liu.seSearch for publications in DiVA
Change search
Refine search result
12 1 - 50 of 73
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf
Rows per page
  • 5
  • 10
  • 20
  • 50
  • 100
  • 250
Sort
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
  • Standard (Relevance)
  • Author A-Ö
  • Author Ö-A
  • Title A-Ö
  • Title Ö-A
  • Publication type A-Ö
  • Publication type Ö-A
  • Issued (Oldest first)
  • Issued (Newest first)
  • Created (Oldest first)
  • Created (Newest first)
  • Last updated (Oldest first)
  • Last updated (Newest first)
  • Disputation date (earliest first)
  • Disputation date (latest first)
Select
The maximal number of hits you can export is 250. When you want to export more records please use the Create feeds function.
  • 1.
    Agvald-Ohman, C
    et al.
    Karolinska University.
    Struwe, J
    Karolinska Institute.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Walther, Sten
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    PROMOTING INFECTION CONTROL IN THE ICU USING A TARGETED PUSH-AND-PULL INTERVENTION2009In: in INTENSIVE CARE MEDICINE, vol 35, 2009, Vol. 35, p. 176-176Conference paper (Refereed)
    Abstract [en]

    n/a

  • 2.
    Agvald-Öhman, Christina
    et al.
    Anestesioch intensivvårdskliniken, Karolinska universitetssjukhuset, Huddinge, CLINTEC, Karolinska institutet, Stockholm, Sweden.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Struwe, Johan
    Strama och avdelningen för epidemiologi, Smittskyddsinstitutet, Stockholm, Sweden.
    Walther, Sten M.
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    »Skjut på« och »dra« metod för att minska vårdrelaterade infektioner på IVA: Pilotprojekt med aktiv uppföljning2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 1-2Article in journal (Refereed)
    Abstract [sv]

    Vårdrelaterade infektioner är ett särskilt stort problem inom intensivvården där patienterna är kritiskt sjuka och har många riskfaktorer.

    För att minska frekvensen vårdrelaterade infektioner måste ett strukturerat arbete bedrivas från flera olika utgångspunkter.

    Vi måste bli bättre på att dia­gnostisera, dokumentera och förebygga dessa infektioner.

    Kombinerad intervention av typen »push« och »pull« visade på lovande resultat med införande av bättre diagnostiska metoder och en upplevelse av ökad motivation hos personalen efter besöket.

  • 3.
    Ammerlaan, H S M
    et al.
    University of Medical Centre Utrecht, Netherlands.
    Harbarth, S
    Geneva University Hospital and Medical Sch, Switzerland.
    Buiting, A G M
    John Radcliffe Hospital, England.
    Crook, D W
    Amphia Hospital, Netherlands.
    Fitzpatrick, F
    Beaumont Hospital, Ireland.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Infectious Diseases in Östergötland.
    Herwaldt, L A
    University of Iowa, IA USA.
    van Keulen, P H J
    Amphia Hospital, Netherlands.
    Kluytmans, J A J W
    St Elizabeth Hospital, Netherlands.
    Kola, A
    Charite University of Medical Berlin, Germany.
    Kuchenbecker, R S
    University of Federal Rio Grande do Sul, Brazil.
    Lingaas, E
    University of Oslo, Norway.
    Meessen, N
    University of Medical Centre Groningen, Netherlands.
    Morris-Downes, M -m.
    Beaumont Hospital, Ireland.
    Pottinger, J M.
    University of Iowa Hospital and Clin, IA USA.
    Rohner, P
    Geneva University Hospital and Medical Sch, Switzerland.
    dos Santos, R P.
    University of Federal Rio Grande do Sul, Brazil.
    Seifert, H
    University of Cologne, Germany.
    Wisplinghoff, H
    University of Cologne, Germany.
    Ziesing, S
    Hannover Medical Sch, Germany.
    Walker, A S.
    John Radcliffe Hospital, England.
    Bonten, M J M.
    University of Medical Centre Utrecht, Netherlands.
    Secular Trends in Nosocomial Bloodstream Infections: Antibiotic-Resistant Bacteria Increase the Total Burden of Infection2013In: Clinical Infectious Diseases, ISSN 1058-4838, E-ISSN 1537-6591, Vol. 56, no 6, p. 798-805Article in journal (Refereed)
    Abstract [en]

    Background. It is unknown whether rising incidence rates of nosocomial bloodstream infections (BSIs) caused by antibiotic-resistant bacteria (ARB) replace antibiotic-susceptible bacteria (ASB), leaving the total BSI rate unaffected.

    Methods. We investigated temporal trends in annual incidence densities (events per 100 000 patient-days) of nosocomial BSIs caused by methicillin-resistant Staphylococcus aureus (MRSA), ARB other than MRSA, and ASB in 7 ARB-endemic and 7 ARB-nonendemic hospitals between 1998 and 2007.

    Results. 33 130 nosocomial BSIs (14% caused by ARB) yielded 36 679 microorganisms. From 1998 to 2007, the MRSA incidence density increased from 0.2 to 0.7 (annual increase, 22%) in ARB-nonendemic hospitals, and from 3.1 to 11.7 (annual increase, 10%) in ARB-endemic hospitals (P = .2), increasing the incidence density difference between ARB-endemic and ARB-nonendemic hospitals from 2.9 to 11.0. The non-MRSA ARB incidence density increased from 2.8 to 4.1 (annual increase, 5%) in ARB-nonendemic hospitals, and from 1.5 to 17.4 (annual increase, 22%) in ARB-endemic hospitals (P < .001), changing the incidence density difference from −1.3 to 13.3. Trends in ASB incidence densities were similar in both groups (P = .7). With annual increases of 3.8% and 5.4% of all nosocomial BSIs in ARB-nonendemic and ARB-endemic hospitals, respectively (P < .001), the overall incidence density difference of 3.8 increased to 24.4.

    Conclusions.  Increased nosocomial BSI rates due to ARB occur in addition to infections caused by ASB, increasing the total burden of disease. Hospitals with high ARB infection rates in 2005 had an excess burden of BSI of 20.6 per 100 000 patient-days in a 10-year period, mainly caused by infections with ARB.

  • 4.
    Chabok, Abbas
    et al.
    Uppsala University.
    Tärnberg, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
    Smedh, Kenneth
    Uppsala University.
    Påhlman, Lars
    Uppsala University.
    Nilsson, Lennart
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
    Lindberg, Christian
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Prevalence of fecal carriage of antibiotic-resistant bacteria in patients with acute surgical abdominal infections2010In: SCANDINAVIAN JOURNAL OF GASTROENTEROLOGY, ISSN 0036-5521, Vol. 45, no 10, p. 1203-1210Article in journal (Refereed)
    Abstract [en]

    Objective. Antibiotic resistance is increasing worldwide. The aims of the current study were to determine the fecal carriage of antibiotic-resistant bacteria and antibiotic treatment in surgical patients admitted to hospital due to acute intra-abdominal infections. Materials and methods. Eight Swedish surgical units participated in this prospective multicenter investigation. Rectal swabs were obtained on admission to hospital. Cultures were performed on chromogenic agar and antibiotic susceptibility testing was performed using the disk diffusion method. Extended-spectrum beta-lactamase (ESBL)phenotype was confirmed by Etest. Results. Rectal samples were obtained and analyzed from 208 patients with intra-abdominal surgical infections. Surgery was performed in 134 patients (65%). Cephalosporins were the most frequently used empirical antibiotic therapy. The highest rates of resistance among Enterobacteriaceae were detected for ampicillin (54%), tetracycline (26%), cefuroxime (26%) and trimethoprim-sulfamethoxazole (20%). The prevalence of decreased susceptibility (I + R) for the other antibiotics tested was for ciprofloxacin 20%, piperacillin-tazobactam 17%, cefotaxime 14%, ertapenem 12%, gentamicin 3% and imipenem 0%. ESBL-producing Enterobacteriaceae were found in samples from 10 patients (5%). Three patients had five E. coli isolates producing AmpC enzymes. Conclusions. This study shows a high rate of resistance among Enterobacteriaceae against antibiotics which are commonly used in Sweden and should have implications for the future choice of antibiotics for surgical patients.

  • 5.
    Claesson, Carina
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Hällgren, Anita
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Nilsson, Maud
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Svensson, Erik
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Hanberger, Håkan
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Nilsson, Lennart
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Susceptibility of staphylococci and enterococci to antimicrobial agents at different ward levels in four north European countries2007In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 39, no 11-12, p. 1002-1012Article in journal (Refereed)
    Abstract [en]

    A multicentre susceptibility study was performed on staphylococci and enterococci isolated from patients at 3 different ward levels: primary care centres (PCCs), general hospital wards (GHWs) and intensive care units (ICUs), in Denmark, Finland, Norway and Sweden. There was a markedly higher incidence of resistance among CoNS in ICUs compared to GHWs and PCCs. Resistance rates were low among S. aureus isolates and no differences were found between the ward levels. Oxacillin resistance was found among 1.6% of S. aureus and 47% of CoNS isolates. 14% of CoNS and 0.9% of S. aureus isolates were glycopeptide intermediate. The prevalence of E. faecium isolates in this study differed significantly between the ward levels with the lowest prevalence found at PCCs. High level gentamicin resistant (HLGR) enterococci occurred in 11-25% of E. faecium and 6-20% of E. faecalis isolates. The HLGR rate was significantly higher among E. faecalis from hospitalized patients (GHWs and ICUs) compared to patients at PCCs. For enterococcal isolates, no other significant differences in antimicrobial resistance were found between the ward levels. All enterococci were teicoplanin susceptible, but decreased susceptibility to vancomycin was found among 2.0% and 0.6% of the E. faecium and E. faecalis isolates, respectively.

  • 6.
    Edlund, Charlotta
    et al.
    Folkhälsomyndigheten, Sverige.
    Skoog, Gunilla
    Folkhälsomyndigheten, Sverige.
    Grape, Malin
    Folkhälsomyndigheten, Sverige.
    Hedin, Katarina
    FoU, Region Kronoberg, Sverige.
    Sundvall, Pär-Daniel
    FoU primärvård, Västra Götalandsregionen, Sverige.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    Dags att fylla kunskapsluckor om antibiotikaanvändning i praxis2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 12Article in journal (Other academic)
  • 7.
    Ekdahl, Christer
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
    Hällgren, Anita
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
    Nilsson, Maria
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
    Svensson, E.
    Division of Clinical Bacteriology, Department of Laboratory Medicine, Sahlgrenska University Hospital, Sweden.
    Nilsson, Lennart E.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
    Rapid decrease of free vancomycin in dense staphylococcal cultures2005In: European journal of clinical microbiology and infectious diseases, ISSN 0934-9723, Vol. 24, no 9, p. 596-602Article in journal (Refereed)
    Abstract [en]

    Bacterial numbers in broth cultures were determined by bioluminescence assay of intracellular bacterial ATP. Broth MICs for strains of Staphylococcus epidermidis (ATCC 14990 and 35984) and Staphylococcus aureus (ATCC 25923, 29213 and 6538) were determined for cultures with different inocula (105–108 bacteria/ml) after 24 h of incubation in supplemented Mueller–Hinton broth containing vancomycin. All of the tested strains except one were susceptible to methicillin, and all of the strains were susceptible to vancomycin. Free vancomycin concentrations in the broth cultures of all strains were determined with an agar well bioassay after 24 h of incubation. Free vancomycin concentrations and bacterial numbers of ATCC 35984 and ATCC 29213 were also determined after 0.5, 2, 4, and 8 h. In a low inoculum (105 bacteria/ml), the broth MICs were 1–4 μg/ml. In a high inoculum (∼108 bacteria/ml), the broth MICs increased two- to fourfold to 4–8 μg/ml. In dense inocula (∼109–1010 bacteria/ml), the concentrations of free vancomycin in the broth were reduced, in most cases below the detection limit of the bioassay (≤0.5 μg/ml). This reduction of free vancomycin was fast, occurring in initially dense inocula in less than 30 min. No emergence of resistance was seen. These results show a rapid reduction of free vancomycin in the broth and a simultaneous increase in broth MICs in high inocula, without development of resistance. This indicates that the dosing regimen of vancomycin is of particular importance in staphylococcal infections with dense inocula, e.g. infective endocarditis.

  • 8.
    Erlandsson, Marcus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Burman, Lars G.
    Swedish Institute for Infectious Disease Control, Stockholm, Sweden.
    Cars, Otto
    Swedish Institute for Infectious Disease Control, Stockholm, Sweden.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Nilsson, Lennart E.
    Walther, Sten
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    ICU-STRAMA Study Group,
    Prescription of antibiotic agents in Swedish intensive care units is empiric and adequate2007In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 39, no 1, p. 63-69Article in journal (Refereed)
    Abstract [en]

    Since the prescription of antibiotics in the hospital setting is often empiric, particularly in the critically ill, and therefore fraught with potential error, we analysed the use of antibiotic agents in Swedish intensive care units (ICUs). We examined indications for antibiotic treatment, agents and dosage prescribed among 393 patients admitted to 23 ICUs at 7 tertiary care centres, 11 secondary hospitals and 5 primary hospitals over a 2-week period in November 2000. Antibiotic consumption was higher among ICU patients in tertiary care centres with a median of 84% (range 58-87%) of patients on antibiotics compared to patients in secondary hospitals (67%, range 35-93%) and in primary hospitals (38%, range 24-80%). Altogether 68% of the patients received antibiotics during the ICU stay compared to 65% on admission. Cefuroxime was the most commonly prescribed antibiotic before and during admission (28% and 24% of prescriptions, respectively). A date for decision to continue or discontinue antibiotic therapy was set in 21% (6/29) of patients receiving prophylaxis, in 8% (16/205) receiving empirical treatment and in 3% (3/88) when culture-based therapy was given. No correlation between antibiotic prescription and laboratory parameters such as CRP levels, leukocyte and thrombocyte counts, was found. The treatment was empirical in 64% and prophylactic in 9% of cases. Microbiological data guided prescription more often in severe sepsis (median 50%, range 40-60% of prescriptions) than in other specified forms of infection (median 32%, range 21-50%). The empirically chosen antibiotic was found to be active in vitro against the pathogens found in 55 of 58 patients (95%) with a positive blood culture. This study showed that a high proportion of ICU patients receive antimicrobial agents and, as expected, empirical-based therapy is more common than culture-based therapy. Antibiotics given were usually active in vitro against the pathogen found in blood cultures. We ascribe this to a relatively modest antibiotic resistance problem in Swedish hospitals.

  • 9.
    Erlandsson, Marcus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Nilsson, Lennart E.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Department of Anaesthesiology, Ullevål University Hospital, University of Oslo, Oslo, Norway.
    Giske, Christian G.
    Division of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
    Jonas, Daniel
    Institute of Environmental Medicine and Hospital Epidemiology, University Medical Centre, Freiburg, Germany.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Nordlinder, David
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
    Antibiotic susceptibility patterns and clones of Pseudomonas aeruginosa in Swedish ICUs2008In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 40, no 6-7, p. 487-494Article in journal (Refereed)
    Abstract [en]

    Pseudomonas aeruginosa is 1 of the bacteria most adaptive to anti-bacterial treatment. Previous studies have shown nosocomial spread and transmission of clonal strains of P. aeruginosa in European hospitals. In this study we investigated antibiotic susceptibility and clonality in 101 P. aeruginosa isolates from 88 patients admitted to 8 Swedish ICUs during 2002. We also compared phenotypes and genotypes of P. aeruginosa and carried out cluster analysis to determine if phenotypic data can be used for surveillance of clonal spread. All isolates were collected on clinical indication as part of the NPRS II study in Sweden and were subjected to AFLP analysis for genotyping. 68 isolates with unique genotypes were found. Phenotyping was performed using MIC values for 5 anti-pseudomonal agents. Almost 6% of the isolates were multi-drug resistant (MDR), and this figure rose to almost 8% when intermediate isolates were also included. We found probable clonal spread in 9 cases, but none of them was found to be an MDR strain. Phenotypical cluster analysis produced 40 clusters. Comparing partitions did not demonstrate any significant concordance between the typing methods. The conclusion of our study is that cross-transmission and clonal spread of MDR P. aeruginosa does not present a clinical problem in Swedish ICUs, but probable cross-transmission of non-MDR clones indicate a need for improved hygiene routines bedside. The phenotype clusters were not concordant with genotype clusters, and genotyping is still recommended for epidemiological tracking.

  • 10.
    Erlandsson, Marcus
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
    Hoffmann, Mikael
    Isaksson, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
    Lindgren, Sune
    Sörén, L.
    Department of Clinical Microbiology, County Hospital, Jönköping .
    Walther, Sten
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences.
    Surveillance of Antibiotic Resistance in ICUs in Southeastern Sweden1999In: Acta Anaesthesiol Scand, Vol. 43, no 8, p. 815-820Article in journal (Refereed)
    Abstract [en]

    Background: A study was designed to assess a computer-based program for continuous registration of antibiotic resistance, statistics concerning severity of illness, and consumption of antibacterial drugs.

    Methods: The frequency of antibiotic resistance among bacteria in eight ICUs in southeastern Sweden was investigated yearly from 1995 through 1997. The antibiotic consumption in the ICUs was registered as defined daily doses (DDD) and compared to severity of illness (APACHE-II scores).

    Results: There was a statistically significant increase in ampicillin resistance among Enterococcus spp. between 1996 and 1997, which was due to a shift from Enterococcus faecalis to Enterococcus faecium. A high prevalence of resistance among coagulase-negative staphylococci to oxacillin (≈ 70%), ciprofloxacin (≈ 50%), fucidic acid (≈ 50%) and netilmicin (≈ 30%) was seen in all ICUs during the whole study period. There was a statistically significant increase in ciprofloxacin resistance among Escherichia coli and Enterococcus spp. The resistance among Enterobacter spp. to cefotaxime decreased but this change was not statistically significant. Efforts were made to avoid betalactam antibiotics, except carbapenems, for treatment of infections caused by Enterobacter spp. and the consumption of cephalosporins decreased whereas the consumption of carbapenems increased. The total antibiotic consumption decreased by 2.5% during the study period. There was no correlation between APACHE II scores and antibiotic consumption.

    Conclusions: Each ICU within a hospital ought to have a program for "on-line" antibiotic resistance surveillance of drugs used in that unit so that changes in empirical treatment can be made when there is an increase in antibiotic-resistant isolates within that unit.

  • 11.
    Fransson, G
    et al.
    Department of Geriatrics and Rehab, County Hospital, Kalmar, Sweden.
    Berkius, J
    Department of Anaesthesia and Intensive Care, Västervik Hospital, Sweden.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Kahlmeter, G
    Department of Clinical Microbiology, Central Hospital, Växjö, Sweden.
    Hanberger, Håkan
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Walther, Sten
    Surgical ICU, Ullevål University Hospital, Oslo, Norway.
    Linking local microbiology databases with the Swedish Intensive Care Registry to examine impact of bacterial resistance on the critically ill.2007In: Acta anaesthesiologica Scandinavica. Volume 51, Issue Supplement s118, Malden, MA, United States: Wiley-Blackwell, 2007, Vol. 51, p. 33-33 (Poster 25)Conference paper (Other academic)
    Abstract [en]

    Background and aims: Bacterial resistance to antibiotics hasemerged as an important factor influencing patient mortalityand morbidity. The overall purpose of this project is to exam-ine the impact of bacterial resistance on resource use andoutcome in the critically ill. The aims of the current report isto demonstrate that linkage of local microbiology databasesand the Swedish Intensive Care Registry (SIR) was possibleand to provide a preliminary analysis of data from a sub-group of ICU patients (chronic obstructive pulmonary dis-ease, COPD).

    Methods: Admissions due to an acute exacerbation of COPDwere matched with bacteriology samples obtained 14 daysbefore ICU admission, during ICU stay and 14 days after dis-charge from ICU by linking six local microbiology databaseswith patient data in SIR. Linkage was by the patient’s uniquepersonal number and ICU admission and discharge days.

    Results: We found 195 patients with median APACHE II prob-ability 0.22 (iqr 0.12–0.37), median length of stay (LOS) 46 (iqr 21–125) hours and 79% 30 day survival. Cultures from 2 weeks before (n=128), during ICU-stay (n=750) and from14 days after ICU discharge (n=228) were identified. During ICU stay airways (n=261), blood or intravascular devices (n=246) and other sites (n=243) were cultured. The totalnumber of airway cultures per patient increased linearly withlength of stay (P<0.01,r2= 0.61). Gram-negative bacteria were most common in positive airway cultures (41%) followedby Candida spp (22%), while positive blood cultures were pre-dominantly Gram-positive (71%). 30-day-mortality was 10/53 with positive and 10/29 with negative airway cultures(P=0.23).

    Conclusion: Linkage of local microbiology databases and theSwedish Intensive Care Registry is possible and can generate information that may be used to examine relationships between bacterial resistance and outcomes in the critically illpatient.

  • 12. Fransson, G
    et al.
    Edström, M
    Nilsson, L E
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    High mortaility in bacteraemia and candidaemia in critically ill patients - report from Swedish Intensive Care Registry2012In: Proceedings of the 22nd European Congress of Clinical Microbiology and Infectious Diseases, 2012, p. P1060-Conference paper (Other academic)
    Abstract [en]

    Objective: Increasing prevalence of  bacteremia and candidemia with significant resistance to antimicrobial agents is an increasing concern among ICU patients. The objective of this report from Swedish Registry of Intensive care (SIR) was to study the frequency and cause of culture verified sepsis in critically ill patients and to analyse mortality in sepsis caused by Candida albicans, Candida non albicans and bacteria.

    Methods: Setting: Starting 10 years ago an increasing number of ICU:s in Sweden reports each episode of care (EOC) to the Swedish Intensive care Registry (SIR).  Mortality is followed weekly for all patients by link to the Swedish population registry. A specific routine for collection of microbial data directly from the laboratories connected individually to each EOC has been tested and implemented for laboratories covering 1/3 of the Swedish population. Participants: 47 ICU:s reported 1540 EOC:s during the period January 2005 to November 2011, with a diagnosis of sepsis (ICD10: A419, R572 or R651) and a positive blood culture within 14 days before admission until discharge.  For patients with more than one EOC was only the last EOC included which reduced the number of observations included in mortality calculations to 1416.

    Variables: Primary outcome was 30 day mortality calculated from admission to ICU.

    Results: 1 416 patients met inclusion criteria and were included in the analysis. The most common causes of sepsis were:  E. coli (24 %) followed by Coagulase Negative Staphylococci (CoNS) (21 %), Streptococcus spp (19 %), S. aureus (14 %), Klebsiella spp (8 %) and Candida spp (6 %) [Candida albicans 4 % and Candida non albicans 2 %]. The 30-days crude mortality was 34% for patients with sepsis caused by S. aureus. Correspondingly 30 days mortality was for  Candida non albicans 34%, Candida albicans 31%,  Klebsiella spp 26 % , CoNS 25 %, E. coli 22 %. Distribution of species in blood cultures from the 87 patients with candidemia were: C. albicans 62, C. glabrata 11, C. krusei 1, C. tropicalis 4, C. other 4, C. non specified 9.

    Conclusion: The highest (>30%) crude mortality in critically ill patients with sepsis was seen in patients with S. aureus and Candida infections. Further analysis of independent risk factors for mortality in sepsis caused by different pathogens are warranted.

  • 13.
    Hammarskjold, F
    et al.
    Ryhov County Hospital, Sweden .
    Mernelius, S
    Ryhov County Hospital, Sweden .
    Andersson, R. E.
    Ryhov County Hospital, Sweden .
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Lofgren, S
    Ryhov County Hospital, Sweden .
    Malmvall, Bo-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Petzold, M
    University of Gothenburg, Sweden .
    Matussek, A
    Ryhov County Hospital, Sweden .
    Possible transmission of Candida albicans on an intensive care unit: genotype and temporal cluster analyses2013In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 85, no 1, p. 60-65Article in journal (Refereed)
    Abstract [en]

    Background: Nosocomial transmission of Candida spp. has not been fully explored and previous studies have shown conflicting results. less thanbrgreater than less thanbrgreater thanAim: To evaluate the possible nosocomial transmission of Candida spp. on an intensive care unit (ICU). less thanbrgreater than less thanbrgreater thanMethods: A prospective study was conducted for a period of 19 months, including all patients on our ICU with growth of Candida spp. from surveillance and directed cultures. Molecular typing with repetitive sequence-based polymerase chain reaction was used to define genotype relationships between the Candida albicans and Candida glabrata isolates. Candida isolates obtained from blood cultures taken from patients in our county outside the ICU were used as a reference. Temporal cluster analysis was performed to evaluate genotype distribution over time. less thanbrgreater than less thanbrgreater thanFindings: Seventy-seven patients with 78 ICU stays, representing 12% of all ICU stays, were found to harbour 180 isolates of Candida spp. Molecular typing revealed 27 C. albicans genotypes and 10 of C. glabrata. Possible clustering, indicated by overlapping stays of patients with indistinguishable candida genotypes, was observed on seven occasions with C. albicans and on two occasions with C. glabrata. Two C. albicans genotypes were found significantly more often in the ICU group compared with the reference group. Moreover, C. albicans genotypes isolated from more than one patient were significantly more often found in the ICU group. Temporal cluster analysis revealed a significantly increased number of pairs with indistinguishable genotypes at a 21-day interval, indicating clustering. less thanbrgreater than less thanbrgreater thanConclusion: This study indicates possible transmission of C. albicans between ICU patients based on genotyping and temporal cluster analysis.

  • 14.
    Hammarskjöld, Fredrik
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
    Berg, Sören
    Linköping University, Department of Medicine and Health Sciences, Thoracic Surgery. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Malmvall, Bo-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
    Low incidence of arterial catheter infections in a Swedish intensive care unit: risk factors for colonisation and infection2010In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 76, no 2, p. 130-134Article in journal (Refereed)
    Abstract [en]

    There is growing concern that arterial catheters (ACs) cause catheter-related infections (CRIs). Limited data are available concerning risk factors for AC-CRI and there are no studies concerning incidence and micro-organisms from northern Europe. The aims of this study were to determine the incidence of, and micro-organisms responsible for, AC colonisation and AC-CRI in a Swedish intensive care unit (ICU), and to determine risk factors contributing to AC colonisation and AC-CRI. We prospectively studied all patients (N=539) receiving ACs (N=691) in a mixed ICU of a county hospital. Six hundred (87%) of all ACs were assessed completely. The total catheterisation time for 482 patients was 2567 days. The incidence of positive tip culture was 7.8 per 1000 catheter-days, with the predominant micro-organism being coagulase-negative staphylococci (CoNS). The incidence of AC-CRI was 2.0 per 1000 catheter-days (with no cases of bacteraemia). All AC-CRIs were caused by CoNS. Multivariate analysis revealed that immunosuppression, central venous catheter (CVC) colonisation and CVC infection were significant risk factors for AC-CRI. We conclude that AC colonisation and infection with systemic symptoms occur at a low rate in our ICU which supports our practice of basic hygiene routines for the prevention of AC-CRI. Colonisation and infection of a simultaneous CVC seem to be risk factors. The role of contemporaneous colonisation and infection of multiple bloodstream catheters has received little attention previously. Further studies are needed to verify the significance of this finding.

  • 15.
    Hammarskjöld, Fredrik
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Berg, Sören
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Taxbro, Knut
    Ryhov County Hospital, Sweden .
    Malmvall, Bo-Eric
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Jonkoping Cty Council, Futurum Acad Hlth Care, Jonkoping, Sweden.
    Sustained low incidence of central venous catheter-related infections over six years in a Swedish hospital with an active central venous catheter team2014In: American Journal of Infection Control, ISSN 0196-6553, E-ISSN 1527-3296, Vol. 42, no 2, p. 122-128Article in journal (Refereed)
    Abstract [en]

    Background: There are limited data on the long-term effects of implementing a central venous catheter (CVC) program for prevention of CVC infections. The aims of this study were to evaluate the incidence of CVC colonization, catheter-related infections (CRI), catheter-related bloodstream infections (CRBSI), and their risk factors over a 6-year period in a hospital with an active CVC team. Methods: We conducted a continuous prospective study aiming to include all CVCs used at our hospital during the years 2004 to 2009, evaluating colonization, CRI, CRBSI, and possible risk factors. Results: A total of 2,772 CVCs was used during the study period. Data on culture results and catheterization time were available for 2,045 CVCs used in 1,674 patients. The incidences of colonization, CRI, and CRBSI were 7.0, 2.2, and 0.6 per 1,000 CVC-days, respectively. Analysis of quarterly incidences revealed 1 occasion with increasing infection rates. Catheterization time was a risk factor for CRI but not for CRBSI. Other risk factors for CRI were hemodialysis and CVC use in the internal jugular vein compared with the subclavian vein. Hemodialysis was the only risk factor for CRBSI. Conclusion: We found that a CRI prevention program led by an active CVC team and adhered to by the entire staff at a county hospital is successful in keeping CVC infections at a low rate over a long period of time.

  • 16.
    Hammarskjöld, Fredrik
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Mernelius, S.
    Microbiology Laboratory, Department of Laboratory Services, Division of Medical Services, Ryhov County Hospital, Jönköping, Sweden.
    Andersson, R.
    Department of Surgery, Ryhov County Hospital, Sweden.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Infectious Diseases in Östergötland.
    Löfgren, S.
    Microbiology Laboratory, Department of Laboratory Services, Division of Medical Services, Ryhov County Hospital, Jönköping, Sweden.
    Malmvall, Bo-Erik
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Petzold, M.
    Centre for Applied Biostatistics, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Matussek, A.
    Microbiology Laboratory, Department of Laboratory Services, Division of Medical Services, Ryhov County Hospital, Jönköping, Sweden.
    Possible transmission of Candida albicans on an intensive care unit: intensive care unit:Manuscript (preprint) (Other academic)
    Abstract [en]

    Background: Nosocomial transmission of Candida spp. has not fully been explored and previous studies have shown conflicting results.

    Aim: To evaluate the possible nosocomial transmission of Candida spp. on an intensive care unit (ICU).

    Methods: We conducted a prospective study over 19 month, including all patients on our ICU with growth of Candida spp. from surveillance and directed cultures. Molecular typing, with rep-PCR (DiversiLab) was used to define genotype relationships between the C. albicans and C. glabrata isolates. Candida isolates obtained from blood cultures taken from patients in our county outside the ICU, were used as a reference. Temporal cluster analysis was performed to evaluate genotype distribution over time.

    Findings: Seventy-seven patients with 78 ICU stays, representing twelve per cent of all ICU stays, were found to harbour 180 isolates of Candida spp. Molecular typing revealed 27 C. albicans genotypes and ten of C. glabrata. Possible clustering, indicated by overlapping stays of patients with indistinguishable candida genotypes was observed on seven occasions with C. albicans and on two occasions with C. glabrata. Two C. albicans genotypes were found significantly more often in the ICU group compared to the reference group. Moreover, C. albicans genotypes isolated from more than one patient were significantly more often found in the ICU group. Temporal cluster analysis revealed a significantly increased number of pairs with indistinguishable genotypes at a 21-dayinterval, indicating clustering.

    Conclusion: This study indicates transmission of C. albicans between ICU patients based on genotyping and temporal cluster analysis.

  • 17.
    Hanberger, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    A nurse's story : life, death, and in-between in an intensive care unit2004 (ed. 1)Book (Other academic)
    Abstract [en]

    The team of nurses that Tilda Shalof found herself working with in the intensive care unit (ICU) of a big-city hospital was known as “Laura’s Line.” They were a bit wild: smart, funny, disrespectful of authority, but also caring and incredibly committed to their jobs. Laura set the tone with her quick remarks. Frances, from Newfoundland, was famous for her improvised recipes. Justine, the union rep, wore t-shirts emblazoned with defiant slogans, like “Nurses Care But It’s Not in the Budget.” Shalof was the one who had been to university. The others accused her of being “sooo sensitive.”They depended upon one another. Working in the ICU was both emotionally grueling and physically exhausting. Many patients, quite simply, were dying, and the staff strove mightily to prolong their lives. With their skill, dedication, and the resources of modern science, they sometimes were almost too successful. Doctors and nurses alike wondered if what they did for terminally-ill patients was not, in some cases, too extreme. A number of patients were admitted when it was too late even for heroic measures. A boy struck down by a cerebral aneurysm in the middle of a little-league hockey game. A woman rescued – too late – from a burning house. It all took its toll on the staff.And yet, on good days, they thrived on what they did. Shalof describes a colleague who is managing a “crashing” patient: “I looked at her. Nicky was flushed with excitement. She was doing five different things at the same time, planning ahead for another five. She was totally focused, in her element, in control, completely at home with the chaos. There was a huge smile on her face. Nurses like to fix things. If they can.”Shalof, a veteran ICU nurse, reveals what it is really like to work behind the closed hospital curtains. The drama, the sardonic humour, the grinding workload, the cheerful camaraderie, the big issues and the small, all are brought vividly to life in this remarkable book.

  • 18.
    Hanberger, Håkan
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Pharmacodynamic effects of antibiotics: studies on bacterial morphology, initial killing, postantibiotic effect and effecitive regrowth time1992Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Pharmacodynamics of antibiotics deals with time course of drug activity and mechanisms of action of drugs on bacteria. In this thesis pharmacodynamic parameters have been studied after brief exposure of gram-positive bacteria to daptomycin, imipenem or vancomycin and after short exposure of gram-negative bacteria to amikacin, ampicillin, aztreonam, cefepime, cefotaxime, ceftazidime, ceftriaxone, cefuroxime, imipenem, mecillinal,11, or piperacillin.The studies have been focused on morphological alterations, initial killing, postantibiotic effect (PAE) and effective regrowth time (ERT) and a method, based on bioluminescence assay of intracellular A TP has been used. The basic principle behind this technique is that A TP in living cells is present in a relatively constant amount, and hence affords a measure of the number of microbial cells. The PAE describes the delayed regrowth of bacteria after brief exposure to antibiotics. The number of cells measured after this antibiotic exposure describes the initialkilling and is also the start value for calculating the PAE. PAEs of 2-3 h were obtained by bioluminescence for gram-positive bacteria exposed to imipenern or v ancomycin. This is in agreement with results obtained by viable count and is probably due to similiar weak initialdecrease in cell density when assayed by both methods. Long (> 3 h) concentration dependent PAEs and moderate (::;; 1 1ogw) initial decrease in intracellular ATP were in general seen for gram-positive bacteria exposed to daptomycin and for gram-negative bacteria exposed to imipenem or amikacin when assayed by bioluminescence. These very long P AEs and rather weak initial killing have to be compared with the shorter PAEs and stronger initial killing reported by us and others using viable count. Furthermore, this study showed that there was a relatively good concordance between microscopy and bioluminescence, which are direct methods, in determining the initial killing and PAE of imipenem on Escherichia coli. The ERT, defined as the time for bacterial density to increase 1 logw from the pre-exposure inoculum, was independent of the method used for measuring regrowth of E. coli after brief exposure to imipenem. The combination of mecillinam with ampicillin, aztreonam, ceftazidime or piperacillin and the combination of amikacin with ceftazidirne, ceftriaxone or piperacillin induced longer PAEs on gram-negative bacteria than the sum of PAEs of the individual antibiotics. A strong initial killing in combination with a long PAE cause a long ERT and may allow the antibiotic concentration to stay below MIC during long periods of time without any regrowth. This may, in clinical practice, have implications for long dosing intervals .

  • 19.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    Sepsis på akuten & IVA: Diagnostik och Antibiotikaterapi2017Collection (editor) (Other academic)
    Abstract [sv]

    Tredje upplagan av ”Sepsis på akuten och IVA” baseras delvis på SK-kursen med samma namn. Bokens innehall har dock utökats for att kunna ge praktiska anvisningar for diagnostik och terapi vid sepsis hos barn och vuxna med olika infektionsfokus. Sepsisboken ger också en inblick i vilka mekanismer som gör att sepsis snabbt kan bli ett livshotande tillstånd och vilka åtgärder som det ar mest bråttom med under de första timmarna av septisk chock. Kort tid mellan upptäckt av septisk chock och ratt insatt behandling sparar både organfunktion och liv. Modern intensivvård med monitorering av vätsketillförsel, vasokativa droger, respirator, dialys etc ar liksom ratt antibiotika i ratt dos en förutsättning for att kunna radda en patient med septisk chock. For att kunna ge ratt antibiotika kravs kunskap om vilka bakterier som ar vanligast vid olika typer av infektioner och deras antibiotikakänslighet. Ett kapitel i denna bok agnas därför at resistensläget i blododlingar från svenska patienter.

    Patienter som har nedsatt njurfunktion löper större risk for felaktig dosering av antimikrobiella läkemedel och behandlingsmisslyckande varför boken innehåller flera tabeller med doseringsanvisningar vid nedsatt njurfunktion och dialys. Ett kapitel agnas at handläggning av allvarliga bakteriella infektioner hos barn eftersom barn reagerar något annorlunda an vuxna vid sepsis, S. aureus ar vanligare och barn har en delvis annorlunda behandlingsalgoritm. Barn med immunsuppression berörs också och det ar ett kapitel om allvarliga infektioner hos vuxna patienter med neutropeni. Ett separat kapitel agnas at de relativt ovanliga men livshotande hud och mjukdelsinfektionerna som kräver snabb kirurgisk intervention och bra samarbete mellan kirurger, intensivvårdsläkare och infektionsläkare. Svampsepsis har okat på IVA pga alltmer avancerad intensivvård och agnas ett eget kapitel da svampsepsis ofta ar svårdiagnosticerat. Empirisk behandling med nya antimykotika har därför blivit allt vanligare och det ar viktigt att ha kännedom om vilka preparat som har bast effekt och ar kostnadseffektiva. Samhällsförvärvade och sjukhusförvärvade intensivvårdskrävande pneumonier har båda hög dödlighet och en sammanfattning av behandlingsalgoritmer ar inkluderade i boken. Intensivvård innebar risk for sjukhusförvärvade infektioner och riktlinjer for hur man skall undvika, diagnosticera och behandla blodkateterassocierade infektioner agnas ett kapitel. For en optimal handläggning av septiska infektioner ar det viktigt att ta reda på förekomst av immunsuppression och komorbiditet, göra en korrekt bedömning av svårighetsgrad, stalla ratt preliminär diagnos inklusive infektionsfokus, sannolik etiologi och risk for antibiotikaresistens. Boken innehåller flera sammanfattningar och checklistor for snabb korrekt empirisk antimikrobiell behandling av intensivvårdskrävande infektioner både på akuten och IVA.

    Vi hoppas att boken skall bidra till att förbättra varden av patienter med sepsis och andra svara infektioner. Stort tack till alla medförfattare som bidragit med sin expertis och till Region Östergötland som bidragit ekonomiskt och möjliggjort utgivning av denna bok.

    Linköping i Januari 2017

    Hakan Hanberger

  • 20.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Heart and Medicine Center, Department of Infectious Diseases.
    Sepsis på akuten & IVA: diagnostik och antibiotikaterapi2013Collection (editor) (Other academic)
    Abstract [sv]

    Sepsis på akuten och IVA baseras på SK-kursen med samma namn. Vi har i andra upplagan flera nya kapitel och hoppas att boken skall bidra till att förbättra vården av patienter med sepsis och andra svåra infektioner.

  • 21.
    Hanberger, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Stora skillnader i antibiotikaresistens pσ Europas intensivvσrdsavdelningar2001In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 98, no 44, p. 4827-4828Article in journal (Other academic)
  • 22.
    Hanberger, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Sustainable high antibiotic susceptibility among bacterial pathogens despite high antibiotic consumption in Swedish ICUs from 1999 to 2003.2004In: 44th ICAAC,2004, 2004Conference paper (Other academic)
  • 23.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Antonelli, Massimo
    Policlinico University of A. Gemelli, Rome, Italy.
    Holmbom, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Lipman, Jeffrey
    University of Queensland, Herston, Australia.
    Pickkers, Peter
    Radboud University Medical Centre, Nijmegen, The Netherlands.
    Leone, Marc
    Aix Marseille University, France.
    Rello, Jordi
    University Autonoma of Barcelona, Spain.
    Sakr, Yasser
    Friedrich-Schiller University, Jena, Germany.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Division of Cardiovascular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Thoracic and Vascular Surgery.
    Vanhems, Philippe
    University of Lyon 1, France.
    Vincent, Jean-Louis
    University Libre Bruxelles, Belgium.
    Infections, antibiotic treatment and mortality in patients admitted to ICUs in countries considered to have high levels of antibiotic resistance compared to those with low levels2014In: BMC Infectious Diseases, ISSN 1471-2334, E-ISSN 1471-2334, Vol. 14, no 513Article in journal (Refereed)
    Abstract [en]

    Background: Antimicrobial resistance is an increasing concern in ICUs worldwide. Infection with an antibiotic resistant (ABR) strain of an organism is associated with greater mortality than infection with the non-resistant strain, but there are few data assessing whether being admitted to an intensive care unit (ICU) with high levels of antimicrobial resistance is associated with a worse outcome than being admitted to an ICU with low rates of resistance. The aim of this study was, therefore, to compare the characteristics of infections and antibiotic treatments and patient outcomes in patients admitted to ICUs in countries considered as having high levels of antibiotic resistance and those admitted to ICUs in countries considered as having low levels of antibiotic resistance. Methods: Data from the large, international EPIC II one-day point prevalence study on infections in patients hospitalized in ICUs were used. For the current study, we compared the data obtained from patients from two groups of countries: countries with reported MRSA rates of greater than= 25% (highABR: Greece, Israel, Italy, Malta, Portugal, Spain, and Turkey) and countries with MRSA rates of less than 5% (lowABR: Denmark, Finland, Netherlands, Norway, and Sweden). Results: On the study day, 1187/2204 (53.9%) patients in the HighABR ICUs were infected and 255/558 (45.7%) in the LowABR ICUs (P less than 0.01). Patients in the HighABR ICUs were more severely ill than those in the LowABR ICUs, as reflected by a higher SAPS II score (35.6 vs 32.7, P less than 0.05) and had longer median ICU (12 days vs 5 days) and hospital (24 days vs 16 days) lengths of stay. They also had higher crude ICU (20.0% vs 15.4%) and hospital (27.0% vs 21.5%) mortality rates (both P less than 0.05). However, after multivariable adjustment and matched pair analysis there were no differences in ICU or hospital mortality rates between High or LowABR ICU patients overall or among those with infections. Conclusions: Being hospitalized in an ICU in a region with high levels of antimicrobial resistance is not associated per se with a worse outcome.

  • 24.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Arman, Dilek
    Gazi University School of Medicine.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Jindrák, Vlastimil
    Na Homolce Hospital, Praha, Czech Republic.
    Kalenic, Smilja
    Clinical Hospital Centre, Zagreb, Croatia.
    Kurcz, Andrea
    National Centre for Epidemiologia, Budapest, Hungary.
    Licker, Monica
    “Victor Babes” University of Medicine and Pharmacy, Timisoara, Romania.
    Naaber, Paul
    United Laboratories, Tartu University Clinics.
    Scicluna, Elizabeth A.
    Mater Dei Hospital, Malta .
    Vanis, Václav
    Na Homolce Hospital, Praha, Czech Republic.
    Walther, Sten M.
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Surveillance of microbial resistance in European Intensive Care Units: a first report from the Care-ICU programme for improved infection control2009In: Intensive Care Medicine, ISSN 0342-4642, E-ISSN 1432-1238, Vol. 35, no 1, p. 91-100Article in journal (Refereed)
    Abstract [en]

    Purpose: To report initial results from a European ICU surveillance programme focussing on antibiotic consumption, microbial resistance and infection control.

    Methods: Thirty-five ICUs participated during 2005. Microbial resistance, antibiotic consumption and infection control stewardship measures were entered locally into a web-application. Results were validated locally, aggregated by project leaders and fed back to support local audit and benchmarking.

    Results: Median (range) antibiotic consumption was 1,254 (range 348–4,992) DDD per 1,000 occupied bed days. The proportion of MRSA was median 11.6% (range 0–100), for ESBL phenotype of E. coli and K. pneumoniae 3.9% (0–80) and 14.3% (0–77.8) respectively, and for carbapenem-resistant P. aeruginosa 22.5% (0–100). Screening on admission for alert pathogens was commonly omitted, and there was a lack of single rooms for isolation.

    Conclusions: The surveillance programme demonstrated wide variation in antibiotic consumption, microbial resistance and infection control measures. The programme may, by providing rapid access to aggregated results, promote local and regional audit and benchmarking of antibiotic use and infection control practices.

  • 25.
    Hanberger, Håkan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Berg, SörenLinköping University, Faculty of Health Sciences. Linköping University, Department of Medical and Health Sciences, Thoracic Surgery. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Sepsishähtet: handläggning av sepsis på akuten och IVA2008Collection (editor) (Other academic)
    Abstract [sv]

    Sepsis på akuten och IVA baseras på SK-kursen med samma namn. Vi har i andra upplagan flera nya kapitel och hoppas att boken skall bidra till att förbättra vården av patienter med sepsis och andra svåra infektioner.

    Linköping april 2013

    Håkan Hanberger och medförfattare

  • 26.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Burman, LG
    Cars, O
    Erlandsson, Marcus
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Nilsson, Lennart
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Nordlinder, D
    Walther, Sten
    Linköping University, Department of Medicine and Care, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    Low antibiotic resistance rates in Staphylococcus aureus, Escherichia coli and Klebsiella spp but not in Enterobacter spp and Pseudomonas aeruginosa: A prospective observational study in 14 Swedish ICUs over a 5-year period2007In: Acta Anaesthesiologica Scandinavica, ISSN 0001-5172, E-ISSN 1399-6576, Vol. 51, no 7, p. 937-941Article in journal (Refereed)
    Abstract [en]

    Background: Intensive care units (ICUs) are hot zones for emergence and spread of antibiotic resistance because of frequent invasive procedures, antibiotic usage and transmission of bacteria. We report prospective data on antibiotic use and bacterial resistance from 14 academic and non-academic ICUs, participating in the ICU-STRAMA programme 1999-2003. Methods: The quantity of antibiotics delivered to each ICU was calculated as defined daily doses per 1000 occupied bed days (DDD1000). Specimens for culture were taken on clinical indications and only initial isolates were considered. Species-related breakpoints according to the Swedish Reference Group for Antibiotics were used. Antibiotic resistance was defined as the sum of intermediate and resistant strains. Results: Mean antibiotic use increased from 1245 DDD1000 in 1999 to 1510 DDD1000 in 2003 (P = 0.11 for trend). Of Staphylococcus aureus, 0-1.8% were methicillin resistant (MRSA). A presumptive extended spectrum beta-lactamase (ESBL) phenotype was found in <2.4% of Escherichia coli, based on cefotaxime susceptibility, except a peak in 2002 (4.6%). Cefotaxime resistance was found in 2.6-4.9% of Klebsiella spp. Rates of resistance among Enterobacter spp. to cefotaxime (20-33%) and among Pseudomonas aeruginosa to imipenem (22-33%) and ciprofloxacin (5-21%) showed no time trend. Conclusion: MRSA and cefotaxime-resistant E. coli and Klebsiella spp strains were few despite high total antibiotic consumption. This may be the result of a slow introduction of resistant strains into the ICUs, and good infection control. The cause of imipenem and ciprofloxacin resistance in P. aeruginosa could reflect the increased consumption of these agents plus spread of resistant clones. © 2007 The Authors.

  • 27.
    Hanberger, Håkan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Diekema, D
    Fluit, A
    Jones, R
    Struelens, M
    Spencer, R
    Wolff, M
    Surveillance of antibiotic resistance in European ICUs2001In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 48, no 3, p. 161-176Article in journal (Refereed)
    Abstract [en]

    Antibiotic resistance among bacteria causing hospital-acquired infections poses a threat, particularly to patients in intensive care units (ICUs). In order to control the spread of resistant bacteria, local, regional and national resistance surveillance data must be used to develop efficient intervention strategies. In an attempt to identify national differences and the dynamics of antibiotic resistance in European ICUs, data have been merged from several networks of resistance surveillance performed during the 1990s. It should be stressed, however, that comparisons of results from different studies using different methods and different population samples must be made with caution. Antibiotic resistance across all species and drugs was, with some exceptions, highest in southern European countries and Russia, and lowest in Scandinavia. More effective strategies are needed to control the selection and spread of resistant organisms. Antibiotic intervention policies, efficient infection control measures and an overall awareness of the serious implications at public health level will contribute to the management of antibiotic resistance.

  • 28.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Infectious Diseases in Östergötland.
    Edlund, Charlotta
    Medical Product Agency, Uppsala.
    Furebring, Mia
    Uppsala University.
    Giske, Christian G.
    MTC – Karolinska Institutet, Karolinska University Hospital, Stockholm.
    Melhus, Åsa
    Uppsala University.
    Nilsson, Lennart E
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Petersson, Johan
    Karolinska Institutet, Stockholm.
    Sjölin, Jan
    Uppsala University.
    Ternhag, Anders
    Swedish Institute for Communicable Disease Control, Solna.
    Werner, Maria
    Södra Älvsborgs Sjukhus, Borås.
    Eliasson, Erik
    Karolinska Institutet, Karolinska University Hospital, Huddinge, Stockholm, Sweden.
    Rational use of aminoglycosides - Review and recommendations by the Swedish Reference Group for Antibiotics (SRGA)2013In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 45, no 3, p. 161-175Article, review/survey (Refereed)
    Abstract [en]

    The Swedish Reference Group for Antibiotics (SRGA) has carried out a risk–benefit analysis of aminoglycoside treatment based on clinical efficacy, antibacterial spectrum, and synergistic effect with beta-lactam antibiotics, endotoxin release, toxicity, and side effects. In addition, SRGA has considered optimal dosage schedules and advice on serum concentration monitoring, with respect to variability in volume of drug distribution and renal clearance. SRGA recommends that aminoglycoside therapy should be considered in the following situations: (1) progressive severe sepsis and septic shock, in combination with broad-spectrum beta-lactam antibiotics, (2) sepsis without shock, in combination with broad-spectrum beta-lactam antibiotics if the infection is suspected to be caused by multi-resistant Gram-negative pathogens, (3) pyelonephritis, in combination with a beta-lactam or quinolone until culture and susceptibility results are obtained, or as monotherapy if a serious allergy to beta-lactam or quinolone antibiotics exists, (4) serious infections caused by multi-resistant Gram-negative bacteria when other alternatives are lacking, and (5) endocarditis caused by difficult-to-treat pathogens when monotherapy with beta-lactam antibiotics is not sufficient. Amikacin is generally more active against extended-spectrum beta-lactamase (ESBL)-producing and quinolone-resistant Escherichia coli than other aminoglycosides, making it a better option in cases of suspected infection caused by multidrug-resistant Enterobacteriaceae. Based on their resistance data, local drug committees should decide on the choice of first-line aminoglycoside. Unfortunately, aminoglycoside use is rarely followed up with audiometry, and in Sweden we currently have no systematic surveillance of adverse events after aminoglycoside treatment. We recommend routine assessment of adverse effects, including hearing loss and impairment of renal function, if possible at the start and after treatment with aminoglycosides, and that these data should be included in hospital patient safety surveillance and national quality registries.

  • 29.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences.
    Erlandsson, Marcus
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Burman, Lars G.
    Swedish Institute for Infectious Diseases Control, Solna, Sweden.
    Cars, Otto
    Swedish Institute for Infectious Diseases Control, Solna, Sweden.
    Gill, Hans
    Linköping University, Department of Biomedical Engineering, Medical Informatics. Linköping University, The Institute of Technology.
    Lindgren, Sune
    Nilsson, Lennart E.
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
    Olsson-Liljequist, Barbro
    Swedish Institute for Infectious Diseases Control, Solna, Sweden.
    Walther, Sten
    Linköping University, Department of Medicine and Health Sciences, Physiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart Centre, Department of Thoracic and Vascular Surgery.
    High Antibiotic Susceptibility Among Bacterial Pathogens In Swedish ICUs2004In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, Vol. 36, no 1, p. 24-30Article in journal (Refereed)
    Abstract [en]

    Local infection control measures, antibiotic consumption and patient demographics from 1999-2000 together with bacteriological analyses were investigated in 29 ICUs participating in the ICU-STRAMA programme. The median antibiotic consumption per ICU was 1147 (range 605-2143) daily doses per 1000 occupied bed d (DDD1000). Antibiotics to which >90% of isolates of an organism were susceptible were defined as treatment alternatives (TA90). The mean number of TA90 was low (1-2 per organism) for Enterococcus faecium (vancomycin:VAN), coagulase negative staphylococci (VAN), Pseudomonas aeruginosa (ceftazidime:CTZ, netilmicin: NET) and Stenotrophomonas maltophilia (CTZ, trimethoprim-sulfamethoxazole: TSU), but higher (3-7) for Acinetobacter spp. (imipenem:IMI, NET, TSU), Enterococcus faecalis (ampicillin:AMP, IMI, VAN), Serratia spp. (ciprofloxacin:CIP, IMI, NET), Enterobacter spp. (CIP, IMI, NET, TSU), E. coli (cefuroxime:CXM, cefotaxime/ceftazidime:CTX/CTZ, CIP, IMI, NET, piperacillin-tazobactam:PTZ, TSU), Klebsiella spp. (CTX/CTZ CIP, IMI, NET, PTZ, TSU) and Staphylococcus aureus (clindamycin, fusidic acid, NET, oxacillin, rifampicin, VAN). Of S. aureus isolates 2% were MRSA. Facilities for alcohol hand disinfection at each bed were available in 96% of the ICUs. The numbers of TA90 available were apparently higher than in ICUs in southern Europe and the US, despite a relatively high antibiotic consumption. This may be due to a moderate ecological impact of the used agents and the infection control routines in Swedish ICUs.

  • 30.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases in Östergötland.
    Fredrikson, Mats
    Linköping University, Department of Clinical and Experimental Medicine, Division of Inflammation Medicine. Linköping University, Faculty of Health Sciences.
    Ternhag, Anders
    Swedish Institute Communicable Disease Control, Sweden .
    Giske, Christian G.
    Karolinska University Hospital, Sweden .
    Letter: Rational use of aminoglycosides - author response2013In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 45, no 8, p. 655-656Article in journal (Other academic)
    Abstract [en]

    n/a

  • 31.
    Hanberger, Håkan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Garcia-Rodriguez, J-A
    Gobernado, M
    Goossens, H
    Nilsson, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment.
    Struelens, MJ
    French and Portuguese ICU Stud,
    French and Portuguese ICU, Study Groups
    Antibiotic suseptibility among aerobic gram-negative bacilli in intensive care units in 5 European countries. 1999In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 281, p. 67-71Article in journal (Refereed)
  • 32.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Giske, Christian G
    Clinical microbiology — Karolinska Institutet, Karolinska University Hospital, Stockholm.
    Giamarellou, Helen
    Athens University Medical School, Athens, Greece.
    When and how to cover for resistant gram-negative bacilli in severe sepsis and septic shock.2011In: Current Infectious Disease Reports, ISSN 1523-3847, E-ISSN 1534-3146, Vol. 13, no 5, p. 416-425Article in journal (Refereed)
    Abstract [en]

    In the 80s and 90s, increasing antibiotic resistance was met by the introduction of new effective agents with broader antibacterial spectra for the empirical treatment of severe infections. In recent years, however, few novel antimicrobials have been developed, and this has critically weakened our strength in the fight against resistant bacteria, especially Gram-negative bacilli. It has been well proven that mortality increases if initial empirical antibiotic treatment for severe infection is inappropriate due to resistance of the pathogen. Physicians are already faced with the increasing challenge of untreatable or almost untreatable Gram-negative infections due to antibiotic resistance. Empirical treatment with broader spectra and high antibiotic pressure both in- and outside hospital is the driving force behind resistance. Since new efficient drugs against Gram-negative bacilli will not be available for some time, the best we can do to stop infections caused by multidrug-resistant bacteria is to improve infection control and choice of antibiotics, which should be based on surveillance of local antibiotic consumption and resistance. We must learn more about the revived antibacterial agents colistin and fosfomycin, and the few next generation Gram-negative antibiotics that have been developed. The aim of this review is to give an update on present therapeutic options in the fight against multidrug-resistant Gram-negative bacteria.

  • 33.
    Hanberger, Håkan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Monnet, Dominique L
    Nilsson, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology.
    Intensive care unit2005In: Antibiotic policies.: Theory and practice. / [ed] Ian M. Gould and Jos W.M. van der Meer, New York: Springer , 2005, p. 261-279Chapter in book (Other academic)
    Abstract [en]

    For 50 years, antibiotics have been dispensed like sweets. This must not be allowed to continue. This unique book assembles contributions from experts around the world concerned with responsible use of antibiotics and the consequences of overuse. For the first time, it provides up to the minute texts on both the theoretical aspects of antibiotic stewardship and the practical aspects of its implementation, with consideration of the key differences between developed and developing countries. All concerned with teaching, practice and administration of clinical medicine, surgery, pharmacy, public health, clinical pharmacology, microbiology, infectious diseases and clinical therapeutics will find Antibiotic Policies: Theory and Practice essential reading. Antibiotic use and resistance is not just the responsibility of specialists in the field but the responsibility of all doctors, pharmacists, nurses, healthcare administrators, patients and the general public.

  • 34.
    Hanberger, Håkan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Nilsson, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment.
    Intensivvårdsavdelningen en het zon för antibiotikaresistens.1999In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 96, p. 1276-1277Article in journal (Other (popular science, discussion, etc.))
  • 35.
    Hanberger, Håkan
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Nilsson, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment.
    Claesson, B
    Kärnell, A
    Larsson, P
    Rylander, M
    Svensson, E
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
    Sörberg, M
    Sörén, L
    New species-related MIC breakpoints for early detection of development of resistance among Gram-negative bacteria in Swedish intensive care units. 1999In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 44, p. 611-619Article in journal (Refereed)
  • 36.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, Lennart E
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Maller, Rolf
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Isaksson, Barbro
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Pharmacodynamics of daptomycin and vancomycin on Enterococcus faecalis and Staphylococcus aureus demonstrated by studies of initial killing and postantibiotic effect and influence of Ca2+ and albumin on these drugs.1991In: Antimicrobial Agents and Chemotherapy, ISSN 0066-4804, E-ISSN 1098-6596, Vol. 35, no 9, p. 1710-1716Article in journal (Refereed)
    Abstract [en]

    The pharmacodynamics of daptomycin and vancomycin on Enterococcus faecalis ATCC 29212 and Staphylococcus aureus ATCC 25923 were investigated by studying the postantibiotic effect (PAE) and initial killing. The influence of Ca2+ and albumin on these drugs was also evaluated. The PAE was studied by use of bioluminescence assay of bacterial ATP. Daptomycin at clinically achievable concentrations produced a dose-dependent PAE on E. faecalis (0.6 to 6.7 h) and S. aureus (1.0 to 6.3 h). The long PAE of daptomycin was seen simultaneously with a potent dose-dependent initial killing assayed by viable count determination. The initial change in bacterial ATP was not as extensive as the decrease in viability. Vancomycin at corresponding concentrations produced shorter PAEs on E. faecalis (0.5 to 1.0 h) and S. aureus (1.3 to 1.8 h). This coincides with a weak non-dose-dependent initial change in viability and intracellular ATP. The MICs of vancomycin were not influenced by different Ca2+ concentrations or by the addition of albumin to the broth. The MICs of daptomycin for both strains were lowered, and the PAEs were prolonged with increasing concentrations of Ca2+ in the broth. The PAE of daptomycin was Ca2+ dependent to the same extent as the MIC was. In the presence of physiological concentrations of albumin and free Ca2+, the PAEs of daptomycin on both strains were reduced and the MICs were increased in comparison with the results obtained in pure Mueller-Hinton broth with approximately the same free Ca2+ concentration. This decrease in daptomycin activity was considered to be due to the albumin binding of daptomycin. Despite the albumin binding of daptomycin, the PAE produced on E. faecalis and S. aureus in the presence of a physiological free Ca2+ concentration was still over 6 h at clinically achievable concentrations.

  • 37.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Odenholt, I.
    Universitetssjukhuset MAS.
    Giske, C.G.
    Karolinska Universitetssjukhuset.
    Kahlmeter, G.
    Centrallasarettet, Växjö.
    Dags att slopa "husets vin" stopp för okritisk empirisk användning av cefuroxim2009In: Läkartidningen, ISSN 0023-7205, Vol. 106, no 5, p. 291-292Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

  • 38.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Skoog, Gunilla
    Public Health Agency Sweden, Sweden .
    Ternhag, Anders
    Public Health Agency Sweden, Sweden Karolinska Institute, Sweden .
    Giske, Christian G.
    Karolinska University Hospital, Sweden .
    Antibiotic consumption and antibiotic stewardship in Swedish hospitals2014In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 119, no 2, p. 154-161Article, review/survey (Refereed)
    Abstract [en]

    Background. The aim of this paper was to describe and analyze the effect of antibiotic policy changes on antibiotic consumption in Swedish hospitals and to review antibiotic stewardship in Swedish hospitals. Results. The main findings were: 1) Antibiotic consumption has significantly increased in Swedish hospitals over the last decade. The consumption of cephalosporins has decreased, whereas that of most other drugs including piperacillin-tazobactam, carbapenems, and penicillinase-sensitive and -resistant penicillins has increased and replaced cephalosporins. 2) Invasive infections caused by ESBL-producing Escherichia coli and Klebsiella pneumoniae have increased, but the proportion of pathogens resistant to third-generation cephalosporins causing invasive infections is still very low in a European and international perspective. Furthermore, the following gaps in knowledge were identified: 1) lack of national, regional, and local data on the incidence of antibiotic resistance among bacteria causing hospital-acquired infections e. g. bloodstream infections and hospital-acquired pneumonia-data on which standard treatment guidelines should be based; 2) lack of data on the incidence of Clostridium difficile infections and the effect of change of antibiotic policies on the incidence of C. difficile infections and infections caused by antibiotic-resistant pathogens; and 3) lack of prospective surveillance programs regarding appropriate antibiotic treatment, including selection of optimal antimicrobial drug regimens, dosage, duration of therapy, and adverse ecological effects such as increases in C. difficile infections and emergence of antibiotic-resistant pathogens. Conclusions. Evidence-based actions to improve antibiotic use and to slow down the problem of antibiotic resistance need to be strengthened. The effect of such actions should be analyzed, and standard treatment guidelines should be continuously updated at national, regional, and local levels.

  • 39.
    Hanberger, Håkan
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Infectious Diseases in Östergötland.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Leone, Marc
    Department of Anesthesiology and Intensive Care Medicine, Nord Hospital, Marseille, France.
    Barie, Philip S
    Department of Surgery, Weill Cornell Medical College, New York, USA.
    Rello, Jordi
    Critical Care Department, Vall d’Hebron University Hospital, CIBERES, VHIR, Universitat Autónoma de Barcelona, Spain.
    Lipman, Jeffrey
    Department of Intensive Care Medicine, Royal Brisbane and Women's Hospital and Burns Trauma Critical Care Research Centre, University of Queensland, Queensland, Australia.
    Marshall, John C
    Department of Surgery, University of Toronto, St Michael's Hospital, Toronto, Ontario, Canada.
    Anzueto, Antonio
    Department of Pulmonary/Critical Care, University of Texas Health Science Center, San Antonio, TX, USA.
    Sakr, Yasser
    Department of Anesthesiology and Intensive Care, Friedrich-Schiller University, Jena, Germany.
    Pickkers, Peter
    Department of Intensive Care Medicine, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
    Felleiter, Peter
    Intensive Care Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland.
    Engoren, Milo
    Department of Anesthesiology, Mercy St Vincent Medical Center, Toledo, OH, USA.
    Vincent, Jean-Louis
    Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, Brussels, Belgium.
    Increased mortality associated with meticillin-resistant Staphylococcus aureus (MRSA) infection in the Intensive Care Unit: results from the EPIC II study2011In: International Journal of Antimicrobial Agents, ISSN 0924-8579, E-ISSN 1872-7913, Vol. 38, no 4, p. 331-335Article in journal (Refereed)
    Abstract [en]

    Controversy continues regarding whether the presence of meticillin resistance increases mortality risk in Staphylococcus aureus infections. In this study, we assessed the role of meticillin resistance in survival of patients with S. aureus infection included in the EPIC II point-prevalence study of infection in critically ill patients performed on 8 May 2007. Demographic, physiological, bacteriological and therapeutic data were collected for 13 796 adult patients in 1265 participating Intensive Care Units (ICUs) from 75 countries on the study day. ICU and hospital outcomes were recorded. Characteristics of patients with meticillin-sensitive S. aureus (MSSA) and meticillin-resistant S. aureus (MRSA) infections were compared. Co-morbidities, age, Simplified Acute Physiology Score (SAPS) II, site of infection, geographical region and MRSA/MSSA were entered into a multivariate model, and adjusted odds ratios (ORs) [95% confidence interval (CI)] for ICU and hospital mortality rates were calculated. On the study day, 7087 (51%) of the 13 796 patients were classified as infected. There were 494 patients with MRSA infections and 505 patients with MSSA infections. There were no significant differences between the two groups in use of mechanical ventilation or haemofiltration/haemodialysis. Cancer and chronic renal failure were more prevalent in MRSA than in MSSA patients. ICU mortality rates were 29.1% and 20.5%, respectively (P andlt; 0.01) and corresponding hospital mortality rates were 36.4% and 27.0% (P andlt; 0.01). Multivariate analysis of hospital mortality for MRSA infection showed an adjusted OR of 1.46 (95% CI 1.03-2.06) (P = 0.03). In ICU patients, MRSA infection is therefore independently associated with an almost 50% higher likelihood of hospital death compared with MSSA infection.

  • 40.
    Hällgren, Anita
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Abednazari, Hossein
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Ekdahl, Christer
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Hanberger, Håkan
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Nilsson, Maud
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Samuelsson, Annika
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Nilsson, Lennart
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Antimicrobial susceptibility patterns of enterococci in intensive care units in Sweden evaluated by different MIC breakpoint systems2001In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 48, no 1, p. 53-62Article in journal (Refereed)
    Abstract [en]

    Three hundred and twenty-two (322) clinical isolates were collected from patients admitted to intensive care units (ICUs) at eight Swedish hospitals between December 1996 and December 1998. Of the isolates, 244 (76%) were Enterococcus faecalis, 74 (23%) were Enterococcus faecium and four (1%) were other Enterococcus spp. MICs of ampicillin, imipenem, meropenem, piperacillin/tazobactam, ciprofloxacin, trovafloxacin, clinafloxacin, gentamicin, streptomycin, vancomycin, teicoplanin, quinupristin/dalfopristin, linezolid and evernimicin were determined by Etest. Susceptible and resistant isolates were defined according to the species-related MIC breakpoints of the British Society for Antimicrobial Chemotherapy (BSAC), the National Committee for Clinical Laboratory Standards (NCCLS) and the Swedish Reference Group for Antibiotics (SRGA). Tentative breakpoints were applied for new/experimental antibiotics. Multidrug resistance among enterococci in ICUs is not uncommon in Sweden, particularly among E. faecium, and includes ampicillin resistance and concomitant resistance to fluoroquinolones. Almost 20% of E. faecalis isolates showed high-level resistance to gentamicin and concomitant resistance to fluoroquinolones. Vancomycin-resistant enterococci were only found sporadically. Among the new antimicrobial agents, linezolid and evernimicin showed the best activity against all enterococcal isolates. There was good concordance between the BSAC, NCCLS and SRGA breakpoints in detecting resistance. When applying the SRGA breakpoints for susceptibility, isolates were more frequently interpreted as intermediate. This might indicate earlier detection of emerging resistance using the SRGA breakpoint when the native population is considered susceptible, but with the risk that isolates belonging to the native susceptible population will be incorrectly interpreted as intermediate.

  • 41.
    Hällgren, Anita
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology.
    Burman, L
    Olsson-Liljequist, B
    Isaksson, Barbro
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
    Saedi, B
    Walther, Sten
    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.
    Nilsson, Lennart
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Hanberger, Håkan
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Hög frekvens an korskolonisering med resistenta enterokocker hos "långliggare" på IVA2004In: Hygiea,2004, 2004, p. 57-57Conference paper (Other academic)
  • 42.
    Hällgren, Anita
    et al.
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Burman, Lars G
    Swedish Institute for Infectious Disease Control, Solna, Sweden.
    Isaksson, Barbro
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Olsson-Liljeqvist, Barbro
    Swedish Institute for Infectious Disease Control, Solna, Sweden.
    Nilsson, Lennart
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Saeedi, Baharak
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Walther, Sten
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Hanberger, Håkan
    Linköping University, Department of Molecular and Clinical Medicine. Linköping University, Faculty of Health Sciences.
    Rectal colonization and frequency of enterococcal cross-transmission among prolonged-stay patients in two Swedish intensive care units2005In: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 37, no 8, p. 561-571Article in journal (Refereed)
    Abstract [en]

    The aims of this study were to gain insight into the dynamics of the rectal flora during prolonged ICU stay, with a particular focus on colonization and cross-transmission with resistant pathogens, and to evaluate methods for the rapid isolation of relevant bacteria from rectal swabs. Patients admitted to a general intensive care unit (GICU) or a cardiothoracic ICU (TICU) at the University Hospital of Linköping, Sweden, between 1 November 2001 and January 2002 with a length of stay > 5 d were included (n = 20). Chromogenic UTI agar medium was used for discrimination of different species, and appropriate antibiotics were added to detect resistance. Direct plating was compared to enrichment broth for a subset of specimens. The study showed an early alteration in rectal flora, with a dramatic decrease in Gram-negative rods in favour of Gram-positive bacteria. An ampicillin- and high-level gentamicin resistant clone of Enterococcus faecium was found in 6 of 10 patients in the GICU and 2 of 11 patients in the TICU. Enrichment broth did not enhance the detection of Gram-negative bacteria compared to direct plating on Chromogenic UTI medium, but enrichment broths were needed for optimal detection of resistant Gram-positive bacteria.

  • 43.
    Hällgren, Anita
    et al.
    Department ofMolecularandClinicalMedicine Linköping University.
    Claesson, Carina
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
    Saeedi, Baharak
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Microbiology.
    Monstein, Hans-Jurg
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Nilsson, Lennart
    Linköping University, Department of Clinical and Experimental Medicine, Clinical Microbiology . Linköping University, Faculty of Health Sciences.
    Molecular detection of aggregation substance, enterococcal surface protein, and cytolysin genes and in vitro adhesion to urinary catheters of Enterococcus faecalis and E. faecium of clinical origin2009In: International Journal of Medical Microbiology, ISSN 1438-4221, E-ISSN 1618-0607, Vol. 299, no 5, p. 323-332Article in journal (Refereed)
    Abstract [en]

    It has been hypothesized that nosocomial enterococci might have virulence factors that enhance their ability to colonise hospitalised patients. The objectives of this study were to investigate the prevalence of genes encoding 3 virulence factors: aggregation substance (asa1), enterococcal surface protein (esp), and 5 genes within the cytolysin operon (cylA, cylB, cylM, cylL(L), cylL(S)) and cytolysin production in 115 enterococcal clinical isolates (21 Enterococcus faecium and 94 E. faecalis). Adhesion to siliconized latex urinary catheters in relation to presence of esp was analysed in a subset of isolates. The isolates were previously characterised by pulsed-field gel electrophoresis (PFGE). esp was the only virulence gene found in E. faecium. It was found in 71% of the 21 E. faecium isolates. asa1, esp, and the cyl operon were found in 79%, 73% and 13% respectively, of the 94 E. faecalis isolates. There was a complete agreement between presence of the cyl operon and phenotypic cytolysin production. Isolates belonging to a cluster of genetically related isolates carried esp and asa1 more often when compared to unique isolates. No difference was found with respect to cyl genes. E. faecalis isolates adhered with higher bacterial densities than E. faecium. E. faecalis isolates within the same PFGE cluster adhered with similar bacterial densities, but there was no association between adhesion and the presence of esp when isolates within the same cluster were compared. In conclusion, E. faecalis isolates with high-level gentamicin resistance (HLGR) belonging to clusters of genetically related isolates widely distributed in Swedish hospitals, were likely to carry both esp and asa1. Adhesion was not affected by esp.   

  • 44.
    Hällgren, Anita
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Claesson, Carina
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Saeedi, Baharak
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Monstein, Hans-Jürg
    Linköping University, Department of Biomedicine and Surgery. Linköping University, Faculty of Health Sciences.
    Hanberger, Håkan
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Nilsson, Lennart E.
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Frequency of aggregation substance, cytolysin and enterococcal surface protein in vitro adhesion to urinary catheters of E. faecalis and E. faecium of clinical originManuscript (preprint) (Other academic)
    Abstract [sv]

    Enterococcal isolates, 21 E. faecium and 94 E. faecalis, isolated from blood cultures, rectal specimens and various other clinical samples were examined for the presence of the virulence factors hemolysin/cytolysin, aggregation substance (asa1) and enterococcal surface protein (esp). The isolates were previously characterized by pulsed-field gel electrophoresis (PFGE). Adhesion to siliconized latex urinary catheters was analysed in 14 clinical isolates and 3 control strains. Densities of adhering bacteria were determined by a bioluminescence assay of bacterial ATP. The only virulence factor found in E. faecium, esp, was found in 71% of the 21 E. faceium isolates. Cytolysin production, asa1 and esp were found in 13%, 79% and 73%, respectively, of the 94 E. faecalis isolates. Isolates belonging to a cluster of genetically related isolates differed significantly with respect to carriage of esp and asa1 compared to unique isolates, with the virulence factors more commonly found among clustered isolates (p<0.01). No difference was found with respect to cytolysio production (p = 0.76). E. faecalis isolates adhered with higher bacterial densities than E. faecium. E. faecalis isolates within the same PFGE cluster adhered with similar bacterial densities, but there was no association between adhesion and the presence of esp when isolates within the same cluster were compared (p = 0.38 and 0.64).

  • 45.
    Hällgren, Anita
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Saeedi, Baharak
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Nilsson, Maud
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Monstein, Hans-Jürg
    Linköping University, Department of Biomedicine and Surgery. Linköping University, Faculty of Health Sciences.
    Isaksson, Barbro
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Hanberger, Håkan
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Nilsson, Lennart
    Linköping University, Department of Molecular and Clinical Medicine, Clinical Microbiology. Linköping University, Faculty of Health Sciences.
    Genetic relatedness among Enterococcus faecalis with transposon-mediated high-level gentamicin resistance in Swedish intensive care units2003In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 52, no 2, p. 162-167Article in journal (Refereed)
    Abstract [en]

    We studied 45 isolates of Enterococcus faecalis with high-level gentamicin resistance (HLGR), all but one concomitantly resistant to ciprofloxacin, and 25 ciprofloxacin-resistant isolates without HLGR for genetic relatedness using pulsed-field gel electrophoresis (PFGE). E. faecalis were isolated from patients admitted to intensive care units at eight hospitals in southern Sweden from December 1996 through December 1998. Genomic analysis by PFGE resulted in three clusters of genetically related isolates (designated clusters I, II and III) and 23 unique clones. Cluster I was found predominantly in the eastern and central parts of southern Sweden and clusters II and III in south-western Sweden. Among the 45 isolates with HLGR, 69% belonged to cluster I, 20% to cluster II, and 11% had unique PFGE patterns, which suggests that the majority of isolates with HLGR are closely related. Among the 25 ciprofloxacin-resistant isolates without HLGR, 68% had unique PFGE patterns, 12% belonged to cluster I and 20% to cluster III, which suggests the ciprofloxacin-resistant isolates are not related. All isolates with HLGR contained the aac(6)Ie-aph(2)Ia gene, which was carried on a Tn5281-like transposon in all isolates except one. We conclude that HLGR in E. faecalis was mainly due to dissemination of genetically related clones during the time studied, and that HLGR in these isolates was due to the presence of the aac(6)Ie-aph(2)Ia gene.

  • 46.
    Håkan, Hanberger
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Medicine, Department of Infectious Diseases in Östergötland.
    Odenholt, I.
    Universitetssjukhuset MAS, Malmö, Sweden.
    Giske, C.G.
    Karolinska universitetssjukhuset, Sweden.
    Kahlmeter, G.
    Uppsala universitet, Kliniskt mikrobiologiska laboratoriet, Centrallasarettet, Växjö, Sweden.
    Cefalosporinerna bör ersättas med smalare och mer riktad behandling2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 38Article in journal (Refereed)
    Abstract [en]

    [No abstract available]

  • 47.
    Isaksson, Barbro
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Maller, Rolf
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Nilsson, Lennart E
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, Maud
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Synergic post-antibiotic effect of amikacin in combination with beta-lactam antibiotics on gram-negative bacteria.1991In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 28, no 1, p. 25-34Article in journal (Refereed)
    Abstract [en]

    The post-antibiotic effect (PAE) of amikacin alone and in combination with ceftazidime, ceftriaxone and piperacillin was studied for two strains each of Pseudomonas aeruginosa and Serratia marcescens using a bioluminescent assay of bacterial ATP. Two models were used for combining beta-lactam antibiotics and amikacin: in one model the cultures were incubated with 32 mg/L of ceftazidime, 128 mg/L of ceftriaxone or 32 mg/L of piperacillin for 1 h. Different concentrations of amikacin (0.5-64 mg/L) were then added. Incubation of the combinations continued for one more hour. The antibiotics were eliminated by dilution. In the second model tested, one strain of S. marcescens was simultaneously exposed to amikacin and a beta-lactam antibiotic for 2 h. The PAEs produced by the drugs in combination were longer than the sum of the individual effects of the drugs when they were used alone. Results were equally good with both models. A synergic PAE was also found with amikacin concentrations close to the MIC in combination with low concentrations of ceftazidime, ceftriaxone and piperacillin.

  • 48.
    Isaksson, Barbro
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Maller, Rolf
    Linköping University, Department of Molecular and Clinical Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    Nilsson, Lennart E
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Nilsson, Maud
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Health Sciences.
    Synergistic post-antibiotic effect of amikacin and beta-lactam antibiotics on Enterococcus faecalis.1991In: Journal of Antimicrobial Chemotherapy, ISSN 0305-7453, E-ISSN 1460-2091, Vol. 27, p. 9-14Article in journal (Refereed)
    Abstract [en]

    The in-vitro post-antibiotic effect (PAE) of amikacin alone and in combination with ceftazidime, ceftriaxone and piperacillin was studied for two strains of Enterococcus faecalis using a bioluminescent assay of bacterial ATP. The two strains of E. faecalis were resistant to amikacin, ceftazidime and ceftriaxone but sensitive to piperacillin. The bacterial cultures were incubated with the beta-lactam antibiotics for 1 h and concentrations of amikacin between 2-64 mg/l were then added. Thereafter, incubation continued with the combinations for one more hour. After dilution, regrowth was monitored by measuring bacterial ATP every hour. Increasing concentrations of amikacin (2-64 mg/l), ceftazidime (8-32 mg/l) and ceftriaxone (32-128 mg/l) resulted in little or no PAE (0-0.3 h) on these strains. PAEs of 0.5 to 1.6 h resulted from exposure to piperacillin (4-32 mg/l). In combination amikacin and piperacillin increased the PAE to 5.5 h. A synergistic PAE was also seen when the enterococci were exposed to amikacin combined with ceftazidime or ceftriaxone in concentrations close to the MICs of the latter antibiotics.

  • 49.
    Johansson, M
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences.
    M Phuong, D
    Department of Microbiology, Bach Mai Hospital, Hanoi, Vietnam.
    Walther, Sten
    Linköping University, Department of Medical and Health Sciences, Physiology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Thoracic and Vascular Surgery in Östergötland.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Infectious Diseases. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Centre, Department of Infectious Diseases in Östergötland.
    Need for improved antimicrobial and infection control stewardship in Vietnamese intensive care units2011In: TROPICAL MEDICINE and INTERNATIONAL HEALTH, ISSN 1360-2276, Vol. 16, no 6, p. 737-743Article in journal (Refereed)
    Abstract [en]

    Pandgt;Objective Survey of antibiotic consumption, microbial resistance and hygiene precautions in the intensive care units of three hospitals in northern Vietnam. Methods Observational study. Data were collected from the microbiological laboratories. Antibiotic consumption was determined based on quantities of drugs delivered from the pharmacy. A protocol to observe the application of hygiene precautions was developed and used. Bacteria were typed and tested for drug susceptibility using the disc-diffusion method. Results The mean antibiotic consumption was 811 defined daily doses per 1000 occupied bed days. The most commonly used antibiotics were third-generation cephalosporins, followed by carbapenems, amoxicillin and ampicillin. Eighty per cent of bacterial isolates were Gram-negative. The most common pathogens found in blood cultures were Escherichia coli and Klebsiella spp., Pseudomonas spp., Acinetobacter spp., Staphylococcus aureus and Enterococcus faecalis. Acinetobacter and Pseudomonas spp. were the two most frequently isolated bacteria from the respiratory tract and all other sources together. Seventy per cent of Acinetobacter species showed reduced susceptibility to imipenem, 80% to ciprofloxacin and 89% to ceftazidime. Forty-four per cent of Pseudomonas spp. showed reduced susceptibility to imipenem, 49% to ciprofloxacin and 49% to ceftazidime. Escherichia coli was fully susceptible to imipenem, but 57% of samples were resistant to both ciprofloxacin and cefotaxime. Hygiene precautions were poor, and fewer than 50% of patient contacts incorporated appropriate hand hygiene. Conclusion Low antibiotic consumption, poor hygiene precautions and the high level of antibiotic resistance indicate that there is room for improvement regarding antibiotic use and infection control.

  • 50.
    Leander, Gunilla
    et al.
    Blekingesjukhuset, Karlskrona.
    Eliasson, Erik
    Institutionen för laboratoriemedicin, Karolinska institutet, Karolinska universitetssjukhuset, Sweden.
    Hanberger, Håkan
    Linköping University, Department of Clinical and Experimental Medicine, Division of Microbiology and Molecular Medicine. Linköping University, Faculty of Medicine and Health Sciences. Östergötlands Läns Landsting, Heart and Medicine Center, Department of Infectious Diseases.
    Giske, CG
    Klinisk mikrobiologi, Karolinska universitetssjukhuset, Sweden.
    Betalaktamantibiotika och frågan om dosregim vid svår infektion: Förlängd infusion teoretiskt tilltalande – Ännu saknas evidens för klinisk nytta2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, no 13, article id CW3PArticle in journal (Refereed)
    Abstract [sv]

    Betalaktamantibiotika är första­handsmedel vid svår sepsis/septisk chock.

    Djurstudier visar att den fria antibiotikakoncentrationen i blodet bör överstiga den koncentration som krävs för att hämma bakterietillväxt (MIC) under minst 50 procent av dygnet för maximal effekt av betalaktamantibiotika. 

    Infusion av betalaktamer under flera timmar eller kontinuerlig infusion kan teoretiskt öka tiden över MIC jämfört med dagens standardadministration av bolusdoser.

    Enligt denna litteraturgenomgång saknas evidens för säker skillnad i klinisk effekt mellan kontinuerlig infusion, förlängd infusion eller standardbolusdos av betalaktamantibiotika. Inkluderade studier är mycket heterogena avseende bl a patienturval, infektionsfokus, bakteriella agens och doseringsregimer.  

    I avvaktan på resultat från nya studier bör patienter med svår sepsis, framför allt vid septisk chock, ges höga och täta intermittenta betalaktamdoser alternativt förlängd infusion i syfte att nå fri antibiotikakoncentration i blodet, som överstiger MIC under minst halva dosintervallet.

12 1 - 50 of 73
CiteExportLink to result list
Permanent link
Cite
Citation style
  • apa
  • harvard1
  • ieee
  • modern-language-association-8th-edition
  • vancouver
  • oxford
  • Other style
More styles
Language
  • de-DE
  • en-GB
  • en-US
  • fi-FI
  • nn-NO
  • nn-NB
  • sv-SE
  • Other locale
More languages
Output format
  • html
  • text
  • asciidoc
  • rtf