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Tetens MM, Omland LH, Dessau RB, Ellermann-Eriksen S, Andersen NS, Jørgensen CS, Østergaard C, Bodilsen J, Søgaard KK, Bangsborg J, Nielsen AC, Møller JK, Chen M, Svendsen JH, Obel N, Lebech AM. Risk of cardiac conduction disorders, and pacemaker implantations among individuals tested for serum Borrelia burgdorferi antibodies, a nationwide, matched, population-based cohort study. Clin Microbiol Infect 2024; 30:621-629. [PMID: 38316360 DOI: 10.1016/j.cmi.2024.01.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 01/18/2024] [Accepted: 01/30/2024] [Indexed: 02/07/2024]
Abstract
OBJECTIVES To investigate the short- and long-term risks of atrioventricular block and other cardiac conduction disorders associated with being tested for Borrelia burgdorferi (Bb) antibodies or Bb seropositivity as measures of confounding by indication and Bb infection, respectively. METHODS We performed a nationwide population-based matched cohort study (Denmark, 1993-2021). We included 52 200 Bb-seropositive individuals (stratified as only Bb-IgM-seropositive [n = 26 103], only Bb-IgG-seropositive [n = 18 698], and Bb-IgM-and-IgG-seropositive [n = 7399]) and two age- and sex-matched comparison cohorts: 104 400 Bb-seronegative individuals and 261 000 population controls. We investigated the risk associated with being tested for serum Bb antibodies and being Bb seropositive. Outcomes were atrioventricular block and other conduction disorders. We calculated short-term odds ratios (aOR) (within 1 month), and long-term hazard ratios (aHR) (after 1 month) adjusted for age, sex, diabetes, chronic heart failure, and kidney disease with 95% CI. RESULTS Compared with population controls, individuals tested for Bb antibodies had increased short- and long-term risks of atrioventricular block (aOR 47.9, 95% CI: 30.0-76.7, aHR 1.3, 95% CI:1.2-1.3), and other conduction disorders (aOR 18.2, 95% CI: 10.1-32.8, aHR 1.2, 95% CI: 1.1-1.4). Compared with Bb-seronegative individuals, only Bb-IgM-and-IgG-seropositive individuals had increased short-term risk of atrioventricular block (aOR: 2.1, 95% CI: 1.5-3.1). DISCUSSION The results suggest that Bb antibody testing is included in the diagnostic work-up of conduction disorders. Finally, that Bb seropositivity is not associated with other conduction disorders than atrioventricular block or with increased long-term risk of conduction disorders.
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Affiliation(s)
- Malte M Tetens
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Nanna S Andersen
- Clinical Centre for Emerging and Vector-borne Infections, Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | | | - Christian Østergaard
- Department of Clinical Microbiology, Copenhagen University Hospital - Hvidovre Hospital, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirstine K Søgaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jette Bangsborg
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
| | - Alex Christian Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jens Kjølseth Møller
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Sønderborg Hospital, Sønderborg, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Tetens MM, Omland LH, Dessau RB, Ellermann-Eriksen S, Andersen NS, Jørgensen CS, Østergaard C, Bodilsen J, Søgaard KK, Bangsborg J, Nielsen ACY, Møller JK, Chen M, Svendsen JH, Obel N, Lebech AM. Risk of heart failure among individuals tested for Borrelia burgdorferi sensu lato antibodies, and serum Borrelia burgdorferi sensu lato seropositive individuals; a nationwide population-based, registry-based matched cohort study. Ticks Tick Borne Dis 2024; 15:102345. [PMID: 38636178 DOI: 10.1016/j.ttbdis.2024.102345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 04/20/2024]
Abstract
BACKGROUND Lyme borreliosis is a tick-borne disease caused by the bacterium Borrelia burgdorferi (Bb) sensu lato complex. Previous studies have suggested an association between Lyme borreliosis and heart failure, which have been suggested to be a possible manifestation of Lyme carditis. We aimed to investigate the risk of heart failure among individuals tested for serum Bb antibodies, and serum Bb seropositive individuals. METHODS We performed a matched nationwide cohort study (Denmark, 1993-2020) and included 52,200 Bb seropositive individuals, and two age- and sex-matched comparison cohorts: 1) 104,400 Bb seronegative comparison cohort members, and 2) 261,000 population controls. We investigated the risk associated with 1) being tested for serum Bb antibodies, and 2) being Bb seropositive. Outcomes were: 1) a composite of heart failure, cardiomyopathy, and/or myocarditis diagnosis, and 2) redemption of cardiovascular medicine used for treatment of heart failure. We calculated short-term odds ratios (aOR) (within 1 month) and long-term hazard rates (aHR) (after 1 month) adjusted for age, sex, diabetes, pre-existing heart failure, and kidney disease. RESULTS Compared with the population controls, individuals tested for Bb antibodies, regardless of the test result, had increased short-term risk of heart failure, cardiomyopathy, and myocarditis (aOR 8.3, 95 %CI: 6.7-10.2), and both increased short- and long-term risk of redemption of cardiovascular medicine (aOR 4.3, 95 %CI: 3.8-4.8, aHR 1.13, 95 % CI: 1.11-1.15). The Bb seropositive individuals had no increased short- or long-term risk of any outcome compared with Bb seronegative comparison cohort members. CONCLUSIONS In conclusion, Bb antibody tests seemed to be performed in the diagnostic work-up of heart failure, but Bb seropositivity was not associated with heart failure.
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Affiliation(s)
- Malte M Tetens
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Zealand Hospital, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Nanna S Andersen
- Clinical Centre for Emerging and Vector-borne Infections, Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | | | - Christian Østergaard
- Department of Clinical Microbiology, Copenhagen University Hospital - Hvidovre Hospital, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirstine K Søgaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jette Bangsborg
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
| | - Alex Christian Yde Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jens Kjølseth Møller
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Sønderborg Hospital, Sønderborg, Denmark
| | - Jesper Hastrup Svendsen
- Department of Cardiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Iversen AM, Hansen MB, Kristensen B, Ellermann-Eriksen S. Hand Hygiene Compliance in Nursing Homes - The Effects Of Feedback With Lights on Alcohol-based Hand Rub Dispensers. Am J Infect Control 2024:S0196-6553(24)00160-3. [PMID: 38583777 DOI: 10.1016/j.ajic.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 03/26/2024] [Accepted: 03/26/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Hand hygiene (HH) among healthcare workers (HCWs) is crucial in preventing infections in nursing homes. However, HH compliance (HHC) among HCWs remains low. This study aimed to investigate the effect of feedback lights on HCWs' HHC. METHODS A five-month interventional study was conducted in three wards in a nursing home in [blinded for reviewers]. During the intervention period, a green light with a smiley appeared on the alcohol-based hand rub (ABHR) dispensers when HCWs used the ABHR, acknowledging HCWs for using the ABHR. HHC was monitored using an automatic hand hygiene monitoring system (AHHMS). RESULTS A total of 64 HCWs were enrolled. The AHHMS collected 23,696 HH opportunities in apartments and dirty utility rooms. Overall, HHC in the apartments increased from 50% at baseline (95% CI: 48, 53) to 56% (95% CI: 54, 58) during the intervention. However, the increased HHC level was not sustained during follow-up. CONCLUSIONS The AHHMS enabled assessment of the intervention. We found a significant effect of light-guided feedback in the apartments. However, the increased HHC was not sustained after the light was switched off.
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Affiliation(s)
- Anne-Mette Iversen
- Department of Oncology, Aarhus University Hospital and Aarhus University, Denmark.
| | | | - Brian Kristensen
- National Center of Infection Control. Statens Serum Institut, Copenhagen, Denmark
| | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital and Aarhus University, Denmark
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Iversen AM, Hansen MB, Münster M, Kristensen B, Ellermann-Eriksen S. Hand hygiene compliance in nursing home wards - the effect of increased accessibility of alcohol-based hand rub. J Hosp Infect 2024:S0195-6701(24)00097-5. [PMID: 38521416 DOI: 10.1016/j.jhin.2024.02.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Revised: 02/26/2024] [Accepted: 02/28/2024] [Indexed: 03/25/2024]
Abstract
BACKGROUND Elderly nursing home (NH) residents are vulnerable to infections due to age, weakened immune system and comorbidities. Furthermore, microorganisms are easily transmitted in shared facilities. Hand hygiene (HH) is considered one of the most important measures to prevent transmission. We determined the effect of increased accessibility to alcohol-based hand rub (ABHR) in NH wards by monitoring HH compliance (HHC) among healthcare workers (HCWs). METHODS An 11-month intervention study was conducted in a Danish six-ward NH. Data were collected using an automatic hand hygiene monitoring system (AHHMS). After a baseline period, one extra ABHR dispenser was placed in each of the 150 apartments. We compared baseline HHC with the HHC during an immediate intervention period and a long-term intervention period. RESULTS We included 159 HCWs. The AHHMS registered 341,078 HH opportunities. Overall baseline HHC was 31% (95% CI: 30-32). A significant +18% absolute immediate effect (first five months) (95% CI: 17-19; p<0.0001) and +13 percentage points (95% CI: 11, 14; p<0.0001) long-term effect (another four months) were recorded. HCWs working day shifts and short-term employees had a higher baseline HHC than HCWs working evening/night shifts. However, HCWs working night shifts achieved the greatest long-term effect with a mean +27 percentage point difference (p<0.0001). CONCLUSIONS Placing an additional ABHR dispenser strategically within staff workflow significantly increased HHC among HCWs, showcasing a noteworthy effect. The study is the first to report the effect on NH dispenser accessibility as a single intervention and demonstrate a significant unmet potential.
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Affiliation(s)
- Anne-Mette Iversen
- Department of Oncology, Aarhus University Hospital and Aarhus University, Denmark.
| | | | | | - Brian Kristensen
- National Centre of Infection Control. Statens Serum Institut, Copenhagen, Denmark
| | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital and Aarhus University, Denmark
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5
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Platz IL, Tetens MM, Dessau R, Ellermann-Eriksen S, Andersen NS, Jensen VVS, Østergaard C, Bodilsen J, Søgaard KK, Bangsborg J, Nielsen ACY, Møller JK, Lebech AM, Omland LH, Obel N. Characteristics and long-term prognosis of Danish residents with a positive intrathecal antibody index test for herpes simplex virus or varicella-zoster virus compared with individuals with a positive cerebrospinal fluid PCR: a nationwide cohort study. Clin Microbiol Infect 2024; 30:240-246. [PMID: 37967615 DOI: 10.1016/j.cmi.2023.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 11/17/2023]
Abstract
OBJECTIVES We compared characteristics and outcomes of individuals who in the cerebrospinal fluid (CSF) were positive for herpes simplex virus (HSV) or varicella-zoster virus (VZV)-intrathecal antibody index test ([AI]-positive) vs. individuals who were PCR-positive for HSV type 1 (HSV1), type 2 (HSV2), and for VZV. METHODS Nationwide cohort study of all Danish residents with positive CSF-AI or -PCR for HSV or VZV (1995-2021). We calculated short- and long-term risks as age-, sex-, and comorbidity-adjusted odds ratios (aOR), adjusted hazard ratios (aHR), and absolute risk differences with 95% CIs. RESULTS Compared with individuals with positive PCR for HSV1 (n = 321), HSV2 (n = 497), and VZV (n = 1054), individuals with a positive AI for HSV (n = 177) and VZV (n = 219) had CSF pleocytosis less frequently (leucocyte count >10/μL: HSV-AI: 39%, VZV-AI: 52%, HSV1-PCR: 81%, HSV2-PCR: 92%, VZV-PCR: 83%), and were less frequently diagnosed with central nervous system infection ([aOR {95%CI}]: HSV-AI vs. HSV1-PCR: [0.1 {0.1, 0.2}], HSV-AI vs. HSV2-PCR: [0.1 {0.0, 0.1}], VZV-AI vs. VZV-PCR: [0.2 {0.2, 0.3}]). Individuals with a positive HSV-AI or VZV-AI had increased risk of demyelinating disease ([aOR {95%CI}; aHR {95%CI}]: HSV-AI vs. HSV1-PCR: [4.6 {0.9, 24.5}; aHR not applicable], HSV-AI vs. HSV2-PCR: [10.4 {2.3, 45.9}; 12.4 {2.3, 66.0}], VZV-AI vs. VZV-PCR: [aOR not applicable; 10.3 {1.8, 58.8}]). Disability pension was less frequent among HSV-AI than HSV1-PCR cohort members (5-year risk difference: -23.6%, 95%CI: -35.2, -11.8), and more frequent among VZV-AI than VZV-PCR cohort members (5-year risk difference: 16.8%, 95%CI: 5.0, 28.7). DISCUSSION AI-positive individuals differ from PCR-positive individuals in several aspects. AI appears unspecific for current central nervous system infections.
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Affiliation(s)
- Isabella L Platz
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Malte M Tetens
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ram Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Nanna S Andersen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | | | - Christian Østergaard
- Department of Clinical Microbiology, Copenhagen University Hospital - Hvidovre Hospital, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Kirstine Kobberøe Søgaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jette Bangsborg
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
| | - Alex Christian Yde Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Tetens MM, Omland LH, Dessau R, Ellermann-Eriksen S, Andersen NS, Jørgensen CS, Østergaard C, Bodilsen J, Søgaard KK, Bangsborg J, Nielsen AC, Møller JK, Chen M, Niemann CU, Lebech AM, Obel N. Risk of haematologic cancers among individuals tested for Borrelia burgdorferi antibodies, and Borrelia burgdorferi seropositive individuals: a nationwide population-based matched cohort study. Clin Microbiol Infect 2024; 30:231-239. [PMID: 37871679 DOI: 10.1016/j.cmi.2023.10.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 10/25/2023]
Abstract
OBJECTIVES In a nationwide, matched cohort study, we aimed to investigate risks of haematologic cancers among individuals tested for Borrelia burgdorferi (Bb) antibodies, and among serum Bb seropositive individuals. METHODS We identified all Bb seropositive individuals in Denmark (1993-2020) (n = 52 200) and constructed two age- and sex-matched comparison cohorts: (a) Bb seronegative controls (n = 104 400) and (b) background population controls (n = 261 000). We calculated short-term OR (aOR) (<1 month of study inclusion), and long-term hazard ratios (aHR) (>1 month after study inclusion) adjusted for age and sex. We stratified seropositive individuals on only Bb-IgM seropositive (n = 26 103), only Bb-IgG seropositive (n = 18 698), and Bb-IgM-and-IgG seropositive (n = 7399). RESULTS Compared with the background population, individuals tested for Bb antibodies had increased short-term (aOR: 12.6, 95% CI: 10.1-15.6) and long-term (aHR: 1.3, 95% CI: 1.2-1.4) risk of haematologic cancers. The Bb seropositive individuals had no increased risk of haematologic cancers compared with those who tested negative for Bb, except that Bb-IgM-and-IgG seropositive individuals had increased long-term risk of chronic lymphatic leukaemia (aHR: 2.0, 95% CI: 1.2-3.4). DISCUSSION Our results suggest that Bb antibody testing is included in the work-up of unspecific symptoms preceding diagnosis of haematologic cancers. Bb-IgM-and-IgG seropositivity was associated with a two-fold increased long-term risk of chronic lymphatic leukaemia, which warrants further investigation.
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Affiliation(s)
- Malte M Tetens
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark.
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Ram Dessau
- Department of Clinical Microbiology, Zealand Hospital, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Nanna S Andersen
- Clinical Centre for Emerging and Vector-borne Infections, Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark; Research Unit of Clinical Microbiology, University of Southern Denmark, Odense, Denmark
| | | | - Christian Østergaard
- Department of Clinical Microbiology, Copenhagen University Hospital - Hvidovre Hospital, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Kirstine K Søgaard
- Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Jette Bangsborg
- Department of Clinical Microbiology, Copenhagen University Hospital - Herlev Hospital, Herlev, Denmark
| | - Alex Christian Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Jens Kjølseth Møller
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark; Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Sønderborg Hospital, Sønderborg, Denmark
| | - Carsten Utoft Niemann
- Department of Hematology, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Iversen AM, Hansen MB, Alsner J, Kristensen B, Ellermann-Eriksen S. Effects of light-guided nudges on health care workers' hand hygiene behavior. Am J Infect Control 2023; 51:1370-1376. [PMID: 37209875 DOI: 10.1016/j.ajic.2023.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 05/02/2023] [Accepted: 05/03/2023] [Indexed: 05/22/2023]
Abstract
BACKGROUND Hospital-acquired infections are the most frequent adverse events in health care and can be reduced by improving the hand hygiene compliance (HHC) of health care workers (HCWs). We aimed to investigate the effect of nudging with sensor lights on HCWs' HHC. METHODS An 11-month intervention study was conducted in 2 inpatient departments at a university hospital. An automated monitoring system (Sani NudgeTM) measured the HHC. Reminder and feedback nudges with lights were displayed on alcohol-based hand rub dispensers. We compared the baseline HHC with HHC during periods of nudging and used the follow-up data to establish if a sustained effect had been achieved. RESULTS A total of 91 physicians, 135 nurses, and 15 cleaning staff were enrolled in the study. The system registered 274,085 hand hygiene opportunities in patient rooms, staff restrooms, clean rooms, and unclean rooms. Overall, a significant, sustained effect was achieved by nudging with lights in relation to contact with patients and patient-near surroundings for both nurses and physicians. Furthermore, a significant effect was observed on nurses' HHC in restrooms and clean rooms. No significant effect was found for the cleaning staff. CONCLUSIONS Reminder or feedback nudges with light improved and sustained physicians' and nurses' HHC, and constitute a new way of changing HCWs' hand hygiene behavior.
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Affiliation(s)
- Anne-Mette Iversen
- Department of Oncology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark.
| | - Marco Bo Hansen
- Konduto ApS, Sani Nudge, Department of Medical & Science, Copenhagen, Denmark
| | - Jan Alsner
- Department of Oncology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Brian Kristensen
- National Center of Infection Control, Statens Serum Institut, Copenhagen, Denmark
| | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
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Iversen AM, Hansen MB, Ellermann-Eriksen S. Effects of data-driven feedback on nurses' and physicians' hand hygiene in hospitals - a non-resource-intensive intervention in real-life clinical practice. Infect Prev Pract 2023; 5:100321. [PMID: 38028363 PMCID: PMC10679856 DOI: 10.1016/j.infpip.2023.100321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Background Hand hygiene (HH) by healthcare workers (HCWs) is one of the most important measures to prevent hospital-acquired infections. However, HCWs struggle to adhere to HH guidelines. We aimed to investigate the effect of a non-resource intensive intervention with group and individual feedback on HCWs HH in a real-life clinical practice during the COVID-19 pandemic. Methods In 2021, an 11-month prospective, interventional study was conducted in two inpatient departments at a Danish university hospital. An automated hand hygiene monitoring system (Sani Nudge™) was used to collect data. HH opportunities and alcohol-based hand rub events were measured. Data were provided as HH compliance (HHC) rates. We compared HHC across 1) a baseline period, 2) an intervention period with weekly feedback in groups, followed by 3) an intervention period with weekly individual feedback on emails, and 4) a follow-up period. Results We analyzed data from physicians (N=65) and nurses (N=109). In total, 231,022 hygiene opportunities were analyzed. Overall, we observed no significant effect of feedback, regardless of whether it was provided to the group or individuals. We found a trend toward a higher HHC in staff restrooms than in medication rooms and patient rooms. The lowest HHC was found in patient rooms. Conclusions The automated hand hygiene monitoring system enabled assessment of the interventions. We found no significant effect of group or individual feedback at the two departments. However, other factors may have influenced the results during the pandemic, such as time constraints, workplace culture, and the degree of leadership support.
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Affiliation(s)
- Anne-Mette Iversen
- Department of Oncology, Aarhus University Hospital and Aarhus University, Denmark
| | | | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital and Aarhus University, Denmark
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Johannesen TB, Munkstrup C, Edslev SM, Baig S, Nielsen S, Funk T, Kristensen DK, Jacobsen LH, Ravn SF, Bindslev N, Gubbels S, Voldstedlund M, Jokelainen P, Hallstrøm S, Rasmussen A, Kristinsson KG, Fuglsang-Damgaard D, Dessau RB, Olsén AB, Jensen CS, Skovby A, Ellermann-Eriksen S, Jensen TG, Dzajic E, Østergaard C, Lomborg Andersen S, Hoffmann S, Andersen PH, Stegger M. Increase in invasive group A streptococcal infections and emergence of novel, rapidly expanding sub-lineage of the virulent Streptococcus pyogenes M1 clone, Denmark, 2023. Euro Surveill 2023; 28:2300291. [PMID: 37382884 PMCID: PMC10311951 DOI: 10.2807/1560-7917.es.2023.28.26.2300291] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 06/29/2023] [Indexed: 06/30/2023] Open
Abstract
A highly virulent sub-lineage of the Streptococcus pyogenes M1 clone has been rapidly expanding throughout Denmark since late 2022 and now accounts for 30% of the new invasive group A streptococcal infections. We aimed to investigate whether a shift in variant composition can account for the high incidence rates observed over winter 2022/23, or if these are better explained by the impact of COVID-19-related restrictions on population immunity and carriage of group A Streptococcus.
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Affiliation(s)
| | - Charlotte Munkstrup
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Sofie Marie Edslev
- Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Sharmin Baig
- Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Stine Nielsen
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Tjede Funk
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | | | | | - Signe Fischer Ravn
- Data Integration and Analysis, Statens Serum Institut, Copenhagen, Denmark
| | - Niels Bindslev
- Data Integration and Analysis, Statens Serum Institut, Copenhagen, Denmark
| | - Sophie Gubbels
- Data Integration and Analysis, Statens Serum Institut, Copenhagen, Denmark
| | | | - Pikka Jokelainen
- Infectious Disease Preparedness, Statens Serum Institut, Copenhagen, Denmark
| | - Søren Hallstrøm
- Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Astrid Rasmussen
- Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Karl Gústaf Kristinsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Clinical Microbiology, Landspitali - the National University Hospital, Reykjavik, Iceland
| | | | - Ram B Dessau
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark
| | - Agnieszka Barbara Olsén
- Department of Clinical Microbiology, Herlev and Gentofte Hospital - University Hospital, Herlev, Denmark
| | | | - Annette Skovby
- Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark
| | | | - Thøger Gorm Jensen
- Department of Clinical Microbiology, Odense University Hospital and Research Unit of Clinical Microbiology, Odense, Denmark
| | - Esad Dzajic
- Clinical Diagnostic Department, Clinical Microbiology, Hospital South West Jutland, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Claus Østergaard
- Department of Clinical Microbiology, Lillebælt Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Steen Lomborg Andersen
- Department of Clinical Microbiology, Sønderjylland Hospital, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Steen Hoffmann
- Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | - Peter Henrik Andersen
- Infectious Disease Epidemiology and Prevention, Statens Serum Institut, Copenhagen, Denmark
| | - Marc Stegger
- Antimicrobial Resistance and Infectious Diseases Laboratory, Harry Butler Institute, Murdoch University, Perth, Australia
- Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
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10
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Leineweber TD, Ghathian K, Lisby JG, Friis-Hansen L, Afzal S, Ellermann-Eriksen S, Ma CMG, Cohen AS, Jørgensen RL, Hansen MB, Kamstrup PR, Larsen H, Steenhard N, Jensen CB, Kallemose T, Forsberg MW, Kirkby NS, Schneider UV. Evaluation of four laboratory-based high-throughput SARS-CoV-2 automated antigen tests compared to RT-PCR on nasal and oropharyngeal samples. J Clin Virol 2023; 164:105472. [PMID: 37178678 PMCID: PMC10152833 DOI: 10.1016/j.jcv.2023.105472] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 04/26/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
BACKGROUND The demand for RT-PCR testing has been unprecedented during the SARS-CoV-2 pandemic. Fully automated antigen tests (AAT) are less cumbersome than RT-PCR, but data on performance compared to RT-PCR are scarce. METHODS The study consists of two parts. A retrospective analytical part, comparing the performance of four different AAT on 100 negative and 204 RT-PCR positive deep oropharyngeal samples divided into four groups based on RT-PCR cycle of quantification levels. In the prospective clinical part, 206 individuals positive for and 199 individuals negative for SARS-CoV-2 were sampled from either the anterior nasal cavity (mid-turbinate) or by deep oropharyngeal swabs or both. The performance of AATs was compared to RT-PCR. RESULTS The overall analytical sensitivity of the AATs differed significantly from 42% (95% CI 35-49) to 60% (95% CI 53-67) with 100% analytical specificity. Clinical sensitivity of the AATs differed significantly from 26% (95% CI 20-32) to 88% (95% CI 84-93) with significant higher sensitivity for mid-turbinate nasal swabs compared to deep oropharyngeal swabs. Clinical specificity varied from 97% to 100%. CONCLUSION All AATs were highly specific for detection of SARS-CoV-2. Three of the four AATs were significantly more sensitive than the fourth AAT both in terms of analytical and clinical sensitivity. Anatomical test location significantly influenced the clinical sensitivity of AATs.
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Affiliation(s)
- Thomas Daell Leineweber
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Khaled Ghathian
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Jan Gorm Lisby
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Lennart Friis-Hansen
- Copenhagen University Hospital Bispebjerg and Frederiksberg, Department of Clinical Biochemistry, Nielsine Nielsens Vej 4B, 2400, Copenhagen, Denmark
| | - Shoaib Afzal
- Copenhagen University Hospital Herlev and Gentofte, Department of Clinical Biochemistry, Borgmester Ib Juuls Vej 52, 2730, Herlev, Denmark
| | - Svend Ellermann-Eriksen
- Aarhus University Hospital, Department of Clinical Microbiology, Palle Juul-Jensens Boulevard 99, Skejby, 8200, Aarhus N., Denmark
| | - Chih Man German Ma
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Arieh S Cohen
- Danish National Test Center, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen, Denmark
| | - Rikke Lind Jørgensen
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Matilde Bøgelund Hansen
- Copenhagen University Hospital Herlev and Gentofte, Department of Clinical Microbiology, Borgmester Ib Juuls Vej 52, 2730, Herlev, Denmark
| | - Pia Rørbæk Kamstrup
- Copenhagen University Hospital Herlev and Gentofte, Department of Clinical Biochemistry, Borgmester Ib Juuls Vej 52, 2730, Herlev, Denmark
| | - Helene Larsen
- Technical University of Denmark - DTU, Centre for Diagnostics Department of Health Technology, Henrik Dams Allé, 2800, Kgs Lyngby, Denmark
| | - Nina Steenhard
- Danish National Test Center, Statens Serum Institut, Artillerivej 5, 2300, Copenhagen, Denmark
| | - Christel Barker Jensen
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Thomas Kallemose
- Copenhagen University Hospital Hvidovre, Department of Clinical Research, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Maria Wendelboe Forsberg
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Nikolai Søren Kirkby
- Rigshospitalet, Department of Clinical Microbiology, Henrik Harpestrengsvej 4A, 2100, Copenhagen, Denmark
| | - Uffe Vest Schneider
- Copenhagen University Hospital Hvidovre, Department of Clinical Microbiology, Kettegaard Alle 30, 2650, Hvidovre, Denmark.
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11
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Fogh K, Eriksen ARR, Larsen TG, Hasselbalch RB, Bundgaard H, Scharff BFSS, Nielsen SD, Jørgensen CS, Erikstrup C, Østergaard L, Ellermann-Eriksen S, Andersen B, Nielsen H, Johansen IS, Wiese L, Hindhede L, Mikkelsen S, Sækmose SG, Aagaard B, Holm DK, Harritshøj L, Simonsen L, Fischer TK, Folke F, Lippert F, Ostrowski SR, Benfield T, Mølbak K, Ethelberg S, Koch A, Vangsted AM, Krause TG, Fomsgaard A, Ullum H, Skov R, Iversen K. A Cross-Sectional Study of SARS-CoV-2 Antibodies and Risk Factors for Seropositivity in Staff in Day Care Facilities and Preschools in Denmark. Microbiol Spectr 2023; 11:e0417422. [PMID: 36546864 PMCID: PMC9927135 DOI: 10.1128/spectrum.04174-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Accepted: 12/06/2022] [Indexed: 12/24/2022] Open
Abstract
The aim of this study was to provide information about immunity against COVID-19 along with risk factors and behavior among employees in day care facilities and preschools (DCS) in Denmark. In collaboration with the Danish Union of Pedagogues, during February and March 2021, 47,810 members were offered a point-of-care rapid SARS-CoV-2 antibody test (POCT) at work and were invited to fill in an electronic questionnaire covering COVID-19 exposure. Seroprevalence data from Danish blood donors (total Ig enzyme-linked immunosorbent assay [ELISA]) were used as a proxy for the Danish population. A total of 21,018 (45%) DCS employees completed the questionnaire and reported their POCT result {median age, 44.3 years (interquartile range [IQR], [32.7 to 53.6]); females, 84.1%}, of which 20,267 (96.4%) were unvaccinated and included in analysis. A total of 1,857 (9.2%) participants tested seropositive, significantly higher than a seroprevalence at 7.6% (risk ratio [RR], 1.2; 95% confidence interval [CI], 1.14 to 1.27) among 40,541 healthy blood donors (median age, 42 years [IQR, 28 to 53]; males, 51.3%). Exposure at work (RR, 2.9; 95% CI, 2.3 to 3.6) was less of a risk factor than exposure within the household (RR, 12.7; 95% CI, 10.2 to 15.8). Less than 25% of participants reported wearing face protection at work. Most of the participants expressed some degree of fear of contracting COVID-19 both at work and outside work. SARS-CoV-2 seroprevalence was slightly higher in DCS staff than in blood donors, but possible exposure at home was associated with a higher risk than at work. DCS staff expressed fear of contracting COVID-19, though there was limited use of face protection at work. IMPORTANCE Identifying at-risk groups and evaluating preventive interventions in at-risk groups is imperative for the ongoing pandemic as well as for the control of future epidemics. Although DCS staff have a much higher risk of being infected within their own household than at their workplace, most are fearful of being infected with COVID-19 or bringing COVID-19 to work. This represents an interesting dilemma and an important issue which should be addressed by public health authorities for risk communication and pandemic planning. This study design can be used in a strategy for ongoing surveillance of COVID-19 immunity or other infections in the population. The findings of this study can be used to assess the need for future preventive interventions in DCS, such as the use of personal protective equipment.
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Affiliation(s)
- Kamille Fogh
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alexandra R. R. Eriksen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Rasmus B. Hasselbalch
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Bibi F. S. S. Scharff
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Susanne D. Nielsen
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Lars Østergaard
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Svend Ellermann-Eriksen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Berit Andersen
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Odense, Denmark
| | - Isik S. Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Lotte Hindhede
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Susan Mikkelsen
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Susanne G. Sækmose
- Department of Clinical Immunology, Zealand University Hospital, Koege, Denmark
| | - Bitten Aagaard
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Dorte K. Holm
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark
| | - Lene Harritshøj
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Lone Simonsen
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Thea K. Fischer
- Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Freddy Lippert
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Sisse R. Ostrowski
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Thomas Benfield
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Kåre Mølbak
- Statens Serum Institut, Copenhagen, Denmark
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg, Denmark
| | - Steen Ethelberg
- Statens Serum Institut, Copenhagen, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Koch
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
- Statens Serum Institut, Copenhagen, Denmark
| | | | | | | | | | | | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Hellerup, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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12
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Omland LH, Bodilsen J, Tetens MM, Helweg-Larsen J, Jarløv JO, Ziebell M, Ellermann-Eriksen S, Justesen US, Frimodt-Møller N, Mortensen PB, Obel N. Risk of Psychiatric Disorders, Use of Psychiatric Hospitals, and Receipt of Psychiatric Medication in Patients With Brain Abscess in Denmark. Clin Infect Dis 2023; 76:315-322. [PMID: 36124707 DOI: 10.1093/cid/ciac773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 09/02/2022] [Accepted: 09/13/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND It is unknown whether patients diagnosed with brain abscess have an increased risk of psychiatric disorders. METHODS In this nationwide, population-based matched cohort study from Denmark, we compared the incidence of psychiatric disorders, use of psychiatric hospitals, and receipt of psychiatric medications between patients diagnosed with brain abscess and individuals from the general population, matched on date of birth, sex, and residential area. RESULTS We included 435 patients diagnosed with brain abscess and 3909 individuals in the comparison cohort: 61% were male and median age was 54 years. Patients diagnosed with brain abscess were more likely to suffer from comorbidity. The risk of a hospital diagnosis of psychiatric disorders was increased the first 5 years of observation. In the subpopulation, who had never been in contact with psychiatric hospitals or received psychiatric medication before study inclusion, the risk of developing psychiatric disorders was close to that of the background population, especially when we excluded dementia from this outcome. There was a substantial increase in the receipt of anxiolytics and antidepressants. The difference in the proportion of individuals who received anxiolytics and antidepressants increased from 4% (95% confidence interval [CI], 0%-7%) and 2% (95% CI, -1% to 5%) 2 years before study inclusion to 17% (95% CI, 12%-21%) and 11% (95% CI, 7%-16%) in the year after study inclusion. CONCLUSIONS Patients with brain abscess without prior psychiatric disorders or receipt of psychiatric medicine are not at increased risk psychiatric disorders diagnosed in psychiatric hospitals, but they have an increased receipt of psychiatric medication.
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Affiliation(s)
- Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Clinical Microbiology, Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Malte Mose Tetens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jannik Helweg-Larsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jens Otto Jarløv
- Department of Clinical Microbiology, Copenhagen University Hospital, Herlev Hospital, Herlev, Denmark
| | - Morten Ziebell
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Ulrik Stenz Justesen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Niels Frimodt-Møller
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Preben Bo Mortensen
- Centre for Integrated Register-Based Research at Aarhus University (CIRRAU), Aarhus, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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13
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Kolstad HA, Frydenberg M, Nielsen KJ, Schlünssen V, Biering K, Kjærsgaard M, Vestergaard JM, Würtz ET, Pugdahl K, Würtz AML, Hansen KK, Jespersen S, Kragh Thomsen M, Sørensen MM, Ellermann-Eriksen S, Dvinge Redder J, Storgaard M. SARS-CoV-2 Infection Rates Following Use of Regular Compared With Defective Respirators When Caring for COVID-19 Patients: A Retrospective Follow-up Study. Ann Work Expo Health 2023; 67:141-146. [PMID: 35488370 DOI: 10.1093/annweh/wxac031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/22/2022] [Accepted: 04/19/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND There is strong observational evidence that respirators are highly effective in protecting the users from being infected with Middle East respiratory syndrome and severe acute respiratory syndrome coronavirus (SARS-CoV), but the evidence for SARS-CoV-2 during daily work is limited. This study utilized a subset of healthcare workers' temporary use of a new brand respirator with frequent defects when caring for coronavirus disease 2019 (COVID-19) patients to assess the protective effect of regular respirators against SARS-CoV-2 infection. METHODS We retrospectively followed 463 participants wearing a regular respirator and 168 wearing the new brand respirator day-by-day when caring for COVID-19 patients until testing polymerase chain reaction positive for SARS-CoV-2 between 27th December 2020 and 14th January 2021. RESULTS We observed seven and eight incident SARS-CoV-2-infected cases. This corresponded with daily infection rates of 0.2 and 0.5%, an incidence rate ratio of 0.4 [95% confidence interval (CI) 0.1; 1.0], and an incidence rate difference of 0.3% (95% CI -0.1; 0.8) when comparing a regular with the new brand respirator. DISCUSSION We regard the new brand respirator a sham intervention, and this study thus provides further evidence for the protective effect of respirators when exposed to SARS-CoV-2 virus.
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Affiliation(s)
- Henrik A Kolstad
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, DK-8200 Aarhus N, Denmark.,Institute of Clinical Medicine, Aarhus University, DK-8200 Aarhus N, Denmark
| | - Morten Frydenberg
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Kent Jacob Nielsen
- Department of Occupational Medicine, Danish Ramazzini Centre, Goedstrup Hospital, DK-7400 Herning, Denmark
| | - Vivi Schlünssen
- Department of Public Health, Work, Environment and Health, Danish Ramazzini Centre, Aarhus University, DK-8000 Aarhus C, Denmark
| | - Karin Biering
- Department of Occupational Medicine, Danish Ramazzini Centre, Goedstrup Hospital, DK-7400 Herning, Denmark
| | - Mona Kjærsgaard
- Department of Clinical Microbiology, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Jesper Medom Vestergaard
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Else Toft Würtz
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Kirsten Pugdahl
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Anne Mette Lund Würtz
- Department of Public Health, Work, Environment and Health, Danish Ramazzini Centre, Aarhus University, DK-8000 Aarhus C, Denmark
| | - Karoline Kærgaard Hansen
- Department of Occupational Medicine, Danish Ramazzini Centre, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Sanne Jespersen
- Department of Infectious Diseases, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Marianne Kragh Thomsen
- Department of Clinical Microbiology, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | - Mette Marie Sørensen
- Department of Infectious Diseases, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
| | | | | | - Merete Storgaard
- Department of Infectious Diseases, Aarhus University Hospital, DK-8200 Aarhus N, Denmark
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14
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Omland LH, Bodilsen J, Helweg-Larsen J, Jarløv JO, Andreasen K, Ziebell M, Ellermann-Eriksen S, Justesen US, Frimodt-Møller N, Obel N. Invasive procedures and risk of brain abscess: a nationwide, population-based case-control study. Infect Dis (Lond) 2023; 55:55-62. [PMID: 36239458 DOI: 10.1080/23744235.2022.2132284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
OBJECTIVES It is unknown whether invasive procedures are associated with brain abscess. METHODS Nationwide, population-based, matched case-control study of patients with culture verified brain abscess in Denmark from 1989 to 2016. Exposure was invasive procedures 0-6 months before study inclusion. RESULTS We identified 435 patients and 3909 controls. The level of comorbidity was higher among patients with brain abscess than among controls. A total of 48 cases (11%) had one or more invasive procedures 0-6 months before study inclusion (adjusted odds ratios (aOR) of 3.6 (95% confidence interval (CI): 2.5-5.1), a population attributable fractions of 8% (95% CI: 7-9)). In primary care, ear, nose and throat (ENT) procedures were associated with brain abscess (aOR of 4.0 (95% CI: 2.0-8.0)), but gastrointestinal endoscopies were not (aOR of 1.0 (95% CI: 0.3-3.2)). No bronchoscopies were performed in primary care. In the hospital-based setting, ENT procedures, bronchoscopies and gastrointestinal endoscopies were associated with an increased risk of brain abscess (aOR of 14.5 (95% CI: 4.8-43.8), 20.3 (95% CI: 3.8-110.1) and 3.4 (95% CI: 2.0-5.6), respectively). CONCLUSIONS The association between invasive procedures and brain abscess was more pronounced in the hospital-based setting than in primary care.
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Affiliation(s)
- Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Jannik Helweg-Larsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Jens Otto Jarløv
- Department of Clinical Microbiology, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark
| | - Kristian Andreasen
- Department of Otorhinolaryngology, Nordsjaellands Hospital, Hillerød, Denmark
| | - Morten Ziebell
- Department of Neurosurgery, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Ulrik S Justesen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Niels Frimodt-Møller
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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15
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van Wijhe M, Fogh K, Ethelberg S, Karmark Iversen K, Nielsen H, Østergaard L, Andersen B, Bundgaard H, Jørgensen CS, Scharff BFSS, Ellermann-Eriksen S, Johansen IS, Fomsgaard A, Grove Krause T, Wiese L, Fischer TK, Mølbak K, Benfield T, Folke F, Lippert F, Ostrowski SR, Koch A, Erikstrup C, Vangsted AM, Sørensen AIV, Ullum H, Skov RL, Simonsen L, Nielsen SD. Persistent Symptoms and Sequelae After Severe Acute Respiratory Syndrome Coronavirus 2 Infection Not Requiring Hospitalization: Results From Testing Denmark, a Danish Cross-sectional Survey. Open Forum Infect Dis 2022; 10:ofac679. [PMID: 36628054 PMCID: PMC9825266 DOI: 10.1093/ofid/ofac679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Accepted: 12/19/2022] [Indexed: 12/24/2022] Open
Abstract
Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with persistent symptoms ("long COVID"). We assessed the burden of long COVID among nonhospitalized adults with polymerase chain reaction (PCR)-confirmed SARS-CoV-2 infection. Methods In the fall of 2020, a cross-sectional survey was performed in the adult Danish general population. This included a self-administered point-of-care test for SARS-CoV-2 antibodies, the Short Form Health Survey (SF-12), and coronavirus disease 2019 (COVID-19)-associated symptom questions. Nonhospitalized respondents with a positive SARS-CoV-2 PCR test ≥12 weeks before the survey (cases) were matched (1:10) to seronegative controls on age, sex, and body mass index. Propensity score-weighted odds ratios (ORs) and ORs for risk factors were estimated for each health outcome. Results In total, 742 cases and 7420 controls were included. The attributable risk of at least 1 long-COVID symptom was 25.0 per 100 cases (95% confidence interval [CI], 22.2-27.4). Compared to controls, cases reported worse general health (OR, 5.9 [95% CI, 5.0-7.0]) and had higher odds for a broad range of symptoms, particularly loss of taste (OR, 11.8 [95% CI, 9.5-14.6]) and smell (OR, 11.2 [95% CI, 9.1-13.9]). Physical and Mental Component Summary scores were also significantly reduced with differences of -2.5 (95% CI, -3.1 to -1.8) and -2.0 (95% CI, -2.7 to -1.2), respectively. Female sex and severity of initial infection were major risk factors for long COVID. Conclusions Nonhospitalized SARS-CoV-2 PCR-positive individuals had significantly reduced physical and mental health, and 1 in 4 reported persistence of at least 1 long-COVID symptom.
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Affiliation(s)
- Maarten van Wijhe
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Kamille Fogh
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steen Ethelberg
- Statens Serum Institut, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Kasper Karmark Iversen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Østergaard
- Statens Serum Institut, Copenhagen, Denmark,Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark
| | - Berit Andersen
- Statens Serum Institut, Copenhagen, Denmark,University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Henning Bundgaard
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Bibi F SS Scharff
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Svend Ellermann-Eriksen
- Statens Serum Institut, Copenhagen, Denmark,Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | | | | | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Thea K Fischer
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark
| | - Kåre Mølbak
- Statens Serum Institut, Copenhagen, Denmark,Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Thomas Benfield
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Department of Infectious Diseases, Copenhagen University Hospital, Amager and Hvidovre, Hvidovre, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Denmark,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Freddy Lippert
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Copenhagen Emergency Medical Services, Copenhagen, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark,Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Anders Koch
- Statens Serum Institut, Copenhagen, Denmark,Department of Public Health, University of Copenhagen, Copenhagen, Denmark,Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | | | | | - Lone Simonsen
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Susanne Dam Nielsen
- Correspondence: Susanne Dam Nielsen, MD, DMSc, Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark ()
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16
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Sandbøl SG, Glassou EN, Ellermann-Eriksen S, Haagerup A. Hand hygiene compliance among healthcare workers before and during the COVID-19 pandemic. Am J Infect Control 2022; 50:719-723. [PMID: 35367321 PMCID: PMC8966111 DOI: 10.1016/j.ajic.2022.03.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 03/22/2022] [Accepted: 03/24/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND Healthcare workers' (HCWs) adherence to hand hygiene is vital in combatting COVID-19 in hospitals. We aimed to investigate HCWs hand hygiene compliance before and during the COVID-19 pandemic and hypothesised that hand hygiene compliance would increase during the pandemic. METHODS We conducted a prospective observational study in three medical departments at the Regional Hospital of West Jutland, Denmark from April 2019 to August 2020. A total of 150 HCWs participated before the COVID-19 pandemic and 136 during the pandemic. Hand hygiene observations were assessed using an automated hand hygiene monitoring system. Students unpaired t-test was used to assess differences in hand hygiene compliance rates in each department. RESULTS Comparison analyses showed, that hand hygiene compliance in department A and B was significantly higher before the COVID-19 pandemic than during the pandemic; a 7% difference in department A and a 5% difference in department B. For department C, the total hand hygiene compliance was unchanged during the pandemic compared to before. CONCLUSION The COVID-19 pandemic did not raise hand hygiene compliance. Further studies are needed to verify these findings and further identify barriers to hand hygiene compliance among HCWs.
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17
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Rebelo AR, Bortolaia V, Leekitcharoenphon P, Hansen DS, Nielsen HL, Ellermann-Eriksen S, Kemp M, Røder BL, Frimodt-Møller N, Søndergaard TS, Coia JE, Østergaard C, Westh H, Aarestrup FM. One Day in Denmark: Comparison of Phenotypic and Genotypic Antimicrobial Susceptibility Testing in Bacterial Isolates From Clinical Settings. Front Microbiol 2022; 13:804627. [PMID: 35756053 PMCID: PMC9226621 DOI: 10.3389/fmicb.2022.804627] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 05/10/2022] [Indexed: 11/13/2022] Open
Abstract
Antimicrobial susceptibility testing (AST) should be fast and accurate, leading to proper interventions and therapeutic success. Clinical microbiology laboratories rely on phenotypic methods, but the continuous improvement and decrease in the cost of whole-genome sequencing (WGS) technologies make them an attractive alternative. Studies evaluating the performance of WGS-based prediction of antimicrobial resistance (AMR) for selected bacterial species have shown promising results. There are, however, significant gaps in the literature evaluating the applicability of WGS as a diagnostics method in real-life clinical settings against the range of bacterial pathogens experienced there. Thus, we compared standard phenotypic AST results with WGS-based predictions of AMR profiles in bacterial isolates without preselection of defined species, to evaluate the applicability of WGS as a diagnostics method in clinical settings. We collected all bacterial isolates processed by all Danish Clinical Microbiology Laboratories in 1 day. We randomly selected 500 isolates without any preselection of species. We performed AST through standard broth microdilution (BMD) for 488 isolates (n = 6,487 phenotypic AST results) and compared results with in silico antibiograms obtained through WGS (Illumina NextSeq) followed by bioinformatics analyses using ResFinder 4.0 (n = 5,229 comparisons). A higher proportion of AMR was observed for Gram-negative bacteria (10.9%) than for Gram-positive bacteria (6.1%). Comparison of BMD with WGS data yielded a concordance of 91.7%, with discordant results mainly due to phenotypically susceptible isolates harboring genetic AMR determinants. These cases correspond to 6.2% of all isolate-antimicrobial combinations analyzed and to 6.8% of all phenotypically susceptible combinations. We detected fewer cases of phenotypically resistant isolates without any known genetic resistance mechanism, particularly 2.1% of all combinations analyzed, which corresponded to 26.4% of all detected phenotypic resistances. Most discordances were observed for specific combinations of species-antimicrobial: macrolides and tetracycline in streptococci, ciprofloxacin and β-lactams in combination with β-lactamase inhibitors in Enterobacterales, and most antimicrobials in Pseudomonas aeruginosa. WGS has the potential to be used for surveillance and routine clinical microbiology. However, in clinical microbiology settings and especially for certain species and antimicrobial agent combinations, further developments in AMR gene databases are needed to ensure higher concordance between in silico predictions and expected phenotypic AMR profiles.
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Affiliation(s)
- Ana Rita Rebelo
- National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
| | - Valeria Bortolaia
- National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark.,Department of Bacteria, Parasites and Fungi, Statens Serum Institut, Copenhagen, Denmark
| | | | | | - Hans Linde Nielsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
| | | | - Michael Kemp
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Bent Løwe Røder
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | | | | | - John Eugenio Coia
- Department of Clinical Microbiology, Hospital of South West Jutland, Esbjerg, Denmark
| | - Claus Østergaard
- Department of Clinical Microbiology, Vejle Hospital, Vejle, Denmark
| | - Henrik Westh
- Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen University Hospital - Amager and Hvidovre, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Frank M Aarestrup
- National Food Institute, Technical University of Denmark, Kongens Lyngby, Denmark
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18
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Eriksen ARR, Fogh K, Hasselbalch RB, Bundgaard H, Nielsen SD, Jørgensen CS, Scharff BFSS, Erikstrup C, Sækmose SG, Holm DK, Aagaard B, Kristensen JH, Bødker CA, Norsk JB, Nielsen PB, Østergaard L, Ellermann-Eriksen S, Andersen B, Nielsen H, Johansen IS, Wiese L, Simonsen L, K.Fischer T, Folke F, Lippert F, Ostrowski SR, Ethelberg S, Koch A, Vangsted AM, Krause T, Fomsgaard A, Nielsen C, Ullum H, Skov R, Iversen K. SARS-CoV-2 antibody prevalence among homeless people and shelter workers in Denmark: a nationwide cross-sectional study. BMC Public Health 2022; 22:1261. [PMID: 35761270 PMCID: PMC9238223 DOI: 10.1186/s12889-022-13642-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Accepted: 06/06/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
People experiencing homelessness (PEH) and associated shelter workers may be at higher risk of infection with “Severe acute respiratory syndrome coronavirus 2” (SARS-CoV-2). The aim of this study was to determine the prevalence of SARS-CoV-2 among PEH and shelter workers in Denmark.
Design and methods
In November 2020, we conducted a nationwide cross-sectional seroprevalence study among PEH and shelter workers at 21 recruitment sites in Denmark. The assessment included a point-of-care test for antibodies against SARS-CoV-2, followed by a questionnaire. The seroprevalence was compared to that of geographically matched blood donors considered as a proxy for the background population, tested using a total Ig ELISA assay.
Results
We included 827 participants in the study, of whom 819 provided their SARS-CoV-2 antibody results. Of those, 628 were PEH (median age 50.8 (IQR 40.9–59.1) years, 35.5% female) and 191 were shelter workers (median age 46.6 (IQR 36.1–55.0) years and 74.5% female). The overall seroprevalence was 6.7% and was similar among PEH and shelter workers (6.8% vs 6.3%, p = 0.87); and 12.2% among all participants who engaged in sex work. The overall participant seroprevalence was significantly higher than that of the background population (2.9%, p < 0.001). When combining all participants who reported sex work or were recruited at designated safe havens, we found a significantly increased risk of seropositivity compared to other participants (OR 2.23, 95%CI 1.06–4.43, p = 0.02). Seropositive and seronegative participants reported a similar presence of at least one SARS-CoV-2 associated symptom (49% and 54%, respectively).
Interpretations
The prevalence of SARS-CoV-2 antibodies was more than twice as high among PEH and associated shelter workers, compared to the background population. These results could be taken into consideration when deciding in which phase PEH are eligible for a vaccine, as part of the Danish national SARS-CoV-2 vaccination program rollout.
Funding
TrygFonden and HelseFonden.
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19
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Iversen AM, Hansen MB, Kristensen B, Ellermann-Eriksen S. Clinical Evaluation of an Electronic Hand Hygiene Monitoring System. Am J Infect Control 2022; 51:376-379. [PMID: 35732254 DOI: 10.1016/j.ajic.2022.06.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 06/16/2022] [Accepted: 06/16/2022] [Indexed: 11/01/2022]
Abstract
BACKGROUND We aimed to test the accuracy of an electronic hand hygiene monitoring system (EHHMS) during daily clinical activities in different wards and with varying healthcare professions. METHOD The accuracy of an EHHMS ([blinded for reviewers]) was assessed during real clinical conditions by comparing events registered by two observers in parallel with events registered by the EHHMS. The events were categorized as true-positive, false-positive, and false-negative registrations. Sensitivity and positive predictive value (PPV) were calculated. RESULTS A total of 103 events performed by 25 healthcare workers (9 doctors, 11 nurses, and 5 cleaning assistants) were included in the analyses. The EHHMS had a sensitivity of 100% and a positive predictive value of 100% when measuring alcohol-based hand rub. When looking at the hand hygiene opportunities of all healthcare workers combined taking place in the patient rooms and working rooms, the sensitivity was 75% and the PPV 95%. For doctors' and nurses' taking care of patients in their beds the EHHMS had a sensitivity of 100% and a PPV of 94%. CONCLUSION The objective accuracy measures demonstrate that this EHHMS can capture hand hygiene behavior under clinical conditions in different settings with clinical healthcare workers but show less accuracy with cleaning assistants.
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Affiliation(s)
- Anne-Mette Iversen
- Department of Oncology, Aarhus University Hospital, Denmark; Department of Clinical Medicine, Aarhus University, Denmark.
| | - Marco Bo Hansen
- Konduto ApS, Sani Nudge, Medical & Science, Copenhagen, Denmark
| | - Brian Kristensen
- National Center of Infection Control, Statens Serum Institut, Copenhagen, Denmarkssss
| | - Svend Ellermann-Eriksen
- Department of Clinical Medicine, Aarhus University, Denmark; Department of Clinical Microbiology, Aarhus University Hospital, Denmark
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20
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Tetens MM, Dessau R, Ellermann-Eriksen S, Andersen NS, Jørgensen CS, Østergaard C, Bodilsen J, Damgaard DF, Bangsborg J, Nielsen AC, Møller JK, Omland LH, Obel N, Lebech AM. The diagnostic value of serum Borrelia burgdorferi antibodies and seroconversion after Lyme neuroborreliosis, a nationwide observational study. Clin Microbiol Infect 2022; 28:1500.e1-1500.e6. [PMID: 35709901 DOI: 10.1016/j.cmi.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 05/18/2022] [Accepted: 06/02/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Clinical guidelines disagree on the diagnostic usefulness of Borrelia burgdorferi (Bb) serum antibodies (serum-Bb) in investigation of Lyme neuroborreliosis (LNB). We investigated the association between serum-Bb and Bb intrathecal antibody index (Bb-AI) and rates of seroconversion and seroreversion after LNB. METHODS Danish residents who had a Bb-AI and corresponding serum-Bb measured between 1994-2020 were identified at all Danish departments of clinical microbiology. We used descriptive statistics to examine the proportions of positive Bb-AI combined with positive or negative serum-Bb antibody tests. Next, the rate of seroconversion and seroreversion among those with positive Bb-AI and either an initial negative or positive serum-Bb was estimated. RESULTS We included 34 609 individuals with a Bb-AI and corresponding serum-Bb. The proportion of individuals with positive Bb-AI who had negative serum-Bb was 16.8% (95% confidence interval (CI), 15.1-18.6). The proportion of individuals with positive serum-Bb IgM, serum-Bb IgG or serum-Bb IgM and IgG antibodies who had positive Bb-AI was 10.6% (95% CI, 9.5-11.8), 24.7% (95% CI, 23.0-26.4) and 45.0% (95% CI, 42.4-48.0), respectively. The proportion of children (<18 years) with positive serum-Bb IgM and IgG antibodies who had a positive Bb-AI was 59.7% (95% CI, 53.4-65.8). The proportion of individuals with positive Bb-AI with initial negative or positive serum-Bb antibodies who seroconverted or seroreverted within 2 years was 17.3% (95% CI, 6.9-27.8) and 23.2% (95% CI, 19.1-27.7), respectively. CONCLUSIONS Serum-Bb antibodies could not predict results of Bb-AI. A fifth of both seronegative and seropositive individuals with positive Bb-AI seroconverted or seroreverted within 2 years.
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Affiliation(s)
- Malte M Tetens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Ram Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark; Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | | | - Nanna S Andersen
- Clinical Centre for Emerging and Vector-borne Infections, Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | | | - Christian Østergaard
- Department of Clinical Microbiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - David F Damgaard
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Jette Bangsborg
- Department of Clinical Microbiology, Herlev Hospital, Herlev, Copenhagen University Hospital, Denmark
| | - Alex Christian Nielsen
- Department of Clinical Microbiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Vejle Hospital, University Hospital of Southern Denmark, Vejle, Denmark
| | - Lars Haukali Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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21
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Rebelo AR, Ibfelt T, Bortolaia V, Leekitcharoenphon P, Hansen DS, Nielsen HL, Ellermann-Eriksen S, Kemp M, Røder BL, Frimodt-Møller N, Søndergaard TS, Coia JE, Østergaard C, Pedersen M, Westh H, Aarestrup FM. One Day in Denmark: Nationwide point-prevalence survey of human bacterial isolates and comparison of classical and whole-genome sequence-based species identification methods. PLoS One 2022; 17:e0261999. [PMID: 35148318 PMCID: PMC8836320 DOI: 10.1371/journal.pone.0261999] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 12/16/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives Implementing whole-genome sequencing (WGS) technologies in clinical microbiology laboratories can increase the amount and quality of information available for healthcare practitioners. In this study, we analysed the applicability of this method and determined the distribution of bacterial species processed in clinical settings in Denmark. Methods We performed a point-prevalence study of all bacterial isolates (n = 2,009) processed and reported in the Clinical Microbiology Laboratories in Denmark in one day in January 2018. We compared species identification as performed by classical methods (MALDI-TOF) and by bioinformatics analysis (KmerFinder and rMLST) of WGS (Illumina NextSeq) data. We compared the national point-prevalence of bacterial isolates observed in clinical settings with the research attention given to those same genera in scientific literature. Results The most prevalent bacterium was Escherichia coli isolated from urine (n = 646), followed by Staphylococcus spp. from skin or soft tissues (n = 197). The distribution of bacterial species throughout the country was not homogeneous. We observed concordance of species identification for all methods in 95.7% (n = 1,919) of isolates, furthermore obtaining concordance for 99.7% (n = 1,999) at genus level. The number of scientific publications in the country did not correlate with the number of bacterial isolates of each genera analysed in this study. Conclusions WGS technologies have the potential to be applied in clinical settings for routine diagnostics purposes. This study also showed that bioinformatics databases should be continuously improved and results from local point-prevalence surveys should not be applied at national levels without previously determining possible regional variations.
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Affiliation(s)
- Ana Rita Rebelo
- Technical University of Denmark, National Food Institute, Kongens Lyngby, Denmark
- * E-mail:
| | - Tobias Ibfelt
- Hvidovre Hospital, Department of Clinical Microbiology, Hvidovre, Denmark
| | - Valeria Bortolaia
- Technical University of Denmark, National Food Institute, Kongens Lyngby, Denmark
| | | | | | - Hans Linde Nielsen
- Aalborg University Hospital, Department of Clinical Microbiology, Aalborg, Denmark
| | | | - Michael Kemp
- Odense University Hospital, Department of Clinical Microbiology, Odense, Denmark
| | - Bent Løwe Røder
- Slagelse Hospital, Department of Clinical Microbiology, Slagelse, Denmark
| | | | | | - John Eugenio Coia
- Sydvestjysk Hospital, Department of Clinical Microbiology, Esbjerg, Denmark
| | - Claus Østergaard
- Vejle Hospital, Department of Clinical Microbiology, Vejle, Denmark
| | - Michael Pedersen
- Hvidovre Hospital, Department of Clinical Microbiology, Hvidovre, Denmark
| | - Henrik Westh
- Hvidovre Hospital, Department of Clinical Microbiology, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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22
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Fogh K, Eriksen ARR, Hasselbalch RB, Kristensen ES, Bundgaard H, Nielsen SD, Jørgensen CS, Scharff BFSS, Erikstrup C, Sækmose SG, Holm DK, Aagaard B, Norsk J, Nielsen PB, Kristensen JH, Østergaard L, Ellermann-Eriksen S, Andersen B, Nielsen H, Johansen IS, Wiese L, Simonsen L, Fischer TK, Folke F, Lippert F, Ostrowski SR, Ethelberg S, Koch A, Vangsted AM, Krause TG, Fomsgaard A, Nielsen C, Ullum H, Skov R, Iversen K. Seroprevalence of SARS-CoV-2 antibodies in social housing areas in Denmark. BMC Infect Dis 2022; 22:143. [PMID: 35144550 PMCID: PMC8830972 DOI: 10.1186/s12879-022-07102-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Accepted: 01/29/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND COVID-19 is thought to be more prevalent among ethnic minorities and individuals with low socioeconomic status. We aimed to investigate the prevalence of SARS-CoV-2 antibodies during the COVID-19 pandemic among citizens 15 years or older in Denmark living in social housing (SH) areas. METHODS We conducted a study between January 8th and January 31st, 2021 with recruitment in 13 selected SH areas. Participants were offered a point-of-care rapid SARS-CoV-2 IgM and IgG antibody test and a questionnaire concerning risk factors associated with COVID-19. As a proxy for the general Danish population we accessed data on seroprevalence from Danish blood donors (total Ig ELISA assay) in same time period. RESULTS Of the 13,279 included participants, 2296 (17.3%) were seropositive (mean age 46.6 (SD 16.4) years, 54.2% female), which was 3 times higher than in the general Danish population (mean age 41.7 (SD 14.1) years, 48.5% female) in the same period (5.8%, risk ratios (RR) 2.96, 95% CI 2.78-3.16, p > 0.001). Seropositivity was higher among males (RR 1.1, 95% CI 1.05-1.22%, p = 0.001) and increased with age, with an OR seropositivity of 1.03 for each 10-year increase in age (95% CI 1.00-1.06, p = 0.031). Close contact with COVID-19-infected individuals was associated with a higher risk of infection, especially among household members (OR 5.0, 95% CI 4.1-6.2 p < 0,001). Living at least four people in a household significantly increased the OR of seropositivity (OR 1.3, 95% CI 1.0-1.6, p = 0.02) as did living in a multi-generational household (OR 1.3 per generation, 95% CI 1.1-1.6, p = 0.003). Only 1.6% of participants reported not following any of the national COVID-19 recommendations. CONCLUSIONS Danish citizens living in SH areas of low socioeconomic status had a three times higher SARS-CoV-2 seroprevalence compared to the general Danish population. The seroprevalence was significantly higher in males and increased slightly with age. Living in multiple generations households or in households of more than four persons was a strong risk factor for being seropositive. Results of this study can be used for future consideration of the need for preventive measures in the populations living in SH areas.
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Affiliation(s)
- Kamille Fogh
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark. .,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark. .,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Alexandra R R Eriksen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus B Hasselbalch
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Emilie Sofie Kristensen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne D Nielsen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Bibi F S S Scharff
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Christian Erikstrup
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Susanne G Sækmose
- Department of Clinical Immunology, Zealand University Hospital, Køge, Denmark
| | - Dorte K Holm
- Department of Clinical Immunology, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Bitten Aagaard
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | - Jakob Norsk
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Brok Nielsen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jonas H Kristensen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Odense, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Lone Simonsen
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Thea K Fischer
- Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Copenhagen Emergency Medical Services, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Steen Ethelberg
- Statens Serum Institut, Copenhagen, Denmark.,Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Koch
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Statens Serum Institut, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | | | | | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospital, Herlev and Gentofte, Borgmester Ib Juuls Vej 1, 2730, Herlev, Denmark.,Department of Emergency Medicine, Copenhagen University Hospital, Herlev and Gentofte, Herlev, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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23
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Omland LH, Bodilsen J, Larsen JH, Jarløv JO, Ziebell M, Ellermann-Eriksen S, Justesen US, Frimodt-Møller N, Obel N. Socioeconomic functioning in patients with brain abscess – a nationwide, population-based cohort study in Denmark. J Infect 2022; 84:621-627. [DOI: 10.1016/j.jinf.2022.02.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Revised: 02/08/2022] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
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24
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Borch L, Holm M, Knudsen M, Ellermann-Eriksen S, Hagstroem S. Long COVID symptoms and duration in SARS-CoV-2 positive children - a nationwide cohort study. Eur J Pediatr 2022; 181:1597-1607. [PMID: 35000003 PMCID: PMC8742700 DOI: 10.1007/s00431-021-04345-z] [Citation(s) in RCA: 130] [Impact Index Per Article: 65.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 11/10/2021] [Accepted: 12/09/2021] [Indexed: 12/22/2022]
Abstract
UNLABELLED Most children have a mild course of acute COVID-19. Only few mainly non-controlled studies with small sample size have evaluated long-term recovery from SARS-CoV-2 infection in children. The aim of this study was to evaluate symptoms and duration of 'long COVID' in children. A nationwide cohort study of 37,522 children aged 0-17 years with RT-PCR verified SARS-CoV-2 infection (response rate 44.9%) and a control group of 78,037 children (response rate 21.3%). An electronic questionnaire was sent to all children from March 24th until May 9th, 2021. Symptoms lasting > 4 weeks were common among both SARS-CoV-2 children and controls. However, SARS-CoV-2 children aged 6-17 years reported symptoms more frequently than the control group (percent difference 0.8%). The most reported symptoms among pre-school children were fatigue Risk Difference (RD) 0.05 (CI 0.04-0.06), loss of smell RD 0.01 (CI 0.01-0.01), loss of taste RD 0.01 (CI 0.01-0.02) and muscle weakness RD 0.01 (CI 0.00-0.01). Among school children the most significant symptoms were loss of smell RD 0.12 (CI 0.12-0.13), loss of taste RD 0.10 (CI 0.09-0.10), fatigue RD 0.05 (CI 0.05-0.06), respiratory problems RD 0.03 (CI 0.03-0.04), dizziness RD 0.02 (CI 0.02-0.03), muscle weakness RD 0.02 (CI 0.01-0.02) and chest pain RD 0.01 (CI 0.01-0.01). Children in the control group experienced significantly more concentration difficulties, headache, muscle and joint pain, cough, nausea, diarrhea and fever than SARS-CoV-2 infected. In most children 'long COVID' symptoms resolved within 1-5 months. CONCLUSIONS Long COVID in children is rare and mainly of short duration. WHAT IS KNOWN • There are increasing reports on 'long COVID' in adults. • Only few studies have evaluated the long-term recovery from COVID-19 in children, and common for all studies is a small sample size (median number of children included 330), and most lack a control group. WHAT IS NEW • 0.8% of SARS-CoV-2 positive children reported symptoms lasting >4 weeks ('long COVID'), when compared to a control group. • The most common 'long COVID' symptoms were fatigue, loss of smell and loss of taste, dizziness, muscle weakness, chest pain and respiratory problems. • These 'long COVID' symptoms cannot be assigned to psychological sequelae of social restrictions. • Symptoms such as concentration difficulties, headache, muscle- and joint pain as well as nausea are not 'long COVID' symptoms. • In most cases 'long COVID' symptoms resolve within 1-5 months.
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Affiliation(s)
- Luise Borch
- Department of Pediatric and Adolescent Medicine, NIDO Denmark, Hospitalsenheden Vest, Gl. Landevej 61, 7400, Herning, Denmark.
| | - Mette Holm
- grid.154185.c0000 0004 0512 597XPediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Maria Knudsen
- grid.27530.330000 0004 0646 7349Unit of Clinical Biostatistics, Aalborg University Hospital, Aalborg, Denmark
| | - Svend Ellermann-Eriksen
- grid.154185.c0000 0004 0512 597XDepartment of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - Soeren Hagstroem
- grid.27530.330000 0004 0646 7349Steno Diabetes Center North Denmark, Aalborg University Hospital, Aalborg, Denmark ,grid.27530.330000 0004 0646 7349Department of Pediatrics, Aalborg University Hospital, Aalborg, Denmark
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25
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Fogh K, Strange JE, Scharff BFSS, Eriksen ARR, Hasselbalch RB, Bundgaard H, Nielsen SD, Jørgensen CS, Erikstrup C, Norsk J, Nielsen PB, Kristensen JH, Østergaard L, Ellermann-Eriksen S, Andersen B, Nielsen H, Johansen IS, Wiese L, Simonsen L, Fischer TK, Folke F, Lippert F, Ostrowski SR, Benfield T, Mølbak K, Ethelberg S, Koch A, Sönksen UW, Vangsted AM, Krause TG, Fomsgaard A, Ullum H, Skov R, Iversen K. Testing Denmark: a Danish Nationwide Surveillance Study of COVID-19. Microbiol Spectr 2021; 9:e0133021. [PMID: 34908473 PMCID: PMC8672904 DOI: 10.1128/spectrum.01330-21] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/12/2021] [Indexed: 11/20/2022] Open
Abstract
"Testing Denmark" is a national, large-scale, epidemiological surveillance study of SARS-CoV-2 in the Danish population. Between September and October 2020, approximately 1.3 million people (age >15 years) were randomly invited to fill in an electronic questionnaire covering COVID-19 exposures and symptoms. The prevalence of SARS-CoV-2 antibodies was determined by point-of care rapid test (POCT) distributed to participants' home addresses. In total, 318,552 participants (24.5% invitees) completed the study and 2,519 (0.79%) were seropositive. Of the participants with a prior positive PCR test (n = 1,828), 29.1% were seropositive in the POCT. Although seropositivity increased with age, participants 61 years and over reported fewer symptoms and were tested less frequently. Seropositivity was associated with physical contact with SARS-CoV-2 infected individuals (risk ratio [RR] 7.43, 95% CI: 6.57-8.41), particular in household members (RR 17.70, 95% CI: 15.60-20.10). A greater risk of seropositivity was seen in home care workers (RR 2.09, 95% CI: 1.58-2.78) compared to office workers. A high degree of adherence with national preventive recommendations was reported (e.g., >80% use of face masks), but no difference were found between seropositive and seronegative participants. The seroprevalence result was somewhat hampered by a lower-than-expected performance of the POCT. This is likely due to a low sensitivity of the POCT or problems reading the test results, and the main findings therefore relate to risk associations. More emphasis should be placed on age, occupation, and exposure in local communities. IMPORTANCE To date, including 318,522 participants, this is the largest population-based study with broad national participation where tests and questionnaires have been sent to participants' homes. We found that more emphasis from national and local authorities toward the risk of infection should be placed on age of tested individuals, type of occupation, as well as exposure in local communities and households. To meet the challenge that broad nationwide information can be difficult to gather. This study design sets the stage for a novel way of conducting studies. Additionally, this study design can be used as a supplementary model in future general test strategy for ongoing monitoring of COVID-19 immunity in the population, both from past infection and from vaccination against SARS-CoV-2, however, with attention to the complexity of performing and reading the POCT at home.
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Affiliation(s)
- Kamille Fogh
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jarl E Strange
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Bibi F S S Scharff
- Department of Clinical Immunology, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Alexandra R R Eriksen
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Rasmus B Hasselbalch
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henning Bundgaard
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne D Nielsen
- Department of Infectious Diseases, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | - Christian Erikstrup
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Infectious Diseases, Aarhus University Hospitalgrid.154185.c, Aarhus, Denmark
| | - Jakob Norsk
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Pernille Brok Nielsen
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Jonas H Kristensen
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Lars Østergaard
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Infectious Diseases, Aarhus University Hospitalgrid.154185.c, Aarhus, Denmark
| | - Svend Ellermann-Eriksen
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Clinical Microbiology, Aarhus University Hospitalgrid.154185.c, Aarhus, Denmark
| | - Berit Andersen
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- University Research Clinic for Cancer Screening, Randers Regional Hospital, Randers, Denmark
| | - Henrik Nielsen
- Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
- Department of Clinical Medicine, Aalborg University, Odense, Denmark
| | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospitalgrid.7143.1, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Lothar Wiese
- Department of Infectious Diseases, Zealand University Hospital, Roskilde, Denmark
| | - Lone Simonsen
- Department of Science and Environment, Roskilde University, Roskilde, Denmark
| | - Thea K Fischer
- Department of Clinical Research, North Zealand Hospital, Hillerød, Denmark
- Department of Public health, University of Copenhagen, Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Freddy Lippert
- Copenhagen Emergency Medical Services, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sisse R Ostrowski
- Department of Clinical Immunology, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Copenhagen University Hospitalgrid.4973.9, Amager and Hvidovre, Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Kåre Mølbak
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Steen Ethelberg
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Public health, University of Copenhagen, Copenhagen, Denmark
| | - Anders Koch
- Department of Infectious Diseases, Copenhagen University Hospitalgrid.4973.9, Rigshospitalet, Denmark
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | | | | | | | | - Henrik Ullum
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
| | - Robert Skov
- Statens Serum Institutgrid.6203.7, Copenhagen, Denmark
| | - Kasper Iversen
- Department of Cardiology, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Emergency Medicine, Copenhagen University Hospitalgrid.4973.9, Herlev and Gentofte, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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26
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Hüttel FB, Iversen AM, Bo Hansen M, Kjær Ersbøll B, Ellermann-Eriksen S, Lundtorp Olsen N. Analysis of social interactions and risk factors relevant to the spread of infectious diseases at hospitals and nursing homes. PLoS One 2021; 16:e0257684. [PMID: 34543324 PMCID: PMC8452062 DOI: 10.1371/journal.pone.0257684] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 09/07/2021] [Indexed: 02/05/2023] Open
Abstract
Ensuring the safety of healthcare workers is vital to overcome the ongoing COVID-19 pandemic. We here present an analysis of the social interactions between the healthcare workers at hospitals and nursing homes. Using data from an automated hand hygiene system, we inferred social interactions between healthcare workers to identify transmission paths of infection in hospitals and nursing homes. A majority of social interactions occurred in medication rooms and kitchens emphasising that health-care workers should be especially aware of following the infection prevention guidelines in these places. Using epidemiology simulations of disease at the locations, we found no need to quarantine all healthcare workers at work with a contagious colleague. Only 14.1% and 24.2% of the health-care workers in the hospitals and nursing homes are potentially infected when we disregard hand sanitization and assume the disease is very infectious. Based on our simulations, we observe a 41% and 26% reduction in the number of infected healthcare workers at the hospital and nursing home, when we assume that hand sanitization reduces the spread by 20% from people to people and 99% from people to objects. The analysis and results presented here forms a basis for future research to explore the potential of a fully automated contact tracing systems.
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27
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Schønning K, Dessau RB, Jensen TG, Thorsen NM, Wiuff C, Nielsen L, Gubbels S, Denwood M, Thygesen UH, Christensen LE, Møller CH, Møller JK, Ellermann-Eriksen S, Østergaard C, Lam JUH, Abushalleeh N, Meaidi M, Olsen S, Mølbak K, Voldstedlund M. Electronic reporting of diagnostic laboratory test results from all healthcare sectors is a cornerstone of national preparedness and control of COVID-19 in Denmark. APMIS 2021; 129:438-451. [PMID: 33949007 PMCID: PMC8239934 DOI: 10.1111/apm.13140] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/07/2021] [Indexed: 12/03/2022]
Abstract
The COVID‐19 pandemic has led to an unprecedented demand for real‐time surveillance data in order to inform critical decision makers regarding the management of the pandemic. The aim of this review was to describe how the Danish national microbiology database, MiBa, served as a cornerstone for providing data to the real‐time surveillance system by linkage to other nationwide health registries. The surveillance system was established on an existing IT health infrastructure and a close network between clinical microbiologists, information technology experts, and public health officials. In 2020, testing capacity for SARS‐CoV‐2 was ramped up from none to over 10,000 weekly PCR tests per 100,000 population. The crude incidence data mirrored this increase in testing. Real‐time access to denominator data and patient registries enabled adjustments for fluctuations testing activity, providing robust data on crude SARS‐CoV‐2 incidence during the changing diagnostic and management strategies. The use of the same data for different purposes, for example, final laboratory reports, information to the public, contact tracing, public health, and science, has been a critical asset for the pandemic response. It has also raised issues concerning data protection and critical capacity of the underlying technical systems and key resources. However, even with these limitations, the setup has enabled decision makers to adopt timely interventions. The experiences from COVID‐19 may motivate a transformation from traditional indicator‐based public health surveillance to an all‐encompassing information system based on access to a comprehensive set of data sources, including diagnostic and reference microbiology.
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Affiliation(s)
- Kristian Schønning
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Zealand University Hospital, Slagelse, Denmark
| | - Thøger Gorm Jensen
- Department of Clinical Microbiology, Odense University Hospital and Clinical Microbiology Research Unit, University of Southern Denmark, Odense, Denmark
| | - Nicklas Myrthue Thorsen
- Data Integration and Analysis, Division of Infection Preparedness, Statens Serum Institut, Copenhagen S, Denmark
| | - Camilla Wiuff
- Department of Clinical Microbiology, The Hospital of South West Jutland, University Hospital of Southern Denmark, Odense, Denmark
| | - Lene Nielsen
- Department of Clinical Microbiology, Copenhagen University Hospital Herlev and Gentofte Hospital, Copenhagen, Denmark
| | - Sophie Gubbels
- Data Integration and Analysis, Division of Infection Preparedness, Statens Serum Institut, Copenhagen S, Denmark
| | - Matt Denwood
- Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Uffe Høgsbro Thygesen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Lasse Engbo Christensen
- Department of Applied Mathematics and Computer Science, Technical University of Denmark, Kgs. Lyngby, Denmark
| | - Camilla Holten Møller
- Expert Group on Mathematical Modeling of COVIDd-19 Infectious Disease Preparedness Statens Serum Institut, Copenhagen S, Denmark
| | | | | | - Christian Østergaard
- Department of Clinical Microbiology, Copenhagen University Hospital, Hvidovre, Denmark
| | - Janni Uyen Hoa Lam
- Data Integration and Analysis, Division of Infection Preparedness, Statens Serum Institut, Copenhagen S, Denmark
| | - Nour Abushalleeh
- Data Integration and Analysis, Division of Infection Preparedness, Statens Serum Institut, Copenhagen S, Denmark
| | - Marianna Meaidi
- Data Integration and Analysis, Division of Infection Preparedness, Statens Serum Institut, Copenhagen S, Denmark
| | - Stefan Olsen
- Data Integration and Analysis, Division of Infection Preparedness, Statens Serum Institut, Copenhagen S, Denmark
| | - Kåre Mølbak
- Data Integration and Analysis, Division of Infection Preparedness, Statens Serum Institut, Copenhagen S, Denmark.,Department of Veterinary and Animal Sciences, University of Copenhagen, Frederiksberg C, Denmark
| | - Marianne Voldstedlund
- Data Integration and Analysis, Division of Infection Preparedness, Statens Serum Institut, Copenhagen S, Denmark
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28
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Iversen AM, Stangerup M, From-Hansen M, Hansen R, Sode LP, Kostadinov K, Hansen MB, Calum H, Ellermann-Eriksen S, Knudsen JD. Light-guided nudging and data-driven performance feedback improve hand hygiene compliance among nurses and doctors. Am J Infect Control 2021; 49:733-739. [PMID: 33186676 PMCID: PMC7654366 DOI: 10.1016/j.ajic.2020.11.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/06/2020] [Accepted: 11/06/2020] [Indexed: 12/30/2022]
Abstract
Background Evidence-based practices to increase hand hygiene compliance (HHC) among health care workers are warranted. We aimed to investigate the effect of a multimodal strategy on HHC. Methods During this 14-month prospective, observational study, an automated monitoring system was implemented in a 29-bed surgical ward. Hand hygiene opportunities and alcohol-based hand rubbing events were measured in patient and working rooms (medication, utility, storerooms, toilets). We compared baseline HHC of health care workers across periods with light-guided nudging from sensors on dispensers and data-driven performance feedback (multimodal strategy) using the Student's t test. Results The doctors (n = 10) significantly increased their HHC in patient rooms (16% vs 42%, P< .0001) and working rooms (24% vs 78%, P= .0006) when using the multimodal strategy. The nurses (n = 26) also increased their HHC significantly from baseline in both patient rooms (27% vs 43%, P = .0005) and working rooms (39% vs 64%, P< .0001). The nurses (n = 9), who subsequently received individual performance feedback, further increased HHC, compared with the period when they received group performance feedback (patient rooms: 43% vs 55%, P< .0001 and working rooms: 64% vs 80%, P< .0001). Conclusions HHC of doctors and nurses can be significantly improved with light-guided nudging and data-driven performance feedback using an automated hand hygiene system.
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Affiliation(s)
| | - Marie Stangerup
- Department of Quality and Education, Infection Control Unit, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark
| | - Michelle From-Hansen
- Department of Quality and Education, Infection Control Unit, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark
| | - Rosa Hansen
- Department of Orthopedic, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Louise Palasin Sode
- Department of Orthopedic, Bispebjerg University Hospital, Copenhagen, Denmark
| | | | | | - Henrik Calum
- Department of Quality and Education, Infection Control Unit, Bispebjerg and Frederiksberg Hospitals, Copenhagen, Denmark; Department of Clinical Microbiology, Amager and Hvidovre Hospital, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Jenny Dahl Knudsen
- Department of Clinical Microbiology, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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29
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Haahr R, Tetens MM, Dessau RB, Krogfelt KA, Bodilsen J, Andersen NS, Møller JK, Roed C, Christiansen CB, Ellermann-Eriksen S, Bangsborg JM, Hansen K, Benfield TL, Andersen CØ, Obel N, Lebech AM, Omland LH. Risk of Neurological Disorders in Patients With European Lyme Neuroborreliosis: A Nationwide, Population-Based Cohort Study. Clin Infect Dis 2021; 71:1511-1516. [PMID: 31598647 DOI: 10.1093/cid/ciz997] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/04/2019] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Lyme neuroborreliosis (LNB), caused by the tick-borne spirochetes of the Borrelia burgdorferi sensu lato species complex, has been suggested to be associated with a range of neurological disorders. In a nationwide, population-based cohort study, we examined the associations between LNB and dementia, Alzheimer's disease, Parkinson's disease, motor neuron disease, epilepsy, and Guillain-Barré syndrome. METHODS We used national registers to identify all Danish residents diagnosed during 1986-2016 with LNB (n = 2067), created a gender- and age-matched comparison cohort from the general population (n = 20 670), and calculated risk estimates and hazard ratios. RESULTS We observed no long-term increased risks of dementia, Alzheimer's disease, Parkinson's disease, motor neuron diseases, or epilepsy. However, within the first year, 8 (0.4%) of the LNB patients developed epilepsy, compared with 20 (0.1%) of the comparison cohort (difference, 0.3%; 95% confidence interval, .02-.6%). In the LNB group, 11 (0.5%) patients were diagnosed with Guillain-Barré syndrome within the first year after LNB diagnosis, compared with 0 (0.0%) in the comparison cohort. After the first year, the risk of Guillain-Barré was not increased. CONCLUSIONS LNB patients did not have increased long-term risks of dementia, Alzheimer's disease, Parkinson's disease, motor neuron diseases, epilepsy, or Guillain-Barré. Although the absolute risk is low, LNB patients might have an increased short-term risk of epilepsy and Guillain-Barré syndrome.
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Affiliation(s)
- Rasmus Haahr
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Malte M Tetens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Karen A Krogfelt
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark.,Department of Natural Sciences and Environment, Roskilde University, Roskilde, Denmark
| | - Jacob Bodilsen
- Departments of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark.,Departments of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Nanna S Andersen
- Clinical Centre for Emerging and Vector-Borne Infections, Odense University Hospital, Odense, Denmark
| | - Jens K Møller
- Department of Clinical Microbiology, Vejle Hospital, Vejle, Denmark
| | - Casper Roed
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus B Christiansen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Jette M Bangsborg
- Department of Clinical Microbiology, Herlev University Hospital, Copenhagen, Denmark
| | - Klaus Hansen
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas L Benfield
- Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian Ø Andersen
- Department of Clinical Microbiology, Hvidovre University Hospital, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Omland LH, Holm-Hansen C, Lebech AM, Dessau RB, Bodilsen J, Andersen NS, Roed C, Christiansen CB, Ellermann-Eriksen S, Midgley S, Nielsen L, Benfield T, Hansen ABE, Andersen CØ, Rothman KJ, Sørensen HT, Fischer TK, Obel N. Long-Term Survival, Health, Social Functioning, and Education in Patients With an Enterovirus Central Nervous System Infection, Denmark, 1997-2016. J Infect Dis 2021; 222:619-627. [PMID: 32236420 DOI: 10.1093/infdis/jiaa151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/31/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The long-term clinical course of patients with an enterovirus central nervous system infection (ECI) is poorly understood. METHODS We performed a nationwide population-based cohort study of all Danish patients with ECI diagnosed 1997-2016 (n = 1745) and a comparison cohort from the general population individually matched on date of birth and sex (n = 17 450). Outcomes were categorized into mortality and risk of cancer and likely measures of neurological sequelae: neuropsychiatric morbidities, educational landmarks, use of hospital services, employment, receipt of disability pension, income, number of sick leave days, and nursing home residency. RESULTS Mortality in the first year was higher among patients with ECI (mortality rate ratio [MRR] = 10.0; 95% confidence interval [CI], 4.17-24.1), but thereafter mortality was not higher (MMR = 0.94; 95% CI, 0.47-1.86). Long-term outcomes for patients with ECI were not inferior to those of the comparison cohort for risk of cancer, epilepsy, mental and behavioral disorders, dementia, depression, school start, school marks, high school education, use of hospital services, employment, receipt of disability pension, income, days of sick leave, or nursing home residency. CONCLUSIONS Diagnosis of an ECI had no substantial impact on long-term survival, health, or social/educational functioning.
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Affiliation(s)
- Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Charlotte Holm-Hansen
- Department of Virus and Specialist Microbiological Diagnostics, Statens Serum Institute, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Jacob Bodilsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark.,Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Nanna S Andersen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Casper Roed
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus B Christiansen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Sofie Midgley
- Department of Virus and Specialist Microbiological Diagnostics, Statens Serum Institute, Copenhagen, Denmark
| | - Lene Nielsen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Ann-Brit E Hansen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Infectious Diseases, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Christian Ø Andersen
- Department of Clinical Microbiology, Hvidovre Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Kenneth J Rothman
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Boston University, Boston, Massachusetts, USA
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark.,Department of Epidemiology, Boston University, Boston, Massachusetts, USA
| | - Thea K Fischer
- Department of Virus and Specialist Microbiological Diagnostics, Statens Serum Institute, Copenhagen, Denmark.,Department of Infectious Diseases, University of Southern Denmark, Odense, Denmark.,Centre for Global Health, University of Southern Denmark, Odense, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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31
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Tetens MM, Haahr R, Dessau RB, Krogfelt KA, Bodilsen J, Andersen NS, Møller JK, Roed C, Christiansen CB, Ellermann-Eriksen S, Bangsborg JM, Hansen K, Andersen CØ, Lebech AM, Obel N, Omland LH. Assessment of the Risk of Psychiatric Disorders, Use of Psychiatric Hospitals, and Receipt of Psychiatric Medication Among Patients With Lyme Neuroborreliosis in Denmark. JAMA Psychiatry 2021; 78:177-186. [PMID: 33026438 PMCID: PMC7542530 DOI: 10.1001/jamapsychiatry.2020.2915] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE The association of Lyme neuroborreliosis with the development of psychiatric disease is unknown and remains a subject of debate. OBJECTIVE To investigate the risk of psychiatric disease, the percentage of psychiatric hospital inpatient and outpatient contacts, and the receipt of prescribed psychiatric medications among patients with Lyme neuroborreliosis compared with individuals in a matched comparison cohort. DESIGN, SETTING, AND PARTICIPANTS This nationwide population-based matched cohort study included all residents of Denmark who received a positive result on an intrathecal antibody index test for Borrelia burgdorferi (patient cohort) between January 1, 1995, and December 31, 2015. Patients were matched by age and sex to a comparison cohort of individuals without Lyme neuroborreliosis from the general population of Denmark. Data were analyzed from February 2019 to March 2020. EXPOSURES Diagnosis of Lyme neuroborreliosis, defined as a positive result on an intrathecal antibody index test for B burgdorferi. MAIN OUTCOMES AND MEASURES The 0- to 15-year hazard ratios for the assignment of psychiatric diagnostic codes, the difference in the percentage of psychiatric inpatient and outpatient hospital contacts, and the difference in the percentage of prescribed psychiatric medications received among the patient cohort vs the comparison cohort. RESULTS Among 2897 patients with Lyme neuroborreliosis (1646 men [56.8%]) and 28 970 individuals in the matched comparison cohort (16 460 men [56.8%]), the median age was 45.7 years (interquartile range [IQR], 11.5-62.0 years) for both groups. The risk of a psychiatric disease diagnosis and the percentage of hospital contacts for psychiatric disease were not higher among patients with Lyme neuroborreliosis compared with individuals in the comparison cohort. A higher percentage of patients with Lyme neuroborreliosis compared with individuals in the comparison cohort received anxiolytic (7.2% vs 4.7%; difference, 2.6%; 95% CI, 1.6%-3.5%), hypnotic and sedative (11.0% vs 5.3%; difference, 5.7%; 95% CI, 4.5%-6.8%), and antidepressant (11.4% vs 6.0%; difference, 5.4%; 95% CI, 4.3%-6.6%) medications within the first year after diagnosis, after which the receipt of psychiatric medication returned to the same level as the comparison cohort. CONCLUSIONS AND RELEVANCE In this population-based matched cohort study, patients with Lyme neuroborreliosis did not have an increased risk of developing psychiatric diseases that required hospital care or treatment with prescription medication. The increased receipt of psychiatric medication among patients with Lyme neuroborreliosis within the first year after diagnosis, but not thereafter, suggests that most symptoms associated with the diagnosis subside within a short period.
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Affiliation(s)
- Malte M. Tetens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Rasmus Haahr
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ram B. Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Karen A. Krogfelt
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Copenhagen, Denmark,Department of Natural Sciences and Environment, Roskilde University, Roskilde, Denmark
| | - Jacob Bodilsen
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark,Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Nanna S. Andersen
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark
| | - Jens K. Møller
- Department of Clinical Microbiology, Vejle Hospital, Vejle, Denmark
| | - Casper Roed
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus B. Christiansen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Jette M. Bangsborg
- Department of Clinical Microbiology, Herlev University Hospital, Copenhagen, Denmark
| | - Klaus Hansen
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Christian Ø. Andersen
- Department of Clinical Microbiology, Hvidovre University Hospital, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars H. Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
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Omland LH, Vestergaard HT, Dessau RB, Bodilsen J, Andersen NS, Christiansen CB, Ellermann-Eriksen S, Nielsen L, Andersen CØ, Lebech AM, Obel N. Characteristics and long-term prognosis of Danish patients with varicella zoster virus detected in the cerebrospinal fluid, compared with the background population. J Infect Dis 2021; 224:850-859. [PMID: 33417703 DOI: 10.1093/infdis/jiab013] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Accepted: 01/07/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Risk factors for and long-term outcomes following detection of varicella zoster virus (VZV) DNA in the cerebrospinal fluid (CSF) are unknown. METHODS We performed a nationwide population-based cohort study of all Danish residents who had VZV DNA detected in the CSF by polymerase chain reaction (PCR) between 1 January 1997 and 1 March 2016 (VZV cohort; n = 517) and an age- and sex- matched comparison cohort from the general Danish population (n = 9823). We examined potential risk factors and mortality, neurologic morbidity, psychiatric morbidity, redemption of medicine prescribed for the nervous system and social outcomes. RESULTS Prior hospital admission, redemption of immunosuppressive medicine, comorbidity and immunosuppressive conditions were associated with detection of VZV DNA in the CSF. Mortality was increased in the VZV cohort, especially during the first year of observation and among patients with encephalitis. Patients in the VZV cohort had an increased risk of dementia and epilepsy. The redemption of antiepileptics and antidepressants was increased in the VZV cohort. CONCLUSIONS Immunosuppression and comorbidity are associated with increased risk of detection of VZV DNA in the CSF and the condition is associated with increased mortality and neurological morbidity.
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Affiliation(s)
- Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Hanne T Vestergaard
- Department of Virus and Specialist Microbiological Diagnostics, Statens Serum Institute, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Jacob Bodilsen
- Department of Clinical Microbiology, Aalborg University hospital, Aalborg, Denmark.,Department of Infectious Diseases, Aalborg University hospital, Aalborg, Denmark
| | - Nanna S Andersen
- Clinical Microbiology Research Unit, Odense University Hospital and University of Southern Denmark, Odense, Denmark
| | - Claus B Christiansen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Microbiology, Medical Service, Region Skåne, Lund, Sweden
| | | | - Lene Nielsen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Denmark
| | - Christian Ø Andersen
- Department of Clinical Microbiology, Hvidovre Hospital, Copenhagen, University of Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Tetens MM, Haahr R, Dessau RB, Krogfelt KA, Bodilsen J, Andersen NS, Møller JK, Roed C, Christiansen CB, Ellermann-Eriksen S, Bangsborg JM, Hansen K, Benfield TL, Andersen CØ, Obel N, Omland LH, Lebech AM. Changes in Lyme neuroborreliosis incidence in Denmark, 1996 to 2015. Ticks Tick Borne Dis 2020; 11:101549. [PMID: 32993955 DOI: 10.1016/j.ttbdis.2020.101549] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 07/31/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022]
Abstract
Lyme neuroborreliosis (LNB) has recently been added to the list of diseases under the European Union epidemiological surveillance in order to obtain updated information on incidence. The goal of this study was to identify temporal (yearly) variation, high risk geographical regions and risk groups, and seasonal variation for LNB in Denmark. This cohort-study investigated Danish patients (n = 2791) diagnosed with LNB (defined as a positive Borrelia burgdorferi sensu lato (s.l.) intrathecal antibody test) between 1996-2015. We calculated incidence and incidence ratios of LNB by comparing 4-yr groups of calendar-years, area of residency, sex and age, income and education groups, and the number of new LNB cases per month. The incidence of LNB was 2.2 per 100,000 individuals and year in 1996-1999, 2.7 in 2004-2007 and 1.1 per 100,000 individuals in 2012-2015. Yearly variations in LNB incidence were similar for most calendar-year groups. LNB incidence was highest in Eastern Denmark and among males and individuals who were 0-14 yrs old, who had a yearly income of >449,000 DKK, and who had a Master's degree or higher education. The number of LNB cases was highest from July to November (p < 0.001). In conclusion, based on Danish nationwide data of patients with positive B. burgdorferi s.l. intrathecal antibody index (1996-2015) the incidence of LNB was found to increase until 2004-2007 but thereafter to decline. European surveillance studies of Lyme borreliosis should be encouraged to monitor the incidence trend.
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Affiliation(s)
- Malte M Tetens
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
| | - Rasmus Haahr
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Karen A Krogfelt
- Department of Virus and Microbiological Special Diagnostics, Statens Serum Institut, Denmark; Department of Natural Sciences and Environment, Roskilde University, Denmark
| | - Jacob Bodilsen
- Departments of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark; Departments of and Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark
| | - Nanna S Andersen
- Clinical Centre for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark
| | - Jens K Møller
- Department of Clinical Microbiology, Vejle Hospital, Vejle, Denmark
| | - Casper Roed
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus B Christiansen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Jette M Bangsborg
- Department of Clinical Microbiology, Herlev University Hospital, Copenhagen, Denmark
| | - Klaus Hansen
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas L Benfield
- Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | | | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Hansen ABE, Vestergaard HT, Dessau RB, Bodilsen J, Andersen NS, Omland LH, Christiansen CB, Ellermann-Eriksen S, Nielsen L, Benfield T, Sørensen HT, Andersen CØ, Lebech AM, Obel N. Long-Term Survival, Morbidity, Social Functioning and Risk of Disability in Patients with a Herpes Simplex Virus Type 1 or Type 2 Central Nervous System Infection, Denmark, 2000-2016. Clin Epidemiol 2020; 12:745-755. [PMID: 32765109 PMCID: PMC7371560 DOI: 10.2147/clep.s256838] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 06/15/2020] [Indexed: 12/24/2022] Open
Abstract
Background The long-term prognosis following herpes simplex virus (HSV) central nervous system (CNS) infection is still debated. Patients and Methods We examined outcomes in all Danish residents who, during 2000–2016, tested PCR positive for HSV-1 (n=208) or HSV-2 (n=283) in the cerebrospinal fluid, compared to comparison cohorts from the general population (n=2080 and n=2830). Results One-year mortality was increased among HSV-1 patients (difference 19.3%; 95% CI: 13.6% to 25.0%) and HSV-2 patients (difference 5.3%; 95% CI: 2.5% to 8.1%), but thereafter mortality was not increased. After exclusion of persons diagnosed with cancer prior to study inclusion, one-year mortality difference for HSV-2 patients was 1.7% (−0.1% to 3.5%). After five years, HSV-1 patients had lower employment (difference −19.8%; 95% CI: −34.7% to −4.8%) and higher disability pension rates (difference 22.2%; 95% CI: 8.4% to 36.0%) than the comparison cohort, but similar number of inpatient days, outpatient visits, and sick leave. HSV-2 patients had employment and disability pension rates comparable to the comparison cohort, but more inpatient days (difference 1.5/year; 95% CI: −0.2 to 3.2), outpatient visits (difference 1.3/year; 95% CI: 0.3 to 3.2), and sick leave days (difference 9.1/year; 95% CI: 7.9 to 10.4). Conclusion HSV-1 and HSV-2 CNS infections differ substantially with respect to prognosis. HSV-1 CNS infection is followed by increased short-term mortality and long-term risk of disability. HSV-2 CNS infection has no substantial impact on mortality or working capability but is associated with increased morbidity.
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Affiliation(s)
- Ann-Brit E Hansen
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Infectious Diseases, Amager Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Hanne T Vestergaard
- Department of Virus & Microbiological Special Diagnostics, Statens Serum Institute, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Jacob Bodilsen
- Departments of Infectious Diseases and Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - Nanna S Andersen
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Claus B Christiansen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Lene Nielsen
- Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, Herlev, Denmark
| | - Thomas Benfield
- Department of Infectious Diseases, Amager Hvidovre Hospital, University of Copenhagen, Hvidovre, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Ø Andersen
- Department of Clinical Microbiology, Amager Hvidovre University Hospital, University of Copenhagen, Hvidovre, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Iversen AM, Kavalaris CP, Hansen R, Hansen MB, Alexander R, Kostadinov K, Holt J, Kristensen B, Knudsen JD, Møller JK, Ellermann-Eriksen S. Clinical experiences with a new system for automated hand hygiene monitoring: A prospective observational study. Am J Infect Control 2020; 48:527-533. [PMID: 31635879 DOI: 10.1016/j.ajic.2019.09.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2019] [Revised: 09/03/2019] [Accepted: 09/03/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Hand hygiene compliance (HHC) among health care workers remains suboptimal, and good monitoring systems are lacking. We aimed to evaluate HHC using an automated monitoring system. METHODS A prospective, observational study was conducted at 2 Danish university hospitals employing a new monitoring system (Sani nudge). Sensors were located on alcohol-based sanitizers, health care worker name tags, and patient beds measuring hand hygiene opportunities and sanitations. RESULTS In total, 42 nurses were included with an average HHC of 52% and 36% in hospitals A and B, respectively. HHC was lowest in patient rooms (hospital A: 45%; hospital B: 29%) and highest in staff toilets (hospital A: 72%; hospital B: 91%). Nurses sanitized after patient contact more often than before, and sanitizers located closest to room exits and in hallways were used most frequently. There was no association found between HHC level and the number of beds in patient rooms. The HHC level of each nurse was consistent over time, and showed a positive correlation between the number of sanitations and HHC levels (hospital A: r = 0.69; hospital B: r = 0.58). CONCLUSIONS The Sani nudge system can be used to monitor HHC at individual and group levels, which increases the understanding of compliance behavior.
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Erikstrup LT, Dinh KM, Andersen PS, Skov RL, Kaspersen KA, Nielsen KR, Ellermann-Eriksen S, Erikstrup C. Cohort description: The Danish Blood Donor Staphylococcus aureus Carriage Study. Clin Epidemiol 2019; 11:885-900. [PMID: 31572018 PMCID: PMC6757111 DOI: 10.2147/clep.s218637] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Accepted: 08/20/2019] [Indexed: 12/15/2022] Open
Abstract
Purpose Staphylococcus aureus carriage poses an increased risk of S. aureus infection. The aim of this study was to investigate the colonization of S. aureus among healthy individuals and to establish a prospective cohort and biobank for research in the health consequences of colonization. Population and methods The Danish Blood Donor S. aureus Carriage Study (DBDSaCS) was established in 2014. So far, a total of 6082 healthy participants have been included with nasal swabs and repeated swabs are performed at subsequent donations. Samples from the first 2217 participants were cultured using a two-step method to evaluate the effect of using enrichment broth. Furthermore, 262 participants were sampled from both the nares and the throat. All participants completed a questionnaire with self-reported health, anthropometric measurements, current smoking status, and physical activity. Plasma samples, nasal swab transport media, and S. aureus isolates were stored. Results The prevalence of S. aureus nasal colonization was 41%. The prevalence of colonization was higher in men (46%) than women (34%), lower for smokers, and decreased with increasing age (<25 years: 44% vs >55 years: 35%). In participants swabbed from the nose and throat, the prevalence of S. aureus colonization after enrichment was 55% with significantly higher prevalence in the throat (45%) than in the nose (40%). The use of an enrichment broth increased the proportion of S. aureus colonization. Conclusion We describe a large and growing cohort of healthy individuals established to investigate predictors for S. aureus carriage and the health consequences of carriage. Multiple projects using data from DBDSaCS linked with Danish health registers, biomarkers, and genetic markers are ongoing. Results will be published in the coming years.
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Affiliation(s)
| | - Khoa Manh Dinh
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Paal Skytt Andersen
- Bacteria, Parasites and Fungi, Statens Serum Institute, Copenhagen, Denmark.,Department Veterinary and Animal Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Robert Leo Skov
- Bacteria, Parasites and Fungi, Statens Serum Institute, Copenhagen, Denmark
| | | | - Kaspar René Nielsen
- Department of Clinical Immunology, Aalborg University Hospital, Aalborg, Denmark
| | | | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
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Skjøt-Arkil H, Mogensen CB, Lassen AT, Johansen IS, Chen M, Petersen P, Andersen KV, Ellermann-Eriksen S, Møller JM, Ludwig M, Fuglsang-Damgaard D, Nielsen FE, Petersen DB, Jensen US, Rosenvinge FS. Detection of meticillin-resistant Staphylococcus aureus and carbapenemase-producing Enterobacteriaceae in Danish emergency departments - evaluation of national screening guidelines. J Hosp Infect 2019; 104:27-32. [PMID: 31494129 DOI: 10.1016/j.jhin.2019.08.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 08/29/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Multi-resistant bacteria (MRB) are an emerging problem. Early identification of patients colonized with MRB is mandatory to avoid in-hospital transmission and to target antibiotic treatment. Since most patients pass through specialized emergency departments (EDs), these departments are crucial in early identification. The Danish National Board of Health (DNBH) has developed exposure-based targeted screening tools to identify and isolate carriers of meticillin-resistant Staphylococcus aureus (MRSA) and carbapenemase-producing Enterobacteriaceae (CPE). AIM To assess the national screening tools for detection of MRSA and CPE carriage in a cohort of acute patients. The objectives were to investigate: (i) if the colonized patients were detected; and (ii) if the colonized patients were isolated. METHODS This was a multi-centre cross-sectional survey of adults visiting EDs. The patients answered the DNBH questions, and swabs were taken from the nose, throat and rectum. The collected samples were examined for MRSA and CPE. Screening performances were calculated. FINDINGS Of the 5117 included patients, 16 were colonized with MRSA and four were colonized with CPE. The MRSA screening tool had sensitivity of 50% [95% confidence interval (CI) 25-75%] for carrier detection and 25% (95% CI 7-52%) for carrier isolation. The CPE screening tool had sensitivity of 25% (95% CI 1-81%) and none of the CPE carriers were isolated. CONCLUSION The national screening tools were of limited use as the majority of MRSA and CPE carriers passed unidentified through the EDs, and many patients were isolated unnecessarily.
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Affiliation(s)
- H Skjøt-Arkil
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark.
| | - C B Mogensen
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark; Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark
| | - A T Lassen
- Emergency Department, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - I S Johansen
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - M Chen
- Department of Regional Health Research, University of Southern Denmark, Aabenraa, Denmark; Department of Clinical Microbiology, Hospital of Southern Jutland, Sønderborg, Denmark
| | - P Petersen
- Emergency Department, Regional Hospital West Jutland, Herning, Denmark
| | - K V Andersen
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | - S Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital, Aarhus, Denmark
| | - J M Møller
- Emergency Department, Aalborg University Hospital, Aalborg, Denmark
| | - M Ludwig
- Emergency Department, North Denmark Regional Hospital, Hjørring, Denmark
| | - D Fuglsang-Damgaard
- Department of Clinical Microbiology, Aalborg University Hospital, Aalborg, Denmark
| | - F E Nielsen
- Emergency Department, Slagelse Hospital, Slagelse, Denmark
| | - D B Petersen
- Emergency Department, Zealand University Hospital, Køge, Denmark
| | - U S Jensen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - F S Rosenvinge
- Department of Clinical Microbiology, Odense University Hospital, Odense, Denmark
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Kjærgaard N, Bodilsen J, Justesen US, Schønheyder HC, Andersen CØ, Ellermann-Eriksen S, Dzajic E, Chen M, Møller JK, Dessau RB, Frimodt-Møller N, Jarløv JO, Nielsen H. Community-acquired meningitis caused by beta-haemolytic streptococci in adults: a nationwide population-based cohort study. Eur J Clin Microbiol Infect Dis 2019; 38:2305-2310. [PMID: 31440914 DOI: 10.1007/s10096-019-03678-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Accepted: 08/09/2019] [Indexed: 10/26/2022]
Abstract
The objective of this study was to examine the clinical presentation of community-acquired beta-haemolytic streptococcal (BHS) meningitis in adults. This is a nationwide population-based cohort study of adults (≥ 16 years) with BHS meningitis verified by culture or polymerase chain reaction of the cerebrospinal fluid (CSF) from 1993 to 2005. We retrospectively evaluated clinical and laboratory features and assessed outcome by Glasgow Outcome Scale (GOS). We identified 54 adults (58% female) with a median age of 65 years (IQR 55-73). Mean incidence rate was 0.7 cases per 1,000,000 person-years. Alcohol abuse was noted among 11 (20%) patients. Group A streptococci (GAS) were found in 17 (32%) patients, group B (GBS) in 18 (34%), group C (GCS) in four (8%) and group G (GGS) in 14 (26%). Patients with GAS meningitis often had concomitant otitis media (47%) and mastoiditis (30%). Among patients with GBS, GCS or GGS meningitis, the most frequent concomitant focal infections were bone and soft tissue infections (19%) and endocarditis (16%). In-hospital mortality was 31% (95% CI 19-45), and 63% (95% CI 49-76) had an unfavourable outcome at discharge (GOS < 5). BHS meningitis in adults is primarily observed among the elderly and has a poor prognosis. GAS meningitis is primarily associated with concomitant ear-nose-throat infection.
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Affiliation(s)
- Nicolai Kjærgaard
- Department of Infectious Disease, Aalborg University Hospital, Mølleparkvej 4, DK-9000, Aalborg, Denmark.
| | - Jacob Bodilsen
- Department of Infectious Disease, Aalborg University Hospital, Mølleparkvej 4, DK-9000, Aalborg, Denmark
| | - Ulrik Stenz Justesen
- Department of Clinical Microbiology, Odense University Hospital, J. B. Winsløws Vej 4, DK-5000, Odense, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Hobrovej 18-22, DK-9000, Aalborg, Denmark
| | | | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, DK-8200, Aarhus N, Denmark
| | - Esad Dzajic
- Department of Clinical Microbiology, Sydvestjysk Sygehus, Finsensgade 35, DK-6700, Esbjerg, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Sydvang 1, DK-6400, Sonderborg, Denmark
| | - Jens Kjølseth Møller
- Department of Clinical Microbiology, Sygehus Lillebælt, Kabbeltoft 25, DK-7100, Vejle, Denmark
| | - Ram Benny Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Ingemannsvej 30, DK-4200, Slagelse, Denmark
| | - Niels Frimodt-Møller
- Department of Clinical Microbiology, Rigshospitalet, Blegdamsvej 9, DK-2100, Copenhagen, Denmark
| | - Jens Otto Jarløv
- Department of Clinical Microbiology, Herlev Hospital, Herlev Ringvej 75, DK-2730, Herlev, Denmark
| | - Henrik Nielsen
- Department of Infectious Disease, Aalborg University Hospital, Mølleparkvej 4, DK-9000, Aalborg, Denmark.,Department of Clinical Medicine, Aalborg University, Søndre Skovvej 15, DK-9000, Aalborg, Denmark
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Skjøt-Arkil H, Mogensen CB, Lassen AT, Johansen IS, Chen M, Petersen P, Andersen KV, Ellermann-Eriksen S, Møller JM, Ludwig M, Fuglsang-Damgaard D, Nielsen FE, Petersen DB, Jensen US, Rosenvinge FS. Carrier prevalence and risk factors for colonisation of multiresistant bacteria in Danish emergency departments: a cross-sectional survey. BMJ Open 2019; 9:e029000. [PMID: 31253624 PMCID: PMC6609076 DOI: 10.1136/bmjopen-2019-029000] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES The aim of this study was to describe the carrier prevalence and demographic variation of four different multiresistant bacteria (MRB) among acute patients in Danish emergency departments (EDs): methicillin-resistant Staphylococcus aureus (MRSA), carbapenemase-producing enterobacteria (CPE), extended-spectrum beta-lactamase-producing enterobacteria (ESBL) and vancomycin-resistant enterococci (VRE), and to analyse the association of MRB carriage to a range of potential risk factors. DESIGN Multicentre descriptive and analytic cross-sectional survey. SETTING Eight EDs and four clinical microbiology departments in Denmark. PARTICIPANTS Adults visiting the ED. MAIN OUTCOME MEASURES Swabs from nose, throat and rectum were collected and analysed for MRSA, ESBL, VRE and CPE. The primary outcome was the prevalence of MRB carriage, and secondary outcomes relation to risk factors among ED patients. RESULTS We included 5117 patients in the study. Median age was 68 years (54-77) and gender was equally distributed. In total, 266 (5.2%, 95% CI 4.6 to 5.8) were colonised with at least one MRB. No significant difference was observed between male and female patients, between age groups and between university and regional hospitals. Only 5 of the 266 patients with MRB were colonised with two of the included bacteria and none with more than two. CPE prevalence was 0.1% (95% CI 0.0 to 0.2), MRSA prevalence was 0.3% (95% CI 0.2 to 0.5), VRE prevalence was 0.4% (95% CI 0.3 to 0.6) and ESBL prevalence was 4.5% (95% CI 3.9 to 5.1). Risk factors for MRB carriage were previous antibiotic treatment, previous hospital stay, having chronic respiratory infections, use of urinary catheter and travel to Asia, Oceania or Africa. CONCLUSION Every 20th patient arriving to a Danish ED brings MRB to the hospital. ESBL is the most common MRB in the ED. The main risk factors for MRB carriage are recent antibiotic use and travel abroad. TRIAL REGISTRATION NUMBER NCT03352167;Post-results.
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Affiliation(s)
- Helene Skjøt-Arkil
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Emergency Department, Hospital Sønderjylland, Aabenraa, Denmark
| | | | | | - Isik S Johansen
- Department of Infectious Diseases, Odense University Hospital, Odense, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Hospital Sønderjylland, Soenderborg, Denmark
| | | | - Karen V Andersen
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørn M Møller
- Emergency Department, Aalborg University Hospital, Aalborg, Denmark
| | - Marc Ludwig
- Emergency Department, North Denmark Regional Hospital, Hjørring, Denmark
| | | | | | - Dan B Petersen
- Emergency Department, Zealand University Hospital, Køge, Denmark
| | - Ulrich S Jensen
- Department of Clinical Microbiology, Slagelse Sygehus, Slagelse, Denmark
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40
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Mogensen CB, Skjøt-Arkil H, Lassen AT, Johansen IS, Chen M, Petersen P, Andersen KV, Ellermann-Eriksen S, Møller JM, Ludwig M, Fuglsang-Damgaard D, Nielsen F, Petersen DB, Jensen US, Rosenvinge FS. Cross sectional study of multiresistant bacteria in Danish emergency departments: prevalence, patterns and risk factors for colonization (AB-RED project). BMC Emerg Med 2018; 18:25. [PMID: 30126361 PMCID: PMC6102814 DOI: 10.1186/s12873-018-0178-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2018] [Accepted: 08/10/2018] [Indexed: 02/04/2023] Open
Abstract
Background Multiresistant bacteria (MRB) is an increasing problem. Early identification of patients with MRB is mandatory to avoid transmission and to target the antibiotic treatment. The emergency department (ED) is a key player in the early identification of patients who are colonized with MRB. There is currently sparse knowledge of both prevalence and risk factors for colonization with MRSA, ESBL, VRE, CPE and CD in acutely admitted patients in Western European countries including Denmark. To develop evidence-based screening tools for identifying carriers of resistant bacteria among acutely admitted patients, systematic collection of information on risk factors and exposures is required. Since a geographical variation is suspected, it is desirable to include emergency departments across the country. The aim of this project is to provide a comprehensive overview of prevalence and risk factors for MRSA, ESBL, VRE, CPE and CD colonization in patients admitted to Danish ED’s. The objectives are to describe the prevalence and demography of resistance, co-infections, to identify risk factors for carrier state and to develop and validate a screening tool for identification of carriers. Methods Multicenter descriptive and analytic cross-sectional survey from January–May 2018 of around 10.000 acutely admitted patients > 18 years in 8 EDs for carrier state and risk factors for antibiotic resistant bacteria. Information about the background and possible risk factors for carrier status together with swabs from the nose, throat and rectum is collected and analyzed for MRSA, ESBL, VRE, CPE and CD. The prevalence of the resistant bacteria are calculated at hospital level, regional level and national level and described with relation to residency, sex, age and risk factors. A screening model for identification of carrier stage of resistant bacteria is developed and validated. Discussion The study will provide the prevalence of colonized patients with resistant bacteria on arrival to the ED and variation in demographic patterns, and will develop a clinical tool to identify certain risk groups. This will enable the clinician to target antibiotic treatments and to reduce the in-hospital spreading of resistant bacteria. This knowledge is important for implementing and evaluating antimicrobial stewardships, screening and infection control strategies. Trial registration Clinicaltrials.gov: NCT03352167 (registration date: 20. November 2017).
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Affiliation(s)
| | | | | | - Isik S Johansen
- Department of infectious diseases, Odense University Hospital, Odense,, Denmark
| | - Ming Chen
- Department of Clinical Microbiology, Hospital of Southern Jutland, Soenderborg, Denmark
| | - Poul Petersen
- Emergency Department, Regional Hospital West Jutland, Herning, Denmark
| | - Karen V Andersen
- Emergency Department, Aarhus University Hospital, Aarhus, Denmark
| | | | - Jørn M Møller
- Emergency Department, Aalborg University Hospital, Aalborg, Denmark
| | - Marc Ludwig
- Emergency Department, North Denmark Regional Hospital, Hjoerring, Denmark
| | | | - Finn Nielsen
- Emergency Department, Slagelse Hospital, Slagelse, Denmark
| | - Dan B Petersen
- Emergency Department, Zealand University Hospital, Koege, Denmark
| | - Ulrich S Jensen
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
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41
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Obel N, Dessau RB, Krogfelt KA, Bodilsen J, Andersen NS, Møller JK, Roed C, Omland LH, Christiansen CB, Ellermann-Eriksen S, Bangsborg JM, Hansen K, Benfield TL, Rothman KJ, Sørensen HT, Andersen CØ, Lebech AM. Long term survival, health, social functioning, and education in patients with European Lyme neuroborreliosis: nationwide population based cohort study. BMJ 2018; 361:k1998. [PMID: 29848547 PMCID: PMC5974636 DOI: 10.1136/bmj.k1998] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To estimate long term survival, health, and educational/social functioning in patients with Lyme neuroborreliosis compared with the general population. DESIGN Nationwide population based cohort study using national registers. SETTING Denmark. PARTICIPANTS All Danish residents diagnosed during 1986-2016 as having Lyme neuroborreliosis (n=2067), defined as a positive Borrelia burgdorferi intrathecal antibody test and a clinical diagnosis of Lyme borreliosis, and a comparison cohort from the general population matched on sex and date of birth (n=20 670). MAIN OUTCOME MEASURES Mortality rate ratios, incidence rate ratios of comorbidities, and differences in educational and social outcomes. RESULTS Mortality among patients with Lyme neuroborreliosis was not higher than in the general population (mortality rate ratio 0.90, 95% confidence interval 0.79 to 1.03). Lyme neuroborreliosis patients had increased risk of haematological (incidence rate ratio 3.07, 2.03 to 4.66) and non-melanoma skin cancers (1.49, 1.18 to 1.88). At diagnosis, Lyme neuroborreliosis patients had slightly higher employment and lower disability pension rates. After five years, patients and comparison cohort members had similar numbers of hospital contacts (difference -0.22, 95% confidence interval -0.45 to 0.02, in-hospital days/year; 0.37, -0.10 to 0.83, outpatient visits/year), employment rates (difference 1.5%, -2.1% to 5.1%), income (difference -1000, -20 000 to 18 000, Danish kroner), days of sick leave (difference -0.3, -3.5 to 3.0, per year), rates of receipt of a disability pension (difference -0.9%, -3.2% to 1.3%), and number of children (difference -0.10, -0.27 to 0.08). More patients were married (difference 4.8%, 2.2% to 7.4%) and had completed high school education (difference 7%, 1% to 12%). CONCLUSION A verified diagnosis of Lyme neuroborreliosis had no substantial effect on long term survival, health, or educational/social functioning. Nevertheless, the diagnosis decreased labour market involvement marginally and was associated with increased risk of haematological and non-melanoma skin cancers.
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Affiliation(s)
- Niels Obel
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Ram B Dessau
- Department of Clinical Microbiology, Slagelse Hospital, Slagelse, Denmark
| | - Karen A Krogfelt
- Bacteria, Parasites and Fungi Department, Statens Serum Institute, Copenhagen, Denmark
| | - Jacob Bodilsen
- Department of Clinical Microbiology and Infectious Diseases, Aalborg University hospital, Aalborg, Denmark
| | - Nanna S Andersen
- Clinical Center for Emerging and Vector-borne Infections, Odense University Hospital, Odense, Denmark
| | - Jens K Møller
- Department of Clinical Microbiology, Vejle Hospital, Vejle, Denmark
| | - Casper Roed
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Lars H Omland
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, DK-2100, Copenhagen, Denmark
| | - Claus B Christiansen
- Department of Clinical Microbiology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | | | - Jette M Bangsborg
- Department of Clinical Microbiology, Herlev University Hospital, Copenhagen, Denmark
| | - Klaus Hansen
- Department of Neurology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Thomas L Benfield
- Department of Infectious Diseases, Hvidovre University Hospital, Copenhagen, Denmark
| | - Kenneth J Rothman
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
- Department of Epidemiology, Boston University, Boston, MA, USA
| | - Henrik T Sørensen
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | - Christian Ø Andersen
- Department of Clinical Microbiology, Hvidovre University Hospital, Copenhagen, Denmark
| | - Anne-Mette Lebech
- Department of Infectious Diseases, Copenhagen University Hospital, Rigshospitalet, DK-2100, Copenhagen, Denmark
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42
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Greve AS, Skals M, Fagerberg SK, Tonnus W, Ellermann-Eriksen S, Evans RJ, Linkermann A, Praetorius HA. P2X 1, P2X 4, and P2X 7 Receptor Knock Out Mice Expose Differential Outcome of Sepsis Induced by α-Haemolysin Producing Escherichia coli. Front Cell Infect Microbiol 2017; 7:113. [PMID: 28428949 PMCID: PMC5382212 DOI: 10.3389/fcimb.2017.00113] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 03/21/2017] [Indexed: 11/13/2022] Open
Abstract
α-haemolysin (HlyA)-producing Escherichia coli commonly inflict severe urinary tract infections, including pyelonephritis, which comprises substantial risk for sepsis. In vitro, the cytolytic effect of HlyA is mainly mediated by ATP release through the HlyA pore and subsequent P2X1/P2X7 receptor activation. This amplification of the lytic process is not unique to HlyA but is observed by many other pore-forming proteins including complement-induced haemolysis. Since free hemoglobin in the blood is known to be associated with a worse outcome in sepsis one could speculate that inhibition of P2X receptors would ameliorate the course of sepsis. Surprisingly, this study demonstrates that [Formula: see text] and [Formula: see text] mice are exceedingly sensitive to sepsis with uropathogenic E. coli. These mice have markedly lower survival, higher cytokine levels and activated intravascular coagulation. Quite the reverse is seen in [Formula: see text] mice, which had markedly lower cytokine levels and less coagulation activation compared to controls after exposure to uropathogenic E. coli. The high cytokine levels in the [Formula: see text] mouse are unexpected, since P2X7 is implicated in caspase-1-dependent IL-1β production. Here, we demonstrate that IL-1β production during sepsis with uropathogenic E. coli is mediated by caspase-8, since caspase-8 and RIPK3 double knock out mice show substantially lower cytokine during sepsis and increased survival after injection of TNFα. These data support that P2X7 and P2X4 receptor activation has a protective effect during severe E. coli infection.
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Affiliation(s)
| | - Marianne Skals
- Department of Biomedicine, Aarhus UniversityAarhus, Denmark.,Department of Clinical Microbiology, Aarhus University HospitalAarhus, Denmark
| | | | - Wulf Tonnus
- Division of Nephrology, Medical Clinic III, University Hospital Carl Gustav Carus DresdenDresden, Germany
| | | | - Richard J Evans
- Department of Molecular and Cell Biology, University of LeicesterLeicester, UK
| | - Andreas Linkermann
- Division of Nephrology, Medical Clinic III, University Hospital Carl Gustav Carus DresdenDresden, Germany
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Condell O, Midgley S, Christiansen CB, Chen M, Chen Nielsen X, Ellermann-Eriksen S, Mølvadgaard M, Schønning K, Vermedal Hoegh S, Andersen PH, Voldstedlund M, Fischer TK. Evaluation of the enterovirus laboratory surveillance system in Denmark, 2010 to 2013. ACTA ACUST UNITED AC 2017; 21:30218. [PMID: 27173593 DOI: 10.2807/1560-7917.es.2016.21.18.30218] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Accepted: 02/20/2016] [Indexed: 11/20/2022]
Abstract
The primary aim of the Danish enterovirus (EV) surveillance system is to document absence of poliovirus infection. The conflict in Syria has left many children unvaccinated and movement from areas with polio cases to Europe calls for increased awareness to detect and respond to virus-transmission in a timely manner. We evaluate the national EV laboratory surveillance, to generate recommendations for system strengthening. The system was analysed for completeness of viral typing analysis and clinical information and timeliness of specimen collection, laboratory results and reporting of clinical information. Of 23,720 specimens screened, 2,202 (9.3%) were EV-positive. Submission of cerebrospinal fluid and faecal specimens from primary diagnostic laboratories was 79.5% complete (845/1,063), and varied by laboratory and patient age. EV genotypes were determined in 68.5% (979/1,430) of laboratory-confirmed cases, clinical information was available for 63.1% (903/1,430). Primary diagnostic results were available after a median of 1.4 days, typing results after 17 days, detailed clinical information after 33 days. The large number of samples typed demonstrated continued monitoring of EV-circulation in Denmark. The system could be strengthened by increasing the collection of supplementary faecal specimens, improving communication with primary diagnostic laboratories, adapting the laboratory typing methodology and collecting clinical information with electronic forms.
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Affiliation(s)
- Orla Condell
- Department of Microbiological Diagnostics and Virology, Statens Serum Insitut, Copenhagen S, Denmark
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Wang M, Ellermann-Eriksen S, Hansen DS, Kjerulf A, Fuglsang-Damgaard D, Holm A, Østergaard C, Røder B, Sönksen UW, Detlefsen M, Hansen F, Hasman H, Hammerum A, Skov RL. [Epidemic increase in the incidence of carbapenemase-producing Enterobacteriaceae in Denmark]. Ugeskr Laeger 2016; 178:V06160422. [PMID: 27855770] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Carbapenemase-producing Enterobacteriaceae (CPE) are extremely multiresistant bacteria with few or no treatment options. Infections with CPE are associated with a mortality of 40-50%. In Denmark, CPE were first detected in 2008. Prior to 2013 the CPE incidence was low, but since then the incidence has increased significantly. Seven outbreaks have occurred, and at least 25 patients have been infected or colonized. The rise in CPE incidence emphasizes the need for a national intervention to reduce the spread. This can be obtained through systematic surveillance, infection control and reduction of antibiotic consumption.
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45
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Dalgaard LS, Nørgaard M, Povlsen JV, Jespersen B, Jensen-Fangel S, Ellermann-Eriksen S, Østergaard L, Schønheyder HC, Søgaard OS. Risk and Prognosis of Bacteremia and Fungemia Among Peritoneal Dialysis Patients: A Population-Based Cohort Study. Perit Dial Int 2016; 36:647-654. [PMID: 27147288 DOI: 10.3747/pdi.2015.00197] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 01/02/2016] [Indexed: 11/15/2022] Open
Abstract
♦ BACKGROUND: The incidence of bacteremia and fungemia (BAF) is largely unknown in end-stage renal disease (ESRD) patients initiating peritoneal dialysis (PD). ♦ OBJECTIVE: The main objective was to estimate and compare incidence rates of first episodes of BAF in incident PD patients and a comparison cohort. A secondary objective was to compare causative agents and 30-day post-BAF mortality between PD patients and the comparison cohort. ♦ METHODS: Design: Observational cohort study. SETTING Central and North Denmark regions. PARTICIPANTS patients who initiated PD during 1995 - 2010. For each patient we sampled up to 10 controls from the general population matched on age, sex, and municipality. ♦ MAIN OUTCOME: Data on positive blood cultures were retrieved from electronic microbiology databases covering the 2 regions. We calculated incidence rates (IRs) of first-time BAF for PD patients and population controls. Incidence-rate ratios (IRRs) were calculated to compare these rates. Thirty-day mortality was estimated by Kaplan-Meier analysis. ♦ RESULTS: Among 1,024 PD patients and 10,215 population controls, we identified 75 and 282 episodes of BAF, respectively. Incidence rates of BAF were 4.7 (95% confidence interval [CI], 3.8 - 5.9) per 100 person-years of follow-up (PYFU) in PD patients and 0.5 (95% CI, 0.4 - 0.5) per 100 PYFU in population controls (IRR = 10.4; 95% CI, 8.1 - 13.5). In PD patients, the most frequent microorganisms were Escherichia coli (18.7%) and Staphylococcus aureus (13.3%). Escherichia coli (27.3%) also ranked first among population controls. Thirty-day mortality following BAF was 20.8% (95% CI, 12.6 - 31.0) and 20.7% (95% CI, 16.3 - 25.9) among PD patients and population controls, respectively. ♦ CONCLUSIONS: Peritoneal dialysis patients are at markedly higher risk of BAF than population controls. Causative agents and the 30-day post-BAF mortality were similar in the 2 cohorts.
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Affiliation(s)
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Denmark
| | | | - Bente Jespersen
- Department of Nephrology, Aarhus University Hospital, Denmark
| | | | | | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Denmark
| | - Henrik Carl Schønheyder
- Department of Clinical Microbiology, Aalborg University Hospital, Denmark.,Department of Clinical Medicine, Aalborg University, Denmark
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Jespersen S, Tolstrup M, Hønge BL, Medina C, Té DDS, Ellermann-Eriksen S, Østergaard L, Wejse C, Laursen AL. High level of HIV-1 drug resistance among patients with HIV-1 and HIV-1/2 dual infections in Guinea-Bissau. Virol J 2015; 12:41. [PMID: 25889017 PMCID: PMC4357169 DOI: 10.1186/s12985-015-0273-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2014] [Accepted: 02/26/2015] [Indexed: 11/10/2022] Open
Abstract
Background With the widespread use of antiretroviral treatment (ART) in Africa, the risk of drug resistance has increased. The aim of this study was to evaluate levels of HIV-1 resistance among patients with HIV-1 and HIV-1/2 dual infections, treated with ART, at a large HIV clinic in Guinea-Bissau. Findings Patients were selected from the Bissau HIV cohort. All patients had HIV-1 or HIV-1/2 dual infection, a CD4 cell count performed before and 3–12 months after starting ART, and a corresponding available plasma sample. We measured viral load in patients with HIV-1 (n = 63) and HIV-1/2 dual (n = 16) infections a median of 184 days after starting ART (IQR: 126–235 days). In patients with virological failure (defined as viral load >1000 copies/ml) and with sufficient plasma available, we performed an HIV-1 genotypic resistance test. Thirty-six patients (46%) had virological failure. The CD4 cell count did not predict treatment failure. Of the 36 patients with virological failure, we performed a resistance test in 15 patients (42%), and nine patients (9/15; 60%) had resistance mutations. The most common mutation was K103N, which confers high-level resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI). No major mutations against protease inhibitors (PI) were found. Conclusions Our results showed that patients with HIV-1 and HIV-1/2 dual infections in Guinea-Bissau had a high rate of virological failure and rapid development of NNRTI resistance. It remains to be determined whether a more robust, PI-based treatment regimen might benefit this population more than NNRTIs.
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Affiliation(s)
- Sanne Jespersen
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau. .,Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Martin Tolstrup
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Bo Langhoff Hønge
- Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau. .,Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. .,Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Candida Medina
- National HIV Programme, Ministry of Health, Bissau, CP 1013, Bissau, Guinea-Bissau.
| | - David da Silva Té
- National HIV Programme, Ministry of Health, Bissau, CP 1013, Bissau, Guinea-Bissau.
| | - Svend Ellermann-Eriksen
- Department of Clinical Microbiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Lars Østergaard
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
| | - Christian Wejse
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. .,GloHAU, Center for Global Health, School of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark.
| | - Alex Lund Laursen
- Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark.
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Horan KA, Hansen K, Jakobsen MR, Holm CK, Søby S, Unterholzner L, Thompson M, West JA, Iversen MB, Rasmussen SB, Ellermann-Eriksen S, Kurt-Jones E, Landolfo S, Damania B, Melchjorsen J, Bowie AG, Fitzgerald KA, Paludan SR. Proteasomal degradation of herpes simplex virus capsids in macrophages releases DNA to the cytosol for recognition by DNA sensors. J Immunol 2013; 190:2311-9. [PMID: 23345332 DOI: 10.4049/jimmunol.1202749] [Citation(s) in RCA: 154] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
The innate immune system is important for control of infections, including herpesvirus infections. Intracellular DNA potently stimulates antiviral IFN responses. It is known that plasmacytoid dendritic cells sense herpesvirus DNA in endosomes via TLR9 and that nonimmune tissue cells can sense herpesvirus DNA in the nucleus. However, it remains unknown how and where myeloid cells, such as macrophages and conventional dendritic cells, detect infections with herpesviruses. In this study, we demonstrate that the HSV-1 capsid was ubiquitinated in the cytosol and degraded by the proteasome, hence releasing genomic DNA into the cytoplasm for detection by DNA sensors. In this context, the DNA sensor IFN-γ-inducible 16 is important for induction of IFN-β in human macrophages postinfection with HSV-1 and CMV. Viral DNA localized to the same cytoplasmic regions as did IFN-γ-inducible 16, with DNA sensing being independent of viral nuclear entry. Thus, proteasomal degradation of herpesvirus capsids releases DNA to the cytoplasm for recognition by DNA sensors.
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Affiliation(s)
- Kristy A Horan
- Department of Biomedicine, Aarhus University, 8000 Aarhus C, Denmark
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Hammerum AM, Larsen AR, Hansen F, Justesen US, Friis-Møller A, Lemming LE, Fuursted K, Littauer P, Schønning K, Gahrn-Hansen B, Ellermann-Eriksen S, Kristensen B. Patients transferred from Libya to Denmark carried OXA-48-producing Klebsiella pneumoniae, NDM-1-producing Acinetobacter baumannii and meticillin-resistant Staphylococcus aureus. Int J Antimicrob Agents 2012; 40:191-2. [PMID: 22743013 DOI: 10.1016/j.ijantimicag.2012.05.003] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2012] [Accepted: 05/02/2012] [Indexed: 11/17/2022]
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Petersen T, Møller-Larsen A, Ellermann-Eriksen S, Thiel S, Christensen T. Effects of interferon-beta therapy on elements in the antiviral immune response towards the human herpesviruses EBV, HSV, and VZV, and to the human endogenous retroviruses HERV-H and HERV-W in multiple sclerosis. J Neuroimmunol 2012; 249:105-8. [PMID: 22608883 DOI: 10.1016/j.jneuroim.2012.04.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2012] [Revised: 04/23/2012] [Accepted: 04/24/2012] [Indexed: 12/22/2022]
Abstract
Effects of treatment of multiple sclerosis patients with IFN-β on elements of the antiviral immune response to herpesviruses were analysed in a longitudinal study. We found significantly increased seroreactivity to EBV EBNA-1, and to VZV, in patients who did not respond to IFN-β therapy. We found no significant changes in seroreactivity to EBV EA, or to HSV. For the same patient cohort, we have previously demonstrated significant decreases in seroreactivities to envelope antigens for the two human endogenous retroviruses HERV-H and HERV-W, closely linked to efficacy of therapy. We further searched for correlations between seroreactivities to EBV, HSV, and VZV, and levels of mannan-binding lectin (MBL), and MBL-associated serine protease 3. We found no such correlations. Our results are in accord with recent reports of increased seroreactivity to EBV EBNA-1, and to VZV in active MS, and they support that the herpesviruses EBV and VZV together with HERV-H/HERV-W and the antiviral immune response may play a role in MS development.
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Affiliation(s)
- Thor Petersen
- Department of Neurology, Aarhus University Hospital, Nørrebrogade 44, Aarhus C, Denmark
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50
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Petersen T, Møller-Larsen A, Thiel S, Hansen TK, Ellermann-Eriksen S, Brudek T, Christensen T. Innate and adaptive anti-viral immune responses in MS patients treated with interferon-beta. Retrovirology 2011. [PMCID: PMC3112692 DOI: 10.1186/1742-4690-8-s1-a214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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