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Isaksson, Barbro
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Publications (10 of 39) Show all publications
Lindqvist, M., Isaksson, B., Swanberg, J., Skov, R., Larsen, A. R., Larsen, J., . . . Hällgren, A. (2015). Long-term persistence of a multi-resistant methicillin-susceptible Staphylococcus aureus (MR-MSSA) clone at a university hospital in southeast Sweden, without further transmission within the region. European Journal of Clinical Microbiology and Infectious Diseases, 34(7), 1415-1422
Open this publication in new window or tab >>Long-term persistence of a multi-resistant methicillin-susceptible Staphylococcus aureus (MR-MSSA) clone at a university hospital in southeast Sweden, without further transmission within the region
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2015 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 34, no 7, p. 1415-1422Article in journal (Refereed) Published
Abstract [en]

The objective of this study was to characterise isolates of methicillin-susceptible Staphylococcus aureus (MSSA) with resistance to clindamycin and/or tobramycin in southeast Sweden, including the previously described ECT-R clone (t002) found in Östergotland County, focusing on clonal relatedness, virulence determinants and existence of staphylococcal cassette chromosome (SCC) mec remnants. MSSA isolates with resistance to clindamycin and/or tobramycin were collected from the three county councils in southeast Sweden and investigated with spa typing, polymerase chain reaction (PCR) targeting the SCCmec right extremity junction (MREJ) and DNA microarray technology. The 98 isolates were divided into 40 spa types, and by microarray clustered in 17 multi-locus sequence typing (MLST) clonal complexes (MLST-CCs). All isolates with combined resistance to clindamycin and tobramycin (n = 12) from Östergotland County and two additional isolates (clindamycin-R) were designated as spa type t002, MREJ type ii and were clustered in CC5, together with a representative isolate of the ECT-R clone, indicating the clones persistence. These isolates also carried several genes encoding exotoxins, Q9XB68-dcs and qacC. Of the isolates in CC15, 83 % (25/30) were tobramycin-resistant and were designated spa type t084. Of these, 68 % (17/25) were isolated from new-borns in all three counties. The persistence of the ECT-R clone in Östergotland County, although not found in any other county in the region, carrying certain virulence factors that possibly enhance its survival in the hospital environment, highlights the fact that basic hygiene guidelines must be maintained even when MRSA prevalence is low.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2015
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-120139 (URN)10.1007/s10096-015-2366-1 (DOI)000356527200017 ()25812999 (PubMedID)
Note

Funding Agencies|Ostergotland County Council, Sweden; Medical Research Council of Southeast Sweden (FORSS); Scandinavian Society for Antimicrobial Chemotherapy (SSAC)

Available from: 2015-07-14 Created: 2015-07-13 Last updated: 2017-12-04
Lindqvist, M., Isaksson, B., Nilsson, L., Wistedt, A., Swanberg, J., Skov, R., . . . Hällgren, A. (2014). Genetic relatedness of multi-resistant methicillin-susceptible Staphylococcus aureus in southeast Sweden.
Open this publication in new window or tab >>Genetic relatedness of multi-resistant methicillin-susceptible Staphylococcus aureus in southeast Sweden
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2014 (English)Manuscript (preprint) (Other academic)
Abstract [en]

Background: A high exchange of patients occurs between the hospitals in southeast Sweden, resulting in a possible transmission of nosocomial pathogens. The objective of this study was to investigate the incidence and possible genetic relatedness of multi-resistant methicillinsusceptible Staphylococcus aureus (MSSA) in the region in general, and in particular the possible persistence and transmission of the ECT-R clone (t002) showing resistance to erythromycin, clindamycin and tobramycin previously found in Östergötland County.

Methods: Three groups of S. aureus isolates with different antibiotic resistance profiles, including the ECT-R profile, were collected from the three County Councils in southeast Sweden and investigated with spa typing, real-time PCR targeting the staphylococcal cassette chromosome (SCC) mec right extremity junction (MREJ), and microarray.

Results: All isolates with the ECT-R resistance profile (n = 12) from Östergötland County and two additional isolates with another antibiotic resistance profile were designated spa type t002, MREJ type ii, and were clustered in the same clonal cluster (CC) (i.e. CC5) by the microarray result, indicating the persistence of the ECT-R clone. In addition, 60 % of the isolates belonged to CC15 from newborns, with 94 % sharing spa type t084, indicating interhospital transmission.

Conclusions: The persistence of the ECT-R clone and the possible transmission of the t084 strain indicate that there is still an insufficiency in the maintenance of basic hygiene guidelines. The ECT-R clone probably possesses mechanisms of virulence and transmission that make it so successful.

Keywords
MSSA, multi-resistance, genetic relatedness, t002, t084
National Category
Clinical Medicine Medical Genetics
Identifiers
urn:nbn:se:liu:diva-103678 (URN)
Available from: 2014-01-22 Created: 2014-01-22 Last updated: 2018-01-11Bibliographically 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, p. 57-63Article 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
Keywords
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
Mernelius, S., Svensson, P.-O., Rensfeldt, G., Davidsson, E., Isaksson, B., Lofgren, S. & Matussek, A. (2013). Compliance with hygiene guidelines: The effect of a multimodal hygiene intervention and validation of direct observations. American Journal of Infection Control, 41(5), E45-E48
Open this publication in new window or tab >>Compliance with hygiene guidelines: The effect of a multimodal hygiene intervention and validation of direct observations
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2013 (English)In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 41, no 5, p. E45-E48Article in journal (Refereed) Published
Abstract [en]

Background

Good compliance with hygiene guidelines is essential to prevent bacterial transmission and health care-associated infections. However, the compliance is usually <50%.

Methods

A multimodal and multidisciplinary hygiene intervention was launched once the baseline compliance was determined through direct observations in 4 departments of obstetrics and gynecology. Detailed evaluations of the compliance rates were performed at point of stability (at 80%) and follow-up (3 years after hygiene intervention). Validation of direct observations was performed using blinded double appraisal and multiappraisal.

Results

At baseline, the compliance with barrier precautions and the dress code at the 4 departments were 39% to 47% and 79% to 98%, respectively. Point of stability was reached approximately 1 year after the hygiene intervention was launched. The compliance with barrier precautions was significantly higher at follow-up compared with baseline in 3 departments. In the validation by double appraisal, 471 of 483 components were judged identical between observers. In the multiappraisal, 95% to 100% of the observers correctly judged the 7 components.

Conclusion

It is possible to improve compliance with hygiene guidelines, but, to ensure a long-lasting effect, a continuous focus on barrier precautions is required. Observation is a valid method to monitor compliance.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Multidisciplinary, Adherence, Double appraisal, Multiappraisal, Self-reporting, Hand hygiene, Barrier precautions, Dress code
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-93971 (URN)10.1016/j.ajic.2012.09.008 (DOI)000318611200002 ()
Note

Funding Agencies|Futurum-the Academy for Healthcare, County Council, Jonkoping||Medical Research Council of Southeast Sweden||

Available from: 2013-06-13 Created: 2013-06-13 Last updated: 2017-12-06Bibliographically approved
Mernelius, S., Lofgren, S., Lindgren, P.-E., Blomberg, M., Olhager, E., Gunnervik, C., . . . Matussek, A. (2013). The effect of improved compliance with hygiene guidelines on transmission of Staphylococcus aureus to newborn infants: The Swedish Hygiene Intervention and Transmission of S aureus study. American Journal of Infection Control, 41(7), 585-590
Open this publication in new window or tab >>The effect of improved compliance with hygiene guidelines on transmission of Staphylococcus aureus to newborn infants: The Swedish Hygiene Intervention and Transmission of S aureus study
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2013 (English)In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 41, no 7, p. 585-590Article in journal (Refereed) Published
Abstract [en]

Background: Newborn infants are often colonized with Staphylococcus aureus originating from health care workers (HCWs). We therefore use colonization with S aureus of newborn infants to determine the effect of an improved compliance with hygiene guidelines on bacterial transmission. Methods: Compliance with hygiene guidelines was monitored prior to (baseline) and after (follow-up) a multimodal hygiene intervention in 4 departments of obstetrics and gynecology. spa typing was used to elucidate transmission routes of S aureus collected from newborn infants, mothers, fathers, staff members, and environment. Results: The compliance with hygiene guidelines increased significantly from baseline to follow-up. The transmission of S aureus from HCWs to infants was however not affected. Fathers had the highest colonization rates. Persistent carriage was indicated in 18% of the HCWs. The most commonly isolated spa type was t084, which was not detected in a previous study from the same geographic area. Conclusion: It is possible to substantially improve the compliance with hygiene guidelines, by using multimodal hygiene intervention. The improved compliance did not decrease the transmission of S aureus from sources outside the own family to newborn infants. Furthermore, we show the establishment of a new spa type (t084), which now is very common in our region. Copyright (C) 2013 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.

Place, publisher, year, edition, pages
Elsevier, 2013
Keywords
Compliance rates; The Swedish HITS-study; spa typing; Persistent carriage; Colonization; Carriage; Multimodal hygiene intervention
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-96178 (URN)10.1016/j.ajic.2012.09.014 (DOI)000321046300004 ()
Available from: 2013-08-14 Created: 2013-08-14 Last updated: 2017-12-06
Samuelsson, A., Isaksson, B., Chabok, A., Jonasson, J., Nilsson, L. E., Eriksson, O. & Hanberger, H. (2012). Changes in the aerobic faecal flora of patients treated with antibiotics for acute intra-abdominal infection. Scandinavian Journal of Infectious Diseases, 44(11), 820-827
Open this publication in new window or tab >>Changes in the aerobic faecal flora of patients treated with antibiotics for acute intra-abdominal infection
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2012 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 44, no 11, p. 820-827Article in journal (Refereed) Published
Abstract [en]

Background: An open observational study was performed to investigate changes in the rectal flora and antibiotic susceptibility among faecal bacteria in patients treated with antibiotics for acute intra-abdominal infection. Methods: One hundred and forty patients with acute intra-abdominal infection requiring antibiotic treatment and hospitalization were included. Eight surgical units from the southern part of Sweden participated, between January 2006 and November 2007. Antibiotic treatments were according to local guidelines. Rectal swabs were obtained on admission (sample 1) and 2-14 days after the end of antibiotic treatment (sample 2). Aerobic bacteria and yeasts were analysed. The material was divided into 2 groups: 1 group with Enterobacteriaceae and 1 group with non-fermentative Gram-negative bacteria. The susceptibility to antibiotics in each group was compared between samples 1 and 2. Results: The main finding of this study on patients with severe intra-abdominal infections was a shift in the aerobic faecal flora following antibiotic treatment, from Escherichia coli to other more resistant Enterobacteriaceae, Enterococcus faecium, and yeasts. The susceptibility to cephalosporins and piperacillin-tazobactam decreased in Enterobacteriaceae. Conclusions: Following antibiotic treatment, a shift in the aerobic rectal flora to species with intrinsic antibiotic resistance was observed. This indicates that the emergence of resistance is not due to new mutations, but rather to selection of more resistant species. This should be taken into account when designing treatments for secondary intra-abdominal infections.

Place, publisher, year, edition, pages
Informa Healthcare, 2012
Keywords
Antibiotic resistance; faecal flora; intra-abdominal infection
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-86555 (URN)10.3109/00365548.2012.695455 (DOI)000310008900003 ()
Available from: 2012-12-19 Created: 2012-12-19 Last updated: 2017-12-06
Lindqvist, M., Isaksson, B., Grub, C., Jonassen, T. Ö. & Hällgren, A. (2012). Detection and characterisation of SCCmec remnants in multiresistant methicillin-susceptible Staphylococcus aureus causing a clonal outbreak in a Swedish county. European Journal of Clinical Microbiology and Infectious Diseases, 31(2), 141-147
Open this publication in new window or tab >>Detection and characterisation of SCCmec remnants in multiresistant methicillin-susceptible Staphylococcus aureus causing a clonal outbreak in a Swedish county
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2012 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 31, no 2, p. 141-147Article in journal (Refereed) Published
Abstract [en]

The purpose of this study was to investigate if multiresistant methicillin-susceptible Staphylococcus aureus (MR-MSSA) causing a clonal outbreak in A-stergotland County, Sweden, were derived from methicillin-resistant S. aureus (MRSA) by carrying remnants of SCCmec, and, if so, to characterise this element. A total of 54 MSSA isolates with concomitant resistance to erythromycin, clindamycin and tobramycin from 49 patients (91% clonally related, spa type t002) were investigated with the BD GeneOhm MRSA assay and real-time polymerase chain reaction (PCR) targeting the SCCmec integration site/SCCmec right extremity junction. DNA sequencing of one isolate representing the MR-MSSA outbreak clone was performed by massive parallel 454 pyrosequencing. All isolates that were part of the clonal outbreak carried SCCmec remnants. The DNA sequencing revealed the carriage of a pseudo-SCC element 12 kb in size, with a genomic organisation identical to an SCCmec type I (TM) I (TM) element, except for a 41-kb gap. This study demonstrates the presence of a pseudo-SCC element resembling SCCmec type II among MR-MSSA, suggesting possible derivation from MRSA. The presence of SCCmec remnants should always be considered when SCCmec typing is used for MRSA detection, and may not be suitable in locations with a high prevalence of MR-MSSA, since this might give a high number of false-positive results.

Place, publisher, year, edition, pages
Springer Verlag (Germany), 2012
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-74635 (URN)10.1007/s10096-011-1286-y (DOI)000298855900006 ()
Note

Funding Agencies|Ostergotland County Council||Scandinavian Society for Antimicrobial Chemotherapy (SSAC)|2009-22495|

Available from: 2012-02-03 Created: 2012-02-03 Last updated: 2017-12-08
Lindqvist, M., Isaksson, B., Samuelsson, A., Nilsson, L. & Hällgren, A. (2009). A clonal outbreak of methicillin-susceptible Staphylococcus aureus with concomitant resistance to erythromycin, clindamycin and tobramycin in a Swedish county. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES, 41(5), 324-333
Open this publication in new window or tab >>A clonal outbreak of methicillin-susceptible Staphylococcus aureus with concomitant resistance to erythromycin, clindamycin and tobramycin in a Swedish county
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2009 (English)In: SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES, ISSN 0036-5548, Vol. 41, no 5, p. 324-333Article in journal (Refereed) Published
Abstract [en]

In contrast to methicillin-resistant Staphylococcus aureus (MRSA), studies on clonal distribution of methicillin-susceptible S. aureus (MSSA) are scarce. Since 2004, an increasing incidence of concomitant resistance to erythromycin, clindamycin and tobramycin (ECT) among MSSA has been detected in Ostergotland County, Sweden. The objectives of this study were to investigate the genetic relatedness among these isolates with 2 genotyping methods, pulsed-field gel electrophoresis (PFGE), and sequence-based typing of the polymorphic region X of the staphylococcal protein A gene (spa typing), and to determine the incidence of the Panton-Valentine leukocidin (PVL) gene. When genotyping 54 ECT-resistant MSSA isolates from 49 patients (1 isolate per patient per y), 91% were shown to be part of a clonal outbreak with both methods used (spa type t002). The clonal outbreak was concentrated in 8 hospital departments and 2 primary care centres, all located in the city of Linkoping. All isolates were negative for the PVL gene. In conclusion, this study demonstrates an ongoing clonal outbreak of PVL-negative ECT-resistant MSSA. This stresses the need to continuously maintain basic hygiene rules, since nosocomial transmission of pathogens is not limited to known resistant bacteria such as MRSA.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-18138 (URN)10.1080/00365540902801202 (DOI)
Available from: 2009-05-09 Created: 2009-05-08 Last updated: 2014-01-22
Melin (Mernelius), S., Haeggman, S., Olsson-Liljequist, B., Sjolund, M., Nilsson, P. A., Isaksson, B., . . . Matussek, A. (2009). Epidemiological typing of methicillin-resistant Staphylococcus aureus (MRSA): spa typing versus pulsed-field gel electrophoresis. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES, 41(6-7), 433-439
Open this publication in new window or tab >>Epidemiological typing of methicillin-resistant Staphylococcus aureus (MRSA): spa typing versus pulsed-field gel electrophoresis
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2009 (English)In: SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES, ISSN 0036-5548, Vol. 41, no 6-7, p. 433-439Article in journal (Refereed) Published
Abstract [en]

Molecular methods based on sequencing, such as spa typing, have facilitated epidemiological typing of bacterial isolates compared to the gold standard pulsed-field gel electrophoresis (PFGE), a technically more demanding method. We studied methicillin-resistant Staphylococcus aureus (MRSA) in 4 Swedish counties from 2003 through 2005, and compared spa typing and PFGE results to epidemiological data. Of 280 MRSA isolates, 91 were from sporadic cases and 189 were associated with 35 outbreaks. A total of 50 spa types and 74 PFGE patterns were detected. 60 (21%) of the MRSA isolates carried the Panton-Valentine leukocidin (PVL) genes. 12 of the PVL-positive MRSA were healthcare associated. 25 of the spa types and 31 of the PFGE patterns were associated with outbreaks. In 1 of the outbreaks we found isolates with different but closely related spa types, and in 6 of the outbreaks we observed isolates with different but related PFGE patterns. In this low-endemic setting, with outbreaks limited in time and place, we found spa typing to be a useful tool for epidemiological typing of MRSA, due to its rapidity, accessibility, ease of use, and standardized nomenclature.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-19886 (URN)10.1080/00365540902962749 (DOI)
Available from: 2009-08-14 Created: 2009-08-14 Last updated: 2015-04-01
Cardell, K., Widell, A., Frydén, A., Åkerlind, B., Månsson, A.-S., FranzÉn, S., . . . Isaksson, B. (2008). Nosocomial hepatitis C in a thoracic surgery unit, retrospective findings generating a prospective study. Journal of Hospital Infection, 68(4), 322-328
Open this publication in new window or tab >>Nosocomial hepatitis C in a thoracic surgery unit, retrospective findings generating a prospective study
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2008 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 68, no 4, p. 322-328Article in journal (Refereed) Published
Abstract [en]

We describe the transmission of hepatitis C virus (HCV) to two patients from a thoracic surgeon who was unaware of his hepatitis C infection. By partial sequencing of the non-structural 5B gene and phylogenetic analysis, the viruses from both patients were found to be closely related to genotype 1a strain from the surgeon. Two further hepatitis C cases were found in relation to the thoracic clinic. Their HCV sequences were related to each other but were of genotype 2b and the source of infection was never revealed. To elucidate the magnitude of the problem, we conducted a prospective study for a period of 17 months in which patients who were about to undergo thoracic surgery were asked to participate. Blood samples were drawn prior to surgery and at least four months later. The postoperative samples were then screened for anti-HCV and, if positive, the initial sample was also analysed. The only two patients (0.4%) identified were confirmed anti-HCV positive before surgery, and none out of 456 evaluable cases seroconverted to anti-HCV during the observation period. Despite the retrospectively identified cases, nosocomial hepatitis C is rare in our thoracic unit. The study points out the risk of transmission of hepatitis C from infected personnel and reiterates the need for universal precautions. © 2008 The Hospital Infection Society.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-43217 (URN)10.1016/j.jhin.2007.12.008 (DOI)72981 (Local ID)72981 (Archive number)72981 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13
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