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Nilsson, Lennart
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Publications (10 of 58) Show all publications
Zou, H., Zheng, B., Sun, M., Ottoson, J., Li, Y., Berglund, B., . . . Nilsson, L. (2019). Evaluating Dissemination Mechanisms of Antibiotic-Resistant Bacteria in Rural Environments in China by Using CTX-M-Producing Escherichia coli as an Indicator. Microbial Drug Resistance
Open this publication in new window or tab >>Evaluating Dissemination Mechanisms of Antibiotic-Resistant Bacteria in Rural Environments in China by Using CTX-M-Producing Escherichia coli as an Indicator
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2019 (English)In: Microbial Drug Resistance, ISSN 1076-6294, E-ISSN 1931-8448Article in journal (Refereed) Epub ahead of print
Abstract [en]

It is becoming increasingly recognized that the environment plays an important role both in the emergence and in dissemination of antibiotic-resistant bacteria (ARB), Mechanisms and factors facilitating this development are, however, not yet well understood. The high detection rate of CTX-M genes in environmental sources provides an opportunity to explore this issue. In this study, 88 CTX-M-producing Escherichia coli were isolated from 30 pig feces samples from 30 pig farms and 201 environmental samples. CTX-M-producing E. coli was detected with the following frequencies in the different types of samples: pig feces, 73%; river water, 64%; river sediment, 52%; wastewater, 31%; drinking water, 23%; outlet sediment, 21%; soil, 17%; and vegetables, 4.4%. Dissemination of CTX-M-producing E. coli to different environmental matrices was evaluated by analyzing the genetic relatedness of isolates from different environmental sources, and putative transmission routes through bird feces, pig feces, drinking water, river sediment, river water, and wastewater were hypothesized. Dissemination through these routes is likely facilitated by anthropogenic activities and environmental factors. Wild birds as potential vectors for dissemination of CTX-M-producing E. coli have the capacity to spread ARB across long distances. Regional dissemination between different environmental matrices of CTX-M-producing E. coli increases the exposure risk of humans and animals in the area.

Place, publisher, year, edition, pages
Mary Ann Liebert, Inc., publishers, 2019
Keywords
ESBL-producing E; coli; dissemination mechanism; multiple environmental matrices; animal
National Category
Microbiology
Identifiers
urn:nbn:se:liu:diva-156562 (URN)10.1089/mdr.2018.0431 (DOI)000463256200001 ()30942653 (PubMedID)
Note

Funding Agencies|National Natural Science Foundation of China [41771499, 81361138021]; Fundamental Research Funds of Shandong University [2018JC102]; Swedish Research Council; Public Health Agency of Sweden [D0879801]; Swedish Research Council Formas [2016-00640]

Available from: 2019-05-14 Created: 2019-05-14 Last updated: 2019-08-12Bibliographically approved
Balkhed Östholm, Å., Tärnberg, M., Nilsson, M., Nilsson, L., Hanberger, H. & Hällgren, A. (2018). Duration of travel-associated faecal colonisation with ESBL-producing Enterobacteriaceae - A one year follow-up study. PLoS ONE, 13(10)
Open this publication in new window or tab >>Duration of travel-associated faecal colonisation with ESBL-producing Enterobacteriaceae - A one year follow-up study
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2018 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 13, no 10Article in journal (Refereed) Published
Abstract [en]

In a previous study, we found that 30% of individuals travelling outside Scandinavia acquired extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-PE) in their faecal flora. The aim of this study was to determine the duration of travel-associated faecal colonisation with ESBL-PE, to assess risk factors for prolonged colonisation and to detect changes in antibiotic susceptibility during prolonged colonisation.

Place, publisher, year, edition, pages
Public Library of Science, 2018
National Category
Infectious Medicine
Identifiers
urn:nbn:se:liu:diva-152504 (URN)10.1371/journal.pone.0205504 (DOI)000448434000058 ()30356258 (PubMedID)
Funder
Medical Research Council of Southeast Sweden (FORSS)Region Östergötland
Available from: 2019-02-24 Created: 2019-02-24 Last updated: 2019-05-01
Gustavsson, O., Johansson, A. V., Monstein, H.-J., Nilsson, L. E. & Bredberg, A. (2016). A wide spectrum of fastidious and ampicillin-susceptible bacteria dominate in animal-caused wounds. European Journal of Clinical Microbiology and Infectious Diseases, 35(8), 1315-1321
Open this publication in new window or tab >>A wide spectrum of fastidious and ampicillin-susceptible bacteria dominate in animal-caused wounds
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2016 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 35, no 8, p. 1315-1321Article in journal (Refereed) Published
Abstract [en]

The main purpose of this study was to assess the actual occurrence of Gram-negative oxidase-positive bacteria (GNOP) in human wounds caused by animals, mostly cat and dog bites and scratches, and with signs of infection. We report a prospective series of 92 wound samples. Routine culturing was combined with a procedure optimised for fastidious GNOP. All GNOP isolates were identified by 16S rDNA sequencing to the species level. We observed a more prominent role of GNOP, including at least 30 species mostly in the families Flavobacteriaceae, Neisseriaceae and Pasteurellaceae, and less of Staphylococcus aureus and streptococci. The antibiotic susceptibility pattern was investigated, as GNOP are associated with sudden onset of serious infections, making an early decision on antibiotic treatment vital. All GNOP isolates judged to be clinically relevant displayed susceptibility to ampicillin and meropenem, but resistance to oxacillin, clindamycin and gentamicin was frequent. Our findings emphasise the need to cover GNOP as recommended in guidelines, and not only common wound pathogens, when treating an animal-caused wound.

Place, publisher, year, edition, pages
SPRINGER, 2016
National Category
Infectious Medicine
Identifiers
urn:nbn:se:liu:diva-130832 (URN)10.1007/s10096-016-2667-z (DOI)000380089800012 ()27197725 (PubMedID)
Note

Funding Agencies|Clinical Microbiology, University Hospital, Linkoping, Sweden

Available from: 2016-08-26 Created: 2016-08-26 Last updated: 2018-03-19
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, article id 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
Sun, Q., Dyar, O. J., Zhao, L., Tomson, G., Nilsson, L. E., Grape, M., . . . Stalsby Lundborg, C. (2015). Overuse of antibiotics for the common cold - attitudes and behaviors among doctors in rural areas of Shandong Province, China. BMC Pharmacology & Toxicology, 16(6)
Open this publication in new window or tab >>Overuse of antibiotics for the common cold - attitudes and behaviors among doctors in rural areas of Shandong Province, China
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2015 (English)In: BMC Pharmacology & Toxicology, E-ISSN 2050-6511, Vol. 16, no 6Article in journal (Refereed) Published
Abstract [en]

Background: Irrational antibiotic use is common in rural areas of China, despite the growing recognition of the importance of appropriate prescribing to contain antibiotic resistance. The aim of this study was to analyze doctors attitudes and prescribing practices related to antibiotics in rural areas of Shandong province, focusing on patients with the common cold. Methods: A survey was conducted with doctors working at thirty health facilities (village clinics, township health centers and county general hospitals) in three counties within Shandong province. Questions were included on knowledge and attitudes towards antibiotic prescribing. Separately, a random selection of prescriptions for patients with the common cold was collected from the healthcare institutions at which the doctors worked, to investigate actual prescribing behaviors. Results: A total of 188 doctors completed the survey. Most doctors (83%, 149/180) had attended training on antibiotic use since the beginning of their medical practice as a doctor, irrespective of the academic level of their undergraduate training. Of those that had training, most had attended it within the past three years (97%, 112/116). Very few doctors (2%, 3/187) said they would give antibiotics to a patient with symptoms of a common cold, and the majority (87%, 156/179) would refuse to prescribe an antibiotic even if patients were insistent on getting them. Doctors who had attended training were less likely to give antibiotics in this circumstance (29% vs. 14%, p less than 0.001). A diagnosis of common cold was the only diagnosis reported on 1590 out of 8400 prescriptions. Over half (55%, 869/1590) of them included an antibiotic. Prescriptions from village clinics were more likely to contain an antibiotic than those from other healthcare institutions (71% vs. 44% [township] vs. 47% [ county], p less than 0.001). Conclusions: Most doctors have recently attended training on antibiotic use and report they would not prescribe antibiotics for patients with a common cold, even when placed under pressure by patients. However, more than half of the prescriptions from these healthcare institutions for patients with the common cold included an antibiotic. Exploring and addressing gaps between knowledge and practice is critical to improving antibiotic use in rural China.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keywords
Antibiotics; Attitudes and behavior; Prescription; Rural area; China
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-117803 (URN)10.1186/s40360-015-0009-x (DOI)000352602900001 ()25884702 (PubMedID)
Note

Funding Agencies|National Nature Science Foundation of China [71073098]; Swedish International Development Cooperation Agency (Sida) [2010-001861]

Available from: 2015-05-11 Created: 2015-05-08 Last updated: 2018-05-26
Woksepp, H., Ryberg, A., Billstrom, H., Hällgren, A., Nilsson, L. E., Marklund, B.-I., . . . Schön, T. (2014). Evaluation of High-Resolution Melting Curve Analysis of Ligation-Mediated Real-Time PCR, a Rapid Method for Epidemiological Typing of ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter Species) Pathogens. Journal of Clinical Microbiology, 52(12), 4339-4342
Open this publication in new window or tab >>Evaluation of High-Resolution Melting Curve Analysis of Ligation-Mediated Real-Time PCR, a Rapid Method for Epidemiological Typing of ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter Species) Pathogens
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2014 (English)In: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 52, no 12, p. 4339-4342Article in journal (Refereed) Published
Abstract [en]

A single-tube method, ligation-mediated real-time PCR high-resolution melt analysis (LMqPCR HRMA), was modified for the rapid typing of Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, and Enterobacter spp. (ESKAPE) pathogens. A 97% agreement (60/62 isolates) was achieved in comparison to pulsed-field gel electrophoresis (PFGE) results, which indicates that LMqPCR HRMA is a rapid and accurate screening tool for monitoring nosocomial outbreaks.

Place, publisher, year, edition, pages
American Society for Microbiology, 2014
National Category
Clinical Medicine Basic Medicine
Identifiers
urn:nbn:se:liu:diva-113004 (URN)10.1128/JCM.02537-14 (DOI)000345222900033 ()25232168 (PubMedID)
Note

Funding Agencies|Marianne and Marcus Wallenberg Foundation; FORSS (The Research Council of Southeast Sweden)

Available from: 2015-01-12 Created: 2015-01-08 Last updated: 2018-01-11
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
Sun, Q., Tärnberg, M., Zhao, L., Stalsby Lundborg, C., Song, Y., Grape, M., . . . Nilsson, L. E. (2014). Varying High Levels of Faecal Carriage of Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae in Rural Villages in Shandong, China: Implications for Global Health. PLoS ONE, 9(11), e113121
Open this publication in new window or tab >>Varying High Levels of Faecal Carriage of Extended-Spectrum Beta-Lactamase Producing Enterobacteriaceae in Rural Villages in Shandong, China: Implications for Global Health
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2014 (English)In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 11, p. e113121-Article in journal (Refereed) Published
Abstract [en]

Antibiotic resistance is considered a major threat to global health and is affected by many factors, of which antibiotic use is probably one of the more important. Other factors include hygiene, crowding and travel. The rapid resistance spread in Gram-negative bacteria, in particular extended-spectrum beta-lactamase (ESBL) producing Enterobacteriaceae (ESBL-E), is a global challenge, leading to increased mortality, morbidity and health systems costs worldwide. Knowledge about resistance in commensal flora is limited, including in China. Our aim was to establish the faecal carriage rates of ESBL-E and find its association with known and suspected risk factors in rural residents of all ages in three socio-economically different counties in the Shandong Province, China. Faecal samples and risk-factor information (questionnaire) were collected in 2012. ESBL-E carriage was screened using ChromID ESBL agar. Risk factors were analysed using standard statistical methods. Data from 1000 individuals from three counties and in total 18 villages showed a high and varying level of ESBL-E carriage. Overall, 42% were ESBL-E carriers. At county level the carriage rates were 49%, 45% and 31%, respectively, and when comparing individual villages (n = 18) the rate varied from 22% to 64%. The high level of ESBL-E carriage among rural residents in China is an indication of an exploding global challenge in the years to come as resistance spreads among bacteria and travels around the world with the movement of people and freight. A high carriage rate of ESBL-E increases the risk of infection with multi-resistant bacteria, and thus the need for usage of last resort antibiotics, such as carbapenems and colistin, in the treatment of common infections.

Place, publisher, year, edition, pages
Public Library of Science, 2014
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-113786 (URN)10.1371/journal.pone.0113121 (DOI)000347121300080 ()25405340 (PubMedID)
Note

Funding Agencies|National Nature Science Foundation of China [71073098]; Swedish International Development Cooperation Agency [2010-001861]; Swedish Research Council [2013-46520-109134-94]; China Medical Board [11-068]

Available from: 2015-02-02 Created: 2015-01-30 Last updated: 2017-12-05
Östholm Balkhed, Å., Tärnberg, M., Monstein, H.-J., Hällgren, A., Hanberger, H. & Nilsson, L. E. (2013). High frequency of co-resistance in CTX-M-producing Escherichia coli to non-beta-lactam antibiotics, with the exception of amikacin, nitrofurantoin, colistin, tigecycline, and fosfomycin, in a county of Sweden. Scandinavian Journal of Infectious Diseases, 45(4), 271-278
Open this publication in new window or tab >>High frequency of co-resistance in CTX-M-producing Escherichia coli to non-beta-lactam antibiotics, with the exception of amikacin, nitrofurantoin, colistin, tigecycline, and fosfomycin, in a county of Sweden
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2013 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 45, no 4, p. 271-278Article in journal (Refereed) Published
Abstract [en]

Background: The objective of this study was to investigate the in vitro activity of different antibiotics against CTX-M-producing Escherichia coli in a county of Sweden, and to determine the occurrence of multi-resistance and plasmid- mediated quinolone resistance among these isolates. Methods: A total of 198 isolates of E. coli with extended-spectrum beta-lactamase (ESBL) phenotype and mainly CTX-M genotype were studied. The minimum inhibitory concentrations (MICs) for amikacin, chloramphenicol, ciprofloxacin, colistin, fosfomycin, gentamicin, nalidixic acid, nitrofurantoin, tigecycline, tobramycin, trimethoprim, and trimethoprim-sulfamethoxazole were determined with the Etest. Susceptibility was defined according to the breakpoints of the European Committee on Antimicrobial Susceptibility Testing (EUCAST). MIC(50) and MIC(90) values were calculated. Results: Ninety-five percent or more of the isolates were susceptible to amikacin, nitrofurantoin, colistin, tigecycline, and fosfomycin. CTX-M group 9 was more susceptible than CTX-M group 1 to ciprofloxacin, gentamicin, and tobramycin. Sixty-eight percent of the isolates were multi-resistant, and the most common multi-resistance pattern was ESBL phenotype with decreased susceptibility to trimethoprim, trimethoprim-sulfamethoxazole, ciprofloxacin, gentamicin, and tobramycin. Only 1 isolate carried a qnrS1 gene, but 37% carried aac(6')-Ib-cr. Conclusions: A high frequency of co-resistance between ESBL-producing E. coli and non-beta-lactam antibiotics was seen. On the other hand, very high susceptibility was seen for amikacin, nitrofurantoin, colistin, tigecycline, and fosfomycin. These data support the replacement of gentamicin and tobramycin, normally used in Sweden, with amikacin, for severe infections.

Keywords
Etest, minimum inhibitory concentration, extended-spectrum beta-lactamase
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-87612 (URN)10.3109/00365548.2012.734636 (DOI)000316693600005 ()23113731 (PubMedID)
Available from: 2013-01-19 Created: 2013-01-19 Last updated: 2017-12-06
Wertheim, H. F. L., Chandna, A., Dinh Vu, P., Van Pham, C., Thi Nguyen, P. D., Minh Lam, Y., . . . Hanberger, H. (2013). Providing Impetus, Tools, and Guidance to Strengthen National Capacity for Antimicrobial Stewardship in Viet Nam. PLoS Medicine, 10(5)
Open this publication in new window or tab >>Providing Impetus, Tools, and Guidance to Strengthen National Capacity for Antimicrobial Stewardship in Viet Nam
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2013 (English)In: PLoS Medicine, ISSN 1549-1277, E-ISSN 1549-1676, Vol. 10, no 5Article in journal, Editorial material (Other academic) Published
Abstract [en]

n/a

Place, publisher, year, edition, pages
Public Library of Science, 2013
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-96143 (URN)10.1371/journal.pmed.1001429 (DOI)000319670900012 ()
Available from: 2013-08-14 Created: 2013-08-14 Last updated: 2017-12-06
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