Treatment for respiratory tract infections (RTI) in the primary care setting is empirical. Antibiotic prescribing patterns differ among countries and are based on the prevalence of antibiotic ...resistance in the geographical area. The aim of this study was to compare the antibiotics prescribed by general practitioners (GPs) for RTIs between Spain and Denmark.
Observational multicenter survey carried out in the primary healthcare setting. Two groups of GPs in Spain and Denmark recorded all contacts with RTI patients during a 3-week period between November 2001 and January 2002.
A total of 2833 RTI cases were registered. Broad-spectrum penicillins and combinations of these drugs plus beta-lactamase inhibitors were the antibiotics most frequently prescribed by Spanish GPs (62.3%), followed by macrolides (22.3%). In contrast, narrow-spectrum penicillins were most commonly prescribed by Danish GPs (58% of all prescriptions), followed by macrolides (29%) (P < .001). Antibiotics most frequently prescribed for ear, tonsillar, sinus and bronchopulmonary infections were broad-spectrum penicillins among Spanish GPs and narrow-spectrum penicillins in Denmark. Spanish GPs prescribed penicillin V only for tonsillitis, accounting for 5.1% of the antibiotics used for this condition, whereas this drug accounted for 91.7% of the prescriptions by their Danish colleagues for the same indication.
The substantial differences in RTI management between the participating GPs should make us reflect on the rational use of antibiotics. The discrepancies disclosed may indicate dissimilarities in recommendations, traditions, habits, or antibiotic pressures between the countries studied.
BACKGROUND:Hemovigilance has shown that bacteria cause more fatalities than other infections together. Surveillance for detection of bacteria in platelets (PLTs) was initiated. Concomitantly, the ...storage period for PLTs was extended from 5 to 7 days to reduce cost. STUDY DESIGN AND METHODS:Analysis was performed of all cases of a positive signal in a screening procedure for contaminated PLTs taking into account results of confirmative cultures and results of culture from blood components including bacteria strains. Records were assessed from patients transfused with blood components issued before the screening culture became positive. RESULTS:Samples were collected from 22,057 PLT units. An initial reaction was seen in 84 (0.38%). Growth was confirmed in 70 of these. Of the associated PLT units, 26 had been issued or outdated at the time when the culture was found to be reactive, in 27 bacteria were found, and in 17 cultures were negative. The bacteria found were mainly from normal skin flora. Sixty-six patients received 75 blood components issued before the screening system alarmed. None of these patients had a transfusion reaction reported. The outdating fell to less than 5 percent. CONCLUSION:A screening system for detection of bacterial contamination was implemented without increase in cost owing to extension of storage time to 7 days. Transfusion of several contaminated blood components was prevented.
Attachment of staphylococci to silicone catheters in vitro Espersen, F; Wilkinson, B J; Gahrn-Hansen, B ...
APMIS : acta pathologica, microbiologica et immunologica Scandinavica,
January 1990, Letnik:
98, Številka:
5
Journal Article
Recenzirano
The adherence of radiolabeled staphylococci to silicone catheters was investigated in vitro. Staphylococcus aureus and Staphylococcus epidermidis strains bound to the same extent to the catheters. ...Also, S. epidermidis strains isolated from patients with plastic-related infections showed binding similar to that of other S. epidermidis strains. By preincubation of catheters the influence of purified staphylococcal cell surface components on the binding was evaluated. The most potent inhibitors of the binding of S. aureus were the two surface proteins, clumping factor and protein A, and the cytoplasmic membrane. Surface proteins and the cell membrane of S. epidermidis also blocked the binding. Only protein-containing surface proteins inhibited the binding. The production of slime correlated with the degree of S. epidermidis binding. Human plasma and serum, as well as purified albumin and IgG, inhibited the binding of both staphylococcal species. Fibrinogen, and to a certain extent fibronectin, inhibited the binding of S. epidermidis, while both these purified plasma proteins enhanced the binding of S. aureus.
Sinusitis is associated with overuse of antibiotics. The aim of this study was to determine whether GPs who use the CRP rapid test (CRP) have a lower antibiotic prescribing rate for sinusitis. During ...a three-week period, a group of GPs registered all patients with respiratory tract infections (n = 17,792). GPs using CRP prescribed antibiotics for 59% and GPs not using CRP prescribed antibiotics for 78% of the patients with sinusitis. CRP was the factor exerting the greatest influence on the prescribing of antibiotics. Implementing CRP in general practice may lead to a reduction in antibiotic prescribing to patients with sinusitis.
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.
Abstract
Background: Severe sepsis and septic shock have a high 30-day mortality (10-50%), but the long-term mortality is not well described. The purpose of this study was to describe long-term ...mortality among patients with community-acquired severe sepsis or septic shock compared to a population-based reference cohort. Methods: Two hundred and twelve patients who, within the first 24 h after arrival at the hospital, presented with infection and had failure of at least 1 organ system were included. A population-based reference group of 79,857 patients was identified, and data on comorbidities were extracted from the National Danish Patient Registry. We analyzed the hazard ratio for mortality at predefined intervals. Results: Absolute mortality within the first 30 days was 69/211 (33%, 95% confidence interval (CI) 25-41%), with a cumulative mortality of 121/211 (57%, 95% CI 48-69%) for the entire follow-up. Among septic patients who survived the first 30 days, the mortality hazard ratio was 2.7 (95% CI 1.7-4.3) until day 365, and among septic patients who survived the first year, the 1-4 y mortality hazard ratio was 2.3 (95% CI 1.7-3.3), compared to the community-based reference persons (multivariate Cox regression controlling for age, sex, and Charlson comorbidity index). Conclusions: Patients with severe sepsis and septic shock who survived the first 30 days had a 2.7 times higher mortality hazard in the first year and a 2.3 times higher mortality hazard in the next 3 y, compared to persons of similar age, sex, and comorbidity level.
A total of 54 strains of Staphylococcus aureus, 37 methicillin-susceptible (MSSA) and 17 methicillin-resistant (MRSA), were investigated for their susceptibility to dicloxacillin as compared to ...methicillin and oxacillin by agar plate dilution at two different temperatures of incubation (30 degrees C and 37 degrees C). Against MSSA strains we found a slight but significant increase (0-2 dilution steps) in minimal inhibitor concentrations (MICs) for all three antibiotics with decrease in incubation temperature. Against MRSA strains methicillin and oxacillin showed a 3-6 fold increase in median MIC with decrease incubation temperature. For dicloxacillin, in contrast, there were no significant differences in median MICs (i.e. 0.4 mg/l) against MSSA strains at 30 degrees C or MRSA strains at either incubation temperature. Population-analysis of the MRSA strains revealed, however, that a highly dicloxacillin-resistant subpopulation appeared with a frequency of 10(-6) to 10(-7). Such heterogenous resistance of MRSA strains to dicloxacillin probably prohibits the use of dicloxacillin against serious infections caused by these pathogens.
Actinomyces pyogenes (Corynebacterium pyogenes), a well-known pathogen in many animals, was isolated from 11 Danish patients since 1968. Bacteriologic characteristics and clinical pictures of the ...patients are described. Ability to hydrolyze gelatine, to produce beta-glucuronidase, to reach with antisera against group-G streptococci, and to produce acid from xylose differentiates A. pyogenes from Arcanobacterium haemolyticum, with which it has at times been confused. Actinomyces pyogenes is an established, but often misrecognized, human pathogen that should be better known to clinical microbiologists.
Malaria in the county of Funen 1987-1999 Hornstrup, Maren Kathrine; Gahrn-Hansen, Bente; Hallas, Jesper ...
Ugeskrift for læger,
2002-Apr-08, Letnik:
164, Številka:
15
Journal Article
We describe epidemiological, prophylactic, and clinical aspects of imported malaria in the county of Funen, 1987-1999.
The medical records of 136 patients were reviewed for age, gender, nationality, ...place of exposure, chemoprophylaxis, time lag from departure to diagnosis, Plasmodium species, treatment, and complications. Data on prescribed chemoprophylaxis dispensed from the pharmacies in the county of Funen were recorded.
Seventy-two per cent of the patients were Danish, 28% foreigners. Sixty per cent of the cases were caused by P. falciparum, of more than 90% which was acquired in sub-Saharan Africa. Cases of benign malaria were most often acquired in SE Asia. In the 49 patients with falciparum malaria, who had taken chemoprophylaxis, only 31 (63%) were fully compliant. Compliance was 76% in patients taking chloroquine phosphate + proguanil and 36% in patients taking only chloroquine phosphate. Six patients had complications, but all recovered.
Contributory causes in a large number of the reported cases of imported malaria in this study were no chemoprophylaxis or poor compliance. With respect to falciparum malaria, prescription of non-recommended chemoprophylaxis also contributed. Chemoprophylaxis dispensed from the pharmacies on Funen over recent years indicates that general practitioners are aware of altered recommendations.
