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Hällgren, Anita
Publications (10 of 22) Show all publications
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
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
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
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
Östholm Balkhed, Å., Tärnberg, M., Nilsson, M., Nilsson, L. E., Hanberger, H. & Hällgren, A. (2013). Travel-associated faecal colonization with ESBL-producing Enterobacteriaceae: incidence and risk factors. Journal of Antimicrobial Chemotherapy, 68(9), 2144-2153
Open this publication in new window or tab >>Travel-associated faecal colonization with ESBL-producing Enterobacteriaceae: incidence and risk factors
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2013 (English)In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 68, no 9, p. 2144-2153Article in journal (Refereed) Published
Abstract [en]

Objectives To study the acquisition of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-PE) among the faecal flora during travel, with a focus on risk factors, antibiotic susceptibility and ESBL-encoding genes.

Methods An observational prospective multicentre cohort study of individuals attending vaccination clinics in south-east Sweden was performed, in which the submission of faecal samples and questionnaires before and after travelling outside Scandinavia was requested. Faecal samples were screened for ESBL-PE by culturing on ChromID ESBL and an in-house method. ESBL-PE was confirmed by phenotypic and genotypic methods. Susceptibility testing was performed with the Etest. Individuals who acquired ESBL-PE during travel (travel-associated carriers) were compared with non-carriers regarding risk factors, and unadjusted and adjusted ORs after manual stepwise elimination were calculated using logistic regression.

Results Of 262 enrolled individuals, 2.4% were colonized before travel. Among 226 evaluable participants, ESBL-PE was detected in the post-travel samples from 68 (30%) travellers. The most important risk factor in the final model was the geographic area visited: Indian subcontinent (OR 24.8, P < 0.001), Asia (OR 8.63, P < 0.001) and Africa north of the equator (OR 4.94, P  = 0.002). Age and gastrointestinal symptoms also affected the risk significantly. Multiresistance was seen in 77 (66%) of the ESBL-PE isolates, predominantly a combination of reduced susceptibility to third-generation cephalosporins, trimethoprim/sulfamethoxazole and aminoglycosides. The most common species and ESBL-encoding gene were Escherichia coli (90%) and CTX-M (73%), respectively.

Conclusion Acquisition of multiresistant ESBL-PE among the faecal flora during international travel is common. The geographical area visited has the highest impact on ESBL-PE acquisition.

Place, publisher, year, edition, pages
Oxford University Press, 2013
Keywords
travel medicine, CTX-M, antibiotic resistance
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-97437 (URN)10.1093/jac/dkt167 (DOI)000323424100029 ()23674762 (PubMedID)
Note

Funding Agencies|Medical Research Council of Southeast Sweden|FORSS-12368FORSS-36511FORSS-87551|ALF grants, Ostergotland County Council|LIO-10885LIO-16741LIO-61341LIO-127281|

Available from: 2013-09-12 Created: 2013-09-12 Last updated: 2017-12-06Bibliographically approved
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
Hällgren, A. & Lindqvist, M. (2011). Enterococcal endocarditis among intravenous drug users: Report of a cluster of cases, possibly caused by contaminated amphetamine. SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES, 43(5), 395-398
Open this publication in new window or tab >>Enterococcal endocarditis among intravenous drug users: Report of a cluster of cases, possibly caused by contaminated amphetamine
2011 (English)In: SCANDINAVIAN JOURNAL OF INFECTIOUS DISEASES, ISSN 0036-5548, Vol. 43, no 5, p. 395-398Article in journal (Refereed) Published
Abstract [en]

Intravenous drug use imposes a high risk of acquiring bacterial infections. In this report we present 3 cases of enterococcal endocarditis in intravenous drug users, diagnosed over a period of 3 months. Genotyping revealed that 2 of the cases were caused by closely related isolates, suggesting possible spread by contaminated drugs.

Place, publisher, year, edition, pages
Informa Healthcare, 2011
Keywords
Endocarditis, intravenous drug abuse, Enterococcus faecalis
National Category
Engineering and Technology
Identifiers
urn:nbn:se:liu:diva-67963 (URN)10.3109/00365548.2010.546367 (DOI)000289560500015 ()
Available from: 2011-05-04 Created: 2011-05-04 Last updated: 2012-03-25
Tärnberg, M., Östholm Balkhed, Å., Monstein, H.-J., Hällgren, A., Hanberger, H. & Nilsson, L. E. (2011). In vitro activity of beta-lactam antibiotics against CTX-M-producing Escherichia coli. European Journal of Clinical Microbiology and Infectious Diseases, 30(8), 981-987
Open this publication in new window or tab >>In vitro activity of beta-lactam antibiotics against CTX-M-producing Escherichia coli
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2011 (English)In: European Journal of Clinical Microbiology and Infectious Diseases, ISSN 0934-9723, E-ISSN 1435-4373, Vol. 30, no 8, p. 981-987Article in journal (Refereed) Published
Abstract [en]

Beta-lactam antibiotics have been discussed as options for the treatment of infections caused by multiresistant extended-spectrum beta-lactamase (ESBL)-producing bacteria if the minimum inhibitory concentration (MIC) is low. The objective of this study was to investigate the in vitro activity of different beta-lactam antibiotics against CTX-M-producing Escherichia coli. A total of 198 isolates of E. coli with the ESBL phenotype were studied. Polymerase chain reaction (PCR) amplification of CTX-M genes and amplicon sequencing were performed. The MICs for amoxicillin-clavulanic acid, aztreonam, cefepime, cefotaxime, ceftazidime, ceftibuten, ertapenem, imipenem, mecillinam, meropenem, piperacillin-tazobactam, and temocillin 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. Isolates from CTX-M group 9 showed higher susceptibility to the beta-lactam antibiotics tested than isolates belonging to CTX-M group 1. More than 90% of the isolates belonging to CTX-M group 9 were susceptible to amoxicillin-clavulanic acid, ceftazidime, ceftibuten, piperacillin-tazobactam, and temocillin. The susceptibility was high to mecillinam, being 91%, regardless of the CTX-M group. All isolates were susceptible to imipenem and meropenem, and 99% to ertapenem. This study shows significant differences in susceptibility to different beta-lactam antibiotics among the CTX-M-producing E. coli isolates and a significant difference for many antibiotics tested between the CTX-M-producing groups 1 and 9. The good in vitro activity of other beta-lactam antibiotics compared to carbapenems indicate that clinical studies are warranted in order to examine the potential role of these beta-lactam antibiotics in the treatment of infections caused by multiresistant ESBL-producing E. coli.

Place, publisher, year, edition, pages
Springer Science Business Media, 2011
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-69787 (URN)10.1007/s10096-011-1183-4 (DOI)000292553500008 ()
Available from: 2011-08-10 Created: 2011-08-08 Last updated: 2017-12-08Bibliographically approved
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
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