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Neonates with suspected or proven sepsis are treated with ampicillin and until recently with 5 mg gentamicin/kg every 24 h. New guidelines recommend the same gentamicin dose, but with longer intervals depending on gestational age. Two neonates receiving gentamicin every 48 h improved initially, but both deteriorated again before the second dose. In both infants ampicillin-resistant but gentamicin-sensitive Escherichia coli was found. In one of the infants a resistant/less sensitive E. coli strain was also found in the cerebrospinal fluid. The rationale for the new dosing guidelines is discussed.

INTRODUCTION: Lyme neuroborreliosis (LNB) is a tick-borne infection of the nervous system caused by the spirochete Borrelia burgdorferi sensu lato. The primary symptoms are usually painful radiculitis, facial palsy and lymphocytic meningitis. The aim of this study was to provide data on the seasonal variation, anamnesis, symptoms, laboratory data and course of the disease in adults (≥ 16 years).METHODS: The medical records of 69 patients with confirmed LNB who attended the Department of Neurology, Lillebaelt Hospital, Vejle, Denmark, were analysed. The diagnosis was confirmed by the presence of leucocytosis in the cerebrospinal fluid and intrathecal production of immunoglobulin M and/or G anti-B. burgdorferi antibodies.RESULTS: Onset of neurological symptoms in LNB occurred year round in the Region of Southern Denmark. Only half of the patients had a history of a tick bite or erythema migrans (EM). Half of the patients who observed a tick bite subsequently reported EM. The duration from the onset of neurological symptoms to referral to hospital was remarkably long for patients with radiculoneuritis, whereas the onset of facial palsy led to a swift referral. Patients who were ≥ 50 years old had a significantly lower age-related risk of facial palsy without radicular symptoms.CONCLUSION: In this study, winter as a low-risk season was not a reliable factor in ruling out LNB. This finding may be relevant when investigating the cause of facial palsy and radicular symptoms.

Objectives: Preterm delivery (PTD) contributes to 70% of all perinatal deaths and nearly 50% of permanent neurological damages in children. Treatment and follow-up to prevent recolonization in pregnant women with Group B Streptococcus (GBS) in the urine may reduce the frequency of PTD. In a Cochrane review, the incidence of low birth weight infants was reduced, however, not for PTD. The association between asymptomatic bacteriuria during pregnancy and PTD remains controversial. The objective of this study was to investigate whether there is an association between GBS bacteriuria (BU) in pregnancy and PTD. Method: A retrospective population-based cohort consisting of 36,097 pregnant women from Hospital Lillebaelt area, Denmark, during January 2002-December 2012, of whom 37.2% (equivalent to 13,417) have undergone culture of their urine at the Department of Clinical Microbiology. Information on gestational age at birth and testing for GBS and other significant variables were obtained from the National Birth Register. Pregnant women with positive BU and GBS and pregnant women with negative BU and GBS were primarily compared for the occurrence of PTD. For statistical analyzes, we mainly used bivariate tests including Chi-square, Student's t-test, stratified analyzes, and multivariate regression analyzes. Results: Out of 13,417 singleton deliveries, 6.9% (n 921) of women had asymptomatic GBS BU during their pregnancy, and 9.1% (n 1,218) delivered preterm. Among women with GBS BU 133 delivered preterm (10.9%), while among the GBS BU negative 1,085 (8.7%) delivered preterm; indicating an association between GBS BU and PTD in crude analyzes (Odds Ratio 1.8; 95% Confidence Interval 1.5-2.2; P30, and 19.0% were smokers in pregnancy. Conclusions: Group B Streptococcus bacteriuria might be a risk factor for preterm delivery.

Background and purpose - It has been suggested that the risk of prosthetic joint infection (PJI) in patients with total hip arthroplasty (THA) may be underestimated if based only on arthroplasty registry data. We therefore wanted to estimate the "true" incidence of PJI in THA using several data sources. Patients and methods - We searched the Danish Hip Arthroplasty Register (DHR) for primary THAs performed between 2005 and 2011. Using the DHR and the Danish National Register of Patients (NRP), we identified first revisions for any reason and those that were due to PJI. PJIs were also identified using an algorithm incorporating data from microbiological, prescription, and clinical biochemistry databases and clinical findings from the medical records. We calculated cumulative incidence with 95% confidence interval. Results - 32,896 primary THAs were identified. Of these, 1,546 had first-time revisions reported to the DHR and/or the NRP. For the DHR only, the 1- and 5-year cumulative incidences of PJI were 0.51% (0.44-0.59) and 0.64% (0.51-0.79). For the NRP only, the 1- and 5-year cumulative incidences of PJI were 0.48% (0.41-0.56) and 0.57% (0.45-0.71). The corresponding 1- and 5-year cumulative incidences estimated with the algorithm were 0.86% (0.77-0.97) and 1.03% (0.87-1.22). The incidences of PJI based on the DHR and the NRP were consistently 40% lower than those estimated using the algorithm covering several data sources. Interpretation - Using several available data sources, the "true" incidence of PJI following primary THA was estimated to be approximately 40% higher than previously reported by national registries alone.

BACKGROUND: To determine if the catheter lock taurolidine can reduce the number of catheter-related bloodstream infections (CRBSI) in pediatric cancer patients with tunneled central venous catheters (CVC).PROCEDURE: During a study period of 34 months, 129 newly placed tunneled CVCs in 112 patients were randomly assigned to standard lock with heparin solution or experimental lock with a taurolidine solution (ClinicalTrials.gov Identifier NCT00735813).RESULTS: Sixty-five CVCs were included in the standard group and 64 CVCs in the experimental group. The groups were comparable regarding patients' characteristics. A total number of 72 bloodstream infections of which 33 were CRBSIs were observed during 39,127 CVC-days. A lower rate of CRBSI (0.4 per 1,000 CVC-days) was observed in the experimental arm compared with the standard arm (1.4 per 1,000 CVC-days, incidence rate ratio (IRR) = 0.26; 95% confidence interval (CI) 0.09-0.61; P = 0.001). A lower rate of total bloodstream infections (1.2 per 1,000 CVC-days) was also observed in the experimental arm compared with the standard arm (2.5 per 1,000 CVC-days, IRR = 0.49; 95% CI 0.29-0.82; P = 0.004). Median interval from catheter insertion until first CRBSI was significantly lower in the standard group (156 days, range 12-602) compared with the experimental group (300 days, range 12-1,176; P = 0.02). Premature removal of the CVC due to infection and overall CVC survival were similar in the two study groups.CONCLUSION: Locking of long-term tunneled CVC with taurolidine significantly reduces catheter-related bloodstream infections in children with cancer.

Evaluering af recomBead borrelia. Ny multiplex metode. Der blev præsenteret overvejelser om hvordan man skal score den den store mængde resultater for at opnå optimal diagnostisk diskriminations evne. Disse metode overvejelser er var vigtige, da det samme kit afprøves både to steder i Sverige også. Der blev diskusteret samarbejde om dette.

Rapid clinical and laboratory diagnoses are the foundation for a successful management of serious infections with Neisseria meningitidis. A species-specific multiplex polymerase chain reaction (PCR) coupled with fluidic microarrays using microbeads (the Luminex xMAP™ Technology) can detect pathogens most frequently found in the cerebrospinal fluid of patients. The Luminex suspension array system uniquely combines flow cytometry, microspheres, laser technology, digital signal processing, and traditional chemistry. In this method, the reaction is carried out in one vessel, in which distinctly color-coded bead sets, each conjugated with a different specific nucleic acid reactant, are hybridized with the PCR products, and a reporter molecule is used to quantify the interaction. The flow-based Luminex array reader identifies each reaction (bead set) after excitation by a red classification laser. Reporter signals from each reaction are simultaneously quantified by fluorescence generated by a green reporter laser. This nonculture, multiplex assay may prove to be an important tool for optimal laboratory diagnosis, not only of meningococcal meningitis, but also of meningitis caused by other bacterial or viral pathogens.

Antibiotic resistant bacteria are a global problem. Drug resistance may spread rapidly due to mobile resistance genes shared by many species. The selection of resistant bacteria is promoted by ever increasing human and veterinarian use of antibiotics. A new paradigm in fighting drug-resistant hospital bacteria is needed to stop the vicious circle of drug-resistance and bring back antibiotic susceptible bacteria. Less antibiotics and more infection control by an improved compliance with hand hygiene is the choice left to minimize the spread of hospital infections with drug resistant bacteria.

Central venous catheters (CVC) are an essential part of the treatment of children with haematological and oncological diseases. Unfortunately, CVC also represent a major risk factor of bloodstream infections. Catheter-related bloodstream infections (CRBSI) in children are often diagnosed based on blood cultures from the CVC only. Most CRBSI can be treated without catheter removal. On suspicion of CRBSI empirical antibiotic treatment with piperacillin-tazobactam, meropenem or ampicillin in combination with gentamicin is recommended. The systemic treatment can be combined with catheter-lock therapy.

To assess the impact of obesity and diabetes on the risk of post-cesarean infections.

Catheter-related bloodstream infections in children with cancer admitted wit fever

Nordic Society of Paediatric Haematology and Oncology (NOPHO), Annual meeting. Tromsø Norway

Udgivelsesdato: 2008-Dec-24 A 45-year-old Caucasian male presented with progressive pains in his left ankle, which had made it difficult for him to cope with his work as a bus driver during the last days before hospitalization. Three weeks previously he had returned from a journey to Bangkok with his Thai wife. There was no history of risk behavior, trauma, fever, or genito-urinary complaints and no exposition to malaria. He was otherwise well, and his past medical history only revealed slightly impaired lung function due to smoking. He took no medications.

Udgivelsesdato: Nov 26 Surveillance of nosocomial infections is essential in order to identify areas with infection control problems. Surveys should be based on incidence data in order to allow for assessment of risk factors. Bedside surveillance may be replaced by computer identification of nosocomial infections in patients with positive microbiology reports and/or are treated with antibiotics. A computer modelling of hospital-acquired bloodstream infections in a Danish hospital is shown. The computer system may also provide ongoing surveillance for other types of nosocomial infections.

Udgivelsesdato: Feb 5 Notification of bacterial meningitis (BM) is likely to be incomplete, and a recent Danish study indicated that unbalanced notification may bias expected aetiology of BM. Therefore the Danish Bacterial Meningitis Group initiated a national registration of culture-positive BM. METHODS: Laboratory data on all bacterial isolates from cerebrospinal fluid deemed to be clinically relevant were identified on a national basis during 2002 and 2003. Bacterial findings were compared to cases notified during the same period. RESULTS: A total of 404 BM cases were identified. The distribution of bacterial species differed from the national notification data during the same period especially with respect to Staphylococcus aureus (6.7% vs. 0.6%), Escherichia coli (3.5% vs. 0%) and non-Streptococcus pneumoniae streptococci (10% vs. 1.9%). The overall notification-rate was 66%, and was below 20% for S. aureus, E. coli, Enterococcus faecalis, non-S. pneumoniae streptococci and for 13 cases of "other bacteria". Sensitivity to antibiotics in the BM cases was as expected for Northern Europe. Reduced sensitivity to penicillin was found in 2/202 S. pneumoniae, in 2/10 Listeria monocytogenes, and 21/27 S. aureus were penicillin resistant. E. coli was resistant to ampicillin in 5 of 13 cases and to gentamicin in 1 of 11 cases. DISCUSSION: A suboptimal notification rate with an unbalanced species distribution was found. Laboratory based data thus constitute an improved basis for future recommendations for empirical treatment of BM. A continued national collaboration may promote the development of quality indicators for diagnosis and initial treatment of BM.

Enterococcus has become a more frequent cause of serious infections over the last 10-15 years. The infections are primarily nosocomial, owing to compromised immunity in the patients and excessive use of antibiotics in the hospitals. The rise is marked in the USA, where the enterococci furthermore tend to become multiresistant. Abroad, many enterococci have developed resistance to all available antibiotics, and their spread is now controllable only by strict hygienic precautions. No increase in enterococcal infections has been noted in Denmark, and very few clinical isolates of vancomycin-resistant enterococci have been found. Because of the worldwide relevance, we present a review of enterococcal infections with the focus on endocarditis and bacteraemia. However, we would emphasise that the classic combination of a penicillin and an aminoglycoside still provides adequate treatment of enterococcal infections in Denmark.