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  • 1.
    Berglund, Carolina
    et al.
    Örebro universitet, Hälsoakademin.
    Mölling, Paula
    Sjöberg, Lennart
    Söderquist, Bo
    Predominance of staphylococcal cassette chromosome mec (SCCmec) type IV among methicillin-resistant Staphylococcus aureus (MRSA) in a Swedish county and presence of unknown SCCmec types with Panton-Valentine leukocidin genes2005Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 11, nr 6, s. 447-456Artikel i tidskrift (Refereegranskat)
  • 2.
    Berglund, Carolina
    et al.
    Örebro universitet, Hälsoakademin.
    Söderquist, Bo
    Örebro universitet, Hälsoakademin.
    The origin of a methicillin-resistant Staphylococcus aureus isolate at a neonatal ward in Sweden: possible horizontal transfer of a staphylococcal cassette chromosome mec between methicillin-resistant Staphylococcus haemolyticus and Staphylococcus aureus2008Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 14, nr 11, s. 1048-1056Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The first methicillin-resistant Staphylococcus aureus (MRSA) strain originated when a staphylococcal cassette chromosome mec (SCCmec) with the gene mecA was integrated into the chromosome of a susceptible S. aureus cell. The SCCmec elements are common among the coagulase-negative staphylococci, e.g. Staphylococcus haemolyticus, and these are considered to be potential SCCmec donors when new clones of MRSA arise. An outbreak of MRSA occurred at a neonatal intensive-care unit, and the isolates were all of sequence type (ST) 45, as characterized by multilocus sequence typing, but were not typeable with respect to SCCmec types I, II, III or IV. During the same time period, methicillin-resistant S. haemolyticus (MRSH) isolates identified in blood cultures at the same ward were found to be genotypically homogenous by pulsed-field gel electrophoresis, and did not carry a type I, II, III or IV SCCmec either. Thus, the hypothesis was raised that an SCCmec of MRSH had been transferred to a methicillin-susceptible S. aureus strain and thereby created a new clone of MRSA that caused the outbreak. This study showed that MRSA from the outbreak carried a ccrC and a class C mec complex that was also found among MRSH isolates. Partial sequencing of the mec complexes showed more than 99% homology, indicative of a common type V SCCmec. This finding may provide evidence for a recent horizontal transfer of an SCCmec from MRSH to an identified potential recipient, an ST45 methicillin-susceptible S. aureus strain, thereby creating a new clone of MRSA that caused the outbreak.

  • 3.
    Hedin, K.
    et al.
    Dept Clin Sci, Family Med, Lund Univ, Malmö, Sweden; Unit Res & Dev, Cent Hosp Växjö, Kronoberg Cty Council, Växjö, Sweden.
    Bieber, L.
    Dept Clin Microbiol, Cent Hosp Växjö, Växjö, Sweden.
    Lindh, M.
    Dept Clin Virol, Sahlgrens Univ Hosp, Gothenburg, Sweden.
    Sundqvist, Martin
    Region Örebro län. Dept Lab Med, Clin Microbiol, Örebro University Hospital, Örebro, Sweden.
    The aetiology of pharyngotonsillitis in adolescents and adults: Fusobacterium necrophorum is commonly found2015Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 21, nr 3Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Sore throat is common in primary healthcare. Aetiological studies have focused on the presence of a limited number of pathogens. The aim of the present study was to investigate the presence of a wide range of bacteria and viruses, including Fusobacterium necrophorum, in patients with pharyngotonsillitis and in asymptomatic controls. A prospective case control study was performed in primary healthcare in Kronoberg County, Sweden. Patients (n = 220) aged 15 to 45 years with a suspected acute pharyngotonsillitis, and controls (n = 128), were included. Nasopharyngeal and throat swabs were analysed for beta-hemolytic streptococci, F. necrophorum, Mycoplasma pneumoniae, and Chlamydophila pneumoniae, and 13 respiratory viruses. Serum samples were analysed for antibodies to Epstein-Barr virus. The patient history and symptoms, including Centor score, were analysed in relation to pathogens. In 155/220 (70.5%) of the patients, as compared to 26/128 (20.3%) of the controls (p < 0.001), at least one microorganism was found. Group A streptococci, F. necrophorum, and influenza B virus were the three most common findings, and all significantly more common in patients than in controls (p < 0.001, p 0.001, and p 0.002, respectively). Patients with F. necrophorum only (n = 14) displayed a lower Centor score than patients with Group A streptococcus only (n = 46), but a higher score than patients with influenza B, other viruses, or no potential pathogen (Kruskal-Wallis p < 0.001). A pathogen was detected in 70% of the patients, displaying a wide range of pathogens contributing to the aetiology of pharyngotonsillitis. This study supports F. necrophorum as one of the pathogens to be considered in the aetiology of pharyngotonsillitis. Clinical Microbiology and Infection (C) 2014 European Society of Clinical Microbiology and Infectious Diseases. Published by Elsevier Ltd. Open access under CC BY-NC-ND license.

  • 4. Hellbacher, C
    et al.
    Törnqvist, E
    Söderquist, Bo
    Örebro universitet, Hälsoakademin.
    Staphylococcus lugdunensis: clinical spectrum, antibiotic susceptibility, and phenotypic and genotypic patterns of 39 isolates2006Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 12, nr 1, s. 43-49Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Staphylococcus lugdunensis is a member of the coagulase-negative staphylococci with the potential to cause clinically significant infections. The spectrum of infections was investigated in 39 isolates of S. lugdunensis from 38 patients. Most (73%) infections were located below the waist, while those above the waist were mainly (5/7) breast abscesses. Most isolates were susceptible to the antibiotics tested, although 15.4% were beta-lactamase-positive and could be identified by the disk-diffusion method for penicillin G. There was very good concordance between the disk-diffusion method and the Etest method for oxacillin resistance. Pulsed-field gel electrophoresis (PFGE) showed that 56% of the isolates belonged to one SmaI pulsotype, while phenotypic analysis by the Phene Plate system identified three main phenotypic groups. Although the S. lugdunensis isolates analysed were obtained from different patients, treated in different wards and hospitals during a 4-year period, there was a low degree of diversity, both genotypically and phenotypically. For this reason, PFGE is not suitable for the analysis of an outbreak situation, and the homogeneity observed may indicate that S. lugdunensis is a genetically conserved species of coagulase-negative Staphylococcus.

  • 5.
    Hellmark, Bengt
    et al.
    Örebro universitet, Hälsoakademin.
    Unemo, Magnus
    Nilsdotter-Augustinsson, Å.
    Söderquist, Bo
    Örebro universitet, Hälsoakademin.
    Antibiotic susceptibility among Staphylococcus epidermidis isolated from prosthetic joint infections with special focus on rifampicin and variability of the rpoB gene2009Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 15, nr 3, s. 238-244Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Staphylococcus epidermidis is the most important pathogen in infections related to implanted foreign materials, especially prosthetic joint infections (PJIs). The aim of this study was to investigate the antimicrobial activities of 16 antibiotics against S. epidermidis isolated from PJIs, with special focus on rifampicin and rpoB variability. Ninety-one per cent of the isolates were multiresistant (i.e. resistant to members of more than three classes of antibiotics). Thirty-nine per cent were resistant to rifampicin, associated with one or two single-nucleotide polymorphisms (SNPs) in rpoB. Using IsoSensitest agar with supplements, 61% were resistant to oxacillin, and using Mueller-Hinton II agar with supplement, 84% were resistant. Using the Etest, 58% were resistant to cefoxitin, and using the disk diffusion test, 91% were resistant. The mecA gene was detected in 85% of the isolates. Regarding recently available antibiotics, all isolates were susceptible to tigecycline and linezolid, and 97% were susceptible to daptomycin. In addition, two novel antibiotics, dalbavancin and ceftobiprole, were tested, although not yet available for routine use. The MIC(50) and MIC(90) values of these novel antibiotics were 0.032 and 0.047 mg/L and 0.5 and 1.5 mg/L, respectively. Among the other antibiotics, the rates of resistance varied between 0% (vancomycin) and 82% (trimethoprim-sulphamethoxazole). S. epidermidis strains causing PJIs often show multiresistance, including resistance to rifampicin, which is mainly caused by one or two SNPs. Some of the newer antimicrobial agents may provide alternatives for monotherapy or combination therapy with rifampicin. Detection of mecA is necessary before initiating treatment of infections due to S. epidermidis when it displays intermediate susceptibility to cefoxitin.

  • 6. Holmberg, A.
    et al.
    Lood, R.
    Mörgelin, M.
    Söderquist, Bo
    Örebro universitet, Hälsoakademin.
    Holst, E.
    Collin, M.
    Christensson, B.
    Rasmussen, M.
    Biofilm formation by Propionibacterium acnes is a characteristic of invasive isolates2009Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 15, nr 8, s. 787-795Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Propionibacterium acnes is a common and probably underestimated cause of delayed joint prosthesis infection. Bacterial biofilm formation is central in the pathogenesis of infections related to foreign material, and P. acnes has been shown to form biofilm both in vitro and in vivo. Here, biofilm formation by 93 P. acnes isolates, either from invasive infections (n = 45) or from the skin of healthy people (n = 48), was analysed. The majority of isolates from deep infections produced biofilm in a microtitre model of biofilm formation, whereas the skin isolates were poor biofilm producers (p <0.001 for a difference). This indicates a role for biofilm formation in P. acnes virulence. The type distribution, as determined by sequencing of recA, was similar among isolates isolated from skin and from deep infections, demonstrating that P. acnes isolates with different genetic backgrounds have pathogenic potential. The biofilm formed on plastic and on bone cement was analysed by scanning electron microscopy (EM) and by transmission EM. The biofilm was seen as a 10-mum-thick layer covering the bacteria and was composed of filamentous as well as more amorphous structures. Interestingly, the presence of human plasma in solution or at the plastic surface inhibits biofilm formation, which could explain why P. acnes primarily infect plasma-poor environments of, for example, joint prostheses and cerebrospinal shunts. This work underlines the importance of biofilm formation in P. acnes pathogenesis, and shows that biofilm formation should be considered in the diagnosis and treatment of invasive P. acnes infections.

  • 7.
    Idelevich, E. A.
    et al.
    Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
    Seifert, H.
    Institute for Medical Microbiology, Immunology and Hygiene, University of Cologne, Cologne, Germany; German Centre for Infection Research, Partner Site Bonn-Cologne, Cologne, Germany.
    Sundqvist, Martin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Laboratory Medicine, Clinical Microbiology.
    Scudeller, L.
    Clinical Epidemiology Unit, Scientific Direction, Fondazione IRCCS, Policlinico San Matteo Pavia Fondazione IRCCS, Pavia, Italy.
    Amit, S.
    Department of Clinical Microbiology and Infectious Diseases, Hadassah Medical Centre, Jerusalem, Israel.
    Balode, A.
    Pauls Stradins Clinical University Hospital, Riga, Latvia.
    Bilozor, A.
    Microbiology Laboratory, Diagnostic Clinic, East-Tallinn Central Hospital, Tallinn, Estonia.
    Drevinek, P.
    Department of Medical Microbiology, 2nd Faculty of Medicine, Charles University and Motol University Hospital, Prague, Czech Republic.
    Tufan, Z. Kocak
    Infectious Diseases and Clinical Microbiology Department, Medical School of Ankara Yildirim Beyazit University, Ankara, Turkey.
    Koraqi, A.
    Clinical Microbiology Laboratory, University Hospital Centre ‘Mother Theresa’, Tirana, Albania.
    Lamy, B.
    Laboratory of Clinical Microbiology, Centre Hospitalier Universitaire de Nice, Université Côte d’Azur, INSERM U1065 (C3M), Nice, France.
    Marekovic, I.
    Department of Clinical and Molecular Microbiology, University Hospital Centre Zagreb, University of Zagreb School of Medicine, Zagreb, Croatia.
    Miciuleviciene, J.
    Vilnius City Clinical Hospital, Vilnius, Lithuania.
    Premru, M. Mueller
    Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
    Pascual, A.
    Unidad de Enfermedades Infecciosas, Microbiologia y Medicina Preventiva, Hospital Universitario Virgen Macarena, Departamento de Microbiología, Universidad de Sevilla, Instituto de Biomedicina de Sevilla (IBiS), Sevilla, Spain.
    Pournaras, S.
    Laboratory of Clinical Microbiology, Attikon Hospital, National and Kapodistrian University of Athens, Athens, Greece.
    Saegeman, V.
    Department of Infection Control and Epidemiology, University Hospitals Leuven, Leuven, Belgium.
    Schønheyder, H. C.
    Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark.
    Schrenzel, J.
    Bacteriology Laboratory, Division of Infectious Diseases, Geneva University Hospitals, Geneva, Switzerland.
    Strateva, T.
    Department of Medical Microbiology, Faculty of Medicine, Medical University of Sofia, Sofia, Bulgaria.
    Tilley, R.
    Department of Microbiology, University Hospitals Plymouth NHS Trust, Plymouth, UK.
    Wiersinga, W. J.
    Department of Infectious Diseases and Centre for Experimental Molecular Medicine, Amsterdam UMC, location AMC, University of Amsterdam, Amsterdam, the Netherlands.
    Zabicka, D.
    National Medicines Institute, Warsaw, Poland.
    Carmeli, Y.
    Division of Epidemiology, Tel Aviv Sourasky Medical Centre, Tel Aviv, Israel.
    Becker, K.
    Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
    Microbiological diagnostics of bloodstream infections in Europe-an ESGBIES survey2019Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 25, nr 11, s. 1399-1407Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: High-quality diagnosis of bloodstream infections (BSI) is important for successful patient management. As knowledge on current practices of microbiological BSI diagnostics is limited, this project aimed to assess its current state in European microbiological laboratories.

    Methods: We performed an online questionnaire-based cross-sectional survey comprising 34 questions on practices of microbiological BSI diagnostics. The ESCMID Study Group for Bloodstream Infections, Endocarditis and Sepsis (ESGBIES) was the primary platform to engage national coordinators who recruited laboratories within their countries.

    Results: Responses were received from 209 laboratories in 25 European countries. Although 32.5% (68/209) of laboratories only used the classical processing of positive blood cultures (BC), two-thirds applied rapid technologies. Of laboratories that provided data, 42.2% (78/185) were able to start incubating BC in automated BC incubators around-the-clock, and only 13% (25/192) had established a 24-h service to start immediate processing of positive BC. Only 4.7% (9/190) of laboratories validated and transmitted the results of identification and antimicrobial susceptibility testing (AST) of BC pathogens to clinicians 24 h/day. Matrix-assisted laser desorption/ionization time-of-flight mass spectrometry from briefly incubated sub-cultures on solid media was the most commonly used approach to rapid pathogen identification from positive BC, and direct disc diffusion was the most common rapid AST method from positive BC.

    Conclusions: Laboratories have started to implement novel technologies for rapid identification and AST for positive BC. However, progress is severely compromised by limited operating hours such that current practice of BC diagnostics in Europe complies only partly with the requirements for optimal BSI management.

  • 8.
    Jacobsen, Marc
    et al.
    Department of Immunology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany; Department of Immunology, Max Planck Institute for Infection Biology, Berlin, Germany.
    Repsilber, Dirk
    Research Institute for the Biology of Farm Animals, Genetics and Biometry, Dummerstorf, Germany.
    Kleinsteuber, K
    Department of Immunology, Bernhard-Nocht-Institute for Tropical Medicine, Hamburg, Germany.
    Gutschmidt, Andrea
    Division of Molecular Biology and Human Genetics, MRC Centre for Molecular and Cellular Biology, DST and NRF Centre of Excellence for Biomedical TB Research, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
    Schommer-Leitner, S
    Department of Immunology, Max Planck Institute for Infection Biology, Berlin, Germany.
    Black, G
    Division of Molecular Biology and Human Genetics, MRC Centre for Molecular and Cellular Biology, DST and NRF Centre of Excellence for Biomedical TB Research, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
    Walzl, G
    Division of Molecular Biology and Human Genetics, MRC Centre for Molecular and Cellular Biology, DST and NRF Centre of Excellence for Biomedical TB Research, Faculty of Health Sciences, Stellenbosch University, Cape Town, South Africa.
    Kaufmann, S H E
    Department of Immunology, Max Planck Institute for Infection Biology, Berlin, Germany.
    Suppressor of cytokine signaling-3 is affected in T-cells from tuberculosis TB patients2011Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 17, nr 9, s. 1323-31Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    T-cells and T-cell-derived cytokines are crucial mediators of protection against Mycobacterium tuberculosis infection, but these factors are insufficient as biomarkers for disease susceptibility. In order to define T-cell molecules involved in tuberculosis (TB), we compared gene expression profiles of T-cells from patients with active TB, healthy donors with latent M. tuberculosis infection (LTBIs) and non-infected healthy donors (NIDs) by microarray analysis. Pathway-focused analyses identified a prevalent subset of candidate genes involved in the Janus kinase (JAK)-signal transducer and activator of transcription signalling pathway, including those encoding suppressor of cytokine signalling (SOCS) molecules, in the subset of protection-associated genes. Differential expression was verified by quantitative PCR analysis for the cytokine-inducible SH2-containing protein (CISH), SOCS3, JAK3, interleukin-2 receptor α-chain (IL2RA), and the proto-oncogene serine/threonine protein kinase (PIM1). Classification analyses revealed that this set of molecules was able to discriminate efficiently between T-cells from TB patients and those from LTBIs, and, notably, to achieve optimal discrimination between LTBIs and NIDs. Further characterization by quantitative PCR revealed highly variable candidate gene expression in CD4(+) and CD8(+) T-cells from TB patients and only minor differences between CD4(+) and CD8(+) T-cell subpopulations. These results point to a role of cytokine receptor signalling regulation in T-cells in susceptibility to TB.

  • 9.
    Lamy, B.
    et al.
    Laboratoire de Bactériologie, Hôpital l’Archet 2, CHU de Nice, Nice, France; INSERM U1065, Centre méditerranéen de médecine moléculaire, Nice, France; FacultédeMédecine, Université Côte d’Azur, Nice, France; ESCMID study group for bloodstream infection and sepsis (ESGBIS), Switzerland.
    Sundqvist, Martin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. ESCMID study group for bloodstream infection and sepsis (ESGBIS), Switzerland; Faculty of Medicine and Health, Department of Laboratory Medicine, Clinical Microbiology, Örebro University Hospital, Örebro, Sweden.
    Towards an improved diagnosis of bloodstream infection: promises and hurdles2018Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 24, nr 9, s. 933-934Artikel i tidskrift (Övrigt vetenskapligt)
  • 10.
    Lamy, Brigitte
    et al.
    Laboratoire de Bactériologie, Hôpital L'archet 2, CHU de Nice, Nice, France; INSERM U1065, Centre Méditerranéen de Médecine Moléculaire, Equipe 6, Nice, France; Faculté de Médecine, Université Côte D’Azur, Nice, France.
    Sundqvist, Martin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. Department of Laboratory Medicine, Clinical Microbiology.
    Idelevich, Evgeny A.
    Institute of Medical Microbiology, University Hospital Münster, Münster, Germany.
    Bloodstream infections - Standard and progress in pathogen diagnostics2020Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 26, nr 2, s. 142-150Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Bloodstream infection (BSI) is a major public health burden worldwide, with high mortality. Patient outcome is critically influenced by delayed therapy, and fast and accurate pathogen diagnostics decisively improves the care of patients. During the past two decades major improvements have been made in the diagnostic performance of blood culture diagnostics through actions on pre-analysis and time to result.

    Aims: To review and discuss the literature for standard procedures and the progress in BSI pathogen diagnostics, and to propose a new mindset to reach an improved diagnostic workflow.

    Sources: Scientific articles and reviews available through NCBI/Pubmed.

    Content: Blood culture performance relies largely on the quality of its pre-analytical phase that is improved with educational actions monitored by using key performance indicators, and external quality assessment. Advanced blood culture systems now provide tools for an automated estimation of bottle filling. These proved efficient to facilitate effective training for improving blood collection. On analytic aspects, rapid methods for pathogen identification, among which matrix-assisted laser desorption/ ionization time of flight mass spectrometry dominates, and rapid antimicrobial susceptibility testing are reviewed. These technical developments call for improvements in all other steps, especially in pre- and post-analytic logistics to give the full reciprocation of these techniques on patient management. This aspect is summarized by the term 'microbiologistics', which covers all possible improvements in the logistic chain from sampling to report.

  • 11.
    Norén, Torbjörn
    et al.
    Örebro universitet, Institutionen för läkarutbildning. Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
    Johansson, Karin
    Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
    Unemo, Magnus
    Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
    Clostridium difficile PCR ribotype 046 is common among neonatal pigs and humans in Sweden2014Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 20, nr 1, s. O2-O6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Clostridium difficile PCR ribotype 046 was found in 67% of neonatal piglets (45/67) sampled from three separate pig-breeding farms in Sweden. Sows from the same farms were tested and 50% were colonized in faeces and 30% were colonized on skin. An environmental source was suggested because identical PCR ribotypes were isolated from faeces as well as externally. Human C.difficile infection outbreaks in southern Sweden by the identical PCR ribotype 046 indicate its zoonotic potential.

  • 12.
    Rob, F.
    et al.
    Dermatovenereology Department, Second Medical Faculty, Charles University, Na Bulovce Hospital, Prague, Czech Republic.
    Klubalová, B.
    Dermatovenereology Department, Second Medical Faculty, Charles University, Na Bulovce Hospital, Prague, Czech Republic.
    Nyčová, E
    Department of Microbiology, Na Bulovce Hospital, Prague, Czech Republic.
    Hercogová, J.
    Dermatovenereology Department, Second Medical Faculty, Charles University, Na Bulovce Hospital, Prague, Czech Republic.
    Unemo, Magnus
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology.
    Gentamicin 240 mg plus azithromycin 2 g vs. ceftriaxone 500 mg plus azithromycin 2 g for treatment of rectal and pharyngeal gonorrhoea: a randomized controlled trial2020Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 26, nr 2, s. 207-212Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: The aim was to evaluate the efficacy and tolerability of gentamicin 240 mg plus azithromycin 2 g for treatment of uncomplicated rectal and pharyngeal gonorrhoea compared to ceftriaxone 500 mg plus azithromycin 2 g, the recommended European first-line gonorrhoea treatment.

    Methods: A non-inferiority, open-label, single-centre randomized controlled trial was conducted in Prague, Czech Republic. Patients, 18-75 years of age, diagnosed with uncomplicated rectal or pharyngeal gonorrhoea by nucleic acid amplification test (NAAT) were randomized to treatment with gentamicin 240 mg intramuscularly plus azithromycin 2 g orally or ceftriaxone 500 g intramuscularly plus azithromycin 2 g orally. The primary outcome was negative culture and negative NAAT, i.e. 1 week and 3 weeks, respectively, after treatment.

    Results: Both clinical cure and microbiological clearance was achieved by 100% (95% CI 0.95-1.00) of patients in the gentamicin/azithromycin arm (n = 72; 40 rectal, 17 pharyngeal and 15 rectal+pharyngeal infections both localizations) and 100% (95% CI 0.95-1.00) in ceftriaxone/azithromycin arm (n = 71; 38 rectal, 14 pharyngeal and 19 rectal+pharyngeal infections). The absolute difference between the two arms was 0.0% (CI95% -5.1 to 5.1), thus less than the pre-specified margin of 7%. Administration of gentamicin was not more painful than ceftriaxone according to the visual analogue scale (1.8 vs. 3.4; p <0.001). Gastrointestinal adverse events were similar in the ceftriaxone arm (33/71, 46.5%) and the gentamicin arm (29/72, 40.3%), and overall in most (52/62, 83.9%) cases they were mild.

    Conclusions: Gentamicin 240 mg plus azithromycin 2 g is an effective alternative for treatment of extragenital gonorrhoea. (C) 2019 European Society of Clinical Microbiology and Infectious Diseases.

  • 13.
    Söderquist, Bo
    et al.
    Örebro universitet, Hälsoakademin.
    Berglund, C
    Methicillin-resistant Staphylococcus saprophyticus in Sweden carries various types of staphylococcal cassette chromosome mec (SCCmec)2009Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 15, nr 12, s. 1176-1178Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Staphylococcus saprophyticus is a common cause of uncomplicated urinary tract infections and is usually susceptible to the antimicrobial agents used for their treatment. However, S. saprophyticus resistant to beta-lactam antibiotics and carrying mecA has been reported. Eight Swedish isolates of mecA-positive S. saprophyticus with diverse origin carrying at least three different types of staphylococcal cassette chromosome mec (SCCmec) are described here.

  • 14.
    Tschudin-Sutter, S.
    et al.
    Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland.
    Kuijper, E. J.
    Department of Medical Microbiology, Centre for Infectious Diseases, Leiden University Medical Center, Leiden, The Netherlands.
    Durovic, A.
    Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland.
    Vehreschild, M. J. G. T.
    Department I of Internal Medicine, University Hospital of Cologne, Cologne, Germany; German Centre for Infection Research (DZIF), Partner Site Bonn-Cologne, Germany.
    Barbut, F.
    National Reference Laboratory for Clostridium difficile, Paris, France.
    Eckert, C.
    National Reference Laboratory for Clostridium difficile, Paris, France.
    Fitzpatrick, F.
    Departments of Clinical Microbiology, Royal College of Surgeons in Ireland and Beaumont Hospital, Ireland.
    Hell, M.
    Department of Medical Microbiology and Infection Control, Academic Teaching Laboratories-Medilab OG, Paracelsus Medizinische Privatuniversität (PMU), Salzburg, Austria.
    Norén, Torbjörn
    Örebro universitet, Institutionen för medicinska vetenskaper. Department of Laboratory Medicine, Clinical Microbiology.
    O'Driscoll, J.
    Department of Medical Microbiology, Stoke Mandeville Hospital, Aylesbury, UK.
    Coia, J.
    Scottish Microbiology Reference Laboratories, Glasgow, UK.
    Gastmeier, P.
    Institute of Hygiene and Environmental Medicine, Charité, Universitätsmedizin Berlin, Berlin, Germany.
    von Müller, L.
    Institute for Medical Microbiology and Hygiene, University of Saarland Medical Center, State Laboratory of Saarland, Consiliary Laboratory for Clostridium difficile, Homburg/Saar, Germany.
    Wilcox, M. H.
    Department of Microbiology, Leeds Teaching Hospitals, Leeds, UK; University of Leeds, Leeds, UK.
    Widmer, A. F.
    Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University Basel, Basel, Switzerland.
    Guidance document for prevention of Clostridium difficile infection in acute healthcare settings2018Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 24, nr 10, s. 1051-1054, artikel-id S1198-743X(18)30195-2Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    SCOPE: Clostridium difficile infection (CDI) is the most important infective cause of healthcare-associated diarrhoea in high income countries and one of the most important healthcare-associated pathogens in both Europe and the United States. It is associated with high morbidity and mortality resulting in both societal and financial burden. A significant proportion of this burden is potentially preventable by a combination of targeted infection prevention and control measures and antimicrobial stewardship. The aim of this guidance document is to provide an update on recommendations for prevention of CDI in acute care settings to provide guidance to those responsible for institutional infection prevention and control programmes.

    METHODS: An expert group was set up by the European society of clinical microbiology and infectious diseases (ESCMID) Study Group for C. difficile (ESGCD), which performed a systematic review of the literature on prevention of CDI in adults hospitalized in acute care settings and derived respective recommendations according to the GRADE approach. Recommendations are stratified for both outbreak and endemic settings.

    QUESTIONS ADDRESSED BY THE GUIDELINE AND RECOMMENDATIONS: This guidance document provides thirty-six statements on strategies to prevent CDI in acute care settings, including 18 strong recommendations. No recommendation was provided for three questions.

  • 15.
    Unemo, Mats
    et al.
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
    Salado-Rasmussen, K.
    Department of Dermatovenereology, Bispebjerg University Hospital, Copenhagen, Denmark.
    Hansen, M.
    World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Faculty of Medicine and Health, Örebro University Hospital, Örebro, Sweden.
    Olsen, A. O.
    Olafia Clinic and National Advisory Unit for Sexually Transmitted Infections, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Falk, M.
    Department of Dermatovenereology, Örebro University Hospital, Örebro, Sweden.
    Golparian, Daniel
    Örebro universitet, Institutionen för medicinska vetenskaper. World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
    Aasterød, M.
    Olafia Clinic and National Advisory Unit for Sexually Transmitted Infections, Oslo University Hospital, Oslo, Norway.
    Ringlander, J.
    World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
    Nilsson, C. Stezckó
    Department of Dermatovenereology, Örebro University Hospital, Örebro, Sweden.
    Sundqvist, Martin
    Örebro universitet, Institutionen för medicinska vetenskaper. Region Örebro län. World Health Organization Collaborating Centre for Gonorrhoea and Other STIs, Department of Laboratory Medicine, Microbiology, Örebro University Hospital, Örebro, Sweden.
    Schønning, K.
    Department of Clinical Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark.
    Moi, H.
    Olafia Clinic and National Advisory Unit for Sexually Transmitted Infections, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
    Westh, H.
    Department of Clinical Medicine, Faculty of Medical Sciences, University of Copenhagen, Copenhagen, Denmark; Department of Clinical Microbiology, Hvidovre University Hospital, Hvidovre, Denmark.
    Jensen, J. S.
    Infection Preparedness, Research Unit for Reproductive Tract Microbiology, Statens Serum Institut, Copenhagen, Denmark.
    Clinical and analytical evaluation of the new Aptima Mycoplasma genitalium assay, with data on M. genitalium prevalence and antimicrobial resistance in M. genitalium in Denmark, Norway and Sweden in 20162018Ingår i: Clinical Microbiology and Infection, ISSN 1198-743X, E-ISSN 1469-0691, Vol. 24, nr 5, s. 533-539Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: Mycoplasma genitalium (MG) causes urethritis and cervicitis, potentially causing reproductive complications. Resistance in MG to first-line (azithromycin) and second-line (moxifloxacin) treatment has increased. We examined the clinical and analytical performance of the new Conformite Europeene (CE)/in vitro diagnostics (IVD) Aptima Mycoplasma genitalium assay (CE/IVD AMG; Hologic); the prevalence of MG, Chlamydia trachomatis (CT) and Neisseria gonorrhoeae (NG); and MG resistance to azithromycin and moxifloxacin in Denmark, Norway and Sweden in 2016.

    Methods: From February 2016 to February 2017, urogenital and extragenital (only in Denmark) specimens from consecutive attendees at three sexually transmitted disease clinics were tested with the CE/ IVD AMG, the research-use-only MG Alt TMA-1 assay (Hologic), Aptima Combo 2 (CT/NG) assay and a laboratory-developed TaqMan real-time mgpB quantitative real-time PCR (qPCR). Resistance-associated mutations were determined by sequencing. Strains of MG and other mycoplasma species in different concentrations were also tested.

    Results: In total 5269 patients were included. The prevalence of MG was 7.2% (382/5269; 4.9-9.8% in the countries). The sensitivity of the CE/IVD AMG, MG Alt TMA-1 and mgpB qPCR ranged 99.13-100%, 99.13 -100% and 73.24-81.60%, respectively, in the countries. The specificity ranged 99.57-99.96%, 100% and 99.69-100%, respectively. The prevalence of resistance-associated mutations for azithromycin and moxifloxacin was 41.4% (120/290; 17.7-56.6%) and 6.6% (18/274; 4.1-10.2%), respectively. Multidrug resistance was found in all countries (2.7%; 1.1-4.2%).

    Conclusions: Both transcription-mediated amplification (TMA)-based MG assays had a highly superior sensitivity compared to the mgpB qPCR. The prevalence of MG and azithromycin resistance was high. Validated and quality-assured molecular tests for MG, routine resistance testing of MG-positive samples and antimicrobial resistance surveillance are crucial.

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