and Global Health, Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Magnus Rasmussen
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ulf Malmqvist
- Clinical Studies Sweden, Forum South, Skåne University Hospital, Lund, Sweden
| | - Fredrik Kahn
- Department of Clinical Sciences Lund, Section for Infection Medicine, Skåne University Hospital, Lund University, Lund, Sweden
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19
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Fraenkel CJ, Böttiger B, Söderlund-Strand A, Inghammar M. Risk of environmental transmission of norovirus infection from prior room occupants. J Hosp Infect 2021; 117:74-80. [PMID: 34547321 DOI: 10.1016/j.jhin.2021.08.026] [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] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Environmental contamination of norovirus (NoV) is believed to be a significant source for further transmission in hospitals. AIM To investigate the risk of acquiring NoV in a cleaned room previously occupied by a patient with NoV infection. The risk of having a roommate with recent NoV infection was also assessed. METHODS In a retrospective cohort, comprising 33,788 room stays at five infectious Disease wards in southern Sweden from 2013 to 2018, the risk of acquiring NoV infection after admission to an exposed or non-exposed room was analysed with uni- and multivariable statistical analysis, controlling for age, colonization pressure and any roommate. RNA sequencing of the NoV strains involved in suspected room transmission was also performed. RESULTS Five of the 1106 patients exposed to a room with a prior occupant with NoV infection and 49 in the non-exposed group acquired NoV infection. An association between NoV acquisition was found in the univariable analysis (odds ratio (OR) 3.3, P=0.01), but not when adjusting for potential confounders (OR 1.9, P=0.2). Sequencing of the NoV samples showed that only two of the five exposed patients with acquired NoV infection were infected by identical strains to the prior room occupant, inferring a room transmission risk of 0.2% (95% confidence interval 0.05-0.78%). None of the 52 patients who shared room with a roommate with NoV symptoms resolved for ≥48 h acquired NoV infection. CONCLUSIONS In absolute terms, the risk of room transmission of NoV is low. Discontinuation of isolation ≥48 h after resolution of symptoms seems adequate.
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Affiliation(s)
- C-J Fraenkel
- Department of Infection Control, Region Skåne, Lund, Sweden; Division of Infection Medicine, Department of Clinical Sciences, Lund University, Sweden.
| | - B Böttiger
- Department of Clinical Microbiology, University and Regional Laboratories, Lund, Sweden
| | - A Söderlund-Strand
- Department of Clinical Microbiology, University and Regional Laboratories, Lund, Sweden
| | - M Inghammar
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Sweden
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20
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Nibell O, Svanström H, Inghammar M. Oral Fluoroquinolone Use and the Risk of Acute Liver Injury: A Nationwide Cohort Study. Clin Infect Dis 2021; 74:2152-2158. [PMID: 34537834 PMCID: PMC9258930 DOI: 10.1093/cid/ciab825] [Citation(s) in RCA: 3] [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: 06/12/2021] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND Antibiotics are considered to be among the most frequent causes of drug-related acute liver injury (ALI). Although many ALIs have mild and reversible clinical outcomes, there is substantial risk of severe reactions leading to acute liver failure, need for liver transplant, and death. Recent studies have raised concerns of hepatotoxic potential related to the use of fluoroquinolones. METHODS This study examined the risk of ALI associated with oral fluoroquinolone treatment compared with amoxicillin (419 930 courses, propensity score matched 1:1). The information on drug use was collected from a national, registry-based cohort derived from all Swedish adults aged 40-85 years. RESULTS During a follow-up period of 60 days, users of oral fluoroquinolones had a >2-fold risk of ALI compared to users of amoxicillin (hazard ratio, 2.32 [95% confidence interval {CI}, 1.01-5.35). The adjusted absolute risk difference for use of fluoroquinolones as compared to amoxicillin was 4.94 (95% CI, .04-16.3) per 1 million episodes. CONCLUSIONS In this propensity score-matched study, fluoroquinolone treatment was associated with an increased risk of ALI in the first 2 months after starting treatment.
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Affiliation(s)
- Olof Nibell
- Correspondence: O. Nibell, Section for Infection Medicine, Department of Clinical Sciences Lund, Lund University, SE-221 00, Lund, Sweden ()
| | - Henrik Svanström
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Malin Inghammar
- Section for Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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21
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Inghammar M, Svanström H, Voldstedlund M, Melbye M, Hviid A, Mølbak K, Pasternak B. Proton-Pump Inhibitor Use and the Risk of Community-Associated Clostridium difficile Infection. Clin Infect Dis 2021; 72:e1084-e1089. [PMID: 33629099 PMCID: PMC8204777 DOI: 10.1093/cid/ciaa1857] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [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: 10/07/2019] [Indexed: 12/26/2022] Open
Abstract
Background Proton-pump inhibitors (PPIs) have been reported to increase the risk of community-associated Clostridium difficile infection (CDI), but the association remains disputed. Methods A nationwide cohort study among adults in Denmark, 2010–2013, linking register data on C. difficile testing, filled prescriptions, and patient characteristics. All incident episodes of community-associated CDI (ie, positive culture, molecular assay, or toxin test in individuals without previous hospitalization in the prior 12 weeks and without a positive test for C. difficile in the prior 8 weeks) were identified in the Danish National Microbiological Database. Self-controlled case-series analyses were used to estimate incidence rate ratios (IRRs) for community-associated CDI, comparing periods with and without exposure to PPIs. By design, models took fixed confounders such as chronic disease, genetics, and socioeconomic status into account; further, time-varying confounders, including hospital stay and antibiotic and corticosteroid use were adjusted for. Results 3583 episodes of community-associated CDI were identified, of which 964 occurred during current use of PPIs, 324 occurred 0–6 months after treatment cessation, 123 occurred 6–12 months after treatment cessation, and 2172 occurred during time periods without use of PPIs. The adjusted IRR was 2.03 (95% confidence interval, 1.74–2.36), comparing use of PPI with nonuse. The increased risk remained elevated in later time periods: 1.54 (1.31–1.80) for 0–6 months, 1.24 (1.00–1.53) for 6–12 months after current use. Conclusions Use of PPIs was associated with moderately increased risk of community-associated CDI. The risk remained elevated up to 1 year after PPI treatment had ended.
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Affiliation(s)
- Malin Inghammar
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Section for Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Henrik Svanström
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Marianne Voldstedlund
- Division of Infectious Diseases Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Mads Melbye
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Department of Medicine, Stanford University School of Medicine, Stanford, California, USA.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Kåre Mølbak
- Division of Infectious Diseases Preparedness, Statens Serum Institut, Copenhagen, Denmark.,Department of Animal and Veterinary Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Björn Pasternak
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark.,Clinical Epidemiology Division, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
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22
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Inghammar M, Sunden-Cullberg J. Prognostic significance of body temperature in the emergency department vs the ICU in Patients with severe sepsis or septic shock: A nationwide cohort study. PLoS One 2020; 15:e0243990. [PMID: 33373376 PMCID: PMC7771849 DOI: 10.1371/journal.pone.0243990] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 12/01/2020] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Increased body temperature in the Emergency Department (BT-ED) and the ICU (BT-ICU) is associated with lower mortality in patients with sepsis. Here, we compared how well BT-ED and BT-ICU predict mortality; investigated mortality in various combinations of BT-ED and BT-ICU, and; compared degree of fever in the ED and ICU and associated quality of care. METHODS 2385 adults who were admitted to an ICU within 24 hours of ED arrival with severe sepsis or septic shock were included. RESULTS Thirty-day mortality was 23.6%. Median BT-ED and BT-ICU was 38.1 and 37.6°C. Crude mortality decreased more than 5% points per°C increase for both BT-ED and BT-ICU. Adjusted OR for mortality was 0.82/°C increase for BT-ED (0.76-0.88, p < 0.001), and 0.89 for BT-ICU (0.83-0.95, p<0.001). Patients who were at/below median temperature in both the ED and in the ICU had the highest mortality, 32%, and those with over median in the ED and at/below in the ICU had the lowest, 16%, (p<0.001). Women had 0.2°C lower median BT-ED (p = 0.03) and 0.3°C lower BT-ICU (p<0.0001) than men. Older patients had lower BT in the ICU, but not in the ED. Fever was associated with a higher rate of sepsis bundle achievement in the ED, but lower nurse workload in the ICU. CONCLUSIONS BT-ED was more useful to prognosticate mortality than BT-ICU. Despite better prognosis in patients with elevated BT, fever was associated with higher quality of care in the ED. Future studies should assess how BT-ED can be used to improve triage of infected patients, assigning higher priority to patients with low-grade/no fever and vice versa. Patients with at/below median BT in both ED and ICU have the highest mortality and should receive special attention. Different BT according to sex and age also needs further study.
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Affiliation(s)
- Malin Inghammar
- Department of Clinical Sciences, Section for Infection Medicine, Lund University, Skåne University Hospital, Lund, Sweden
| | - Jonas Sunden-Cullberg
- Division of Infectious Diseases and Center for Infectious Medicine, Karolinska Institutet at Karolinska University Hospital Huddinge, Stockholm, Sweden
- * E-mail:
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23
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Borand L, de Lauzanne A, Nguyen NL, Cheng S, Pham TH, Eyangoh S, Ouedraogo AS, Ung V, Msellati P, Tejiokem M, Nacro B, Inghammar M, Dim B, Delacourt C, Godreuil S, Blanche S, Marcy O. Isolation of Nontuberculous Mycobacteria in Southeast Asian and African Human Immunodeficiency Virus-infected Children With Suspected Tuberculosis. Clin Infect Dis 2020; 68:1750-1753. [PMID: 30689814 PMCID: PMC6495014 DOI: 10.1093/cid/ciy897] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2018] [Accepted: 11/02/2018] [Indexed: 12/23/2022] Open
Abstract
We enrolled 427 human immunodeficiency virus-infected children (median age, 7.3 years), 59.2% severely immunodeficient, with suspected tuberculosis in Southeast Asian and African settings. Nontuberculous mycobacteria were isolated in 46 children (10.8%); 45.7% of isolates were Mycobacterium avium complex. Southeast Asian origin, age 5-9 years, and severe immunodeficiency were independently associated with nontuberculous mycobacteria isolation. CLINICAL TRIALS REGISTRATION NCT01331811.
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Affiliation(s)
- Laurence Borand
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Agathe de Lauzanne
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Ngoc Lan Nguyen
- Biochemistry, Hematology and Immunology Department, Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Sokleaph Cheng
- Medical Biology Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Thu Hang Pham
- Microbiology Department, Pham Ngoc Thach Hospital, Ho Chi Minh City, Vietnam
| | - Sara Eyangoh
- Service de Mycobactériologie, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaounde, Cameroon
| | | | - Vibol Ung
- TB/HIV Department, National Pediatric Hospital, Phnom Penh, Cambodia.,University of Health Sciences, Phnom Penh, Cambodia
| | - Philippe Msellati
- UMI 233-TransVIHMI, Institut de Recherche pour le Développement (IRD), U1175, Université de Montpellier, France
| | - Mathurin Tejiokem
- Service d'Epidémiologie et de Santé Publique, Centre Pasteur du Cameroun, Réseau International des Instituts Pasteur, Yaounde, Cameroon
| | - Boubacar Nacro
- Service de Pédiatrie, Centre Hospitalier Universitaire Souro Sanou, Bobo Dioulasso, Burkina Faso
| | - Malin Inghammar
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.,Department of Clinical Sciences LUND, Section for Infection Medicine, Lund University, Sweden
| | - Bunnet Dim
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Christophe Delacourt
- Service de Pneumologie et d'Allergologie Pédiatriques, Hôpital Necker-Enfants Malades, Assistance Publique-Hôpitaux de Paris (AP-HP), France
| | - Sylvain Godreuil
- Laboratoire de Bactériologie, Centre Hospitalier Universitaire de Montpellier, France.,France (SG) Unité Mixte de Recherche (UMR) Maladies Infectieuses et Vecteurs : écologie, génétique, évolution et contrôle (MIVEGEC) IRD - Centre National de la Recherche Scientifique (CNRS), Université de Montpellier, IRD, délégation Occitanie, Montpellier, France (SG)
| | - Stéphane Blanche
- Unité d'Immunologie Hématologie Rhumatologie Pédiatrique, Hôpital Necker Enfants Malades, AP-HP, Paris, France
| | - Olivier Marcy
- Epidemiology and Public Health Unit, Institut Pasteur du Cambodge, Phnom Penh, Cambodia.,Université de Bordeaux, Centre Institut national de la santé et de la recherche médicale U1219, Bordeaux Population Health, France
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24
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Linder A, Fjell CD, Inghammar M, Hsu J, Walley KR, Boyd JH, Russell JA. The Specific Organism: Not Bacterial Gram Type: Drives the Inflammatory Response in Septic Shock. J Innate Immun 2019; 12:182-190. [PMID: 31242491 DOI: 10.1159/000500418] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 12/01/2018] [Accepted: 04/08/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND AND HYPOTHESIS The inflammatory response was targeted by unsuccessful therapies but ignored pathogen. We hypothesized that the inflammatory response differs according to organism in human septic shock. MATERIALS AND METHODS We measured 39 cytokines at baseline and 24 h in patients (n = 363) in the Vasopressin and Septic Shock Trial (VASST). We compared cytokine profiles (cytokine functional class) at baseline and at 24 h by organism and used hierarchical clustering to classify cytokines according to 28-day outcomes. RESULTS In 363 patients, 88 and 176 patients had at least 1 species isolated from blood and other sites, respectively. Cytokine levels differed significantly according to organism: Neisseria meningitidis and Streptococcus pneumoniae had the highest (baseline and at 24 h), while Enterococcus faecalis (blood) had the lowest mean cytokine levels. N. meningitidis and Klebsiella pneumoniae had significantly higher cytokine levels at baseline versus 24 h (p = 0.01 and 0.02, respectively); E. faecalis had significantly higher cytokine levels at 24 h versus baseline. Hierarchical clustering heat maps showed that pathogens elicited similar cytokine responses not related to the functional cytokine class. CONCLUSION The organism type induces different cytokine profiles in septic shock. Specific gram-positive and gram-negative pathogens stimulated similar plasma cytokine-level patterns.
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Affiliation(s)
- Adam Linder
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden,
| | - Chris D Fjell
- Centre for Heart Lung Innovation and Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Malin Inghammar
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Joseph Hsu
- Pulmonary and Critical Care Medicine, Department of Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Keith R Walley
- Centre for Heart Lung Innovation and Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - John H Boyd
- Centre for Heart Lung Innovation and Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - James A Russell
- Centre for Heart Lung Innovation and Division of Critical Care Medicine, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
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Inghammar M, Borand L, Goyet S, Rammaert B, Te V, Lorn Try P, Guillard B, Buchy P, Vong S, Tek Chheng E, Cavailler P, Mayaud C, Tarantola A. Community-acquired pneumonia and Gram-negative bacilli in Cambodia-incidence, risk factors and clinical characteristics. Trans R Soc Trop Med Hyg 2019; 112:57-63. [PMID: 29579302 PMCID: PMC6018679 DOI: 10.1093/trstmh/try022] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [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: 10/08/2017] [Accepted: 03/07/2018] [Indexed: 11/13/2022] Open
Abstract
Background In Western settings, community-acquired pneumonia (CAP) due to Gram-negative bacilli (GNB) is relatively rare. Previous studies from Asia, however, indicate a higher prevalence of GNB in CAP, but data, particularly from Southeast Asia, are limited. Methods This is a prospective observational study of 1451 patients ≥15 y of age with CAP from two hospitals in Cambodia between 2007 and 2010. The proportion of GNB was estimated. Risk factors and clinical characteristics of CAP due to GNB were assessed using logistic regression models. Results The prevalence of GNB was 8.6% in all CAP patients and 15.8% among those with a valid respiratory sample. GNB infection was independently associated with diabetes, higher leucocyte count and CAP severity. Mortality was higher in patients with CAP due to GNB. Conclusions We found a high proportion of GNB in a population hospitalized for CAP in Cambodia. Given the complex antimicrobial sensitivity patterns of certain GNBs and the rapid emergence of multidrug-resistant GNB, microbiological laboratory capacity should be strengthened and prospective clinical trials comparing empiric treatment algorithms according to the severity of CAP are needed.
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Affiliation(s)
- Malin Inghammar
- Institut Pasteur du Cambodge, Reseau International des Instituts Pasteur, Phnom Penh, Cambodia.,Lund University, Department of Clinical Sciences Lund, Section for Infection Medicine, Lund, Sweden
| | - Laurence Borand
- Institut Pasteur du Cambodge, Reseau International des Instituts Pasteur, Phnom Penh, Cambodia
| | - Sophie Goyet
- Institut Pasteur du Cambodge, Reseau International des Instituts Pasteur, Phnom Penh, Cambodia
| | - Blandine Rammaert
- Université de Poitiers, Service de maladies infectieuses et tropicales, CHU de Poitiers, Poitiers, France.,INSERM U1070, Pôle Biologie Santé, Poitiers, France
| | - Vantha Te
- Takeo Provincial Hospital, Takeo, Cambodia
| | | | - Bertrand Guillard
- Institut Pasteur du Cambodge, Reseau International des Instituts Pasteur, Phnom Penh, Cambodia
| | - Philippe Buchy
- Institut Pasteur du Cambodge, Reseau International des Instituts Pasteur, Phnom Penh, Cambodia.,GlaxoSmithKline Vaccines R&D Asia-Pacific, Scientific Affairs and Public Health, Singapore
| | - Sirenda Vong
- Institut Pasteur du Cambodge, Reseau International des Instituts Pasteur, Phnom Penh, Cambodia
| | - Eap Tek Chheng
- Institut Pasteur du Cambodge, Reseau International des Instituts Pasteur, Phnom Penh, Cambodia
| | - Philippe Cavailler
- Institut Pasteur du Cambodge, Reseau International des Instituts Pasteur, Phnom Penh, Cambodia
| | - Charles Mayaud
- Service de Pneumologie, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Paris VI, France
| | - Arnaud Tarantola
- Institut Pasteur du Cambodge, Reseau International des Instituts Pasteur, Phnom Penh, Cambodia
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26
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Stjärne Aspelund A, Hammarström H, Inghammar M, Larsson H, Hansson L, Riise GC, Friman V, Christensson B, Påhlman LI. Microbiological findings in bronchoalveolar lavage fluid from lung transplant patients in Sweden. Transpl Infect Dis 2018; 20:e12973. [PMID: 30107073 PMCID: PMC7169803 DOI: 10.1111/tid.12973] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [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: 03/02/2018] [Revised: 07/19/2018] [Accepted: 07/25/2018] [Indexed: 11/30/2022]
Abstract
Background Lung transplant patients experience a high risk of airway infections and microbial colonization of the lung due to constant exposure to the environment through inhaled microorganisms, denervation, reduced ciliary transport, and decreased cough. Methods In this nationwide prospective study on Swedish lung transplant patients, we evaluated the microbiological panorama of bacteria, fungi, and virus found in bronchoalveolar lavage fluid (BALF) obtained the first year after lung transplantation (LTx). Differences in microbiological findings depending of concomitant signs of infection and background factors were assessed. Results A total of 470 bronchoscopies from 126 patients were evaluated. Sixty‐two percent (n = 293) of BALF samples had positive microbiological finding(s). Forty‐six percent (n = 217) had bacterial growth, 29% (n = 137) fungal growth, and 9% (n = 43) were positive in viral PCR. In 38% of BALF samples (n = 181), a single microbe was found, whereas a combination of bacteria, fungi or virus was found in 24% (n = 112) of bronchoscopies. The most common microbiological findings were Candida albicans, Pseudomonas aeruginosa and coagulase negative Staphylococcus (in 42 (33%), 36 (29%), and 25 (20%) patients, respectively). Microbiological findings were similar in BALF from patients with and without signs of lung infection and the frequency of multidrug resistant (MDR) bacteria was low. No significant association was found between background factors and time to first lung infection. Conclusion This study gives important epidemiologic insights and reinforces that microbiological findings have to be evaluated in the light of clinical symptoms and endobronchial appearance in the assessment of lung infections in lung transplant patients.
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Affiliation(s)
- Anna Stjärne Aspelund
- Division of Infection Medicine, Hospital of Helsingborg, Helsingborg, Sweden.,Division of Infection Medicine, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Helena Hammarström
- Department of Infectious Diseases, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Malin Inghammar
- Division of Infection Medicine, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Hillevi Larsson
- Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lennart Hansson
- Department of Clinical Sciences Lund, Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Gerdt C Riise
- Department of Respiratory Medicine, Sahlgrenska University Hospital, Göteborg, Sweden
| | - Vanda Friman
- Department of Infectious Diseases, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden
| | - Bertil Christensson
- Division of Infection Medicine, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lisa I Påhlman
- Division of Infection Medicine, Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Lund, Sweden
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27
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Inghammar M, Nibell O, Pasternak B, Melbye M, Svanström H, Hviid A. Long-Term Risk of Cardiovascular Death With Use of Clarithromycin and Roxithromycin: A Nationwide Cohort Study. Am J Epidemiol 2018; 187:777-785. [PMID: 29155931 DOI: 10.1093/aje/kwx359] [Citation(s) in RCA: 10] [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: 03/04/2017] [Accepted: 11/07/2017] [Indexed: 11/14/2022] Open
Abstract
Recent studies have raised concern that macrolide antibiotics may be associated with an increased long-term risk of cardiovascular death. We examined the 1-year risk associated with treatment with clarithromycin (n = 187,887) or roxithromycin (n = 698,899) compared with penicillin V (n = 3,473,081), matched 1:4 on propensity score, in a nationwide, registry-based cohort study in Danish outpatients, 1997-2011. Among clarithromycin courses, the rate ratio for cardiovascular death was 1.24 (95% confidence interval (CI): 0.96, 1.59). Among roxithromycin courses, the rate ratio was 0.99 (95% CI: 0.86, 1.16). In analyses by time after treatment start, the rate ratio associated with clarithromycin was 1.66 (95% CI: 0.98, 2.79) during days 0-7. This was attenuated in later time periods (days 8-89, rate ratio = 1.30, 95% CI: 0.88, 1.94; and days 90-364, rate ratio = 0.96, 95% CI: 0.63, 1.47). For roxithromycin, the rate ratios were 0.88 (95% CI: 0.59, 1.32) during days 0-7, 1.17 (95% CI: 0.92, 1.48) during days 8-89, and 0.88 (95% CI: 0.70, 1.10) during days 90-364. We found no increased risk of cardiovascular death in a general outpatient population. With clarithromycin, we observed a transient increased risk during days 0-7 after treatment start, which corresponds to the period of active treatment. This association was absent in later time periods, which is consistent with no long-term toxicity resulting in cardiovascular death.
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Affiliation(s)
- Malin Inghammar
- Department of Epidemiology Research, Division of Health Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
- Division of Infection Medicine, Skåne University Hospital and Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Olof Nibell
- Department of Epidemiology Research, Division of Health Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
- Division of Infection Medicine, Skåne University Hospital and Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Björn Pasternak
- Department of Epidemiology Research, Division of Health Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
- Clinical Epidemiology Unit, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden
| | - Mads Melbye
- Department of Epidemiology Research, Division of Health Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
- Department of Medicine, Stanford University School of Medicine, Stanford, California
| | - Henrik Svanström
- Department of Epidemiology Research, Division of Health Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
| | - Anders Hviid
- Department of Epidemiology Research, Division of Health Surveillance and Research, Statens Serum Institut, Copenhagen, Denmark
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Abstract
OBJECTIVE To investigate whether oral fluoroquinolone use is associated with an increased risk of aortic aneurysm or dissection. DESIGN Nationwide historical cohort study using linked register data on patient characteristics, filled prescriptions, and cases of aortic aneurysm or dissection. SETTING Sweden, July 2006 to December 2013. PARTICIPANTS 360 088 treatment episodes of fluoroquinolone use (78%ciprofloxacin) and propensity score matched comparator episodes of amoxicillin use (n=360 088). MAIN OUTCOME MEASURES Cox regression was used to estimate hazard ratios for a first diagnosis of aortic aneurysm or dissection, defined as admission to hospital or emergency department for, or death due to, aortic aneurysm or dissection, within 60 days from start of treatment. RESULTS Within the 60 day risk period, the rate of aortic aneurysm or dissection was 1.2 cases per 1000 person years among fluoroquinolone users and 0.7 cases per 1000 person years among amoxicillin users. Fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection (hazard ratio 1.66 (95% confidence interval 1.12 to 2.46)), with an estimated absolute difference of 82 (95% confidence interval 15 to 181) cases of aortic aneurysm or dissection by 60 days per 1 million treatment episodes. In a secondary analysis, the hazard ratio for the association with fluoroquinolone use was 1.90 (1.22 to 2.96) for aortic aneurysm and 0.93 (0.38 to 2.29) for aortic dissection. CONCLUSIONS In a propensity score matched cohort, fluoroquinolone use was associated with an increased risk of aortic aneurysm or dissection. This association appeared to be largely driven by aortic aneurysm.
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Affiliation(s)
- Björn Pasternak
- Clinical Epidemiology Unit T2, Department of Medicine Solna, Karolinska Institutet, 17176 Stockholm, Sweden
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
| | - Malin Inghammar
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
- Section for Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Henrik Svanström
- Department of Epidemiology Research, Statens Serum Institut, Copenhagen, Denmark
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Stjärne Aspelund A, Hammarström H, Inghammar M, Larsson H, Hansson L, Christensson B, Påhlman LI. Heparin-binding protein, lysozyme, and inflammatory cytokines in bronchoalveolar lavage fluid as diagnostic tools for pulmonary infection in lung transplanted patients. Am J Transplant 2018; 18:444-452. [PMID: 28787761 PMCID: PMC5813223 DOI: 10.1111/ajt.14458] [Citation(s) in RCA: 24] [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: 02/07/2017] [Revised: 07/21/2017] [Accepted: 07/29/2017] [Indexed: 01/25/2023]
Abstract
Pulmonary infection is a common complication after lung transplantation, and early detection is crucial for outcome. However, the condition can be clinically difficult to diagnose and to distinguish from rejection. The aim of this prospective study was to evaluate heparin-binding protein (HBP), lysozyme, and the cytokines interleukin (IL)-1β, IL-6, IL-8, IL-10 and tumor necrosis factor (TNF) in bronchoalveolar lavage fluid (BALF) as potential biomarkers for pulmonary infection in lung-transplanted patients. One hundred thirteen BALF samples from 29 lung transplant recipients were collected at routine scheduled bronchoscopies at 3 and 6 months, or on clinical indication. Samples were classified into no, possible, probable, or definite infection at the time of sampling. Rejection was defined by biopsy results. HBP, lysozyme, and cytokines were analyzed in BALF and correlated to likelihood of infection and rejection. All biomarkers were significantly increased in BALF during infection, whereas patients with rejection presented low levels that were comparable to noninfection samples. HBP, IL-1β, and IL-8 were the best diagnostic markers of infection with area under the receiver-operating characteristic curve values of 0.88, 0.91, and 0.90, respectively. In conclusion, HBP, IL-1β, and IL-8 could be useful diagnostic markers of pulmonary infection in lung-transplanted patients.
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Affiliation(s)
- Anna Stjärne Aspelund
- Department of Infection ControlSkåne CountyLundSweden,Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
| | - Helena Hammarström
- Department of Infectious DiseasesSahlgrenska Academy at University of GothenburgGöteborgSweden
| | - Malin Inghammar
- Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
| | - Hillevi Larsson
- Division of Respiratory Medicine and AllergologyDepartment of Clinical SciencesLund UniversitySkåne University HospitalLundSweden
| | - Lennart Hansson
- Division of Respiratory Medicine and AllergologyDepartment of Clinical SciencesLund UniversitySkåne University HospitalLundSweden
| | - Bertil Christensson
- Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
| | - Lisa I. Påhlman
- Division of Infection MedicineDepartment of Clinical Sciences LundLund UniversitySkåne University HospitalLundSweden
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Fraenkel CJ, Inghammar M, Söderlund-Strand A, Johansson PJH, Böttiger B. Risk factors for hospital norovirus outbreaks: impact of vomiting, genotype, and multi-occupancy rooms. J Hosp Infect 2018; 98:398-403. [PMID: 29355578 DOI: 10.1016/j.jhin.2018.01.011] [Citation(s) in RCA: 6] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2017] [Accepted: 01/12/2018] [Indexed: 11/26/2022]
Abstract
BACKGROUND Norovirus is frequently introduced to the hospital and is a frequent cause of hospital outbreaks. Recognition of the factors that facilitate or impede norovirus transmission is an important step to effectively prevent hospital outbreaks. AIM To investigate risk factors for norovirus outbreaks in hospital settings. METHODS Clinical data, ward setting, and norovirus genotype were collected from all 65 norovirus-positive index cases in outbreaks and all 186 sporadic norovirus cases at 192 wards in southern Sweden during 2010-2012 in a nested case-control study. Uni- and multivariate statistical analyses were conducted. FINDINGS Outbreak was independently associated with the number of patients sharing a room with the norovirus case (odds ratio (OR): 1.9 per additional patient in the room; P < 0.01), vomiting (OR: 2.6; P = 0.04), age >80 years (OR: 3.2; P < 0.01), comorbidity (OR: 2.3; P = 0.05), and onset of symptoms after admission to the ward (OR: 3.5; P < 0.01) in the multivariate analysis. Infection with genotype GII.4 was found to be strongly associated with outbreak in the univariate analysis (OR: 5.7; P < 0.01). Moreover, associations between GII.4 and vomiting (OR: 2.5; P = 0.01) and old age (OR: 4.3: P < 0.01) were found. CONCLUSION This is the first study to investigate clinical, ward and genotype risk factors for norovirus hospital outbreaks. Recognition of these factors may help direct and prioritize infection control actions based on the outbreak risk. The results also suggest that the outbreak association with GII.4 partly may be explained by an enhanced ability to induce vomiting.
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Affiliation(s)
- C J Fraenkel
- Department of Infection Control, Region Skåne, Lund, Sweden; Division of Infection Medicine, Department of Clinical Sciences, Lund University, Sweden.
| | - M Inghammar
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Sweden
| | - A Söderlund-Strand
- Department of Clinical Microbiology, University and Regional Laboratories, Region Skåne, Lund, Sweden
| | | | - B Böttiger
- Department of Clinical Microbiology, University and Regional Laboratories, Region Skåne, Lund, Sweden
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31
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Inghammar M, By Y, Farris C, Phe T, Borand L, Kerleguer A, Goyet S, Saphonn V, Phoeung C, Vong S, Rammaert B, Mayaud C, Guillard B, Yasuda C, Kasper MR, Ford G, Newell SW, An US, Sokhal B, Touch S, Turner P, Jacobs J, Messaoudi M, Komurian-Pradel F, Tarantola A. Serotype Distribution of Clinical Streptococcus pneumoniae Isolates before the Introduction of the 13-Valent Pneumococcal Conjugate Vaccine in Cambodia. Am J Trop Med Hyg 2018; 98:791-796. [PMID: 29313476 PMCID: PMC5930902 DOI: 10.4269/ajtmh.17-0692] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [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] [Indexed: 01/05/2023] Open
Abstract
Childhood vaccination with the 13-valent pneumococcal conjugate vaccine (PCV13) was introduced in Cambodia in January 2015. Baseline data regarding circulating serotypes are scarce. All microbiology laboratories in Cambodia were contacted for identification of stored isolates of Streptococcus pneumoniae from clinical specimens taken before the introduction of PCV13. Available isolates were serotyped using a multiplex polymerase chain reaction method. Among 166 identified isolates available for serotyping from patients with pneumococcal disease, 4% were isolated from upper respiratory samples and 80% were from lower respiratory samples, and 16% were invasive isolates. PCV13 serotypes accounted for 60% (95% confidence interval [CI] 52–67) of all isolates; 56% (95% CI 48–64) of noninvasive and 77% (95% CI 57–89) of invasive isolates. Antibiotic resistance was more common among PCV13 serotypes. This study of clinical S. pneumoniae isolates supports the potential for high reduction in pneumococcal disease burden and may serve as baseline data for future monitoring of S. pneumoniae serotypes circulation after implementation of PCV13 childhood vaccination in Cambodia.
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Affiliation(s)
- Malin Inghammar
- Section for Infection Medicine, Department of Clinical Sciences Lund, Lund University, Skane University Hospital, Lund, Sweden.,Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Youlet By
- University of Health Science, Phnom Pen, Cambodia.,Fondation Mérieux, Phnom Penh, Cambodia
| | | | - Thong Phe
- Sihanouk Hospital Center of Hope, Phnom Penh, Cambodia
| | | | | | - Sophie Goyet
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | | | | | - Sirenda Vong
- Institut Pasteur du Cambodge, Phnom Penh, Cambodia
| | - Blandine Rammaert
- CHU de Poitiers, Service de Maladies Infectieuses et Tropicales, INSERM U1070, Université de Poitiers, Poitiers, France
| | | | | | | | | | - Gavin Ford
- Naval Medical Research Unit No. 2, Phnom Penh, Cambodia
| | | | - Ung Sam An
- Cambodian National Laboratory of Public Health, Phnom Penh, Cambodia
| | - Buth Sokhal
- Cambodian National Laboratory of Public Health, Phnom Penh, Cambodia
| | - Sok Touch
- Cambodian Communicable Disease Control Department, Phnom Penh, Cambodia
| | - Paul Turner
- Nuffield Department of Medicine, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, United Kingdom.,Cambodia Oxford Medical Research Unit, Siem Reap, Cambodia
| | - Jan Jacobs
- Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.,Department of Clinical Sciences, Institute of Tropical Medicine, Antwerp, Belgium.,Sihanouk Hospital Center of Hope, Phnom Penh, Cambodia
| | - Mélina Messaoudi
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, Lyon, France
| | - Florence Komurian-Pradel
- Emerging Pathogens Laboratory, Fondation Mérieux, Centre International de Recherche en Infectiologie, INSERM U1111, Lyon, France
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Pasternak B, Inghammar M, Svanstrom H. P6023Fluoroquinolone use and risk of aortic aneurysm: nationwide cohort study in Sweden. Eur Heart J 2017. [DOI: 10.1093/eurheartj/ehx493.p6023] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Abstract
OBJECTIVE To evaluate if oral fluoroquinolone use is associated with an increased risk of serious arrhythmia. DESIGN Bi-national cohort study, linking register data on filled prescriptions, cases of serious arrhythmia, and patient characteristics. SETTING Denmark, 1997-2011; Sweden, 2006-13. PARTICIPANTS The study cohort was derived from a source population of all Danish and Swedish adults, aged 40 to 79 years. 909,656 courses of fluoroquinolone use (ciprofloxacin 82.6%, norfloxacin 12.1%, ofloxacin 3.2%, moxifloxacin 1.2%, and other fluoroquinolones 0.9%) and 909,656 courses of penicillin V use, matched 1:1 on propensity score, were included. MAIN OUTCOME MEASURE The main outcome was risk of serious arrhythmia (fatal and non-fatal), comparing courses of fluoroquinolone use with courses of penicillin V use (an antibiotic with no pro-arrhythmic effect). The risk period of interest was current use, defined as days 0-7 of treatment. Subgroup analyses were conducted according to country, sex, age, underlying cardiovascular disease, concomitant use of drugs known to increase the risk of torsades de pointes, fluoroquinolone type, and levels of arrhythmia risk score. RESULTS 144 cases of serious arrhythmia occurred during follow-up, 66 among current fluoroquinolone users (incidence rate 3.4 per 1000 person years) and 78 among current penicillin users (4.0 per 1000 person years); comparing oral fluoroquinolone treatment with penicillin V, the rate ratio was 0.85 (95% confidence interval 0.61 to 1.18). Compared with penicillin V, the absolute risk difference was -13 (95% confidence interval -35 to 16) cases of serious arrhythmia per 1,000,000 courses of fluoroquinolones. The risk of serious arrhythmia was not statistically significantly increased in any of the subgroups, including analyses by fluoroquinolone type. CONCLUSIONS Contrary to previous reports, oral fluoroquinolone treatment was not associated with an increased risk of serious arrhythmia in the general adult populations of Denmark and Sweden. Given the statistical power of the study, even small increases in relative and absolute risk could be ruled out. Since ciprofloxacin was the most commonly used fluoroquinolone in our study, we cannot exclude that intraclass differences influence the risk of serious arrhythmia associated with other less frequently used fluoroquinolones.
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Affiliation(s)
- Malin Inghammar
- Lund University, Department of Clinical Sciences Lund, Section for Infection Medicine, Lund, Sweden
| | - Henrik Svanström
- Department of Epidemiology Research, Statens Serum Institut, 2300 Copenhagen S, Denmark
| | - Mads Melbye
- Department of Epidemiology Research, Statens Serum Institut, 2300 Copenhagen S, Denmark
| | - Björn Pasternak
- Department of Epidemiology Research, Statens Serum Institut, 2300 Copenhagen S, Denmark
| | - Anders Hviid
- Department of Epidemiology Research, Statens Serum Institut, 2300 Copenhagen S, Denmark
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Söderholm M, Inghammar M, Hedblad B, Egesten A, Engström G. Incidence of stroke and stroke subtypes in chronic obstructive pulmonary disease. Eur J Epidemiol 2015; 31:159-68. [PMID: 26711630 DOI: 10.1007/s10654-015-0113-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 12/16/2015] [Indexed: 11/25/2022]
Abstract
It is uncertain whether the incidence of stroke is increased in patients with chronic obstructive pulmonary disease (COPD), and whether COPD is associated with all subtypes of stroke (i.e. ischemic stroke, intracerebral haemorrhage and subarachnoid haemorrhage). We evaluated the association between COPD and incidence of stroke in a nation-wide cohort study. All individuals between 40 and 84 years of age, hospitalised for COPD between 1987 and 2003 in Sweden were identified in the Swedish hospital discharge register. For each COPD patient (n = 103,419), one reference individual was randomly selected from the general population matched for year of birth, sex and county of residence. After excluding subjects with prior stroke, incidence rates during 10 years follow-up were calculated. Hazard ratios (HR) for stroke comparing COPD patients with reference subjects were estimated using Cox regression adjusting for demographics and comorbidities. Incidence of all-cause stroke (n events = 17,402) was significantly increased in COPD patients compared to reference individuals (HR 1.24, 95 % CI 1.19-1.28), especially during the first 2 years after COPD diagnosis (HR 1.46, 1.37-1.55). Incidences of ischemic stroke (HR 1.20, 1.15-1.25), intracerebral haemorrhage (HR 1.29, 1.16-1.43) and subarachnoid haemorrhage (HR 1.46, 1.16-1.85) were all increased in COPD patients. Incidences of all stroke subtypes are increased in COPD, especially during the first years after COPD diagnosis. The association was independent of several comorbidities, although residual confounding from smoking and hypertension cannot be excluded. A global evaluation of stroke risk factors seems warranted in patients with COPD.
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Affiliation(s)
- Martin Söderholm
- Cardiovascular Epidemiology Research Group, Department of Clinical Sciences Malmö, Lund University, CRC Building 60, Floor 13, Jan Waldenströms gata 35, 20502, Malmö, Sweden.
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden.
| | - Malin Inghammar
- Section for Infection Medicine, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Bo Hedblad
- Cardiovascular Epidemiology Research Group, Department of Clinical Sciences Malmö, Lund University, CRC Building 60, Floor 13, Jan Waldenströms gata 35, 20502, Malmö, Sweden
| | - Arne Egesten
- Section for Respiratory Medicine, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Gunnar Engström
- Cardiovascular Epidemiology Research Group, Department of Clinical Sciences Malmö, Lund University, CRC Building 60, Floor 13, Jan Waldenströms gata 35, 20502, Malmö, Sweden
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Hansson L, Lindberg U, Inghammar M, Skog I. WS8.6 Bacterial flora in the airways after lung transplantation in patients with cystic fibrosis. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60057-6] [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: 10/25/2022]
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Abstract
Background Erysipelas is a common infection that often recurs, but the impact of specific risk factors for reoccurrence remains elusive. In the present study we aimed at clarifying predisposing conditions for reoccurrence. Methods Medical records were reviewed from all patients ≥18 years of age diagnosed with erysipelas at the Department of Infectious Diseases at Skåne University Hospital, Sweden, from January 2007 to February 2011. 502 patients were included, of which 357 were single episode erysipelas and 145 had recurrent erysipelas. These two groups were compared regarding underlying conditions and clinical presentation. Results Erysipelas in the lower limbs had the greatest propensity of recurrence. The associations between underlying conditions and recurrence were largely depending on the site of erysipelas. Overall, the most prominent risk factor for recurrence was lymphedema and other conditions causing a chronic impairment of the defence against microbes. Conditions temporarily disrupting the skin barrier (e.g. a local wound or toe web intertrigo), although likely being risk factors for erysipelas per se, did not seem to predispose to repeated episodes. Individuals with recurrent erysipelas tended to seek medical attention earlier, and were less likely to be hospitalized or receive intravenous antibiotics, but there was no evidence of any difference in inflammatory reaction when taking confounding factors into account. Conclusions In this large cross-sectional study of over 500 patients with erysipelas, lymphedema was the most prominent risk factors for recurrence although the distribution of predisposing conditions varies depending on the site of erysipelas.
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Affiliation(s)
- Malin Inghammar
- Department of Clinical Sciences, Division of Infection Medicine, Klinikgatan 1, Skåne University Hospital, Lund, Lund SE-221 85, Sweden.
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Inghammar M, Engström G, Ljungberg B, Löfdahl CG, Roth A, Egesten A. Increased incidence of invasive bacterial disease in chronic obstructive pulmonary disease compared to the general population--a population based cohort study. BMC Infect Dis 2014; 14:163. [PMID: 24661335 PMCID: PMC3976148 DOI: 10.1186/1471-2334-14-163] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2013] [Accepted: 03/18/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Innate defence mechanisms of the airways are impaired in chronic obstructive pulmonary disease (COPD), predisposing patients to lower respiratory tract infections, but less is known about the association with other infections. In this population-based cohort study, we investigated the associations between COPD and invasive bacterial disease by comparing incidence rates of bacteraemia in COPD patients and randomly selected reference individuals from the general population. METHODS In this population based cohort study all patients with COPD, ≥40 years of age, who were discharged from hospitals in southern Sweden between 1990 and 2003 were identified in the Swedish Inpatient Register (n = 15,403). Age and gender matched reference individuals were randomly selected from the general population. Records were cross-referenced to the microbiological databases covering the region, 1990-2010. The hazard ratios (HR) of bloodstream infections and hospitalisations for infections were estimated by Cox proportional hazards regression. RESULTS We found that individuals with COPD had a 2.5-fold increased incidence of bacteraemia compared to the reference individuals from the general population adjusted for other co-morbidity and socio-economic status (hazard ratio: 2.5, 95% confidence interval: 2.2-2.7). The increased incidence of bacteraemia was paralleled by an increased incidence of hospitalisation for non-respiratory infections, i.e., skin infections, pyelonephritis, or septic arthritis. Despite higher absolute rates of bloodstream infections among COPD patients than among the general population, the distribution of different pathogens was similar. CONCLUSIONS In summary this population-based study shows COPD is associated with an increased incidence of invasive bacterial infections compared to the general population, indicating a general frailty of acquiring severe infections in addition to the specific susceptibility to infections of respiratory origin. The underlying contributory factors (e.g. smoking, corticosteroid use, co-morbid diseases or a frailty inherent to COPD itself) need to be disentangled in further studies.
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Affiliation(s)
- Malin Inghammar
- Infection Medicine, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Respiratory Medicine & Allergology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
- Department of Infectious Diseases, Skåne University Hospital, SE-221 85 Lund, Sweden
| | - Gunnar Engström
- Cardiovascular Epidemiology Research Group, Department of Clinical Sciences Malmö, Lund University, Skåne University Hospital, Malmö, Sweden
| | - Bengt Ljungberg
- Infection Medicine, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Claes-Göran Löfdahl
- Respiratory Medicine & Allergology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Adam Roth
- Medical Microbiology, Department of Laboratory Sciences Malmö, Lund University, Skåne University Hospital Malmö, Malmö, Sweden
| | - Arne Egesten
- Respiratory Medicine & Allergology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Inghammar M, Engström G, Kahlmeter G, Ljungberg B, Löfdahl CG, Egesten A. Invasive pneumococcal disease in patients with an underlying pulmonary disorder. Clin Microbiol Infect 2013; 19:1148-54. [PMID: 23464817 DOI: 10.1111/1469-0691.12182] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2012] [Revised: 12/10/2012] [Accepted: 01/26/2013] [Indexed: 11/28/2022]
Abstract
Chronic pulmonary disease is a recognized risk factor for invasive pneumococcal disease (IPD). However, previous studies have often not been large enough to allow detailed analyses of less prevalent pulmonary diseases, and findings regarding case fatality have been inconsistent. We examined the associations between an underlying pulmonary disease and IPD, and the impact of these diseases on the case fatality rate. Patients with IPD ≥18 years of age, between 1990 and 2008, were identified in microbiological databases. The associations between IPD and the pulmonary diseases were assessed using conditional logistic regression, comparing IPD cases to ten control subjects per case, randomly selected from the general population (matched for gender, year of birth and county of residence). Adjustments were made for other co-morbidities, level of education and socio-economic status, 4085 cases of IPD and 40 353 controls were identified. A more than four-fold increased risk of IPD was seen in chronic obstructive pulmonary disease, a doubled risk in asthma and a five-fold increased risk in subjects with pulmonary fibrosis. In univariate analysis, sarcoidosis and bronchiectasis were associated with a two-fold to seven-fold increase in the risk of IPD, but there was no statistical support for the associations when adjustments for confounders were made. No increased risk was seen in subjects with a history of pneumoconiosis or allergic alveolitis. The mortality following IPD was not increased in patients with chronic obstructive pulmonary disease, asthma, pulmonary fibrosis or bronchiectasis. Several chronic pulmonary diseases increase the risk of IPD but mortality following IPD seems not to be affected.
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Affiliation(s)
- M Inghammar
- Section for Infection Medicine, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden; Section for Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Abstract
AIMS The Swedish National Inpatient Registry is an important source of data for numerous epidemiological studies, amongst them studies on chronic obstructive pulmonary disease (COPD). General validation studies indicate that in general 85-95% of diagnoses reported are correct, but this is not true for all groups of diseases, why specific validation studies are of great importance. METHODS Charts from 374 individuals discharged with a COPD diagnosis between 2000-07 from two central hospitals and two university hospitals in the county of Skåne were validated against the original medical files. Criteria for the degree of certainty of the COPD diagnosis were predefined and the association between predictors of diagnostic probability and the level of certainty was assessed using an ordinal logistic regression model. RESULTS According to the Global Initiative for Chronic Obstructive Lung Disease criteria, 21.7% of the diagnosis were classified as proven COPD, 35.5% were classified as probable, another 34.0% as possible COPD, 2.1% were classified as having an uncertain diagnosis, and 7.0% as an unlikely COPD diagnosis. Age category (adjusted ORs: 60-79 years, 2.6, 95% CI 1.2-5.4; ≥80 years, 1.6, 95% CI 0.7-3.3) and discharge from a non-surgical department (adjusted OR: 1.7, 95% CI 1.1-2.8) were significantly associated with higher level of diagnostic certainty. CONCLUSIONS A COPD diagnoses from the Swedish Inpatient Registry is of acceptable validity for epidemiological research. The degree of certainty of the diagnosis varies but less than 10% were considered as misclassified or having an uncertain COPD diagnosis.
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Affiliation(s)
- Malin Inghammar
- Respiratory Medicine and Allergology, Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden.
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Linder A, Åkesson P, Inghammar M, Treutiger CJ, Linnér A, Sundén-Cullberg J. Elevated plasma levels of heparin-binding protein in intensive care unit patients with severe sepsis and septic shock. Crit Care 2012; 16:R90. [PMID: 22613179 PMCID: PMC3580636 DOI: 10.1186/cc11353] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2012] [Accepted: 05/21/2012] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Rapid detection of, and optimized treatment for, severe sepsis and septic shock is crucial for successful outcome. Heparin-binding protein (HBP), a potent inducer of increased vascular permeability, is a potentially useful biomarker for predicting outcome in patients with severe infections. Our aim was to study the systemic release and dynamics of HBP in the plasma of patients with severe sepsis and septic shock in the ICU. METHODS A prospective study was conducted of two patient cohorts treated in the ICU at Karolinska University Hospital Huddinge in Sweden. A total of 179 patients was included, of whom 151 had sepsis (126 with septic shock and 25 patients with severe sepsis) and 28 a non-septic critical condition. Blood samples were collected at five time points during six days after admission. RESULTS HBP levels were significantly higher in the sepsis group as compared to the control group. At admission to the ICU, a plasma HBP concentration of ≥ 15 ng/mL and/or a HBP (ng/mL)/white blood cell count (109/L) ratio of >2 was found in 87.2% and 50.0% of critically ill patients with sepsis and non-septic illness, respectively. A lactate level of >2.5 mmol/L was detected in 64.9% and 56.0% of the same patient groups. Both in the sepsis group (n = 151) and in the whole group (n = 179), plasma HBP concentrations at admission and in the last measured sample within the 144 hour study period were significantly higher among 28-day non-survivors as compared to survivors and in the sepsis group, an elevated HBP-level at baseline was associated with an increased case-fatality rate at 28 days. CONCLUSIONS Plasma HBP levels were significantly higher in patients with severe sepsis or septic shock compared to patients with a non-septic illness in the ICU. HBP was associated with severity of disease and an elevated HBP at admission was associated with an increased risk of death. HBP that rises over time may identify patients with a deteriorating prognosis. Thus, repeated HBP measurement in the ICU may help monitor treatment and predict outcome in patients with severe infections.
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Abstract
OBJECTIVE Chronic obstructive pulmonary disease (COPD) continues to be an important cause of morbidity, mortality and healthcare costs in the western world. Although smoking is an important trigger of COPD, other factors such as chronic inflammation and malnutrition are known to influence its development. Because coeliac disease (CD) is characterized both by dysregulated inflammation and malnutrition, the possibility of an association between CD and COPD was investigated. METHODS Through biopsy data from all Swedish pathology departments, we identified 10 990 individuals with CD who were biopsied between 1987 and 2008 (Marsh 3: villous atrophy). As controls, 54 129 reference individuals matched for age, sex, county and calendar year of first biopsy were selected. Cox regression analysis was then performed to estimate hazard ratios (HRs) for having a diagnosis of COPD according to the Swedish Patient Register. RESULTS During follow-up, 380 individuals with CD (3.5%) and 1391 (2.6%) controls had an incident diagnosis of COPD, which corresponds to an HR of 1.24 (95% CI: 1.10-1.38) and an excess risk of COPD of 79/100 000 person-years in CD. The risk increase remained 5 years after biopsy (HR = 1.17; 95% CI: 1.00-1.37). Risk estimates did not change with adjustment for type 1 diabetes, thyroid disease, rheumatoid arthritis, country of birth or level of education. Men with CD were at a higher risk of COPD (HR = 1.39; 95% CI: 1.18-1.62) than women with CD (HR = 1.11; 95% CI: 0.94-1.30). Of note, CD was also associated with COPD before CD diagnosis (odds ratio = 1.22; 95% CI: 1.02-1.46). Conclusion. Patients with CD seem to be at a moderately increased risk of COPD both before and after CD diagnosis.
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Affiliation(s)
- J F Ludvigsson
- Department of Paediatrics, Örebro University Hospital, Örebro, Sweden.
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Inghammar M, Löfdahl CG, Winqvist N, Ljungberg B, Egesten A, Engström G. Impaired pulmonary function and the risk of tuberculosis: a population-based cohort study. Eur Respir J 2011; 37:1285-7. [PMID: 21532019 DOI: 10.1183/09031936.00091110] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Inghammar M, Ekbom A, Engström G, Ljungberg B, Romanus V, Löfdahl CG, Egesten A. COPD and the risk of tuberculosis--a population-based cohort study. PLoS One 2010; 5:e10138. [PMID: 20405056 PMCID: PMC2854124 DOI: 10.1371/journal.pone.0010138] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 03/20/2010] [Indexed: 11/19/2022] Open
Abstract
Background Both chronic obstructive pulmonary disease (COPD) and tuberculosis (TB) primarily affect the lungs and are major causes of morbidity and mortality worldwide. COPD and TB have common risk factors such as smoking, low socioeconomic status and dysregulation of host defence functions. COPD is a prevalent co-morbid condition, especially in elderly with TB but in contrast to other diseases known to increase the risk of TB, relatively little is known about the specific relationship and impact from COPD on TB-incidence and mortality. Methods and Findings All individuals ≥40 years of age, discharged with a diagnosis of COPD from Swedish hospitals 1987–2003 were identified in the Swedish Inpatient Register (n = 115,867). Records were linked to the Swedish Tuberculosis Register 1989–2007 and the relative risk of active TB in patients with COPD compared to control subjects randomly selected from the general population (matched for sex, year of birth and county of residence) was estimated using Cox regression. The analyses were stratified by year of birth, sex and county of residence and adjusted for immigration status, socioeconomic status (SES) and inpatient co-morbidities previously known to increase the risk of TB. COPD patients had a three-fold increased hazard ratio (HR) of developing active TB (HR 3.0 (95% confidence interval 2.4 to 4.0)) that was mainly dependent on an increased risk of pulmonary TB. In addition, logistic regression estimates showed that COPD patients who developed active TB had a two-fold increased risk of death from all causes within first year after the TB diagnosis compared to the general population control subjects with TB (OR 2.2, 95% confidence interval 1.2 to 4.1). Conclusions This population-based study comprised of a large number of COPD patients shows that these patients have an increased risk of developing active TB compared to the general population. The results raise concerns that the increasing global burden of COPD will increase the incidence of active TB. The underlying contributory factors need to be disentangled in further studies.
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Affiliation(s)
- Malin Inghammar
- Section for Infection Medicine, Department of Clinical Sciences Lund, Lund University, Lund University Hospital, Lund, Sweden.
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Egesten A, Brandt L, Olsson T, Granath F, Inghammar M, Löfdahl CG, Ekbom A. Increased Prevalence of Multiple Sclerosis Among COPD Patients and Their First-Degree Relatives: A Population-based Study. Lung 2008; 186:173-178. [DOI: 10.1007/s00408-008-9081-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Accepted: 02/11/2008] [Indexed: 11/24/2022]
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Appelros S, Inghammar M, Andersson EL, Ekelund GR. Intravenous 5-Fluorouracil based regimes as adjuvant to curative surgery for carcinoma of the colon with local lymphnode spread (Dukes' stage C). Hippokratia 2008. [DOI: 10.1002/14651858.cd002196.pub2] [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: 11/10/2022]
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Börjesson A, Wang X, Sun Z, Inghammar M, Truedsson L, Andersson R. Early treatment with lexipafant, a platelet-activating factor-receptor antagonist, is not sufficient to prevent pulmonary endothelial damage after intestinal ischaemia and reperfusion in rats. Dig Liver Dis 2002; 34:190-6. [PMID: 11990391 DOI: 10.1016/s1590-8658(02)80192-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [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] [Indexed: 12/11/2022]
Abstract
BACKGROUND Intestinal ischaemia-reperfusion can lead to pulmonary injury characterised by increased macromolecular leakage and leukocyte sequestration. Important mediators of ischaemia-reperfusion-associated injury include polymorphonuclear granulocytes and platelet-activating factor. AIM To investigate the potential therapeutic inhibition of platelet-activating factor in intestinal ischaemia-reperfusion associated pulmonary injury, by use of a potent platelet-activating factor-receptor antagonist, lexipafant. METHODS Rats were subjected to 30 minutes of intestinal ischaemia followed by 3 or 12 hours reperfusion. Lexipafant or saline was given intraperitoneally after 30 minutes reperfusion. RESULTS Increased leakage of radiolabelled human serum albumin was found in the lungs after intestinal ischaemia followed by 3 or 12 hours reperfusion. Administration of lexipafant did not significantly prevent the increased leakage. Pulmonary myeloperoxidase content increased after intestinal ischaemia-reperfusion, indicating polymorphonuclear granulocyte sequestration through the pulmonary endothelium. The increase in interleukin-1beta seen after 3 hours reperfusion was partly reversed by lexipafant. CONCLUSIONS Pulmonary injury occurred following intestinal ischaemia-reperfusion, characterised by increased leakage of radiolabelled albumin over the endothelial barrier; correlating with increased pulmonary myeloperoxidase-content, implying involvement of polymorphonuclear granulocytes in the pathogenesis of remote organ injury after intestinal ischaemia-reperfusion. Lexipafant did not significantly decrease severity of pulmonary damage.
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Affiliation(s)
- A Börjesson
- Department of Surgery, Lund University Hospital and Laboratory Medicine, Sweden
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Abstract
UNLABELLED Incubator covers are increasingly being used in neonatal care as part of minimal disturbance strategies. The aim of this study was to examine possible effects of incubator covers on sleep patterns in stable premature infants. Quiet sleep (QS) can be investigated by amplitude-integrated electroencephalography (aEEG) at 32-34 wk gestational age. In nine premature infants (gestational ages 26-32 wk, median 29) QS periods were measured at a postconceptional age of 32-34 wk (median 34) during two consecutive 24 h periods, one period with a padded dark cover over the incubator and one period without the cover, in a randomized order. There were no significant differences between the two 24 h periods (with incubator cover and without cover, respectively) regarding the duration of the QS periods, the percentage of QS of the total recording time (%QS) or the duration of QS intervals. However, there was a positive correlation between postnatal age in days and the mean duration of QS periods when incubator covers were used (r = 0.90, p = 0.001). When the covers were used there was a difference between the girls and the boys in the duration of QS intervals (p = 0.032); the QS intervals increased in the five girls from median (range) 63.2 (49.4-94.6) min to 77.2 (59.3-100.9) min (p = 0.043). There was no difference in the duration of QS periods between girls and boys. CONCLUSION Incubator covers seem to have some short-term effects on sleep quality in premature infants but the clinical significance and possible long-term effects are not known.
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Appelros S, Inghammar M, Andersson EL, Bohe M, Ekelund GR. Intravenous 5-Fluorouracil based regimes as adjuvant to curative surgery for carcinoma of the colon with local lymphnode spread (Dukes' stage C). Hippokratia 2000. [DOI: 10.1002/14651858.cd002196] [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: 11/09/2022]
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