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Clustering of enterococcal infections in a general intensive care unit
Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine.
Linköping University, Faculty of Health Sciences. Linköping University, Department of Medicine and Care, Anaesthesiology. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
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2003 (English)In: Journal of Hospital Infection, ISSN 0195-6701, Vol. 54, no 3, 188-195 p.Article in journal (Refereed) Published
Abstract [en]

This is a retrospective study comparing patients' characteristics, antibiotic consumption and environmental contamination before the impact of a new regimen of intensified infection control measures in a general intensive care unit (ICU) at a university-affiliated tertiary-care teaching hospital. The new regimen consisted of (1) reorganization of patient rooms (2) improved hygienic measures including strict hygiene barrier nursing (3) more isolated patient care and (4) more restrictive use of antibiotics. The regimen was introduced after a cluster of enterococcal infections. All patients admitted to the ICU from 1 March 1995 to 28 february 1997 were included. A study period of 12 months after reorganization of the ward was compared with the 12 months immediately before it. The antibiotic consumption, the individual patient's severity of disease (APACHE score), and the extent of therapeutic interventions (TISS score) were recorded. Enterococci were typed biochemically, antibiograms were established and the relation between the isolates was investigated with pulsed-field gel electrophoresis. The bacteriological results and the patient data suggested a hospital-acquired spread as the cause of the ICU enterococcal outbreak. After implementation of the new regimen, we observed a reduction in the rate of enterococcal bloodstream infections from 3.1 to 1.8%. The consumption of antibiotics fell from 6.11 to 4.24 defined daily doses per patient.The introduction of strict hygiene and barrier nursing, more restrictive use of antibiotics, isolation of infected patients, thorough cleaning and disinfection of the unit was followed by an absence of enterococcal infection clustering and reduction in incidence of enterococcal bacteraemia. We were not able to determine whether the reduction in antibiotic consumption was due to the intervention programme. ⌐ 2003 The Hospital Infection Society. Published by Elsevier Science Ltd. All rights reserved.

Place, publisher, year, edition, pages
2003. Vol. 54, no 3, 188-195 p.
National Category
Medical and Health Sciences
URN: urn:nbn:se:liu:diva-26498DOI: 10.1016/S0195-6701(03)00122-1Local ID: 11054OAI: diva2:247047
Available from: 2009-10-08 Created: 2009-10-08 Last updated: 2013-09-20
In thesis
1. The faecal flora: a source of healthcare-associated infections and antibiotic resistance
Open this publication in new window or tab >>The faecal flora: a source of healthcare-associated infections and antibiotic resistance
2013 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Healthcare-associated infections (HAI) are important causes of mortality and morbidity, and antibiotic treatment is often necessary. Development and availability of new antibiotics are closely followed by development of resistance among microorganisms. During antibiotic therapy, a fraction of the antibiotic given is found in the gut. The human gut is an important reservoir of bacteria. Microorganisms residing or passing the gut is referred to as the gut flora or microbiota. The results of this thesis showed spread of Enterococcus spp between patients on a general intensive care unit, causing septicaemia. After improved hygiene, reorganisation of rooms and thorough cleaning of the unit, together with revision of antibiotic strategy, the incidence of septicaemia with Enterococcus spp fell. Investigation of patients treated for acute intra-abdominal infections showed a shift in the aerobic faecal flora from antibiotic-susceptible Enterobacteriaceae spp towards Enterococcus faecium, yeasts and species of Enterobacteriaceae more resistant to antibiotics, after antibiotic treatment and hospital care. Investigation of recurrent outbreaks of Serratia marcescens sepsis in patients admitted to a neonatal intensive care unit showed different clones with each outbreak. Multiple hygiene interventions and revision of antibiotic strategy subsequently obviated recurrent outbreaks of sepsis, but spread of S. marcescens was not reduced until compliance with basic hygiene guidelines remained stable above 80%. We also found that low gestational age at birth, ventilator treatment and central venous or umbilical catheters are independent risk factors for late onset sepsis. Investigation of the faecal microbiota in patients with acute appendicitis or diverticulitis revealed that disturbance of the faecal microbiota already existed on admission, with higher numbers of Enterobacteriaceae and less Bacteroides, Faecalibacterium, Ruminococcus and Prevotella prior to antibiotic treatment and hospitalisation, than the control population. After treatment and hospitalisation diversity increased significantly in the diverticulitis group, approaching the healthy controls in composition.

Place, publisher, year, edition, pages
Linköping: Linköping University Electronic Press, 2013. 82 p.
Linköping University Medical Dissertations, ISSN 0345-0082 ; 1368
National Category
Medical and Health Sciences
urn:nbn:se:liu:diva-97709 (URN)10.3384/diss.diva-97709 (DOI)978-91-7519-591-9 (print) (ISBN)
Public defence
2013-10-11, Berzeliussalen, Campus US, Linköpings Universitet, Linköping, 13:00 (Swedish)
Available from: 2013-09-20 Created: 2013-09-20 Last updated: 2013-12-03Bibliographically approved

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Jonasson, JonBerg, SörenIsaksson, Barbro
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Faculty of Health SciencesDepartment of Molecular and Clinical MedicineDepartment of Clinical MicrobiologyAnaesthesiologyDepartment of Thoracic and Vascular Surgery
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Journal of Hospital Infection
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