PubMed Health⌕ Search

Biomedical subjects

D Berild

Publications and source records attributed to D Berild.

At least 19 recordsLinked to original sources
PubMed2003

Clostridium difficile infections related to antibiotic use and infection control facilities in two university hospitals.

We investigated whether a reduction in antibiotic use at the Aker University Hospital (Aker) led to a reduction in Clostridium difficile-associated diarrhoea (CDAD). We compared the incidence of CDAD in Aker and Tromsoe University Hospitals (Tromsoe) and related it to antibiotic use and facilities for infection control between 1993-2001. For this purpose we also performed point prevalence studies. Total antibiotic use was the same in the two hospitals. In spite of a reduction in the use of broad-spectrum antibiotics in Aker the incidence of CDAD increased during 1993-1999. In Tromsoe the use of broad-spectrum antibiotics and clindamycin was two to three times higher than in Aker, but until 1999 the incidence of CDAD remained constant and only half that of Aker. After 1999 the incidence of CDAD was halved in Aker, and increased three-fold in Tromsoe. Point prevalence studies in 2001 revealed an equal prevalence of antibiotic-associated diarrhoea. The facilities for infection control were better in Tromsoe. The percentage of single rooms were 8% in Aker and 14% in Tromsoe, and the percentage of single rooms with a WC was 6% in Aker and 12% in Tromsoe. The bed occupancy was much higher in Aker than in Tromsoe. Lack of facilities for infection control and higher bed occupancy could have contributed to the higher incidence of CDAD in Aker in spite of decreased use of broad-spectrum antibiotics and clindamycin. To limit CDAD in hospitals the focus must be on both rational antibiotic use and infection control.

Anti-Bacterial Agents↗
PubMed2002

Occurrence and clinical presentation of systemic pneumococcal infections in an unselected population in Oslo, Norway, between 1993 and 1997.

In order to describe the clinical and microbiological manifestations of systemic pneumococcal infection in an unselected urban population, 147 cases that occurred in the period 1993-1997 were retrospectively reviewed. An unexpected finding was that gastrointestinal symptoms were remarkably common. All pneumococcal isolates were fully susceptible to penicillin. The 7-valent conjugated vaccine covered 71% of those under 2 years of age, but only 21% of those 15-65 years of age were covered. Although the case fatality rate was 17%, the rate of early fatality due to systemic pneumococcal infection was unchanged compared with data published in the era before antibiotics. This study emphasizes the importance of continuing efforts to prevent systemic pneumococcal infections.

Adolescent↗
PubMed2001

Antibiotic guidelines lead to reductions in the use and cost of antibiotics in a university hospital.

The object of this study was to improve the use of antibiotics at Aker University Hospital, a 600-bed university hospital. We developed and implemented guidelines for antibiotic treatment and prophylaxis. We describe the impact of these guidelines on the use and cost of antibiotics and evaluate compliance with the guidelines. From 1994 to 1996 there was an 11% reduction in the use of antibacterial agents and a 42% reduction in the use of antifungal agents. The use of broad-spectrum antibiotics was reduced by 23%. The use of penicillin V and G increased by 5%, dikloxacillin/kloxacillin by 46% and erythromycin by 33%. Compared with 1994 values there was a 27% reduction in antibiotic costs in 1995, amounting to US$ 319,300, and a 32% reduction in antibiotic costs in 1996, amounting to US$ 380,000. A point-prevalence investigation conducted 18 months after the introduction of the guidelines indicated that compliance was > 95%. It proved possible to reduce the use of broad-spectrum antibacterial and antifungal agents, with significant cost savings. Point-prevalence studies may be a useful tool to detect deviations from guidelines and provide physicians with educational feedback.

Anti-Bacterial Agents↗
PubMed2000

[Intraspinal infections in patients treated with epidural analgesia].

BACKGROUND: Intraspinal infections (meningitis, epidural abscess) may occur spontaneously or present as a complication of epidural analgesia. MATERIAL AND METHODS: All cases during the 1991-99 period of clinically significant intraspinal infections in patients treated with epidural analgesia were analysed from clinical records in our institution. RESULTS: One patient with uncertain, three patients with well documented meningitis, and one patient with epidural abscess were identified. The treatment time varied from 12 to 49 days in patients with documented infections; the number of catheters varied from one to six. Skin bacteria were isolated from one patient (Staphylococcus sp), opportunistic bacteria (Pseudomonas, Enterococcus, Micrococcus sp) were isolated from three others. Two of the patients were at risk because of probable immunosuppression and chronic infections. Diagnosis and surgery of the patient who developed epidural abscess were significantly delayed because of three negative MRs with and without gadolinium enhancement. INTERPRETATION: Because of the danger of infection related to epidural analgesia, all patients have to be properly monitored as long as they have epidural catheters and also after the removal of catheters. Some epidural abscesses spread longitudinally and may present as a diffuse process on MR without mechanical compression of the medulla, and may be interpreted as negative findings. Myelography with CT scan is an alternative method of investigation in such cases. Early neurosurgical diagnosis and intervention may prevent serious complications.

Adult↗
PubMed2000

Difficulties in diagnosing Brucella spondylitis.

We describe a case of culture-proven Brucella spondylitis in a 28-y-old Turkish male asylum seeker who had arrived to Norway 6 months earlier. Several diagnostic difficulties, including rapid in vitro growth and misidentification of the causative microorganism in biochemical gallery strip tests, resulted in late diagnosis.

Adult↗
PubMed1999

[Once-daily dosage of aminoglycosides--a therapeutic simplification and an economical benefit].

Conventionally, aminoglycosides have been administered in two or three daily doses. Numerous in-vitro and animal experiments and several clinical trials favour a once-daily dosage regimen of aminoglycosides, which provides a more rapid concentration-dependent bacterial killing and is probably less toxic than two or three dosage regimens. In this article the pharmacological and microbiological background for once-daily aminoglycoside administration is reviewed, and some controlled trials are discussed. Recommendations for clinical practice are given.

Anti-Bacterial Agents↗
PubMed1999

Influence of prescription patterns in general practice on anti-microbial resistance in Norway.

BACKGROUND: The global pandemic of antibiotic resistance is causing considerable concern, and a major reason for the growing world-wide resistance problem is the overuse of anti-infective drugs, especially the use of broad spectrum antibiotics. This is still a relatively minor problem in most of the Nordic countries where the consumption of antibiotics is less than half of that reported from southern Europe and the United States of America (USA). AIM: To describe the resistance pattern among common respiratory tract pathogens in Norwegian general practice, the national consumption of antibiotics, and GPs' prescription patterns for respiratory tract infections. To offer some suggestions as to why Norway has maintained a favourable situation regarding resistant microbes during the past 10 years. METHODS: An analysis of the prescription patterns in Norwegian general practice. RESULTS: There is a low total prescription volume of antibiotics compared with other countries. Penicillin V is the most commonly used antibiotic for the most common airway diseases in general practice in Norway. CONCLUSION: Although there is a low prevalence of antibiotic resistance in Norway, there is still a great potential for reducing the unnecessary antibiotic prescribing for the most common respiratory illnesses.

Anti-Bacterial Agents↗
PubMed1998

Prolonged nosocomial outbreak of hepatitis A arising from an alcoholic with pneumonia.

From April to June 1996, an outbreak of hepatitis A virus (HAV) infection affecting 15 nurses, patients and household contacts occurred in the Department of Internal Medicine at Aker University Hospital, Oslo. The index case was a homeless alcoholic who was hospitalized in March 1996 with pneumonia while simultaneously incubating HAV infection. Four secondary cases were infected by the index case, while another 10 cases were caused by a continuous spread of infection within the department during the following months. Sequence of the VP1/P2A junction of HAV was obtained from 9 patients, including the index case, and all sequences were identical to each other. Mass vaccination of hospital employees with a formalin-inactivated HAV-vaccine took place in late May, and following this the outbreak stopped. Several factors probably combined to account for this unusual outbreak, e.g. an index case unsuspected of incubating with HAV infection, and a low prevalence rate of protective antibodies to HAV among the hospital staff.

Adult↗
PubMed1997

[Is it possible to influence the utilization of antibiotics?].

Excessive and inappropriate use of antibiotics in hospitals contributes to the development of antibiotic resistance and higher costs. At Aker University Hospital the use of antibiotics and the associated costs have increased over the last years. In an attempt to reverse this trend we introduced guidelines for prescribing antibiotics, based on knowledge of the local pattern of resistance. The programme resulted in a reduction of 9% in the use of antimicrobial drugs and of 24% in the associated costs, i.e. a saving of NOK 2.2 million in one year. From 1995 to 1996 there was a further reduction in antibiotic consumption by 7%. We conclude that guidelines for use of antibiotics, and relevant information, can be useful tools in influencing the prescription of such drugs.

Anti-Bacterial Agents↗
PubMed1997

[An outbreak of hepatitis A among intravenous drug addicts in Oslo 1995-96].

Intravenous drug abuse is a well-known risk factor for acquiring hepatitis A infection. Among drug abusers most cases are sporadic, but epidemic outbreaks may occur occasionally. In this article we describe an epidemic outbreak including 144 serologically proved cases of hepatitis A among intravenous heroin and amphetamine abusers in Oslo. The outbreak lasted for 11 months. 59 (41%) of the patients were admitted to hospital. One of them died and seven developed severe but reversible acute hepatitis. We also registered 26 cases of hepatitis A among close contacts, 14 of whom were associated with a nosocomial outbreak that affected nurses, fellow patients and relatives. We do not know how the hepatitis A virus was introduced into the abuser population, but the further spread was probably dominated by a combination of faecal-oral transmission and parenteral transmission secondary to sharing needles. Although we were unable to detect hepatitis A virus in confiscated drug samples by means of polymerase chain reaction we cannot exclude that some abusers were infected by injection of contaminated amphetamine.

Adult↗
PubMed1997

[Pneumococcal endocarditis of the tricuspid valve. A case report with review of the literature].

The incidence of invasive infections caused by Streptococcus pneumoniae has increased dramatically in Norway the last 5-10 years. We describe a patient with a pneumococcal endocarditis of the tricuspic valve who illustrates some of the diagnostic and therapeutic problems often connected with right-sided endocarditis. We also review literature on pneumococcal endocarditis. Since the introduction of antibiotics, the incidence of pneumococcal endocarditis has decreased significantly. The most important predisposition still seems to be alcoholism. Cases of pneumococcal endocarditis require prolonged and consistent antibiotic treatment. Rapid destruction of the valves is typical, and often demands surgical intervention at an early stage. So far no multiresistant pneumococci have been observed in Norway. The increased incidence of serious pneumococcal infections has recently made it necessary to recommend that pneumococcal vaccine be given on wider indications.

Endocarditis, Bacterial↗
PubMed1997

Reduced serum IgG reactivities with bacteria from dental plaque in HIV-infected persons with periodontitis.

Serum samples were obtained from 44 HIV-seropositive (HIV+) and 37 HIV-seronegative (HIV-) persons that were grouped according to periodontal status. Serum IgG and IgA reactivities towards Streptococcus mutans, Actinobacillus actinomycetemcomitans, Porphyromonas gingivalis. Prevotella intermedia, Prevotella nigrescens and Fusobacterium nucleatum were measured by means of ELISA. HIV+ persons with chronic marginal periodontitis showed significantly lower IgG reactivities to the periodontal pathogens A. actinomycetemcomitans, P. gingivalis, P. intermedia and F. nucleatum as compared with their HIV- counterparts (p < 0.05). Specific serum IgA reactivities were similar in the two periodontitis groups, except for P. nigrescens where the HIV+ group with chronic marginal periodontitis had lower values than their systemically healthy counterparts (p < 0.05). The results indicate that HIV infection affects the humoral serum immune responses against bacteria in dental plaque; the depressed antibody responses may contribute to the increased susceptibility for periodontal infections in HIV-infected patients.

Adult↗
PubMed1995

[Tuberculosis among AIDS patients in Ullev]l hospital].

Records of patients with concomitant HIV infection and human tuberculosis were analysed. Nine out of 232 AIDS patients (4%) developed human tuberculosis with a preponderance (6/9) of immigrants from sub-Saharan Africa. In three patients the diagnosis was delayed because of atypical manifestations of the disease and lack of typical chest X-ray findings. Tuberculin skin tests were positive in only three patients, and became negative in one patient who developed two episodes of tuberculosis. All the patients who complied with the conventional triple anti-tuberculosis regimen responded well, and no multidrug-resistant tuberculosis was observed.

AIDS-Related Opportunistic Infections↗
PubMed1995

Leukotriene B4 receptor levels and intracellular calcium signalling in polymorphonuclear leukocytes from patients with Crohn's disease.

OBJECTIVE: To investigate the leukotriene B4 (LTB4) signal transducing mechanism in polymorphonuclear neutrophils (PMNs) from patients with Crohn's disease. METHODS: Cytosolic free calcium ([Ca2+]i), inositol (1,4,5)-trisphosphate [(1,4,5)-IP3] chemotaxis, LTB4 receptor number and affinity were investigated in peripheral PMNs from 11 patients with Crohn's disease and 11 healthy controls. RESULTS: There was a slight reduction (P = 0.31) in the number of LTB4 receptor sites per cell expressed on PMNs (mean Bmax 931) from nine of the 11 patients studied compared with the healthy controls (mean Bmax 1095). LTB4-mediated (1,4,5)-IP3 formation and the increase in [Ca2+]i were markedly decreased in PMNs from the 11 patients with Crohn's disease [(1,4,5)-IP3, mean +/- SEM 12 +/- 0.84 and 27.4 +/- 1.4 pmol/l/tube for patients and controls, respectively; [Ca2+]i, mean +/- SEM 295 +/- 2.75 and 598 +/- 4.7 nmol/l for patients and controls, respectively]. The decrease in calcium might be related to the decrease in Bmax (P < 0.05). Ionomycin, a calcium ionophore which bypasses the initial steps of LTB4 receptor activation, showed only a minor difference in peak [Ca2+]i between PMNs from patients and controls. LTB4-directed chemotaxis showed that the sensitivity to suboptimal concentrations of LTB4 (1.0 nmol/l) was significantly depressed in PMNs from patients (P < 0.05). CONCLUSION: Peripheral PMNs from patients with Crohn's disease had a small deficit in the expression of LTB4 receptors. This deficiency was paralleled by marked alterations in cellular signalling. Whether these results are specific to Crohn's disease or simply result from the exposure of circulating PMNs to elevated levels of LTB4 remains to be established.

Adult↗
PubMed1993

Effect of 5-aminosalicylic acid and analogous substances on superoxide generation and intracellular free calcium in human neutrophilic granulocytes.

Activated polymorphonuclear leukocytes (PMNs), which are found in the inflammatory lesions of chronic inflammatory bowel disease, produce tissue-destructive oxygen-derived free radicals. The influence of 5-aminosalicylic acid (5-ASA), its acetylated metabolite (Ac-5-ASA), sulfasalazine (SAZ), and olsalazine (OLZ) (5-ASA dimer linked by an azo group) in pharmacologically relevant concentrations (0.1-10 mM) were tested on PMN superoxide production with either the receptor-specific agent formyl-methionyl-leucyl-phenylalanine (fMLP) or the protein kinase C activator phorbol myristate acetate (PMA). Inhibition of receptor-specific superoxide production occurred at 0.07, 0.32, and 0.63 mM (IC50 values) for 5-ASA, SAZ, and OLZ, respectively. No inhibitory effects of SAZ and OLZ were observed when PMA was applied as stimulus for PMN superoxide production. The results indicate that the signal to which PMNs respond by generating superoxide is primarily due to calcium release from intracellular stores. They further suggest that SAZ and OLZ may affect the oxygen-derived free radical production in human PMNs by unspecific cytotoxicity or by interference with the nicotinamide adenine dinucleotide phosphate, reduced (NADPH) oxidase system, whereas 5-ASA itself is a free radical scavenger.

Aminosalicylic Acids↗
PubMed1992

Leucocyte scintigraphy to localize inflammatory activity in ulcerative colitis and Crohn's disease.

The validity of using autologous leucocytes labelled with technetium -99m hexamethyl-propyleneamine-oxine (Tc-HMPAO) for scintigraphy in inflammatory bowel disease was evaluated in 12 patients with clinically active ulcerative colitis (UC) and 10 with Crohn's disease (CD). Colonoscopy and biopsy were used as reference. Scintigrams taken 1 h and 3 h after leucocyte reinjection were evaluated blindly by two independent observer groups. Full agreement was found in 11 of 12 UC patients when compared with colonoscopy but in only 3 of 10 CD patients. Segments with agreement in CD patients often showed neutrophilic granulocyte infiltration at biopsy. The judgements of clinicians and physiologists differed for only 2 of totally 70 UC segments but for 13 of 59 CD segments (kappa, 0.94 and 0.52). It is concluded that Tc-HMPAO scintigraphy might be an alternative to colonoscopy in the control of disease extent in UC. In CD patients the technique might warn about infections complications.

Adult↗