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Hanberger, Håkan
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Hanberger, H. (Ed.). (2017). Sepsis på akuten & IVA: Diagnostik och Antibiotikaterapi (3ed.). Linköping: Linköpings universitet.
Open this publication in new window or tab >>Sepsis på akuten & IVA: Diagnostik och Antibiotikaterapi
2017 (Swedish)Collection (editor) (Other academic)
Abstract [sv]

Tredje upplagan av ”Sepsis på akuten och IVA” baseras delvis på SK-kursen med samma namn. Bokens innehall har dock utökats for att kunna ge praktiska anvisningar for diagnostik och terapi vid sepsis hos barn och vuxna med olika infektionsfokus. Sepsisboken ger också en inblick i vilka mekanismer som gör att sepsis snabbt kan bli ett livshotande tillstånd och vilka åtgärder som det ar mest bråttom med under de första timmarna av septisk chock. Kort tid mellan upptäckt av septisk chock och ratt insatt behandling sparar både organfunktion och liv. Modern intensivvård med monitorering av vätsketillförsel, vasokativa droger, respirator, dialys etc ar liksom ratt antibiotika i ratt dos en förutsättning for att kunna radda en patient med septisk chock. For att kunna ge ratt antibiotika kravs kunskap om vilka bakterier som ar vanligast vid olika typer av infektioner och deras antibiotikakänslighet. Ett kapitel i denna bok agnas därför at resistensläget i blododlingar från svenska patienter.

Patienter som har nedsatt njurfunktion löper större risk for felaktig dosering av antimikrobiella läkemedel och behandlingsmisslyckande varför boken innehåller flera tabeller med doseringsanvisningar vid nedsatt njurfunktion och dialys. Ett kapitel agnas at handläggning av allvarliga bakteriella infektioner hos barn eftersom barn reagerar något annorlunda an vuxna vid sepsis, S. aureus ar vanligare och barn har en delvis annorlunda behandlingsalgoritm. Barn med immunsuppression berörs också och det ar ett kapitel om allvarliga infektioner hos vuxna patienter med neutropeni. Ett separat kapitel agnas at de relativt ovanliga men livshotande hud och mjukdelsinfektionerna som kräver snabb kirurgisk intervention och bra samarbete mellan kirurger, intensivvårdsläkare och infektionsläkare. Svampsepsis har okat på IVA pga alltmer avancerad intensivvård och agnas ett eget kapitel da svampsepsis ofta ar svårdiagnosticerat. Empirisk behandling med nya antimykotika har därför blivit allt vanligare och det ar viktigt att ha kännedom om vilka preparat som har bast effekt och ar kostnadseffektiva. Samhällsförvärvade och sjukhusförvärvade intensivvårdskrävande pneumonier har båda hög dödlighet och en sammanfattning av behandlingsalgoritmer ar inkluderade i boken. Intensivvård innebar risk for sjukhusförvärvade infektioner och riktlinjer for hur man skall undvika, diagnosticera och behandla blodkateterassocierade infektioner agnas ett kapitel. For en optimal handläggning av septiska infektioner ar det viktigt att ta reda på förekomst av immunsuppression och komorbiditet, göra en korrekt bedömning av svårighetsgrad, stalla ratt preliminär diagnos inklusive infektionsfokus, sannolik etiologi och risk for antibiotikaresistens. Boken innehåller flera sammanfattningar och checklistor for snabb korrekt empirisk antimikrobiell behandling av intensivvårdskrävande infektioner både på akuten och IVA.

Vi hoppas att boken skall bidra till att förbättra varden av patienter med sepsis och andra svara infektioner. Stort tack till alla medförfattare som bidragit med sin expertis och till Region Östergötland som bidragit ekonomiskt och möjliggjort utgivning av denna bok.

Linköping i Januari 2017

Hakan Hanberger

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2017. 163 p. Edition: 3
Keyword
Sepsis - drug therapy, Anti-bacterial agents - administration & dosage, Sepsis - behandling
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-134869 (URN)9789176856147 (ISBN)
Note

Medförfattare

Sören Berg, Linköping

Rutger Bennet, Stockholm

Erik Eliasson, Stockholm

Britt-Marie Eriksson, Uppsala

Margareta Eriksson, Stockholm

Mia Furebring, Uppsala

Christian Giske, Stockholm

Bengt Gårdlund, Stockholm

Fredrik Hammarskjöld, Jönköping

Håkan Hanberger, Linköping

Jonas Hedlund, Stockholm

Per Ljungman, Stockholm

Lennart E Nilsson, Linköping

Martin Nilsson, Linköping

Johan Petersson, Stockholm

Jan Sjölin, Uppsala

Johanna Sjöwall, Linköping

Available from: 2017-02-28 Created: 2017-02-28 Last updated: 2017-03-10Bibliographically approved
Phu, V. D., Wertheim, H. F., Larsson, M., Nadjm, B., Dinh, Q.-D., Nilsson, L. E., . . . Hanberger, H. (2016). Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units. PLoS ONE, 11(1), Article ID e0147544.
Open this publication in new window or tab >>Burden of Hospital Acquired Infections and Antimicrobial Use in Vietnamese Adult Intensive Care Units
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2016 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, no 1, e0147544Article in journal (Refereed) Published
Abstract [en]

Background Vietnam is a lower middle-income country with no national surveillance system for hospital-acquired infections (HAIs). We assessed the prevalence of hospital-acquired infections and antimicrobial use in adult intensive care units (ICUs) across Vietnam. Methods Monthly repeated point prevalence surveys were systematically conducted to assess HAI prevalence and antimicrobial use in 15 adult ICUs across Vietnam. Adults admitted to participating ICUs before 08: 00 a.m. on the survey day were included. Results Among 3287 patients enrolled, the HAI prevalence was 29.5% (965/3266 patients, 21 missing). Pneumonia accounted for 79.4% (804/1012) of HAIs Most HAIs (84.5% [855/1012]) were acquired in the survey hospital with 42.5% (363/855) acquired prior to ICU admission and 57.5% (492/855) developed during ICU admission. In multivariate analysis, the strongest risk factors for HAI acquired in ICU were: intubation (OR 2.76), urinary catheter (OR 2.12), no involvement of a family member in patient care (OR 1.94), and surgery after admission (OR 1.66). 726 bacterial isolates were cultured from 622/1012 HAIs, most frequently Acinetobacter baumannii (177/726 [24.4%]), Pseudomonas aeruginosa (100/726 [13.8%]), and Klebsiella pneumoniae (84/726 [11.6%]), with carbapenem resistance rates of 89.2%, 55.7%, and 14.9% respectively. Antimicrobials were prescribed for 84.8% (2787/ 3287) patients, with 73.7% of patients receiving two or more. The most common antimicrobial groups were third generation cephalosporins, fluoroquinolones, and carbapenems (20.1%, 19.4%, and 14.1% of total antimicrobials, respectively). Conclusion A high prevalence of HAIs was observed, mainly caused by Gram-negative bacteria with high carbapenem resistance rates. This in combination with a high rate of antimicrobial use illustrates the urgent need to improve rational antimicrobial use and infection control efforts.

Place, publisher, year, edition, pages
PUBLIC LIBRARY SCIENCE, 2016
National Category
Infectious Medicine
Identifiers
urn:nbn:se:liu:diva-125684 (URN)10.1371/journal.pone.0147544 (DOI)000369528600034 ()26824228 (PubMedID)
Available from: 2016-03-03 Created: 2016-02-29 Last updated: 2017-11-30
Skoog, G., Struwe, J., Cars, O., Hanberger, H., Odenholt, I., Prag, M., . . . Erntell, M. (2016). Repeated nationwide point-prevalence surveys of antimicrobial use in Swedish hospitals: data for actions 2003-2010. Eurosurveillance, 21(25), 13-21.
Open this publication in new window or tab >>Repeated nationwide point-prevalence surveys of antimicrobial use in Swedish hospitals: data for actions 2003-2010
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2016 (English)In: Eurosurveillance, ISSN 1025-496X, E-ISSN 1560-7917, Vol. 21, no 25, 13-21 p.Article in journal (Refereed) Published
Abstract [en]

This study sought to analyse antimicrobial pressure, indications for treatment, and compliance with treatment recommendations and to identify possible problem areas where inappropriate use could be improved through interventions by the network of the local Swedish Strategic Programme Against Antibiotic Resistance (Strama) groups. Five point-prevalence surveys were performed in between 49 and 72 participating hospitals from 2003 to 2010. Treatments were recorded for 19 predefined diagnosis groups and whether they were for community-acquired infection, hospital-acquired infection, or prophylaxis. Approximately one-third of inpatients were treated with antimicrobials. Compliance with guidelines for treatment of community-acquired pneumonia with narrow-spectrum penicillin was 17.0% during baseline 2003-2004, and significantly improved to 24.2% in 2010. Corresponding figures for quinolone use in uncomplicated cystitis in women were 28.5% in 2003-2004, and significantly improved, decreasing to 15.3% in 2010. The length of surgical prophylaxis improved significantly when data for a single dose and 1 day were combined, from 56.3% in 2003-2004 to 66.6% in 2010. Improved compliance was possibly the effect of active local feedback, repeated surveys, and increasing awareness of antimicrobial resistance. Strama groups are important for successful local implementation of antimicrobial stewardship programs in Sweden.

Place, publisher, year, edition, pages
EUR CENTRE DIS PREVENTION & CONTROL, 2016
National Category
Infectious Medicine
Identifiers
urn:nbn:se:liu:diva-130426 (URN)10.2807/1560-7917.ES.2016.21.25.30264 (DOI)000379244000003 ()27367646 (PubMedID)
Available from: 2016-08-07 Created: 2016-08-05 Last updated: 2017-11-28
Leander, G., Eliasson, E., Hanberger, H. & Giske, C. (2015). Betalaktamantibiotika och frågan om dosregim vid svår infektion: Förlängd infusion teoretiskt tilltalande – Ännu saknas evidens för klinisk nytta. Läkartidningen, 112(13), Article ID CW3P.
Open this publication in new window or tab >>Betalaktamantibiotika och frågan om dosregim vid svår infektion: Förlängd infusion teoretiskt tilltalande – Ännu saknas evidens för klinisk nytta
2015 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 13, CW3PArticle in journal (Refereed) Published
Abstract [sv]

Betalaktamantibiotika är första­handsmedel vid svår sepsis/septisk chock.

Djurstudier visar att den fria antibiotikakoncentrationen i blodet bör överstiga den koncentration som krävs för att hämma bakterietillväxt (MIC) under minst 50 procent av dygnet för maximal effekt av betalaktamantibiotika. 

Infusion av betalaktamer under flera timmar eller kontinuerlig infusion kan teoretiskt öka tiden över MIC jämfört med dagens standardadministration av bolusdoser.

Enligt denna litteraturgenomgång saknas evidens för säker skillnad i klinisk effekt mellan kontinuerlig infusion, förlängd infusion eller standardbolusdos av betalaktamantibiotika. Inkluderade studier är mycket heterogena avseende bl a patienturval, infektionsfokus, bakteriella agens och doseringsregimer.  

I avvaktan på resultat från nya studier bör patienter med svår sepsis, framför allt vid septisk chock, ges höga och täta intermittenta betalaktamdoser alternativt förlängd infusion i syfte att nå fri antibiotikakoncentration i blodet, som överstiger MIC under minst halva dosintervallet.

National Category
Cardiac and Cardiovascular Systems
Identifiers
urn:nbn:se:liu:diva-126421 (URN)
Available from: 2016-03-24 Created: 2016-03-24 Last updated: 2017-11-30
Åkerlund, A., Sundqvist, M., Hanberger, H., Åhrén, C., Serrander, L. & Giske, C. G. (2015). Svarstiderna kan kortas vid mikrobiologisk diagnostik av sepsis: Bättre öppettider på laboratorier och aktiv rådgivning ger snabbare terapi. Läkartidningen, 112(7), Article ID C73S.
Open this publication in new window or tab >>Svarstiderna kan kortas vid mikrobiologisk diagnostik av sepsis: Bättre öppettider på laboratorier och aktiv rådgivning ger snabbare terapi
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2015 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 7, C73SArticle in journal (Refereed) Published
Abstract [sv]

Snabbt insatt adekvat antibiotikabehandling är livräddande vid allvarliga bakteriella infektioner. 

Snabb mikrobiologisk diagnostik krävs i och med ökande antibiotikaresistens och kommer att ge medicinska vinster.

En enkät till landets mikrobiologiska laboratorier visar på stora skillnader avseende tillgänglighet, snabbhet och kommunikation med svarsmottagande enhet vad gäller positiva blododlingar.

För snabbare svar krävs att mikrobiologiska laboratorier erbjuder mer generösa öppettider, effektivare transportsystem och patientnära blododlingsinkubatorer samt tidig och aktiv rådgivning till behandlande läkare.

n/a

National Category
Infectious Medicine
Identifiers
urn:nbn:se:liu:diva-126420 (URN)
Available from: 2016-03-24 Created: 2016-03-24 Last updated: 2017-11-30
Ternhag, A., Giske, C. G. & Hanberger, H. (2014). Aminoglykosider är effektiva – men oto- och njurtoxiska. Läkartidningen, 111(7), 268-269, Article ID CMLD.
Open this publication in new window or tab >>Aminoglykosider är effektiva – men oto- och njurtoxiska
2014 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 7, 268-269 p., CMLDArticle in journal (Refereed) Published
Abstract [sv]

Aminoglykosider har en snabb bakterie­avdödande effekt, men oto- och njurtoxicitet begränsar deras användning.

Vid septisk chock bedöms nyttan med aminoglykosidbehandling överväga risken, men på grund av ökad distributionsvolym bör högre doser ges.

Vid känd och/eller genetisk disposition för hörselnedsättning och gravt nedsatt njurfunktion ska aminoglykosider undvikas.

National Category
Infectious Medicine
Identifiers
urn:nbn:se:liu:diva-126423 (URN)24669487 (PubMedID)
Available from: 2016-03-24 Created: 2016-03-24 Last updated: 2017-11-30
Hanberger, H., Skoog, G., Ternhag, A. & Giske, C. G. (2014). Antibiotic consumption and antibiotic stewardship in Swedish hospitals. Upsala Journal of Medical Sciences, 119(2), 154-161.
Open this publication in new window or tab >>Antibiotic consumption and antibiotic stewardship in Swedish hospitals
2014 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 119, no 2, 154-161 p.Article, review/survey (Refereed) Published
Abstract [en]

Background. The aim of this paper was to describe and analyze the effect of antibiotic policy changes on antibiotic consumption in Swedish hospitals and to review antibiotic stewardship in Swedish hospitals. Results. The main findings were: 1) Antibiotic consumption has significantly increased in Swedish hospitals over the last decade. The consumption of cephalosporins has decreased, whereas that of most other drugs including piperacillin-tazobactam, carbapenems, and penicillinase-sensitive and -resistant penicillins has increased and replaced cephalosporins. 2) Invasive infections caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae have increased, but the proportion of pathogens resistant to third-generation cephalosporins causing invasive infections is still very low in a European and international perspective. Furthermore, the following gaps in knowledge were identified: 1) lack of national, regional, and local data on the incidence of antibiotic resistance among bacteria causing hospital-acquired infections e. g. bloodstream infections and hospital-acquired pneumonia-data on which standard treatment guidelines should be based; 2) lack of data on the incidence of Clostridium difficile infections and the effect of change of antibiotic policies on the incidence of C. difficile infections and infections caused by antibiotic-resistant pathogens; and 3) lack of prospective surveillance programs regarding appropriate antibiotic treatment, including selection of optimal antimicrobial drug regimens, dosage, duration of therapy, and adverse ecological effects such as increases in C. difficile infections and emergence of antibiotic-resistant pathogens. Conclusions. Evidence-based actions to improve antibiotic use and to slow down the problem of antibiotic resistance need to be strengthened. The effect of such actions should be analyzed, and standard treatment guidelines should be continuously updated at national, regional, and local levels.

Place, publisher, year, edition, pages
Informa Healthcare / Upsala Medical Society, 2014
Keyword
Antibiotic consumption; antibiotic resistance; antibiotic treatment guidelines
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-108178 (URN)10.3109/03009734.2014.909911 (DOI)000336526100014 ()
Available from: 2014-06-26 Created: 2014-06-26 Last updated: 2017-12-05
Lundin, F., Personne, M. & Hanberger, H. (2014). Botulism är en behandlingsbar, mycket sällsynt förgiftning. Läkartidningen, 111(12-13), 551-552.
Open this publication in new window or tab >>Botulism är en behandlingsbar, mycket sällsynt förgiftning
2014 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 12-13, 551-552 p.Article in journal (Refereed) Published
Abstract [sv]

Botulism är en sällsynt förgiftning orsakad av botulinumtoxin från bakterien Clostridium botulinum.

Bakterien tillväxer under anaeroba förhållanden och återfinns på våra breddgrader oftast i bristfälligt tillagad fisk.

Botulism ska misstänkas vid snabbt progredierande symmetrisk nedåtstigande muskelparalys och autonoma symtom – framför allt vid pupillpåverkan (mydriasis). Behandlingen består i tillförsel av antitoxin för att förhindra symtomprogress samt symtomatiskt omhändertagande, speciellt med avseende på andningsunderstöd.Långvarig intensivvårdsbehandling kan bli aktuell, men på sikt är prognosen relativt god.

National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-115893 (URN)24734378 (PubMedID)
Available from: 2015-03-23 Created: 2015-03-23 Last updated: 2017-12-04Bibliographically approved
Hanberger, H., Antonelli, M., Holmbom, M., Lipman, J., Pickkers, P., Leone, M., . . . Vincent, J.-L. (2014). Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels. BMC Infectious Diseases, 14(513).
Open this publication in new window or tab >>Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels
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2014 (English)In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 14, no 513Article in journal (Refereed) Published
Abstract [en]

Background: Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance. Methods: Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of greater than= 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of less than 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden). Results: On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P less than 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P less than 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P less than 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections. Conclusions: Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome.

Place, publisher, year, edition, pages
BioMed Central, 2014
Keyword
Infection; Critically ill; Antibiotic; Resistance
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-111602 (URN)10.1186/1471-2334-14-513 (DOI)000342365300001 ()25245620 (PubMedID)
Available from: 2014-10-27 Created: 2014-10-27 Last updated: 2017-12-05Bibliographically approved
Samuelsson, A., Isaksson, B., Hanberger, H. & Olhager, E. (2014). Late onset neonatal sepsis, risk factors and interventions: an analysis of recurrent outbreaks of Serratia marcescens 2006-2011. Journal of Hospital Infection, 86(1), 57-63.
Open this publication in new window or tab >>Late onset neonatal sepsis, risk factors and interventions: an analysis of recurrent outbreaks of Serratia marcescens 2006-2011
2014 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 86, no 1, 57-63 p.Article in journal (Refereed) Published
Abstract [en]

Background: during the period 2006 to 2011 we observed 11 patients with Serratia marcescens sepsis, a total of 47 patients were colonised due to spread of different clones. These recurrent clusters brought about interventions to reduce spread between patients.

Aim: to evaluate the effect of stepwise introduced interventions to prevent S marcescens colonisation/sepsis and to analyse risk factors for late onset sepsis (LOS).

Methods: to evaluate the interventions an open retrospective observational study was performed. A retrospective case-control study was performed to analyse risk factors for LOS.

Findings: main findings of this study were the decrease in S marcescens sepsis and colonisation after the stepwise adoption of hygiene interventions, as well as identifying low gestational age, low birth weight, indwelling central venous or umbilical catheter and ventilator treatment as risk factors for LOS. Compliance to basic hygiene guidelines was the only intervention continuously monitored from late 2007. Compliance increased gradually to a steady high level early 2009. There was a decrease in LOS with S marcescens (LOS-Ser) clustering after the second quarter of 2008. After the first quarter of 2009 we saw a decrease in S marcescens colonisation.

Conclusion: We were not able to isolate specific effects of each intervention, but an update of our antibiotic policy probably had effect on the occurrence of LOS-ser. The delayed effect of interventions on S marcescens colonisation was probably due to the time it takes for new routines to have impact, illustrated by the gradual increase in compliance to basic hygiene guidelines.

Place, publisher, year, edition, pages
Elsevier, 2014
Keyword
Serratia marcescens, outbreak, neonatal, late onset sepsis
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-97707 (URN)10.1016/j.jhin.2013.09.017 (DOI)000328481500009 ()
Available from: 2013-09-20 Created: 2013-09-20 Last updated: 2017-12-06Bibliographically approved
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