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Darelid, Johan
Publications (8 of 8) Show all publications
Malmvall, B.-E., Mölstad, S., Darelid, J., Hiselius, A., Larsson, L., Swanberg, J. & Åbom, P.-E. (2007). Reduction of antibiotics sales and sustained low incidence of bacterial resistance: report on a broad approach during 10 years to implement evidence-based indications for antibiotic prescribing in Jönköping County, Sweden. Quality Management in Health Care, 16(1), 60-67
Open this publication in new window or tab >>Reduction of antibiotics sales and sustained low incidence of bacterial resistance: report on a broad approach during 10 years to implement evidence-based indications for antibiotic prescribing in Jönköping County, Sweden
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2007 (English)In: Quality Management in Health Care, ISSN 1063-8628, E-ISSN 1550-5154, Vol. 16, no 1, p. 60-67Article in journal (Refereed) Published
Abstract [en]

Background: Increased prevalence of resistance in major pathogens decreases the possibility to treat common infectious conditions. In the beginning of the 1990s, resistant pneumococci spread among children in southern Sweden, which alarmed both the profession and the medical authorities. We describe the measures taken to curb the spread of resistance and to reduce the use of antibiotics in outpatient care.

Method: A national organization, Strama (Swedish Strategic Programme for the Rational Use of Antimicrobial Agents and Surveillance of Resistance), was initiated in 1994 and a regional committee was formed in Jönköping County in 1995. A multifaceted program was started aiming at reducing antibiotic use in the county by 25% and that the prevalence of resistant pneumococci should not increase.

Results: The efforts by the Jönköping County committee has resulted in a 31% total reduction of the consumption of antibiotic drugs in primary care between 1993 and 2005 and a 50% reduction among children aged 0 to 4 years. There has been no increase in the prevalence of resistant pneumococci or Haemophilus influenzae in the county. The decrease in antibiotic use was greater than the average in Sweden.

Conclusion: Our regional efforts have been successful. This has probably been achieved by a sustained strategy including repeated campaigns in the media, information to the profession, implementation of guidelines, and feedback to the profession on data on antibiotic prescribing and resistance. We believe it is of outmost importance not only to inform the profession but also the public on the limited effects of antibiotics in most respiratory tract infections.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-41442 (URN)17235252 (PubMedID)56573 (Local ID)56573 (Archive number)56573 (OAI)
Available from: 2009-10-10 Created: 2009-10-10 Last updated: 2017-12-13Bibliographically approved
Darelid, J. (2003). Epidemiology and long term control of nosocomial legionnaires' disease. (Doctoral dissertation). Linköping: Linköpings universitet
Open this publication in new window or tab >>Epidemiology and long term control of nosocomial legionnaires' disease
2003 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

The first nosocomial legionella outbreak in a Scandinavian general district hospital was identified in an epidemiological investigation of a cluster of pneumonia cases in Värnamo in 1991. During 3 months, 28 patients and 3 staff fell ill and 3 died. Legionella pneumophila serogroup (sg) 1, was found in high counts throughout the hospital hot water system and was probably spread by aerosolisation via shower nozzles. The outbreak was arrested when the circulating hot water temperature was raised from <45°C to >55°C.

The nosocomial infections proved to be part of a wider legionella outbreak and 10 cases contracted outside the hospital were also detected. Legionellae were cultured from 7 of 15 community buildings and 31% (109/354) of subjects living in the Värnamo area had an elevated titre (≥6) to L. pneumophila sg 1 in 1991, indicating a temporary spread of legionella in the community. Subclinical infection was demonstrated and it was estimated that only 10% of all infections had been clinically identified. Nosocomial legionnaires' disease should alert physicians to possible legionella transmission in the community.

In 21 patients from the nosocomial outbreak, the median L. pneumophila sg 1 antibody titre fell from 1:256 to 1:16 in 3 years. After 10 years, the titre level in this clinical cohort had reached the same level as observed in the background population 5 years earlier. Current international serological criteria (a fourfold or greater rise in antibody titre to ≥1:128) identified only 40% (21/52) of pneumonia cases caused by L. pneumophila sg 1 in a Swedish population in 1991-2001. When the antibody response was related to the antibody titre in local residents, the sensitivity rose to 87% (45/52).

Keeping the circulating hospital hot water temperature above 55°C, and vigilant clinical surveillance of nosocomial pneumonia as a method for control of nosocomial legionnaires' disease was evaluated after 10 years of practice. Infection with L. pneumophila sg 1 was diagnosed in 4 out of 366 (1.1 %) patients treated for nosocomial pneumonia, representing 1 case per 26,000 admissions. All patients were cured without complications. L. pneumophila sg 1 was isolated in 30 of 251 (12%) cultured hospital water samples during the monitoring period. It was concluded that this approach was safe and effective for long term control of nosocomial legionnaires' disease in a primary referral hospital.

The hospital hot water system was found to be colonised with a single genotype of L. pneumophila sg 1 over a 12-year period. The same genotype, identified using amplified fragment length polymorphism (AFLP) analysis, was also demonstrated in 18/20 (90%) community isolates. The phenotypic variation was confined to the monoclonal antibody subtypes Benidorm and Bellingham. The hospital genotype was identified in 2 out of 6 Swedish hospitals, both located within 100 km of Värnamo. Obviously, an entire municipal water network may constitute a distinct ecological niche for a single legionella strain. Certain clones also seem to be widely spread in the environment. This implies that results from molecular subtyping must be interpreted cautiously in epidemiological investigations of legionnaires' disease.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2003. p. 88
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 814
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26648 (URN)11213 (Local ID)91-7373-497-7 (ISBN)11213 (Archive number)11213 (OAI)
Public defence
2003-10-24, Föreläsningssalen, Qulturum, Hus B4, Länssjukhuset Ryhov, Jönköping, 13:00 (Swedish)
Opponent
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2012-10-04Bibliographically approved
Darelid, J., Löfgren, S., Malmvall, B.-E., Olinder-Nielsen, A.-M., Briheim, G. & Hallander, H. (2003). Legionella pneumophila serogroup 1 antibody kinetics in patients with Legionnaires' disease: implications for serological diagnosis. Scandinavian Journal of Infectious Diseases, 35(1), 15-20
Open this publication in new window or tab >>Legionella pneumophila serogroup 1 antibody kinetics in patients with Legionnaires' disease: implications for serological diagnosis
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2003 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 35, no 1, p. 15-20Article in journal (Refereed) Published
Abstract [en]

To evaluate current serological criteria for Legionella pneumophila serogroup 1 (Lp1), the antibody response was prospectively studied in all patients hospitalized for Legionnaires' disease in a Swedish county during 11 y (n = 62). A 4-fold or greater rise in antibody titre to ≥ 128 (the minimum convalescent antibody level for diagnosis, as recommended by the Centers for Disease Control and Prevention), using the indirect immunofluorescence antibody test, was found in 21/52 (40%) of tested patients. By referring to the titre levels in healthy residents from the local population (World Health Organization criteria), 45/52 (87%) cases were confirmed serologically. In 21 patients followed longitudinally for 10 y, the median antibody titre fell from 256 (range 32-1024) to 16 (range 2-128) in 3 y. No booster reactions were observed in any patient. After 10 y, the geometric mean titre of this clinical cohort had reached the same level as observed in the background population 5 y earlier. Titre levels in subjects exposed to Legionella from a municipal water system indicate that only 1 out of 10 of all infections are identified clinically. Indirect immunofluorescent antibody testing with local reference sera is a sensitive method for laboratory confirmation of Lp1 in an unselected pneumonia population.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-46696 (URN)10.1080/0036554021000026998 (DOI)
Available from: 2009-10-11 Created: 2009-10-11 Last updated: 2017-12-13Bibliographically approved
Darelid, J., Löfgren, S. & Malmvall, B.-E. (2002). Control of nosocomial Legionnaires' disease by keeping the circulating hot water temperature above 55°C: experience from a 10-year surveillance programme in a district general hospital. Journal of Hospital Infection, 50(3), 213-219
Open this publication in new window or tab >>Control of nosocomial Legionnaires' disease by keeping the circulating hot water temperature above 55°C: experience from a 10-year surveillance programme in a district general hospital
2002 (English)In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 50, no 3, p. 213-219Article in journal (Refereed) Published
Abstract [en]

After a nosocomial outbreak of Legionnaires' disease in a 450-bed district general hospital in 1991, the circulating hot water temperature was kept above 55°C as the sole control measure. From 1991 to 2000, all cases of nosocomial pneumonia were clinically monitored and tested for Legionella pneumophila serogroup 1 by serology or urinary antigen detection. Water samples from peripheral tap sites were cultured for Legionella spp. twice a year. An infection with L. pneumophila serogroup 1 was diagnosed in four out of 366 (1.1%) patients treated for nosocomial pneumonia, representing one case per 26 000 admissions. All patients were cured without complications. L. pneumophila serogroup 1 was isolated in 30 of 251 (12%) cultured hospital water samples during the monitoring period. We conclude that control of nosocomial Legionnaires' disease in a primary referral hospital is possible by keeping the circulating hospital hot water temperature above 55°C, together with careful clinical surveillance. Complete eradication of Legionella spp. from the hot water system does not seem necessary.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26410 (URN)10.1053/jhin.2002.1185 (DOI)10951 (Local ID)10951 (Archive number)10951 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
Nayeri, F., Brudin, L., Darelid, J., Nilsson, I., Frydén, A., Söderström, C. & Forsberg, P. (2002). Hepatocyte growth factor may act as an early therapeutic predictor in pneumonia. Scandinavian Journal of Infectious Diseases, 34(7), 500-504
Open this publication in new window or tab >>Hepatocyte growth factor may act as an early therapeutic predictor in pneumonia
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2002 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 34, no 7, p. 500-504Article in journal (Refereed) Published
Abstract [en]

High serum levels of hepatocyte growth factor (HGF) may reflect the regenerative effect and enhanced local and systemic production of this cytokine after organ injuries. The possibility of using serial serum HGF values in order to predict the results of therapy for pneumonia was investigated in this study. In a prospective multicenter study we investigated the serum levels of HGF and CRP before and within 48 h after treatment in 70 patients with pneumonia. Serum levels of HGF before treatment were significantly higher than the HGF levels of a normal population (p < 0.0001). Within 48 h serum HGF levels had decreased significantly in those patients who ultimately responded to the initial antibiotic therapy (p < 0.0001). Serum HGF levels at 48 h were unchanged or increased in cases in whom the initial therapy was ineffective and had to be changed. CRP and HGF levels were significantly correlated. Using multivariate logistic regression analysis it was found that individual changes in acute serum HGF levels and serum HGF levels obtained within 48 h could predict the results of therapy at least as significantly (p < 0.003) as CRP (p = 0.05), although CRP levels were known and used by the physician to decide whether or not to change the initial therapy. We conclude that serial control of serum HGF levels can be used as an early indicator to predict the results of therapy during treatment of pneumonia.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-26409 (URN)10.1080/00365540110080890 (DOI)10950 (Local ID)10950 (Archive number)10950 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
Darelid, J., Hallander, H., Löfgren, S., Malmvall, B.-E. & Olinder-Nielsen, A.-M. (2001). Community spread of legionella pneumophila serogroup 1 in temporal relation to a nosocomial outbreak. Scandinavian Journal of Infectious Diseases, 33(3), 194-199
Open this publication in new window or tab >>Community spread of legionella pneumophila serogroup 1 in temporal relation to a nosocomial outbreak
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2001 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 33, no 3, p. 194-199Article in journal (Refereed) Published
Abstract [en]

To clarify whether a nosocomial outbreak of legionnaires' disease in the Värnamo hospital in Sweden was part of a wider outbreak in the Värnamo community a number of investigations were performed. First, the proportion of cases of legionnaires' disease in a group with nosocomially acquired pneumonia (11%) was compared to the proportion within a group with community-acquired pneumonia (14%) and the difference was found not to be significant (p>0.05). Second, the proportion of the nursing staff at the Värnamo hospital with an elevated antibody titre (≥ 16) to Legionella pneumophila serogroup (sg) 1 (33%, 84/258) was compared to the proportion in a group of local residents of Värnamo community (26%, 25/96) and found not to be significant; in contrast, comparison with the proportion in a group from the assistant nursing staff at another hospital 60 km away (5%, 4/80) was highly significant (p<0.001). Furthermore, Legionella species were cultured from samples drawn from the hospital water supply as well from the water supply from municipal buildings. In 1996 a follow-up study was conducted, which showed that <1% of the assistant nurses and local residents had an elevated titre to L. pneumophila sg 1. These results indicate that there was a temporary spread of L. pneumophila sg 1 in the Värnamo community at the beginning of 1991, both in the local hospital and the surrounding community. This implies that physicians should be aware of community-acquired cases of legionnaires' disease when a nosocomial outbreak is detected.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-25879 (URN)10.1080/00365540151060824 (DOI)10316 (Local ID)10316 (Archive number)10316 (OAI)
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2017-12-13Bibliographically approved
Darelid, J., Bengtsson, L., Gästrin, B., Hallander, H., Löfgren, S., Malmvall, B.-E., . . . Thelin, A.-C. (1994). An outbreak of Legionnaires’ Disease in a Swedish Hospital. Scandinavian Journal of Infectious Diseases, 26(4), 417-425
Open this publication in new window or tab >>An outbreak of Legionnaires’ Disease in a Swedish Hospital
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1994 (English)In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 26, no 4, p. 417-425Article in journal (Refereed) Published
Abstract [en]

We report a nosocomial outbreak of Legionella pneumophila serogroup (sg) 1 infection at the general hospital, Värnamo, Sweden. From December 1990 to February 1991, 28 patients and 3 staff fell ill with pneumonia and 3 died. L. pneumophila sg 1 together with several other Legionellae were isolated from the hot water supply to 17 of 20 hospital wards, probably being spread by aerosolization via shower nozzles. Raising the hospital's hot water temperature from 45°C to 65°C, together with heat disinfection of the shower equipment, arrested the outbreak within a week. Keeping the hot water temperature < 60°C without chlorination eliminated L. pneumophila from < 75% of the wards. During a period of 2 years after the outbreak we have diagnosed only 1 case of nosocomial legionellosis at the hospital despite an active surveillance program.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84311 (URN)10.3109/00365549409008615 (DOI)
Available from: 2012-10-04 Created: 2012-10-04 Last updated: 2017-12-07Bibliographically approved
Darelid, J., Bernander, S., Jacobson, K. & Löfgren, S.A single genotype of Legionella pneumophila serogroup 1 found in 96% of isolates from a hospital and minucipal water distribution system over a 12-year period.
Open this publication in new window or tab >>A single genotype of Legionella pneumophila serogroup 1 found in 96% of isolates from a hospital and minucipal water distribution system over a 12-year period
(English)Manuscript (preprint) (Other academic)
Abstract [en]

The genotypic distribution of Legionella pneumophila serogroup 1 was investigated in the water distribution system of a 450 bed Swedish hospital and the surrounding community. A single genotype identified by amplified fragment length polymorphism (AFLP) analysis, was found in all 34 hospital isolates and in 18/20 (90%) community isolates over a 12-year surveillance period. All enviromnental isolates were either monoclonal antibody subtypes Benidorm or Bellingham. In a geographic comparison, the hospital genotype was also identified in two out of six Swedish hospitals; both located within 100 km of the studied community. In all, 70 isolates from seven Swedish communities clustered in four groups, each also containing one AFLP type as defined by the European Working Group on Legionella Infections (EWGLI). It was concluded that a single Legionella pneumophila serogroup 1 genotype may colonise a large water distribution system over a long period of time, and that certain clones seem to be widely spread in the environment. Results frorn molecular typing of isolates originating from a limited geographical area must, therefore, be interpreted cautiously in epidemiological investigations of Legionnaires' disease.

National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-84313 (URN)
Available from: 2012-10-04 Created: 2012-10-04 Last updated: 2012-10-04Bibliographically approved
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