Utilization of blood cultures in Danish hospitals: a population-based descriptive analysis.

This national population-based study was conducted as part of the development of a national automated surveillance system for hospital-acquired bacteraemia and ascertains the utilization of blood cultures (BCs). A primary objective was to understand how local differences may affect interpretation of nationwide surveillance for bacteraemia. From the Danish Microbiology Database, we retrieved all BCs taken between 2010 and 2013 and linked these to admission data from the National Patient Registry. In total, 4 587 295 admissions were registered, and in 11%, at least one BC was taken. Almost 50% of BCs were taken at admission. The chance of having a BC taken declined over the next days but increased after 4 days of admission. Data linkage identified 876 290 days on which at least one BC was taken; 6.4% yielded positive results. Ten species, Escherichia coli, Staphylococcus aureus, Klebsiella pneumoniae, Streptococcus pneumoniae, Enterococcus faecium, Enterococcus faecalis, Pseudomonas aeruginosa, Candida albicans, Enterobacter cloacae and Klebsiella oxytoca, accounted for 74.7% of agents for this purpose classified as pathogenic. An increase in BCs and positive BCs was observed over time, particularly among older patients. BCs showed a seasonal pattern overall and for S. pneumoniae particularly. A predominance of male patients was seen for bacteraemias due to S. aureus, E. faecium and K. pneumoniae. Minor differences in BCs and positive BCs between departments of clinical microbiology underpin the rationale of a future automated surveillance for bacteraemia. The study also provides important knowledge for interpretation of surveillance of invasive infections more generally.

Epidemiological changes with potential implication for antifungal prescription recommendations for fungaemia: data from a nationwide fungaemia surveillance programme.

Significant changes in the management of fungaemia have occurred over the last decade with increased use of fluconazole prophylaxis, of empirical treatment and of echinocandins as first-line agents for documented disease. These changes may impact the epidemiology of fungaemia. We present nationwide data for Denmark from 2010 to 2011. A total of 1081 isolates from 1047 episodes were recorded in 995 patients. The numbers of patients, episodes and recovered isolates increased by 13.1%, 14.5% and 14.1%, respectively, from 2010 to 2011. The incidence rate was significantly higher in 2011 (10.05/100 000) than in 2010 (8.82/100 000), but remained constant in the age groups 0-79 years. The incidence rate was highest at the extremes of age and in males. Candida albicans accounted for 52.1% but declined during 2004-11 (p 0.0155). Candida glabrata accounted for 28% and increased during 2004-2011 (p <0.0001). Candida krusei, Candida tropicalis and Candida parapsilosis remained rare (3.3-4.2%). The species distribution changed with increasing age (fewer C. parapsilosis and more C. glabrata) and by study centre. Overall, the susceptibility rates were: amphotericin B 97.3%, anidulafungin 93.8%, fluconazole 66.7%, itraconazole 69.6%, posaconazole 64.2% and voriconazole 85.0%. Acquired echinocandin resistance was molecularly confirmed in three isolates. The use of systemic antifungals doubled over the last decade (2002-2011) (from 717 000 to 1 450 000 defined daily doses/year) of which the vast majority (96.9%) were azoles. The incidence of fungaemia continues to increase in Denmark and is associated with a decreasing proportion being susceptible to fluconazole. Changes in demography, higher incidence in the elderly and higher antifungal consumption can at least in part explain the changes.

[Clinical microbiological service in general practice in the municipality of Copenhagen. Experiences from the clinical microbiological department at the Hvidovre Hospital 1987-1991]. / Klinisk mikrobiologisk betjening af praksissektoren i Københavns Kommune. Erfaringer fra Hvidovre Hospitals klinisk mikrobiologiske afdeling 1987-1991.

Since 1987, the clinical microbiological department in Hvidovre Hospital has served physicians in primary health care in the municipality of Copenhagen with microbiological diagnoses and instruction. This paper describes the service model and experience gained during the past four years. During the observation period, the annual number of analyses doubled. In 1990, 66,460 analyses were performed for a total of 399 physicians. The number of specimens per physician varied from 1 to 1903 with a median value of 95. Chlamydia specimens (CS) and vaginal discharge specimens (VDS) examined for yeasts, Gardnerella and Trichomonas comprised the two largest categories. In spite of the increasing number of specimens, the overall rate of positive samples remained unchanged. Physicians who sent many CS in 1990 scored a significantly lower positive rate than physicians who sent few, however, no corresponding difference was demonstrable for VDS. Thus, there is scarcely evidence to assume that microbiological specimens are taken on less strict indications than previously. The increasing number of specimens reflects rather a hitherto uncovered need for microbiological diagnosis in primary health care. Specialists scored significantly lower positive rates for CS and VDS than general practitioners, which may indicate that these specimens are often repeated unnecessarily, when a patient is referred to a specialist. With a view to decentralizing selected categories of specimens, including VDS, courses in microscopy were held, in which one fourth of the physicians of the region participated. A questionnaire survey evaluating the course showed that there is a great interest among physicians in primary health care to perform simplified microbiological diagnosis, but there is still a great need for training and education.

Phenotypical properties of Enterobacter agglomerans (Pantoea agglomerans) from human, animal and plant sources.

Clinical, animal and plant isolates, representing different geographical areas, were identified as Enterobacter agglomerans (Pantoea agglomerans) using a quantitative bacterial dot method for DNA-DNA hybridization. The phenotypical properties of the 65 strains were investigated by conventional test methods. No strain decarboxylated ornithine. Twenty-two strains, mainly plant isolates, showed delayed acid production from alpha-methyl-glycoside, a trait which may have ecological significance. With regard to these two properties, our results differed from the description of Pantoea agglomerans given by Gavini et al. (6); further investigations will clarify these differences. Three non-pigmented, maltose-negative and salicin-negative variants were derived from yellow pigmented, maltose-positive, salicin-positive strains.

Nosocomial outbreak of cryptosporidiosis in AIDS patients.

OBJECTIVE: To describe a nosocomial outbreak of cryptosporidiosis during four months after June 1989. SETTING: A department of infectious diseases in Copenhagen, seeing about half the patients with AIDS in Denmark. SUBJECTS: 73 HIV antibody negative subjects and 60 antibody positive subjects admitted as inpatients during the transmission period of the outbreak (20 June-14 August), of whom 18 (17 with AIDS, one with AIDS related complex), developed cryptosporidiosis. Two further HIV negative subjects (one departmental secretary, one visiting relative) developed cryptosporidiosis. MAIN OUTCOME MEASURES: Cryptosporidia in stool samples, clinical symptoms, CD4 cell count, HIV antigen concentration, chemotherapeutic treatment. RESULTS: The source of the outbreak was identified as ice from an ice machine in the ward, contaminated by an incontinent, psychotic patient with cryptosporidiosis picking out ice for cold drinks. The mean incubation time was at least 13 days-that is, twice that in HIV-negative patients. Of the 18 patients with AIDS who developed cryptosporidiosis, five recovered, two were symptomless carriers, three died of unrelated causes, and eight died after prolonged diarrhoea. Among the 57 exposed HIV antibody positive inpatients (excluding two patients and the index case with cryptosporidiosis diagnosed elsewhere), significantly more of those who developed symptomatic cryptosporidiosis received oral sulphonamides than those who did not (91%, 10/11 v 48%, 21/44, p less than 0.05). CONCLUSIONS: The clinical and epidemiological findings indicate that infection was the consequence of very small inocula. Increased sensitivity to cryptosporidiosis may be an unrecognised side effect of oral sulphonamide treatment in patients with AIDS.

Phage-typing of coagulase-negative staphylococci. Factors influencing typability.

Factors influencing the phage-typability of coagulase-negative Micrococcaceae have been studied in 2,778 clinical isolates comprising A) 209 consecutive isolates from one laboratory, B) 2,107 clinical strains submitted for phage-typing for epidemiological reasons, and C) 462 strains representing all isolates of presumed clinical significance found in two laboratories during one month. The reproducibility was acceptable at duplicate repeated typing of the same strains as well as by typing epidemiologically-related pairs of strains from the same patient. Strains of Staphylococcus haemolyticus were seldom typable, whereas strains of S. epidermidis and S. hominis had a higher typability. Methicillin-resistant strains and other multiple-resistant strains were rarely typable (11-13%). The typability was higher among susceptible strains (36%) and strains resistant to penicillin only (43-50%). The typability of strains of the same species and antibiotic-resistance pattern differed between hospitals compared and decreased markedly over the years for multiple-resistant S. epidermidis isolates.

Mixed bacterial meningitis in an adult caused by Haemophilus influenzae and Streptococcus pneumoniae. A case report.

A case of mixed bacterial meningitis with Haemophilus influenzae and Streptococcus pneumoniae is reported in a 26-year-old woman without demonstrable predisposing conditions, who recovered after treatment with ampicillin, without sequelae.

[Fatal catheter septicemia with finding of Candida lusitaniae]. / Letal kateterseptikaemi med fund af Candida lusitaniae.

A case of lethal pulmonary infection after catheter septicaemia with demonstration of C. lusitaniae in the blood is reported in a 73 year old patient with terminal Crohn's disease receiving long-term parenteral nutrition.

The DANOP-DATA system: a low-cost personal computer based program for monitoring of wound infections in surgical ward.

A low-cost personal computer program to monitor surgical wound infections was developed in parallel to the Danish national guidelines for recording postoperative wound infections. Internationally accepted definitions were used. The program offers three fixed-data entry screens and produces user-specified variations of four standard tables, comprising most of the epidemiological data needed for surveillance and infection control. The program was tested in Danish hospitals and was found to serve well as a simple local tool for the operating staff, offering fast information on infection rates. Results from two hospitals consisting of 3904 operations are presented. Infections occurring after discharge were included. Overall infection rates for clean wounds were 2.3%, clean-contaminated wounds 4.7%, contaminated wounds 4.3% and dirty operations 8.3%. None of the hospitals had used infection surveillance systems before.

[Postoperative wound infections at a mixed surgical department. 1 year's registration employing a PC-based system]. / Postoperative sårinfektioner på en blandet kirurgisk afdeling. Et års registrering ved hjaelp af et PC-baseret system.

Operation wounds and surgical wound infections (S.W.I.) in the surgical department of Holbaek County Hospital were recorded over a period of one year. This registration was conducted in co-operation with the National Centre for Hospital Hygiene to test a standardised and simplified registration system and edb-programme, the Danop-Data system, developed to record S.W.I. on PC. 1.377 wounds and 45 S.W.I. were recorded. The overall infection rate was 3.3%. This compares favourably with rates reported in more extensive foreign investigations. There were significantly fewer infections during the second six months than during the first six month of the year. This was not due to changed conditions during the period of registration. The registration system and the edb-programme provide a satisfactory method of continuous surveillance of S.W.I. At the same time, the system itself proved very easy to use.

[Registration of postoperative wound infections by ADB. A trial of the Danop program]. / Registrering af postoperative sårinfektioner på edb. En afprøvning af programmet Danop.

The EDB programme, Danop, which was developed in cooperation with Statens Seruminstitut which is the central department for hospital hygeine in Denmark, was employed during the period 1.7.1987-30.6.1988 for consecutive registration of operative interventions and postoperative wound infection. During the period, 1,660 interventions were registered with a total frequency of infection of 3.5%; 2.6% of these in clean cases and 13.8% in infected cases. About one third of the infections were demonstrated by the general practitioners after discharge. In connection with introduction of registration, a considerable decrease in the number of postoperative wound infections occurred. It is decisive for the employability of the system that a reliable procedure for registration and return information is organized. The system is easy to use and functions well and does not require prior knowledge of edb and it provides excellent current control of and review of postoperative wound infections in one or more departments.

[The Danop Data System for decentralized postoperative surveillance of wound infections]. / Decentral overvågning af postoperative sårinfektioner med Danop data system.

The Danop Data System is a microcomputer system designed for the local (ward) surveillance of postoperative surgical infections. The system is served by a simply operated microcomputer program capable of tabulating data input in four standard tables providing continuous information sufficient for surveillance purposes. The aim is that, within a five-year period, 50 per cent of all Danish hospitals will adopt this or similar systems. The system is envisaged as a preliminary to more systematic surveillance of all nosocomial infections.

Colonization priority among Staphylococcus aureus strains--correlation with phage-type.

We have studied the distribution of phage-type patterns among strains of Staphylococcus aureus isolated from patients in a burns unit. From 51 patients the same phage-type was isolated from succeeding swabs during the observation period. In 20 patients new types were introduced, but the original strain remained. In 23 patients the first strain was replaced by one other strain, in eight patients two or more. Strains of type 95 seemed to have a high colonization priority, whereas strains of group III had a low one. In 1986 phage-typing was performed on two or more S. aureus strains from the same patient, in 4561 instances. Recurrence of strains of the same phage-type pattern was demonstrated in 70% of the patients when the first and the fourth sample were compared. The "newer epidemic" strains of phage-type 95 and of the 94,96 complex had the highest percentage of recurrence (more than 80%) when adjacent samples were compared, and 68-69% when the first and the fourth sample were compared. The good colonization capacity of these strains might be one of the explanations why they occur frequently today although they are resistant only to penicillin.

Detection of staphylococcal toxic shock syndrome toxin 1 by a latex agglutination kit.

A commercial reversed passive latex agglutination kit (Oxoid), that detects toxic shock syndrome toxin 1 (TSST-1), was evaluated for its ability to support the clinical diagnosis of toxic shock syndrome (TSS) by detecting the presence of TSST-1 producing Staphylococcus aureus. 15/16 isolates from patients with TSS were positive, while 4/50 vaginal isolates from patients without TSS were positive. The kit can be recommended as it was easy to handle, and gave results identical with those obtained by a standard assay.

Two isolations of enteric group 69 from human clinical specimens.

Enteric Group 69 has previously only been isolated from beef muscle. Two cases of isolations from human clinical specimens are reported on here: One from a throat swab and one from an abscess. In both cases, only EG 69 was cultured. This group has biochemical reactions similar to Enterobacter cloacae and Enterobacter sakazakii. EG 69 produces yellow pigment as E. sakazakii but only the former ferments sorbitol and dulcitol. EG 69 utilizes malonate and usually ferments sucrose slowly (3-4 days). EG 69 is distinguished from E. Cloacae by production of yellow pigment, fermentation of dulcitol and usually late fermentation of sucrose. EG 69 was found resistant to ampicillin and carbenicillin and susceptible to cephalothin. The pathogenic potential for man is still questionable, but EG 69 is shown to occur in human clinical specimens.

Continuous ambulatory peritoneal dialysis: microbiological diagnosis in peritonitis.

Dialysate samples from 29 Continuous Ambulatory Peritoneal Patients (CAPD)-patients were taken in periods with and without peritonitis and cultured simultaneously in the Hemobact system and on conventional plate media, using a standard technique. Bacteria were demonstrated in 23 (92%) of 25 CAPD-patients with peritonitis by the Hemobact method and only in 6 (24%) by the standard technique. Sixty-four (100%) of the 64 samples taken during periods without peritonitis were negative by the standard technique. Sixty-two (97%) of the 64 samples were negative in the Hemobact system. In the remaining two samples coagulase negative staphylococci were demonstrated on the third day in only one of the bottles. In conclusion, blood cultivation systems should be preferred to conventional standard methods for adequate microbiological diagnosis in CAPD-patients with peritonitis.