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  • 1.
    Ahlstrand, Erik
    et al.
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Medicine.
    Cajander, Sara
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Infectious Diseases.
    Cajander, Per
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care.
    Ingberg, Edvin
    Faculty of Medicine and Health, Department of Infectious Diseases, Örebro University, Örebro, Sweden.
    Löf, Erika
    Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    Wegener, Matthias
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Lidén, Mats
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Radiology.
    Visual scoring of chest CT at hospital admission predicts hospitalization time and intensive care admission in Covid-192021In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 53, no 8, p. 622-632Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Chest CT is prognostic in Covid-19 but there is a lack of consensus on how to report the CT findings. A chest CT scoring system, ÖCoS, was implemented in clinical routine on 1 April 2020, in Örebro Region, Sweden. The ÖCoS-severity score measures the extent of lung involvement. The objective of the study was to evaluate the ÖCoS scores as predictors of the clinical course of Covid-19.

    METHODS: Population based study including data from all hospitalized patients with Covid-19 in Örebro Region during March to July 2020. We evaluated the correlations between CT scores at the time of admission to hospital and intensive care in relation to hospital and intensive care length of stay (LoS), intensive care admission and death. C-reactive protein and lymphocyte count were included as covariates in multivariate regression analyses.

    RESULTS: In 381 included patients, the ÖCoS-severity score at admission closely correlated to hospital length of stay, and intensive care admission or death. At admission to intensive care, the ÖCoS-severity score correlated with intensive care length of stay. The ÖCoS-severity score was superior to basic inflammatory biomarkers in predicting clinical outcomes.

    CONCLUSION: Chest CT visual scoring at admission to hospital predicted the clinical course of Covid-19 pneumonia.

  • 2.
    Athlin, Simon
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    Lidman, Christer
    Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Lundqvist, Anders
    Department of Infectious Diseases, Södra Älvsborgs Hospital, Borås, Sweden.
    Naucler, Pontus
    Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Nilsson, Anna C.
    Infectious Disease Research Unit, Department of Translational Medicine, Lund University, Malmö, Sweden.
    Spindler, Carl
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Strålin, Kristoffer
    Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Hedlund, Jonas
    Unit of Infectious Diseases, Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Management of community-acquired pneumonia in immunocompetent adults: updated Swedish guidelines 20172018In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 50, no 4, p. 247-272Article, review/survey (Refereed)
    Abstract [en]

    Based on expert group work, Swedish recommendations for the management of community-acquired pneumonia in adults are here updated. The management of sepsis-induced hypotension is addressed in detail, including monitoring and parenteral therapy. The importance of respiratory support in cases of acute respiratory failure is emphasized. Treatment with high-flow oxygen and non-invasive ventilation is recommended. The use of statins or steroids in general therapy is not found to be fully supported by evidence. In the management of pleural infection, new data show favourable effects of tissue plasminogen activator and deoxyribonuclease installation. Detailed recommendations for the vaccination of risk groups are afforded.

  • 3.
    Ingberg, Edvin
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Infectious Diseases.
    Ahlstrand, Erik
    Örebro University Hospital. Örebro University, School of Medical Sciences. Department of Medicine.
    Cajander, Per
    Örebro University, School of Medical Sciences. Department of Anesthesiology and Intensive Care.
    Löf, Erika
    Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    Sundqvist, Martin
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Laboratory Medicine, Clinical Microbiology.
    Wegener, Matthias
    Department of Radiology, Örebro University Hospital, Örebro, Sweden.
    Lidén, Mats
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Radiology.
    Cajander, Sara
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    RT-PCR cycle threshold value in combination with visual scoring of chest computed tomography at hospital admission predicts outcome in COVID-192022In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 54, no 6, p. 431-440Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: COVID-19 has a most variable prognosis. Several risk factors for an unfavourable outcome have been identified including extensive lung involvement on chest CT and high viral load estimated by RT-PCR cycle threshold (Ct) values. We investigated Ct value for outcome prediction, relation between Ct value and extent of lung involvement on chest CT and the combination of Ct value and chest CT lung involvement to predict outcome in COVID-19.

    METHODS: Population-based retrospective study on all patients (n = 286) hospitalised for COVID-19 in Örebro Region, Sweden, between 1 March and 31 August 2020. Nasopharyngeal samples and chest CT at hospital admission were evaluated in relation to outcome of COVID-19.

    RESULTS: Both Ct value and chest CT lung involvement were independently associated with risk for ICU admission or death. Lung involvement was superior as a single parameter, but addition of Ct value increased the prediction performance. Ct value was especially useful to identify patients with high risk for severe disease despite limited lung involvement.

    CONCLUSIONS: The addition of RT-PCR Ct value to the assessment of lung involvement on chest CT adds valuable prognostic information in COVID-19. We believe that this information can be used to support clinical decision-making when managing COVID-19 patients.

  • 4.
    Ivarsson, Lovisa
    et al.
    Department of Clinical Microbiology, Uppsala University Hospital, Uppsala, Sweden; Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    de la Campa, Magdalena de Arriba Sánchez
    Department of Clinical Microbiology, Uppsala University Hospital, Uppsala, Sweden; Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Elfving, Karin
    Department of Clinical Microbiology, Laboratory Medicine, Falu Hospital, Falun, Sweden.
    Yin, Hong
    Department of Clinical Microbiology, Laboratory Medicine, Falu Hospital, Falun, Sweden.
    Gullsby, Karolina
    Centre for Research and Development, Uppsala University/Region Gävleborg, Gävle, Sweden.
    Stark, Lisa
    Department of Clinical Microbiology, Ryhov County Hospital, Jönköping, Sweden.
    Andersen, Berit
    University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark; Department for Clinical Medicine, Aarhus University, Aarhus, Denmark.
    Hoffmann, Steen
    Bacteria, Parasites & Fungi, Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark.
    Gylfe, Åsa
    Bacteria, Parasites & Fungi, Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark.
    Unemo, Magnus
    Örebro University, School of Medical Sciences. Örebro University Hospital. WHO Collaborating Centre for Gonorrhoea and other STIs, Örebro University Hospital, Örebro, Sweden; Institute for Global Health, University College London (UCL), London, United Kingdom.
    Herrmann, Björn
    Department of Clinical Microbiology, Uppsala University Hospital, Uppsala, Sweden; Section of Clinical Bacteriology, Department of Medical Sciences, Uppsala University, Uppsala, Sweden.
    Changes in testing and incidence of Chlamydia trachomatis and Neisseria gonorrhoeae: the possible impact of the COVID-19 pandemic in the three Scandinavian countries2022In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 52, no 9, p. 623-631Article in journal (Refereed)
    Abstract [en]

    Background: This study aimed to investigate what impact the COVID-19 pandemic and its associated restrictions had on Chlamydia trachomatis and Neisseria gonorrhoeae infections in Sweden, Denmark and Norway, countries with very different governmental strategies for handling this pandemic.

    Methods: Retrospective analysis of data collected via requests to Swedish regions and to health authorities in Denmark and Norway. The data were collected for the years 2018-2020 and the data from Sweden were more detailed.

    Results: When the pandemic restrictions were installed in 2020, the number of reported chlamydia cases decreased. The decline was most pronounced in Norway 10.8% (2019: n = 28,446; 2020: n = 25,444) while it was only 3.1% in Denmark (2019: n = 35,688; 2020: n = 34,689) and 4.3% in Sweden (2019: n = 34,726; 2020: n = 33,339). Nucleic acid amplifications tests for chlamydia decreased in Sweden (10%) and Norway (18%) in 2020 compared to 2019, while in Denmark a 21% decrease was noted in April 2020 but thereafter increased to a higher level than 2019. The number of reported gonorrhoea cases decreased in Sweden (17%) and in Norway (39%) in 2020 compared to 2019, while a 21% increase was noted in Denmark.

    Conclusions: Pandemic restrictions had an impact on the number of reported chlamydia infections in all three countries, but only temporarily and did not seem to be correlated to the restriction levels. The number of reported gonorrhoea infections in Sweden and Norway significantly decreased but not in Denmark. Pandemic restrictions appear to have had a limited effect on the spread of chlamydia and gonorrhoea.

  • 5.
    Krifors, Anders
    et al.
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Västmanland, Uppsala University, Hospital of Västmanland, Västerås, Sweden.
    Blennow, Ola
    Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, and Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden.
    Påhlman, Lisa I.
    Department of Clinical Sciences Lund, Section for Infection Medicine, Lund University, Skåne University Hospital, Lund, Sweden; Wallenberg Centre for Molecular Medicine, Lund University, Lund, Sweden.
    Gille-Johnson, Patrik
    Department of Infectious Diseases, Danderyd Hospital, Stockholm, Sweden.
    Janols, Helena
    Department of Medical Sciences, Section of Infectious Diseases, Uppsala University, Uppsala, Sweden.
    Lipcsey, Miklos
    Anaesthesiology and Intensive Care Medicine, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Hedenstierna Laboratory, Department of Surgical Sciences, Uppsala University, Uppsala, Sweden.
    Källman, Jan
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Infectious Diseases.
    Tham, Johan
    Department of Translational Medicine, Lund University, Lund, Sweden; Department of Clinical Infection Medicine, Skåne University Hospital, Malmö, Sweden.
    Stjärne Aspelund, Anna
    Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Clinical Microbiology and Infection Prevention and Control, Skåne University Hospital, Lund, Sweden.
    Ljungquist, Oskar
    Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden; Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden.
    Hammarskjöld, Fredrik
    Department of Anaesthesia and Intensive Care Medicine, Ryhov County Hospital, Jönköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Hällgren, Anita
    Department of Infectious Diseases in Östergötland and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    De Geer, Lina
    Department of Anaestesiology and Intensive Care and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Lemberg, Marie
    Department of Anesthesia and Intensive Care, Västerås Hospital, Västerås, Sweden.
    Petersson, Johan
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Stockholm, Sweden.
    Castegren, Markus
    Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Sörmland, Uppsala University, Mälarsjukhuset, Eskilstuna, Sweden.
    Influenza-associated invasive aspergillosis in patients admitted to the intensive care unit in Sweden: a prospective multicentre cohort study2024In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 56, no 2, p. 110-115Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The purpose of this study was to prospectively investigate the incidence of influenza-associated pulmonary aspergillosis (IAPA) in influenza patients admitted to intensive care units in Sweden.

    METHODS: The study included consecutive adult patients with PCR-verified influenza A or B in 12 Swedish intensive care units (ICUs) over four influenza seasons (2019-2023). Patients were screened using serum galactomannan and β-d-glucan tests and fungal culture of a respiratory sample at inclusion and weekly during the ICU stay. Bronchoalveolar lavage was performed if clinically feasible. IAPA was classified according to recently proposed case definitions.

    RESULTS: The cohort included 55 patients; 42% were female, and the median age was 59 (IQR 48-71) years. All patients had at least one galactomannan test, β-d-glucan test and respiratory culture performed. Bronchoalveolar lavage was performed in 24 (44%) of the patients. Five (9%, 95% CI 3.8% - 20.4%) patients were classified as probable IAPA, of which four lacked classical risk factors. The overall ICU mortality was significantly higher among IAPA patients than non-IAPA patients (60% vs 8%, p = 0.01).

    CONCLUSIONS: The study represents the first prospective investigation of IAPA incidence. The 9% incidence of IAPA confirms the increased risk of invasive pulmonary aspergillosis among influenza patients admitted to the ICU. Therefore, it appears reasonable to implement a screening protocol for the early diagnosis and treatment of IAPA in influenza patients receiving intensive care.

    TRIAL REGISTRATION: ClinicalTrials.gov NCT04172610, registered November 21, 2019.

  • 6.
    Krifors, Anders
    et al.
    Department of Infectious Diseases, Västmanlands Hospital, Västerås, Sweden; Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden; Centre of Clinical Research, Region Västmanland-Uppsala University, Västerås, Sweden.
    Freyhult, Elisabeth
    Department of Laboratory Medicine, Västmanlands Hospital, Västerås, Sweden.
    Rashid Teljebäck, Mulki
    Department of Infectious Diseases, Västmanlands Hospital, Västerås, Sweden.
    Wallin, Robert P. A.
    SciEd Solutions, Stockholm, Sweden.
    Winqvist, Ola
    ABC Labs, Stockholm, Sweden.
    Månsson, Emeli
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Västmanlands Hospital, Västerås, Sweden; Centre of Clinical Research, Region Västmanland-Uppsala University, Västerås, Sweden .
    Long-lasting T-cell response to SARS-CoV-2 antigens after vaccination-a prospective cohort study of HCWs working with COVID-19 patients2023In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 53, no 2, p. 142-148Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Vaccination against SARS-CoV-2 reduces the risk of hospitalisation and death, but vaccine-induced IgG antibodies against the spike protein (IgG S) decline over time. Less is known about the nature of the vaccine-induced T-cell response to SARS-CoV-2 antigens.

    METHODS: IgG antibodies against nucleocapsid protein (IgG N), IgG S, and T-cell response towards SARS-CoV-2 antigens were determined in samples taken between November 2020 and November 2021 from a cohort of healthcare workers at an Infectious Diseases Department. RT-PCR screening for SARS-CoV-2 was encouraged once every four weeks in addition to testing when symptomatic or identified through contact tracing. Vaccination data were collected at the end of the study.

    RESULTS: At inclusion, T-cell response to SARS-CoV-2 antigens was found in 10/15 (66.7%) of participants with a previous/current COVID-19 infection and in 9/54 (16.7%) of participants with no prior/current history of COVID-19 infection. All participants with complete follow-up (n = 59) received two doses of a SARS-CoV-2 vaccine during the study. All participants demonstrated detectable IgG (S) antibodies at the end of the study, in median 278 days (IQR 112) after the second vaccine dose. All but four participants displayed T-cell responses towards SARS-CoV-2 antigens. IgG S antibody levels correlated with time since the second vaccine dose. In addition, previous COVID-19 infection and the strength of the S1 T-cell response correlated with IgG S antibody levels. However, no correlation was demonstrated between the strength of the T-cell response and time since the second vaccine dose.

    CONCLUSION: COVID-19 vaccination induces robust T-cell responses that remain for at least nine months.

  • 7.
    Lagging, Martin
    et al.
    Department of Infectious Diseases, Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Wejstål, Rune
    Department of Infectious Diseases, Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Aleman, Soo
    Department of Medicine, Division of Infectious Diseases, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Weiland, Ola
    Department of Medicine, Division of Infectious Diseases, Karolinska Institute at Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Westin, Johan
    Department of Infectious Diseases, Institute of Biomedicine at Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Swedish Reference Group for Antiviral Therapy (RAV), Stockholm, Sweden.
    Treatment of hepatitis C virus infection for adults and children: updated Swedish consensus guidelines 20172018In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 50, no 8, p. 569-583Article, review/survey (Refereed)
    Abstract [en]

    Aim: Following the approval of two new therapeutic combinations within the European Union in 2017, the former Swedish recommendations for the treatment of hepatitis C virus (HCV) infection from 2016 were deemed in need of updating.

    Materials and methods: An expert meeting to this end was held in Stockholm, Sweden in October 2017.

    Results and conclusions: An interferon-free combination of direct-acting antiviral agents is now recommended for all patients with chronic HCV infection, regardless of liver fibrosis stage, in order to limit morbidity and spread of the disease. An extended discussion of treatment for people who inject drugs in order to diminish transmission is included.

  • 8.
    Magnusson, Charlotta
    et al.
    School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Stegger, Marc
    Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark.
    Hellmark, Bengt
    Örebro University, School of Health Sciences.
    Stenmark, Bianca
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Söderquist, Bo
    Örebro University, School of Medical Sciences.
    Staphylococcus aureus isolates from nares of orthopaedic patients in Sweden are mupirocin susceptible2019In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 51, no 6, p. 475-478Article in journal (Refereed)
  • 9.
    Millbourn, Charlotta
    et al.
    Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Huddinge, Sweden; Department of Infectious Diseases, Danderyd Hospital, Stockholm, Sweden.
    Lybeck, Charlotte
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Einberg, Afrodite Psaros
    Department of Clinical Science, Intervention and Technology, CLINTEC, Stockholm, Sweden; Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden.
    Nordin, Margareta
    Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
    Lindh, Gudrun
    Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    Hökeberg, Ingegerd
    Department of Communicable Disease Prevention and Control, Stockholm County Council, Stockholm, Sweden.
    Fredlund, Hans
    Department of Microbiology, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Fischler, Björn
    Department of Clinical Science, Intervention and Technology, CLINTEC, Stockholm, Sweden; Department of Pediatrics, Karolinska University Hospital, Stockholm, Sweden.
    Fadl, Helena
    Örebro University, School of Medical Sciences. Department of Obstetrics and Gynecology.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Department of Infectious Diseases.
    Lindahl, Karin
    Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Huddinge, Sweden.
    Anti-HCV prevalence and risk factor-based screening for hepatitis C in pregnant women and their partners in Sweden2020In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 52, no 11, p. 776-785Article in journal (Refereed)
    Abstract [en]

    Background: The hepatitis C virus (HCV) prevalence in Sweden is estimated to be <0.5%, but unclear in pregnant women. The dominating route of transmission is drug use (DU), blood transfusions constituted a risk before 1992. The aim was to examine the anti-HCV prevalence and risk factors for HCV among pregnant women and their partners to evaluate screening strategies.

    Methods: Pregnant women and partners in Örebro County and in southern Stockholm were offered HCV-screening when visiting an antenatal clinic in 2013-2016, and completed a questionnaire concerning the country of birth, knowledge of HCV-status and HCV risk factors.

    Results: In Örebro 2,827 pregnant women and 707 partners, and in Stockholm 1,281 pregnant women and 320 partners participated. Anti-HCV was positive in 34 (0.7%) (25 pregnant women) and the associated risk factors were DU (n = 27), partner with HCV (n = 24) and not born in Sweden (n = 8). HCV RNA was positive in 23 (0.4%), 4 previously unknown and 10 who had been lost to follow-up. The most effective risk factor-based screening model for pregnant women included DU, blood transfusions, born in high prevalence country, partner with HCV, resulting in 538 (13%) pregnant women tested with 96% sensitivity, 87% specificity.

    Conclusions: In this study of expecting parents in two Swedish regions, the anti-HCV prevalence was 0.7% and 0.4% were viraemic, of which about 60% were previously unknown or lost to follow-up. Awaiting more studies, including cost-benefit analysis evaluating universal screening, we recommend this improved risk factor-based screening model to identify HCV-infected individuals who need follow-up and therapy.

  • 10.
    Ocias, Lukas Frans
    et al.
    Department of Clinical Microbiology, Karlstad Hospital, Karlstad, Sweden; Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Skogstam, Anna
    Department of Infection Prevention and Control, Karlstad Hospital, Karlstad, Sweden.
    Kjerstadius, Torbjörn
    Department of Clinical Microbiology, Karlstad Hospital, Karlstad, Sweden.
    Lundin, Fredrik
    Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden.
    Tevell, Staffan
    Örebro University, School of Medical Sciences. Örebro University Hospital. Centre for Clinical Research and Education, Region Värmland, Karlstad, Sweden; Department of Infectious Diseases, Karlstad Hospital, Karlstad, Sweden.
    Higher rate of SARS-CoV-2 IgG seropositivity in hospital-based healthcare workers compared to elderly care staff in a Swedish low-prevalence region: a cross-sectional study2021In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 53, no 12, p. 920-929Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Previous seroprevalence studies have demonstrated higher anti-SARS-CoV-2 IgG seroprevalence in healthcare workers (HCWs) than in the background population during the first phase of the 2020 COVID-19 pandemic. These studies, however, focussed mainly on hospital employees.

    AIM: To perform a cross-sectional study comparing the seroprevalence of hospital-based HCWs with those employed in elderly care (home care and nursing homes).

    METHODS: Employees (n = 4955) in the county of Värmland, Sweden, were recruited between weeks 27 and 42 and tested for IgG antibodies against SARS-CoV-2. Serological results were combined with self-reported questionnaire data.

    FINDINGS: IgG seroprevalence was 5.7% in the total group of HCWs, and was higher among those employed in hospital-based healthcare than among those working in elderly care (8.4% vs. 3.7%, p < .001). Being employed as an assistant nurse, working in a COVID-19 unit, and being exposed via co-workers or private acquaintances were all associated with IgG seropositivity.

    CONCLUSION: The difference in seroprevalence between HCWs in the two settings suggests that not only the profession but also factors in the workplace environment may be of importance. As all studied exposures were associated with IgG seropositivity, and asymptomatic infection was detected in 7.5% of participants, preventing outbreaks among HCWs is challenging. Adequate use of personal protective equipment when working with patients regardless of COVID-19 status, source control in situations with co-workers in which distancing is not possible, and routines enabling symptomatic staff to isolate pending PCR results are required to prevent healthcare-associated outbreaks of COVID-19.

  • 11.
    Strålin, Kristoffer
    et al.
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden; National Program Group for Infectious Diseases, National System for Knowledge-Driven Management within Swedish Healthcare, Sweden's Regions in Collaboration, Sweden.
    Linder, Adam
    Department of Infectious Diseases, Skåne University Hospital, Lund, Sweden; Department of Clinical Sciences, Division of Infection Medicine, Lund University, Lund, Sweden.
    Brink, Magnus
    National Program Group for Infectious Diseases, National System for Knowledge-Driven Management within Swedish Healthcare, Sweden's Regions in Collaboration, Sweden; Department of Infectious Diseases, Sahlgrenska University Hospital, Gothenburg, Sweden.
    Benjaminsson-Nyberg, Patrik
    Department of Emergency Medicine, Linköping University Hospital, Linköping, Sweden; Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden.
    Svefors, Jesper
    Department of Infectious Diseases, Ryhov Hospital, Jönköping, Sweden.
    Bengtsson-Toni, Maria
    Department of Internal Medicine, Skåne University Hospital, Malmö, Sweden.
    Abelson, Christina
    Funäsdalen Primary Healthcare Centre, Funäsdalen, Sweden.
    Offenbartl, Karsten
    Expert and Consultant in Surgery, Jönköping County, Jönköping, Sweden.
    Björkqvist, Kristina
    Sepsisföreningen (Patient Organization), Sweden.
    Rosenqvist, Mari
    Department of Infectious Diseases, Skåne University Hospital, Malmö, Sweden.
    Rönnkvist, Annica
    Division of Inflammation and ageing, Karolinska University Hospital, Stockholm, Sweden.
    Svärd-Backlund, Jenny
    Health and Medical Care Administration, Stockholm, Sweden.
    Wallgren, Karin
    Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
    Tydén, Jonas
    Department of Anesthesiology and Intensive Care, Östersund Hospital, Östersund, Sweden; Department of Surgical and Perioperative Sciences, Anaesthesiology and Critical Care Medicine, Umeå University, Umeå, Sweden.
    Wallgren, Ulrika
    Fisksätra Primary Healthcare Centre, Stockholm, Sweden; Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.
    Vicente, Veronica
    Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Ambulance Medical Service in Stockholm, Stockholm, Sweden.
    Cajander, Sara
    Örebro University, School of Medical Sciences. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden; Department of Infectious Diseases, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lipcsey, Miklós
    Department of Anesthesiology and Intensive Care, Uppsala University Hospital, Uppsala, Sweden; Department of Surgical Sciences, Anesthesiology and Intensive Care Medicine, Uppsala University, Uppsala, Sweden.
    Nauclér, Pontus
    Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
    Kurland, Lisa
    Örebro University, School of Medical Sciences. Department of Emergency Medicine, Örebro University Hospital, Örebro, Sweden; Department of Medical Sciences, Örebro University, Örebro, Sweden; National Program Group for Emergency Care, National System for Knowledge-Driven Management within Swedish Healthcare, Sweden's Regions in Collaboration, Sweden.
    Design of a national patient-centred clinical pathway for sepsis in Sweden2023In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 55, no 10, p. 716-724Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The World Health Organization has adopted a resolution on sepsis and urged member states to develop national processes to improve sepsis care. In Sweden, sepsis was selected as one of the ten first diagnoses to be addressed, when the Swedish government in 2019 allocated funds for patient-centred clinical pathways in healthcare. A national multidisciplinary working group, including a patient representative, was appointed to develop the patient-centred clinical pathway for sepsis.

    METHODS: The working group mapped challenges and needs surrounding sepsis care and included a survey sent to all emergency departments (ED) in Sweden, and then designed a patient-centred clinical pathway for sepsis.

    RESULTS: The working group decided to focus on the following four areas: (1) sepsis alert for early detection and management optimisation for the most severely ill sepsis patients in the ED; (2) accurate sepsis diagnosis coding; (3) structured information to patients at discharge after sepsis care and (4) structured telephone follow-up after sepsis care. A health-economic analysis indicated that the implementation of the clinical pathway for sepsis will most likely not drive costs. An important aspect of the clinical pathway is implementing continuous monitoring of performance and process indicators. A national working group is currently building up such a system for monitoring, focusing on extraction of this information from the electronic health records systems.

    CONCLUSION: A national patient-centred clinical pathway for sepsis has been developed and is currently being implemented in Swedish healthcare. We believe that the clinical pathway and the accompanying monitoring will provide a more efficient and equal sepsis care and improved possibilities to monitor and further develop sepsis care in Sweden.

  • 12.
    Westin, Johan
    et al.
    Deparment of Infectious Diseases, Institute of Biomedicine at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Aleman, Soo
    Deparment of Medicine, Division of Infectious Diseases, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Castedal, Maria
    Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Duberg, Ann-Sofi
    Örebro University, School of Medical Sciences. Deparment of Infectious Diseases.
    Eilard, Anders
    Deparment of Infectious Diseases, Institute of Biomedicine at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Fischler, Björn
    Deparment of Pediatrics, CLINTEC, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
    Kampmann, Christian
    Deparment of Infectious Diseases, Skåne University Hospital Lund, Lund, Sweden.
    Lindahl, Karin
    Deparment of Medicine, Division of Infectious Diseases, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Lindh, Magnus
    Deparment of Infectious Diseases, Institute of Biomedicine at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Norkrans, Gunnar
    Deparment of Infectious Diseases, Institute of Biomedicine at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Stenmark, Stephan
    Deparment of Clinical Microbiology and Infectious Diseases, Umeå University, Umeå, Sweden.
    Weiland, Ola
    Deparment of Medicine, Division of Infectious Diseases, Karolinska Institutet and Karolinska University Hospital Huddinge, Stockholm, Sweden.
    Wejstål, Rune
    Deparment of Infectious Diseases, Institute of Biomedicine at the Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Management of hepatitis B virus infection, updated Swedish guidelines2020In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 52, no 1, p. 1-22Article in journal (Refereed)
    Abstract [en]

    Despite access to effective antiviral drugs and vaccines, hepatitis B virus (HBV) infection remains a major health issue worldwide. HBV is highly infectious and may cause chronic infection, progressive liver damage, hepatocellular cancer (HCC) and death. Early diagnosis, proper management and timing of treatment are crucial. The Swedish Reference group for Antiviral Treatment (RAV) here provides updated evidence-based guidelines for treatment and management of HBV infection which may be applicable also in other countries. Tenofovir alafenamide (TAF) has been introduced as a novel treatment option and new principles regarding indication and duration of treatment and characterization of hepatitis B have been gradually introduced which justifies an update of the previous guidelines from 2007. Updated guidelines on HCC surveillance in HBV-infected patients, treatment and prophylaxis for patients undergoing liver transplantation as well as management of pregnant women and children with HBV infection are also provided.

  • 13.
    Ziegler, Ingrid
    et al.
    Department of Infectious Diseases, Örebro University Hospital , Örebro, Sweden.
    Cajander, Sara
    Örebro University, School of Medical Sciences. Örebro University Hospital. Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden.
    Rasmussen, Gunlög
    Department of Infectious Diseases, Örebro University Hospital, Örebro, Sweden; School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ennefors, Theresa
    Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden.
    Mölling, Paula
    Department of Laboratory Medicine, Örebro University Hospital, Örebro, Sweden.
    Strålin, Kristoffer
    School of Health and Medical Sciences, Örebro University, Örebro, Sweden; Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Huddinge, Karolinska Institutet, Stockholm, Sweden.
    High nuc DNA load in whole blood is associated with sepsis, mortality and immune dysregulation in Staphylococcus aureus bacteraemia2019In: Infectious Diseases, ISSN 2374-4235, E-ISSN 2374-4243, Vol. 51, no 3, p. 216-226Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Staphylococcus aureus bacteraemia is a disease with varying presentation, ranging from uncomplicated to life-threatening infections. In S. aureus bacteraemia, a high load of bacterial DNA in blood has been linked to mortality. We hypothesized that a high DNA load would also be linked to the presence of sepsis, and to high C-reactive protein (CRP) and lymphopaenia, indicating inflammation and immunosuppression.

    METHODS: Twenty-seven patients with culture-proven S. aureus bacteraemia, 13 (48%) with sepsis and six (22%) non-survivors, were enrolled in a prospective study. Blood samples were collected on days 0, 1-2, 3-4, 6-8, 13-15 and 26-30, and subjected to droplet digital PCR targeting the nuc gene to determine the nuc DNA load.

    RESULTS: nuc DNA was detected on days 0-2 in 22 patients (81%), and on days 6-8 in three patients (all non-survivors). The nuc DNA load on days 1-2 was significantly elevated in patients with sepsis (median 2.69 versus 1.32 log10 copies/mL; p = .014) and in non-survivors (median 2.5 versus 1.0 log10 copies/mL; p = .033). Patients with a high nuc DNA load (>3.0 log10 copies/mL) on days 1-2 had significantly elevated CRP levels at all timepoints, and significantly decreased lymphocyte counts on days 0, 1-2, 13-15 and 26-30.

    CONCLUSIONS: Our results indicate that a high initial load of S. aureus DNA in blood is associated with sepsis, mortality and persistent immune dysregulation in S. aureus bacteraemia patients. Further studies are needed to define the role of bacterial DNA load monitoring in the management of S. aureus bacteraemia.

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