Search

Antimicrobial stewardship (AMS) and Infection prevention and control (IPC) are two key complementary strategies that combat development and spread of antimicrobial resistance. The ESGAP (ESCMID Study Group for AMS), EUCIC (European Committee on Infection Control) and TAE (Trainee Association of ESCMID) investigated how AMS and IPC activities and training are organized, if present, at national level in Europe. From February 2018 to May 2018, an internet-based cross-sectional survey was conducted through a 36-item questionnaire, involving up to three selected respondents per country, from 38 European countries in total (including Israel), belonging to the ESGAP/EUCIC/TAE networks. All 38 countries participated with at least one respondent, and a total of 81 respondents. Education and involvement in AMS programmes were mandatory during the postgraduate training of clinical microbiology and infectious diseases specialists in up to one-third of countries. IPC was acknowledged as a specialty in 32% of countries. Only 32% of countries had both guidance and national requirements regarding AMS programmes, in contrast to 61% for IPC. Formal national staffing standards for AMS and IPC hospital-based activities were present in 24% and 63% of countries, respectively. The backgrounds of professionals responsible for AMS and IPC programmes varied tremendously between countries. The organization and training of AMS and IPC in Europe are heterogeneous and national requirements for activities are frequently lacking., peer-reviewed

Karen Rokkedal Lausch,1 Mette Søgaard,2,3 Flemming Schønning Rosenvinge,4,5 Helle Krogh Johansen,6 Trine Boysen,7 Bent Løwe Røder,8 Klaus Leth Mortensen,1,9Lene Nielsen,10 Lars Lemming,9 Bente Olesen,10 Christine Leitz,11 Lise Kristensen,9,12 Esad Dzajic,13 Lars Jørgen Østergaard,1 Henrik Carl Schønheyder,14,15 Maiken Cavling Arendrup6,16,17 1Department of Infectious Disease, Aarhus University Hospital, 8200 Aarhus, Denmark; 2Department of Cardiology, Aalborg University Hospital, 9000 Aalborg, Denmark; 3Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Faculty of Health, Aalborg University, 9000 Aalborg, Denmark; 4Department of Clinical Microbiology, Odense University Hospital, 5000 Odence C, Denmark; 5Department of Clinical Microbiology, Lillebaelt Hospital, 5500 Middelfart, Denmark; 6Department of Clinical Microbiology, Rigshospitalet, 2100 Copenhagen, Denmark; 7Department of Clinical Microbiology, Hvidovre Hospital, 2650 Hvidovre, Denmark; 8Department of Clinical Microbiology, Hospital of Slagelse, Slagelse Sygehus, 4200 Slagelse, Denmark; 9Department of Clinical Microbiology, Aarhus University Hospital, 8200 Aarhus, Denmark; 10Department of Clinical Microbiology, Herlev and Gentofte Hospital, University of Copenhagen, 2730 Herlev, Denmark; 11Department of Clinical Microbiology, Viborg Regionshospital, 8800 Viborg, Denmark; 12Department of Clinical Microbiology, Herning Regionshospital, 7400 Herning, Denmark; 13Department of Clinical Microbiology, Sydvestjysk Sygehus, 6700 Esbjerg, Denmark; 14Department of Clinical Microbiology, Aalborg University Hospital, 9000 Aalborg, Denmark; 15Department of Clinical Medicine, University of Aalborg, 9000 Aalborg, Denmark; 16Unit of Mycology, Statens Serum Institute, 2300 København, Denmark; 17Department of Clinical Medicine, University of Copenhagen, 2200 Copenhagen, Denmark Background: In accordance with international guidelines, primary antifungal treatment (AFT) of candidemia with echinocandins has been nationally recommended in Denmark since 2009. Our nationwide cohort study describes the management of candidemia treatment focusing on the impact of prophylactic AFT on species distribution, the rate of adherence to the recommended national guidelines for AFT, and the effect of AFT on patient outcomes.Materials and methods: Incident candidemia cases from a 2-year period, 2010–2011, were included. Information on AFT was retrospectively collected from patient charts. Vital status was obtained from the Danish Civil Registration System. HRs of mortality were reported with 95% CIs using Cox regression.Results: A total of 841 candidemia patients was identified. Prior to candidemia diagnosis, 19.3% of patients received AFT (162/841). The risk of non-albicans candidemia increased after prior AFT (59.3% vs 45.5% among nontreated). Echinocandins as primary AFT were given for 44.2% (302/683) of patients. Primary treatment with echinocandins resulted in adequate treatment in a higher proportion of patients (97.7% vs 72.1%) and was associated with lower 0- to 14-day mortality compared with azole treatment (adj. HR 0.76, 95% CI: 0.55–1.06). Significantly lower 0- to 14-day mortality was observed for patients with Candida glabrata and Candida krusei with echinocandin treatment compared with azole treatment (adj. HR 0.50, 95% CI: 0.28–0.89), but not for patients with Candida albicans or Candida tropicalis.Conclusion: The association shown between prior AFT and non-albicans species underlines the importance of treatment history when selecting treatment for candidemia. Compliance with national recommendations was low, but similar to previously reported international rates. Primary treatment of candidemia with echinocandins compared with azoles yielded both a higher proportion of adequately treated patients and improved mortality rates. This real-life setting supports guidelines recommendation, and further focus on compliance with these seems warranted. Keywords: candidemia, candida, antifungal treatment, echinocandin, azole, Candida albicans, Candida glabrata

New data from the Danish National Fungaemia Surveillance 2012-15 is reported and epidemiological trends are investigated in a 12-year perspective (2004-15). During 2012-15, 1900 out of 1939 (98%) fungal bloodstream isolates were included. The average incidence was 8.4/100,000 inhabitants and this appears to be stabilizing after the increase to 10.1/100,000 in 2011. The incidence was higher in males than females (10.0 vs 6.8) and in patients above 50 years, mainly driven by an increasing incidence among 80-89 years old males (65.3/100,000 in 2014-15). The proportion ofCandida albicansdecreased 2004-15 (64.4% to 42.4%) in parallel with a doubling ofCandida glabrata(16.5% to 34.6%, p

This study compares the structure of eelgrass (Zostera marina L.) meadows and associatedfood webs in two eelgrass habitats in Denmark, differing in exposure, connection to theopen sea, nutrient enrichment and water transparency. Meadow structure strongly reflectedthe environmental conditions in each habitat. The eutrophicated, protected site had higherbiomass of filamentous algae, lower eelgrass biomass and shoot density, longer and narrowerleaves, and higher above to below ground biomass ratio compared to the less nutrient-enriched and more exposed site. The faunal community composition and food webstructure also differed markedly between sites with the eutrophicated, enclosed site having higher biomass of consumers and less complex food web. These relationships resulted in acolumn shaped biomass distribution of the consumers at the eutrophicated site whereas theless nutrient-rich site showed a pyramidal biomass distribution of consumers coupled with amore diverse consumer community. The differences in meadow and food web structure ofthe two seagrass habitats, suggest how physical setting may shape ecosystem response and resilience to anthropogenic pressure. We encourage larger, replicated studies to furtherdisentangle the effects of different environmental variables on seagrass food web structure.

Relationships between land use and stream consumer δ15N values are well established and, as a consequence, different primary consumers have been suggested as suitable system-specific baseline indicators in isotope studies of trophic structure. These baselines are often based on bulked data including several taxonomic groups and feeding types due to difficulties of finding ubiquitous taxonomic groups. We identified taxonomic groups which correlated well with land use in Danish lowland streams, and several of those are widely distributed in running waters in the Northern hemisphere. Particularly Baetidae, Simuliidae and Gammarus pulex appeared to be good indicators of land use. Scrapers (Baetidae), however, generally had higher δ15N than filtrators (Simuliidae) in catchments with a high level of anthropogenic activities, but lower δ15N in nature-dominated catchments. The trophic position of two common fish species (three-spined stickleback, Gasterosteus aculeatus, and brown trout Salmo trutta) differed markedly depending on the baseline chosen. The estimated trophic position was lowest when based on Baetidae and highest when using Simuliidae. The trophic position of Gasterosteus aculeatus was independent of land use (proxy used=%nature) when based on Gammarus pulex and Simuliidae, and the trophic position of Salmo trutta was independent of land use when based on Simuliidae only. The trophic position estimates based on Baetidae and mean primary consumers correlated with %nature in the catchment and had a slope deviating from zero for both fish species, despite gut content analysis revealed no such trophic level dependency of land use. This suggests that Baetidae are not good baseline indicators of trophic position, perhaps because their main food item (periphyton) may include nitrogen-fixing cyanobacteria, being potentially more important in less anthropogenic affected streams, resulting in lower scraper (e.g. Baetidae) δ15N values at such sites. We also found that within-site variation in δ15N was highest for Gammarus pulex, then Baetidae and the lowest for Simuliidae. Filtrators (e.g. Simuliidae) are thus apparently the best indicator of land uses, not least when the gradient of land use is large. Our results strongly support the use of these organisms as baseline in stable isotope studies of trophic webs.

More than 30 years after the First International Indoor Climate Symposium, ten researchers from the USA, Slovakia, Sweden, and Denmark gathered to review the current status of indoor environmental research. We initiated our review with discussions during the 1-day meeting and followed that with parallel research and writing efforts culminating with internal review and revision cycles. In this paper, we present our choices for the most important research findings on indoor environmental quality from the past three decades followed by a discussion of the most important research questions in our field today. We then continue with a discussion on whether there are research areas for which we can 'close the book' and say that we already know what is needed. Finally, we discuss whether we can maintain our identity in the future or it is time to team up with new partners. PRACTICAL IMPLICATIONS: In the early years of this field, the accumulated knowledge was small and it was possible for any researcher to acquire a complete understanding. To do so has become impossible today as what we know has grown to exceed the learning capacity of any person. These circumstances challenge us to work collectively to synthesize what we do know and to define clearly what remains to be learned. If we fail to do these things well, we risk repeating research without memory, an inefficiency that we cannot afford.

International audience; At present, indoor air quality is assessed exclusively by human panels. As this method is time consuming and cost intensive, little attention is paid to indoor air quality in the planning and operation of buildings. In recent years multi-gas sensor systems have been developed in order to mimic the human sense of smell. These systems comprise an array of gas sensors, with sensors of different sensitivity and selectivity, and a data processing unit. Up to now the sensors are not sensitive enough to mimic the perception of a human being. To further the development of these systems, the European research project SysPAQ (Innovative Sensor System for Measuring Perceived Air Quality and Brand Specific Odours) was started in September 2006. It will end in September 2009.

Substantial progress in our understanding of human response to thermal environments has been made since Standard 55- 1992, including the amendment 55-95a. Incorporating many of these advances, Standard 55-2004, Thermal Environmental Conditions for Human Occupancy, was recently published after completingfour public reviews and receiving approval by both ASHRAEand the American National Standards Institute (ANSI). The standard specifies conditions of the indoor thermal environment that occupants will find acceptable. It is intended for use in design, commissioning, and testing of buildings and other occupied spaces and their HVAC systems, and for the evaluation of existing thermal environments. Because of the inherent variations in occupants’ metabolic rates and clothing levels, and because it is not possible to prescribe or enforce what these should be, this standard cannot practically mandate operating setpoints for buildings. The two most important additions included in this new standard are an analytical method based on the PMV-PPD indices and introduction of the concept of adaptation with a separate method for naturally conditioned buildings. The adaptive model and several other changes are based on various ASHRAE sponsored research projects. This article provides an overview of the key features and limits of applicability of Standard 55-2004.

The effect of cloned alpha-interferon (alpha-IFN) on the in vitro and in vivo expression of HLA-ABC antigens and beta-2-microglobulin (beta-2-m) on subpopulations of human lymphoid cells was studied by flow cytometry. Mononuclear cells isolated from patients and cell cultures were labelled with saturating amounts of FITC conjugated monoclonal anti-HLA-ABC or anti-beta-2-m. Phycoerythrin conjugated monoclonal antibodies were simultaneously used for the selection of T lymphocytes. T helper lymphocytes, T suppressor lymphocytes, B lymphocytes and monocytes. In vitro, alpha-IFN induced a significant increase of beta-2-m on all subsets investigated. The increase was more pronounced on B lymphocytes (64%) and monocytes (69%) than on T lymphocytes (39%) (P less than 0.01). Also the pretreatment level of beta-2-m was found to be higher on B lymphocytes (0.64 arbitrary units (a.u.)) and monocytes (0.65 a.u.) than on T lymphocytes (0.24 a.u.) (P less than 0.001). In vivo, the expression of both HLA-ABC antigens and beta-2-m was studied in three patients 24 h after administration of 50 x 10(6) units alpha-IFN/m2 i.m. HLA-ABC antigens were significantly (P less than 0.05) increased on all subsets investigated, except for T suppressor lymphocytes. The increase in beta-2-m only reached significance on T lymphocytes. T helper lymphocytes and monocytes (P less than 0.02). At 48 h after administration of alpha-IFN, expression of HLA-ABC antigens and beta-2-m approached pretreatment levels. Enhanced expression of HLA-ABC antigens and beta-2-m could be reinduced by treatment of alpha-IFN on day 7.

The effect of cloned human interferon-alpha (IFN-alpha) on the expression of HLA-ABC antigens (HLA-ABC) and beta 2-microglobulin (beta 2m) on human peripheral lymphoid cells in vivo was studied by cytofluorometry using monoclonal antibodies and fluorescein-labelled rabbit anti-mouse immunoglobulin. A significant increase in the mean fluorescence intensity of HLA-ABC (median 59%, P less than 0.001) and beta 2m (median 57%, P less than 0.001) on small lymphoid cells was observed 24 h after initiation of IFN-alpha treatment (50 X 10(6) units IFN-alpha/m2 three times a week). The enhanced expression of these antigens in vivo was found in 11 of 12 examined patients with primary bronchial carcinoma. A concomitant increase in serum beta 2m (median 90%, P less than 0.001) was found in all patients. In contrast the amount of cell-associated HLA-ABC and beta 2m remained unchanged (P greater than 0.1 and P greater than 0.5, respectively) by day-to-day analysis of an untreated healthy control group. An increased expression of both HLA-ABC (mean 55%, P less than 0.0005) and beta 2m (mean 23%, P less than 0.01) was also observed prior to treatment in the lung cancer patients when compared to a group of age matched healthy individuals. Treatment with IFN-alpha caused a significant redistribution of mononuclear cells resulting in both absolute and relative lymphopenia. Pre-treatment lymphocyte counts were 1.09 X 10(9)/1 (range 0.49-1.73), post-treatment counts were 0.55 X 10(9)/1 (range 0.39-1.06).