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Lack of hygiene routines among patients and family members at patient hotels - a possible route for transmitting puerperal fever
2010 (Engelska)Ingår i: Scandinavian Journal of Infectious Diseases, ISSN 0036-5548, E-ISSN 1651-1980, Vol. 42, s. 554-556Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

The use of patient hotels for ambulatory care of women with uncomplicated deliveries has become a routine in Sweden. This report describes a minor outbreak of a group A Streptococcus strain in 2 newly delivered mothers and their newborn babies at a patient hotel.

Ort, förlag, år, upplaga, sidor
2010. Vol. 42, s. 554-556
Nationell ämneskategori
Infektionsmedicin
Identifikatorer
URN: urn:nbn:se:uu:diva-366358DOI: 10.3109/00365541003699656OAI: oai:DiVA.org:uu-366358DiVA, id: diva2:1264406
Tillgänglig från: 2018-11-20 Skapad: 2018-11-20 Senast uppdaterad: 2018-12-12
Ingår i avhandling
1. Dissemination of Multiresistant Bacteria: Their Selection, Transmission, Virulence and Resistance
Öppna denna publikation i ny flik eller fönster >>Dissemination of Multiresistant Bacteria: Their Selection, Transmission, Virulence and Resistance
2019 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Abstract [en]

Multiresistant bacteria are an emerging threat in modern medicine. Consumption of antimicrobial agents among humans, animals and in agriculture causes a selection of resistance genes. Dissemination of bacteria carrying resistance genes occurs both globally and locally, and hospital settings pose a special risk for spread when staff, environment and vulnerable patients interact. The overall aim of this thesis was to analyse underlying factors that facilitate the dissemination of multiresistant pathogenic bacteria in hospital settings.

Clusters of resistant bacteria from six occasions were investigated. Vancomycin-Resistant Enterococci (VRE), Methicillin-Resistant Staphylococcus pseudintermedius (MSRP), ESBL-producing Escherichia coli and Klebsiella pneumoniae, and carbapenemase-producing Pseudomonas aeruginosa were analysed by a range of methods, from cultures on broth to PCR and whole genome sequencing. Type of resistance, clonality, virulence factors, mobile genetic elements, epidemiology, survival in the environment, and patient history were examined variously depending on study.

The results showed that VRE resistance genes can be acquired during treatment with vancomycin. Furthermore, contamination of the hospital environment could quickly cause an outbreak, when patients are frequently relocated and exposition to contaminated rooms increase. Resistant bacteria emerging among companion animals, such as the dog-associated MRSP, can pose a zoonotic threat, when a virulent clone finds a new niche in humans.

The ability of Gram-negative bacteria to survive in a hospital environment is probably better than expected, given the right prerequisites; incorrect use of sinks enabled the spread of ESBL-producing K. pneumoniae and carbapenemase-producing P. aeruginosa. Additionally, the survival on hospital associated materials was longer for ESBL-producing E. coli than the AmpC-producing counterpart, which could tell part of why ESBL-producing E. coli is increasing. Hence, the survival in the environment calls for consideration when choosing materials and equipment for hospitals and nursing homes.

Exchange of bacteria occurs continuously between humans and our surroundings. Outbreaks of multiresistant bacteria are rare in Sweden but expose the weaknesses in healthcare when occurring. The organization, materials and equipment of hospitals facilitate the dissemination of resistant bacteria, as does animals and humans around us and even the genes in our own microbiota.

Ort, förlag, år, upplaga, sidor
Uppsala: Acta Universitatis Upsaliensis, 2019. s. 84
Serie
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 1527
Nationell ämneskategori
Infektionsmedicin
Forskningsämne
Klinisk bakteriologi
Identifikatorer
urn:nbn:se:uu:diva-369302 (URN)978-91-513-0537-0 (ISBN)
Disputation
2019-02-15, Jupiter, The Hub, Science Park, Dag Hammarskjölds väg 38, Uppsala, 13:00 (Engelska)
Opponent
Handledare
Tillgänglig från: 2019-01-22 Skapad: 2018-12-12 Senast uppdaterad: 2019-02-18

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