Asbjørn Digranes

Candidemia in Norway (1991 to 2003): Results from a Nationwide Study

ABSTRACT A long-term, nationwide prospective candidemia study has been ongoing in Norway since 1991. All medical microbiological laboratories in the country have participated. During the period 1991 to 2003 a total of 1,393 episodes of candidemia occurred in 1,348 patients. The incidence of candidemia episodes per 100,000 inhabitants increased from approximately 2 episodes in the early 1990s to 3 episodes in 2001 to 2003. The average annual incidences varied markedly between the age groups. The incidence was high in patients aged <1 year and in patients aged ≥70 years. In patients ≥80 years of age, the incidence has increased during the last 3 years from an annual average of 6.5 to 15.6 cases/100,000 inhabitants in 2003. Four Candida species (C. albicans [70%], C. glabrata [13%], C. tropicalis [7%], and C. parapsilosis [6%]) accounted for 95.5% of the isolates. The species distribution has been constant during the 13-year study period. The distribution of the most important species varied with the age of the patient. In patients <1 year of age, the majority of episodes were caused by C. albicans (91%). The occurrence of C. glabrata increased with age. In patients ≥80 years of age, approximately 1/3 of all episodes were due to this species. All C. albicans strains were susceptible to fluconazole. The percentage of yeast isolates with decreased susceptibility to fluconazole (MICs ≥ 16 μg/ml) was 10.7% during the first period of this study (1991 to 1996) and 11.7% during the second period (1997 to 2003).

Acupuncture Treatment in the Prevention of Uncomplicated Recurrent Lower Urinary Tract Infections in Adult Women

Acute lower urinary tract infections (UTIs) are common in adult women, and as many as 6% of members of the adult female population experience 3 or more episodes during a given year.1 In 1995, an estimated 11.3 million women in the United States received antibiotic treatment for at least 1 presumed UTI, resulting in associated costs of

A multi-centre prospective study of febrile neutropenia in Norway: Microbiological findings and antimicrobial susceptibility

1.6 billion during that year.2 Women with frequently recurrent cystitis may need prophylactic antibacterial treatment. However, such treatment may result in development of antimicrobial resistance, which is a medical problem of increasing concern.3 A recent study indicated that the rate of cystitis among cystitis-prone women treated with acupuncture was one third the rate among untreated women and half the rate among women treated by sham acupuncture (shallow needling outside known acupuncture points).4 In the present study, we sought to evaluate the effect of acupuncture treatment in preventing uncomplicated recurrent lower UTIs among adult nonpregnant women.

Bacteriuria in patients treated with clean intermittent catheterization

The urgent need to treat presumptive bacterial or fungal infections in neutropenic patients has meant that initial therapy is empiric and based on the pathogens most likely to be responsible, and drug resistance. The traditional empirical treatment in Norway has been penicillin G and an aminoglycoside, and this combination has been criticized over recent y. We wished to analyse the microbiological spectrum and susceptibility patterns of pathogens causing bacteraemia in febrile neutropenic patients. This was a prospective multicentre study. During the study period of 2 y, a total of 282 episodes of fever involving 243 neutropenic patients was observed. In 34% of episodes bacteraemia was documented. Overall, 40% of the episodes were caused by Gram-positive organisms, 41% by Gram-negative organisms and 19% were polymicrobial. The most frequently isolated bacteria were Escherichia coli (25.6%), α- and non-haemolytic streptococci (15.6%), coagulase-negative staphylococci (12.4%) and Klebsiella spp. (7.4%). None of the Gram-negative isolates was resistant to gentamicin, meropenem, ceftazidime or ciprofloxacin. Only 5 coagulase-negative staphylococci isolates were resistant to both penicillin G and aminoglycoside. The overall mortality rate was 7%, and 1.2% due to confirmed bacteraemic infection.

Bacteriological findings in the transtracheal aspirate from patients with acute exacerbation of chronic bronchitis

Bacteriuria has been studied in 407 patients treated with clean intermittent catheterization (CIC) during 1 year. Significant bacteriuria was found in 50.6% of 1413 analyzed urine samples. Escherichia coli was the dominating species (54.8%). The relative distribution of species was different in males and females, but there were no differences between the CIC patients and a reference group of outpatients. On the other hand, a higher frequency of resistance among enterobacteria was found in samples from CIC patients compared to the reference group. The majority of CIC patients with bacteriuria had no symptoms, and bacteriuria per se does not seem to be an indication for treatment in most of these patients.

Use of single-dose ofloxacin to eradicate tonsillopharyngeal carriage of Neisseria meningitidis.

SummaryTranstracheal aspirates from 87 patients with acute exacerbations of chronic bronchitis who had received no recent antibiotic treatment were examined. A single bacterial species was found in 83% of positive cultures. Predominant pathogens wereHaemophilus influenzae andStreptococcus pneumoniae which occurred jointly or separately in 50% of positive cultures. Bacteria traditionally considered as non-pathogenic for the lower respiratory tract also appeared to play an aetiological role.Enterobacteriaceae and anaerobes were infrequent. No bacterial growth was found in 11 cases.ZusammenfassungDas Transtrachealaspirat von 87 Patienten mit antibiotisch unbehandelter, akuter Exazerbation einer chronischen Bronchitis wurde bakteriologisch untersucht. In 83% der positiven Kulturen wurde nur eine Bakterienart nachgewiesen. Die weit vorwiegenden Befunde warenHaemophilus influenzae undStreptococcus pneumoniae die, vereinzelt oder gemeinsam, in 50% der positiven Kulturen auftraten. Auch Bakterienspezies, die in bezug auf die Luftwege gewöhnlich als nicht pathogen betrachtet werden, waren anscheinend von ätiologischer Bedeutung.Enterobacteriaceae und Anaerobier wurden selten isoliert. In 11 Fällen wurden keine Bakterien nachgewiesen.

Assessment of clinical features predicting streptococcal pharyngitis.

After an outbreak of three cases of serogroup B meningococcal disease at a Norwegian college, 84 of 392 (21%) subjects were tonsillopharyngeal carriers of Neisseria meningitidis. To eradicate meningococcal carriage, 80 volunteers received a single dose of 400 mg of ofloxacin. Three days after treatment, all 75 evaluable volunteers were culture negative for N. meningitidis, and after 7 days none carried the strain that they carried initially, as judged by DNA fingerprinting. A single dose of ofloxacin was found to be 97.2% effective in eradicating carriage of N. meningitidis for a period of 33 days. The carriage acquisition rate among treated students was four times higher than that among nontreated noncarriers (P = 0.02). After ofloxacin treatment, no case of meningococcal disease occurred for 6 months. Ofloxacin may thus prevent the outbreak and spread of meningococcal disease.

Are resistance patterns in uropathogens published by microbiological laboratories valid for general practice

A total of 133 patients who consulted 4 general practitioners in Bergen 1988/89 for sore throat were examined. 8 clinical parameters with expected predictive value for identifying streptococcal tonsillopharyngitis were recorded. Clinical examination was validated against bacteriologic examination at a microbiological laboratory. The prevalence of streptococcal infection (group A, C and G) was 29%. An algorithm was constructed which identifies 3 groups with varying probabilities of streptococcal infection. A positive predictive value of 62% in the group with highest prevalence and a negative predictive value of 90% in the group with lowest prevalence was found. The consequences of performing a confirmative test only on patients in the group with uncertain prediction for streptococcal disease was elaborated. Although slightly reduced accuracy was demonstrated, due to diminished sensitivity, selective testing is recommended. Another algorithm was constructed for use in situations where no confirmative testing is available. The positive predictive value in the group with highest probability of streptococcal infection was 51%, and the negative predictive value in the group with lowest probability was 84%.

Low Faecal Carrier Rate of Vancomycin Resistant Enterococci in Norwegian Hospital Patients

During 7 months from August 1994, 171 urine samples were collected consecutively in general practice in Western Norway from female patients with suspected lower urinary tract infection. For each of the 171 samples, 2 samples from adult females received from general practice at the microbiological laboratory on the same day were selected using a predetermined system. Samples noted as treatment controls and samples from pregnant patients were discarded. Bacteriuria was found in 101/171 (59.1%) vs 220/342 (64.3%) of the samples. The general practice material contained more bacteriuric samples with Escherichia coli (83.2% vs 71.8%, p<0.05) and Staphylococcus saprophyticus (11.9 vs 6.4%), and fewer with other Gram‐negative rods (4.0% vs 15.9%, p<0.01) and enterococci (1.0% vs 5.9%, p<0.01). The frequency of resistant isolates was substantially lower in the samples from general practice for all antibacterial agents tested: amoxycillin 18.9% vs 23.9%, mecillinam 1.1% vs 4.7%, trimethoprim 12.9% vs 18.5%, cotrimoxazole 12.0% vs 15.4%, sulphonamide 20.0% vs 28.4%, nitrofurantoin 3.0% vs 9.7% (p<0.05). Data from local laboratories exaggerate the resistance problems among uropathogens found in urine samples in general practice.

Outbreak of meningococcal disease in western Norway due to a new serogroup C variant of the ET-5 clone: effect of vaccination and selective carriage eradication.

The faecal carrier rate of vancomycin resistant enterococci (VRE) was surveyed among 616 patients in selected departments of 7 Norwegian hospitals. One Enterococcus gallinarum isolate harbouring a vanB2 element was recovered from a child with malignant disease treated with vancomycin and ceftazidime. No vancomycin resistant Enterococcus faecalis or Enterococcus faecium were detected and no VRE isolates of the VanA type were identified. The low level of VRE carriage corresponds to the limited use of glycopeptide antibiotics for human therapeutic purposes in Norway. It indicates a low risk of acquiring VRE infections in Norwegian hospitals.