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ABSTRACT: Objectives: To determine the incidence of herpes zoster (HZ) and frequency of complications, mainly the incidence of postherpetic neuralgia (PHN). Design: Prospective follow-up study. Setting: Primary health care in Iceland. Main outcome measures: Incidence of HZ, age and sex distribution of patients and discomfort or pain 1, 3 and 12 months after the rash. Results: During an observation period of 229,547 person years, 462 episodes of acute zoster developed (incidence equals; 2.0/1,000/year) in 457 patients. End points were gained for all (100%) after 12 months follow up. Those still having pain after 12 months were followed further, 23 to 57 months more. Systemic acyclovir was used in less than 4%. A fourth of all HZ cases occurred in children and teenagers. PHN was rare in patients younger than 60 years of age; 2% and 1% experienced only mild pain at 3 and 12 months respectively. No patient had moderate or severe pain in this age group at these time points. In contrast pain was experienced by 19% and 8% of patients 60 years of age and older at 3 and 12 months respectively. However, after 12 months only two patients (0.4%) had moderate pain, none had severe pain. Potential immuno-modulating conditions (diabetes mellitus, cancer, HIV-infection, steroid treatment) were present in 24 patients (5%), 4 (1%) of whom were diagnosed with a malignancy within 6 months of contracting HZ. Conclusions: HZ is more common in younger age groups than has previously been reported. In patients younger than 60, the probability of PHN is very low. Malignancy is seldom associated with zoster rash in the primary care setting. The use of routine computerised medical records increases the possibility of collecting epidemiological information on the clinical course of a disease.
07/2009; 2(1):12-16.
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ABSTRACT: Poisoning is a common cause of emergency visits and hospital admission in Western countries. The purpose of this study was to assess the incidence and type of toxic exposures presenting to emergency medical facilities in Iceland.
The study was prospective and included all patients with confirmed or suspected poisoning presenting to hospitals and rural medical centers providing emergency services in Iceland during the twelve-month period from April 2001 until March 2002.
A total of 1,121 toxic exposures were documented representing an incidence of 3.91 cases per 1,000 inhabitants per year. The female to male ratio was 1.23. The majority of exposures (56.7%) occurred in the patient's home, 60% were deliberate, 72% had drugs and/or alcohol as their main cause, and 11% involved illicit drugs. Exposures to chemicals other than drugs were usually unintentional.
Toxic exposures requiring emergency medical care are common in Iceland. Self-poisonings by ingestion of prescription drugs and/or alcohol accounted for the majority of cases.
Clinical Toxicology 03/2008; 46(2):126-32. · 2.22 Impact Factor
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ABSTRACT: The relative effects of risk factors on the prevalence of resistant pneumococcal clones are hard to determine. Our aim was to evaluate the effect of risk factors on the prevalence of resistant pneumococci in Iceland in 2003 and compare these data with results of identical studies performed in 1993 and 1998. A randomized sample of 1,107 children was chosen from all 2,532 children 1 to 6 years old living in four communities. Pneumococci were carried by 64% of the 824 children enrolled and 9.5% were penicillin nonsusceptible (PNSP), as opposed to 8.1% (1998) and 8.5% (1993), and multiresistant strains of serotype 6B were 2.5% compared to 7.5% and 7.7% (p < 0.001). Antimicrobial use had declined in 10 years from 1.5 to 1.0 courses/child per year. The only significant risk factor for carriage of PNSP and erythromycin-resistant pneumococci was antimicrobial consumption. The multiresistant type 6B strains disappeared from the areas with the lowest antimicrobial use but maintained unchanged prevalence in the area with the highest use. The number of erythromycin- resistant, penicillin-susceptible strains of all pneumococci (37/475, 7.8%) increased significantly from the previous studies (7/353, 2.0%, 1998, and 2/390, 0.5%, 1993). This observation is associated with increased use of macrolides, especially azithromycin, in one of the study areas. Spread of novel resistant clones appears to be the main reason for rapid and significant changes in pneumococcal resistance rates. The choice of antimicrobial class appears to influence the selective environment favoring particular resistant clones.
Microbial Drug Resistance 01/2006; 12(3):169-76. · 2.15 Impact Factor
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ABSTRACT: To investigate potential links between antimicrobial drug use for acute otitis media (AOM) and tympanostomy tube placements, and the relationship between parental views and physician antimicrobial prescribing habits.
Cross-sectional community study repeated after five years.
Representative samples of children aged 1-6 years in four well-defined communities in Iceland, examined in 2003 (n = 889) and 1998 (n = 804).
Prevalence of antimicrobial treatments for AOM, tympanostomy tube placements, and parental expectations of antimicrobial treatment. Results. Tympanostomy tubes had been placed at some time in 34% of children in 2003, as compared with 30% in 1998. A statistically significant association was found between tympanostomy tube placement rate and antimicrobial use for AOM in 2003. In the area where antimicrobial use for AOM was lowest in 1998, drug use had further diminished significantly. At the same time, the prevalence of tympanostomy tube placements had diminished from 26% to 17%. Tube placements had increased significantly, from 35% to 44%, in the area where antimicrobial use for AOM was highest. Parents in the area where antimicrobial consumption was lowest and narrow spectrum antimicrobials were most often used were less likely to be in favour of antimicrobial treatment.
Comparison between communities showed a positive correlation between antimicrobial use for AOM and tympanostomy tube placements. The study supports a restrictive policy in relation to prescriptions of antibiotics for AOM. It also indicates that well-informed parents predict a restrictive prescription policy.
Scandinavian Journal of Primary Health Care 10/2005; 23(3):184-91. · 2.05 Impact Factor
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ABSTRACT: Dietary fish oil is believed to have a beneficial effect in various infections and in autoimmune disorders. This effect may correspond to an altered immune response. In order to discover whether the effect of dietary fish oil is different in various infections, we studied the survival of mice fed fish oil or corn oil supplemented diets and infected in the lungs with either Klebsiella pneumoniae or Streptococcus pneumoniae. 120 NMRI mice were divided into 4 groups, of which 2 groups were fed a fish oil supplemented diet and 2 a corn oil supplemented diet. After 6 weeks the mice were infected in the lungs with Klebsiella pneumoniae (fish oil groups and corn oil groups) or with Streptococcus pneumoniae serotype 3 (both groups). The survival rate was monitored. The experiment was performed twice. The survival of the mice fed fish oil enriched diet and infected with Klebsiella pneumoniae was significantly better compared with the mice fed corn oil enriched diet (p = 0.0001 and p = 0.0013). No difference was found between the mice fed corn oil enriched diet or fish oil enriched diet and infected with Streptococcus pneumoniae serotype 3 (p = 0.74 and p = 0.15). Our results indicate that dietary fish oil has a beneficial effect on survival of mice after experimental pneumoniae when infected with Klebsiella pneumoniae, but not after infection with Streptococcus pneumoniae serotype 3.
Scandinavian Journal of Infectious Diseases 02/2004; 36(2):102-5. · 1.72 Impact Factor
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ABSTRACT: Pharmacokinetic (PK) and pharmacodynamic (PD) properties for the selection of resistant pneumococci were studied by using three strains of the same serotype (6B) for mixed-culture infection in time-kill experiments in vitro and in three different animal models, the mouse peritonitis, the mouse thigh, and the rabbit tissue cage models. Treatment regimens with penicillin were designed to give a wide range of T(>MIC)s, the amounts of time for which the drug concentrations in serum were above the MIC. The mixed culture of the three pneumococcal strains, 10(7) CFU of strain A (MIC of penicillin, 0.016 micro g/ml; erythromycin resistant)/ml, 10(6) CFU of strain B (MIC of penicillin, 0.25 micro g/ml)/ml, and 10(5) CFU of strain C (MIC of penicillin, 4 micro g/ml)/ml, was used in the two mouse models, and a mixture of 10(5) CFU of strain A/ml, 10(4) CFU of strain B/ml, and 10(3) CFU of strain C/ml was used in the rabbit tissue cage model. During the different treatment regimens, the differences in numbers of CFU between treated and control animals were calculated to measure the efficacies of the regimens. Selective media with erythromycin or different penicillin concentrations were used to quantify the strains separately. The efficacies of penicillin in vitro were similar when individual strains or mixed cultures were studied. The eradication of the bacteria, independent of the susceptibility of the strain or strains or the presence of the strains in a mixture or on their own, followed the well-known PK and PD rules for treatment with beta-lactams: a maximum efficacy was seen when the T(>MIC) was >40 to 50% of the observation time and the ratio of the maximum concentration of the drug in serum to the MIC was >10. It was possible in all three models to select for the less-susceptible strains by using insufficient treatments. In the rabbit tissue cage model, a regrowth of pneumococci was observed; in the mouse thigh model, the ratio between the different strains changed in favor of the less-susceptible strains; and in the mouse peritonitis model, the susceptible strain disappeared and was overgrown by the less-susceptible strains. These findings with the experimental infection models confirm the importance of eradicating all the bacteria taking part in the infectious process in order to avoid selection of resistant clones.
Antimicrobial Agents and Chemotherapy 08/2003; 47(8):2499-506. · 4.84 Impact Factor
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ABSTRACT: Widespread antimicrobial use is a risk factor for development of antimicrobial resistance. Antimicrobial treatment of acute otitis media (AOM) may not always be necessary. Little is known about the influence of parental expectations on physicians' decision-making in relation to treatment of AOM. Evidence is insufficient as to whether tympanostomy tube placement reduces antibiotic consumption.
We randomly selected 1,030 children 1 to 6 years old living in 4 geographic areas in Iceland to be invited to participate in the study. Information about sociodemographic factors, antimicrobial prescriptions and their indications during the preceding 12 months, tympanostomy tube placements and parental views on antimicrobial use and bacterial resistance were obtained from a questionnaire completed by the parents and medical records.
The incidence of AOM episodes resulting in antimicrobial prescription for 804 children recruited into the study was 0.7 (95% confidence interval, 0.6 to 0.8) per child per year, highest among children age 1 year, i.e. 1.8 prescriptions (95% confidence interval, 1.4 to 2.2). The cumulative incidence of tympanostomy tube placements was approximately 30%. Antimicrobial use during the preceding 8 weeks for children with and without tubes did not differ (P = 0.36). Fifteen percent of children with tubes had received antimicrobials during the preceding 8 weeks at last once for AOM compared with 14% of those without tubes (P = 0.97). Parents in the area where antimicrobial consumption was lowest were less likely to accept antimicrobial treatment than parents in the other areas (P = 0.005). Parents of children who had previously received antimicrobials for AOM were more likely to accept antimicrobials (P = 0.04).
Parental expectations to antimicrobial treatment and awareness about resistance development appear to influence treatment strategies for AOM. The high rate of tympanostomy tube placement in preschool children does not result in reduced antimicrobial consumption.
The Pediatric Infectious Disease Journal 01/2003; 21(12):1110-5. · 3.58 Impact Factor
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ABSTRACT: The effects of community-wide interventions to reduce resistance rates are poorly understood. This study evaluated the effect of reduced antimicrobial usage on the spread of penicillin-nonsusceptible pneumococci (PNSP) in four communities in Iceland. The study was performed after interventions to reduce antimicrobial usage and compared to an identical study performed 5 years before. A randomized sample of 953 children was chosen from all 2,900 1- to 6-year-old children living in four well-defined communities. The main outcome measures were nasopharyngeal carriage of PNSP and individual and community use of antimicrobials. Pneumococci were carried by 51.7% of the 743 children enrolled, and 8.1% of the pneumococci were PNSP as opposed to 8.5% in the previous study. The antimicrobial use of participants had been reduced from 1.5 to 1.1 courses/year and the overall use among children <7 years old living in the study areas from 13.6 to 11.1 defined daily dosages/1000 children per day. The prevalence of PNSP increased in the two areas furthest away from the capital area despite reduced consumption. The major risk factors for carriage of PNSP remained the same. Interventions can be effective in reducing antimicrobial use. Pandemic multiresistant clones can also spread fast in small communities with low antimicrobial use, where their appearance may be delayed compared to highly populated urban areas. Clonal spread and herd immunity are important factors to be considered in the evaluation of intervention effects.
Microbial Drug Resistance 01/2002; 8(3):187-92. · 2.15 Impact Factor
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ABSTRACT: OBJECTIVE: To study the postantibiotic effect (PAE) for Bacteroides fragilis after exposure to common anaerobic antimicrobials with two different methods, by viable counting and by measuring CO2 generation in a BACTEC(R) blood culture system. METHODS: Four strains of B. fragilis were exposed for 1, 2 and 4 h to cefoxitin, chloramphenicol, clindamycin, imipenem or metronidazole at concentrations from 1 to 16 x MIC. The drugs were removed by dilution into BACTEC 7A(R) vials and growth determined with viability counts and CO2 production. RESULTS: The durations of the PAEs determined by the two methods correlated well (r=0.913, p<0.005). PAEs of up to 4-5 h were induced by imipenem and metronidazole with achievable concentrations and exposure durations. Chloramphenicol induced short or no PAEs, but cefoxitin and clindamycin induced PAEs up to 2 h with high AUC values. The imipenem PAEs and the short cefoxitin and clindamycin PAEs were dependent on AUC. CONCLUSIONS: Significant PAEs against B. fragilis were induced by imipenem and metronidazole. Determining PAE by measuring CO2 production is an accurate and less time-consuming alternative to the conventional method of viable counts.
Clinical Microbiology and Infection 02/1997; 3(1):82-88. · 4.54 Impact Factor
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ABSTRACT: Postantibiotic effects (PAE) and control-related effective regrowth time (CERT) of dicloxacillin, vancomycin, rifampin and gentamicin in Staphylococcus aureus and imipenem, gentamicin, tobramycin, doxycycline and rifampin in Escherichia coli were measured by standard viability counting and [3H]thymidine incorporation. For PAE determination, the two methods correlated well; r2 = 0.821 for S. aureus and r2 = 0.939 for E. coli. For viable counts below the detection limits of 105 to 106 log10 CFU/mL, the PAE was overestimated by the [3H]thymidine method. Quantitation of CERT by both methods showed a good correlation, r2 = 0.867 for S. aureus and r2 = 0.997 for E. coli. Measuring [3H]thymidine incorporation in bacteria is a novel alternative method for the determination of PAE and CERT.
Clinical Microbiology and Infection 09/1996; 2(2):99 - 104. · 4.54 Impact Factor
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ABSTRACT: Introduction: Antibiotics are responsible for 20-25% of the total drug-cost in the larger hospitals in Iceland. Studies from other countries, both in Europe and North-America suggest that 40-70% of both antibiotic therapy and prophylaxis is inappropriate in the larger teaching hospitals. We undertook a prospective study to determine the patterns of antimicrobial use in a university hospital. Methods: Data on antibiotic prescriptions were collected over two four week periods in April and August 1994 on 12 wards at the National University Hospital. Results: During the eight weeks 302 (30%) of 1020 hospitalized medical, surgical and gynecological patients received one or more courses of antimicrobial therapy. Presumptive infection was the reason for therapy in 73% of the cases, prophylaxis in 35% and both therapy and prophylaxis in 8%. Cephalosporins were the most commonly used drugs for antimicrobial therapy and cloxacillin for prophylaxis. Therapy was judged appropriate in only 45% of the courses. Poor drug choice (bacterologically, pharmacologically), misguided prophylaxis, wrong drug dosage or unneccessary therapy were the most frequent reason for inappropriate therapy. Conclusion: Because of the worldwide increase of antibiotic-resistant strains the results of this study clearly indicate the need for additional measures to improve antibiotic use.
Laeknabladid 82(1):39-45. · 0.23 Impact Factor
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ABSTRACT: Objective: To identify infection rates, sites, pathogens, modes of acquisition and outcome in the Intensive Care Unit (ICU) of Borgarspitalinn. Patients and methods: Two hundred patients admitted longer than 24 hours were studied prospectively. Definitions of infections were based on criteria from the Centers of Disease Control. Results: Seventy eight patients (39%) had a total of 128 infections. Sixty one percent were ICU acquired, 19% community acquired and 23% were other nosocomial infections. Thus, 24% of the patients developed an ICU acquired infection. The most common infections were pneumonia 30%, urinary tract infection 30%, septicemia 7% and intraabdominal infections 7%. The most common organisms isolated were S. epidermidis, E. coli, enterococci, S. aureus, S. pneumoniae, H. influenzae and P. aeruginosa. Infected patients stayed significantly longer in the unit, 7.9 days, but non- infected patients stayed 2.9 days. Infections were not related to age or gender, but were significantly associated with tracheal intubation, central lines, treatment with H2-blockers, and underlying heart- or lung disease. ICU mortality for infected patients was 13%, for non-infected patients 7% (p=ns), but 81% and 91% of infected and non-infected patients, respectively, survived to hospital discharge (p<0.05). Conclusions: Nearly 40% of the ICU patients had an infection in the unit, 24% of the patients with ICU acquired infections. The need for continuing specific and accurate control and prevention of infections in the ICU setting is clear.
Laeknabladid 82(1):46-52. · 0.23 Impact Factor
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ABSTRACT: Objective: To determine the nosocomial infection rate, pathogens, colonisation and hospital mortality in the Intensive Care Unit (ICU) at Landspitalinn, which is a ten bed, general medical-surgical ICU. Methods: Patients admitted for more than 48 hours were included. Surveillance- cultures were performed on admission and thereafter three times a week (tracheal aspirate, oropharyngeal swab, gastric aspirate, urine and other specimens as indicated). ICU infections were defined by the criteria of CDC, USA. In the first 12 months 140 patients met the inclusion criteria at 150 admissions. The study is ongoing. Results: Eighty-seven ICU-acquired infections were diagnosed in 48 of the 150 admissions (32%), the mean age was 58 years (0-87) and 60% were males. The most common infections were: UTI 27 (31%), pneumonia 18 (21%), septicemia 15 (17%), wound infections eight (9%) and tracheitis seven (8%). Etiologic agents of the 87 infections were E. coli (15), Klebsiella sp. (7) and other Enterobacteriacae (9), Enterococcus sp. (12), Candida sp. (12), S. epidermidis (7), P. aeruginosa (7) and other/unknown pathogens (18). Infected patients stayed for a mean of 15.0 days and uninfected patients 4.2 days (p<0.05). Every patient staying for more than three weeks had at least one infection. The mean age of infected patients was 63 years and of uninfected patients 56 years (p<0.05). Neither APACHE-II nor TISS score on admission differed significantly between the infected and uninfected groups. Mortality in the ICU was 10.4% (5/48) in the infected group and 19.6% (20/102) in the uninfected group (p=0.24). Conclusion: Nosocomial infections in patients admitted to the ICU were common and associated with extended stay. Most of the infections were caused by Gram-negative bacilli.
Laeknabladid 82(1):60-65. · 0.23 Impact Factor
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ABSTRACT: Information on incidence, epidemiology and complications of human and animal bites in Nordic countries is limited, but these injuries can carry serious infectious complications. We conducted a prospective study at the Borgarspitalinn Emergency Department (ED) from August 1991 to July 1992. During this time 145 individuals entered the ED due to bites (accounting for ~0.4% of all admissions to the ED); 66 subjects (46%) had been bitten by dogs (41 provoked), 29 (20%) by cats, 34 (23%) by humans and 16 (11%) by other animals (horse, rabbit, hamster, rat, parrot, piranha fish, guinea pig, mink). The victims of dog and human bites were primarily men under 30 years of age, 73% and 79%, respectively. Dog and human bites were most common during the summer months and 41% of subjects bitten by humans were inebriated. Culture specimens were obtained on admission from 67 subjects, 31 from dog bites (58% positive), 10 from cat bites (80% positive), 19 from human bites (84% positive) and 7 from other bites (43% positive). The most common organisms isolated from dog bites were beta-hemolytic streptococci, S. aureus and CDC M-5, from cat bites Pasturella multocida, Flavobacterium sp. and from human bites S. aureus and beta-hemolytic streptococci. Prophylactic antibiotics were prescribed to 92 (63%) of the victims. Clinical infection was observed in 23 (16%) individuals. The infection rates after dog, cat and human bites were 8%, 28% and 29%, respectively. Three individuals bitten by humans had to be hospitalized due to osteomyelitis and/or severe cellulitis. The demography of bites in this study was similar to that reported elsewhere. Infection rates were comparatively low, possibly due to current habits of prophylactic antimicrobial use.
Laeknabladid 81(2):126-132. · 0.23 Impact Factor
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ABSTRACT: Introduction: Although acute bacterial meningitis is most common among children, the disease nevertheless poses serious problems in the adult population. However, most clinical overviews of the disease have either focused on children or all age groups combined. Subjects and methods: Information on all patients 5=16 years of age diagnosed in Iceland during the years 1975-1994 was collected from patient records from 10 hospitals and the records of the Dept. of Microbiology at the University Hospital which processes all bacterial isolates from the CSF identified in the country. Results: One hundred thirty six patients were identified, but complete records were found for 123 patients. Yearly incidence ranged from 1.7-7.2/100,000 inhabitants with a mean of 3.8/100,000. The most common causative organisms were Neisseria meningitidis (54%), Streptococcus pneumoniae (20%), Listeria monocytogenes (6%) and Haemophilus influenzae (5%). The relative incidence of N. meningitidis was dependent on age, the organism caused 93% of infections in the 16-20 year age group, whereas only 25% of infections in subjects 3=45 years of age were due to meningococci. On the other hand, the relative incidence of S. pneumoniae did increase from 2% in the younger age group to 37% in the older subjects. L. monocytogenes caused 14% of cases among patients 3=45 years of age. The mean mortality was 19.1% and did not change significantly during the study period. A significant underlying illness or condition was present in 39% of the patients. During the first third of the study period penicillin or ampicillin alone or in combination with chloramphenicol were used as initial empiric therapy in 76% of cases, wheras during the last third of the period these agents were used initially in 24% of patients. The third generation cephalosporins either alone or in combination were instead employed for empiric treatment in almost two-thirds of the patients. Conclusions: Meningococci were the most common cause of bacterial meningitis in adults in Iceland during the study period, albeit age dependent, and causing only a fourth of infections in patients 3=45 years of age. Mortality did not change during the period. The third generation cephalosporins are now the most commonly used agents for empiric therapy.
Laeknabladid 81(8):594-604. · 0.23 Impact Factor
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ABSTRACT: Background:
Most clinical overviews of acute bacterial meningitis have either focused on children or all age groups combined, although the disease poses serious problems in the adult population.
Archives of Internal Medicine 157(4):425-430. · 11.46 Impact Factor
