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Biomedical subjects

J K Møller

Publications and source records attributed to J K Møller.

At least 19 recordsLinked to original sources
PubMed1998

[Bacteremia in children with acute lymphoblastic leukemia].

The purpose of this study was to describe the pattern of bacterial infections in children with acute lymphoblastic leukemia. Forty-six children with ALL were treated for 119 febrile episodes. Antibiotic therapy was initiated with ampicillin and gentamicin, +/- dicloxacillin and lasted for 5-8 days. Bacterial cultures were positive in 36 of 119 febrile events. At the beginning of the febrile disease there was no difference in CRP and neutrophil count between children with positive and negative blood cultures. The maximum CRP was, however, significantly higher in children with positive blood cultures. In 75% there was no need to change the initial antibiotic treatment with ampicillin and gentamicin +/- dicloxacillin. If the temperature has been normal for 2-3 days and the neutrophil count is increasing it appears safe to discontinue the antibiotic therapy after five days when blood cultures are negative and after 7-8 days when cultures are positive.

Anti-Bacterial Agents↗
PubMed1998

Formation of amino acid (L-leucine, L-phenylalanine) derived volatile flavour compounds by Moraxella phenylpyruvica and Staphylococcus xylosus in cured meat model systems.

A bacterial strain isolated from Danish immersion curing brine, Moraxella phenylpyruvica 0100, and a commercial meat starter culture, Staphylococcus xylosus DD34, were tested for their ability to form characteristic volatile compounds in minimal medium with the added amino acid L-leucine or L-phenylalanine under different environmental conditions (pH 5.5 and 6.0; 0 and 210 ppm nitrate; pre-incubation with and without agitation) and compared with respect to their ability to form volatile compounds in cured meat extracts and vacuum-packed cured meat cuts. The characteristic cured meat aroma precursors/compounds 3-methylbutanal and 3-methylbutanol were found to be formed in cured meat extracts and vacuum-packed cured meat cuts inoculated with M. phenylpyruvica. These volatiles are most probably formed by metabolic conversion of the amino acid L-leucine by M. phenylpyruvica, as they were also produced in minimal media with added L-leucine inoculated with this organism. The characteristic L-phenylalanine derived compound, benzaldehyde, formed by M. phenylpyruvica in minimal medium in the presence of nitrate (210 ppm), was not produced in any noticeable amount in cured meat extracts or vacuum-packed cured meat inoculated with M. phenylpyruvica. In contrast, benzacetaldehyde, which has been described as a possible metabolic product of the microbial conversion of L-phenylalanine, was found to be a characteristic volatile compound formed in cured meat extracts and vacuum-packed cured meat inoculated with M. phenylpyruvica, indicating an alternative metabolic pathway for L-phenylalanine by this organism in a cured meat environment. Even though S. xylosus was able to form volatile compounds characteristic of cured meats (3-methylbutanal, 3-methylbutanol) in minimal media with added L-leucine, this bacterial strain seemed not to be able to produce these characteristic volatiles in the studied cured meat systems. The present data imply that M. phenylpyruvica, in particular, is a potential meat starter for ensuring superior flavour development in cured meat.

Aldehydes↗
PubMed1997

[Self-collected and mailed samples for diagnosis of urogenital Chlamydia trachomatis infection in women].

The study compared urine and vaginal flush samples, collected by women at home by endocervical and urine swabs obtained from their general practitioners, for their efficacy in the diagnosis of Chlamydia trachomatis infection. The study was a multipractice study in 33 general practices. A total of 222 women aged 18-25 years, who attended the general practitioner for a gynaecological examination, were included. Diagnostic tests-eight per woman-were performed by the polymerase chain reaction and the ligase chain reaction. A test was considered true positive if two tests or more were positive The prevalence of infection was 11.2% (23/205). Test sensitivity in samples obtained by general practitioners, samples obtained at home subjected to polymerase chain reaction, and samples obtained at home subjected to ligase chain reaction were 91%, 96%, and 100% respectively. The corresponding specificities were 100%, 92.9% and 99.5%. It is concluded that the diagnostic efficacy of samples obtained at home is as good as tests obtained by the general practitioner.

Adolescent↗
PubMed1997

[Preventive strategies against infections in autologous bone marrow transplantation].

The routine microbial surveillance, the prophylatic antibiotic regime and the management of infections were retrospectively evaluated in 26 autologous bone marrow transplantation episodes. The surveillance specimens indicated that ciprofloxacin prophylaxis was effective in minimising gram-negative functions. The comparison between specimens taken before and during the granulocytopenic period showed a shift towards more yeast, otherwise there were no big differences. The surveillance specimen could not identify the causative organisms in case of fever. The proven infections comprised four cases of bacteriaemia and one case of gastro-enteritis. Two patients died from disseminated Aspergillus infection not diagnosed prior to death. In 11 episodes the cause of fever remained unknown. Both fungal infections were related to nearby building construction work. None of the patients with bacterial infections were in a serious clinical condition. In the future the number of routine microbial surveillance specimens will be reduced. The aim of surveillance will be to monitor the potential occurrence of fluoroquinolone resistance, and more attention will be paid to possible fungal infections. The antibacterial policy will be continued.

Adolescent↗
PubMed1997

[Utilization of antibiotics at the Arhus Municipal Hospital. A prevalence study].

The hospital charts of 689 patients in Aarhus Municipal Hospital were surveyed on a single day in the autumn of 1994. Antibiotics were administered to 22% of the patients. In the intensive care unit, 69% of the patients received antibiotics, while 24% of the surgical patients and 17% of medical patients received antibiotics. Twenty-seven percent of 203 prescriptions were given as prophylaxis, mainly to surgical patients. Sixty-four percent were prescribed as monotherapy. Penicillins constituted 41% of the total usage of antibiotics. Antibiotics were administered orally in 55%, intravenously in 37%, topically in 5% and rectally in 3%. The prescription was noted in the medical chart for 96%, the indication in 74% and the planned duration of treatment in only 58% of the cases. Information concerning previous allergic reactions to penicillin was noted for 7% of the patients. It is concluded that the usage of antibiotics and the microbiological findings in the departments should be evaluated regularly, and the antibiotic regime and the practice of prescription adjusted accordingly.

Anti-Bacterial Agents↗
PubMed1997

The influence of antimicrobial prophylaxis on the microbial and clinical findings in patients after autologous bone marrow transplantation.

The influence of a prophylactic regimen consisting of ciprofloxacin 250 mg bid, was examined by surveillance cultures from nose, throat, axilla, gingiva, exit site of central venous catheters, blood, rectum and urine of 60 patients undergoing autologous bone marrow transplantation during a 6-year period. None of the 60 patients developed any infectious with Gram-negative rods belonging to the Enterobacteriaceae, or deep fungal infections, during hospitalization. All patients were neutropenic. Febrile episodes were seen in all patients but 3. From 13 patients, microorganisms in the blood, mostly nonhaemolytic streptococci (9/13), were cultured. Surveillance cultures did not predict later infections, but revealed the marked influence of the prophylactic antibiotics on the normal flora. Thus, mainly streptococci, coagulase-negative staphylococci and yeasts were cultured from the sites examined. It is concluded that the future objective of the microbiological surveillance should be restricted to monitoring the possible selection of drug-resistant microorganisms, and that routine cultures of blood and urine are unnecessary.

Adolescent↗
PubMed1996

Diagnosis of urogenital Chlamydia trachomatis infection in women based on mailed samples obtained at home: multipractice comparative study.

OBJECTIVE: To compare urine and vaginal flush samples collected by women at home with endocervical and urethral swabs obtained by general practitioners for their efficacy in the diagnosis of urogenital Chlamydia trachomatis infection. DESIGN: Multipractice comparative study. SETTING: 33 general practices and a central department of clinical microbiology in Aarhus County, Denmark. SUBJECTS: 222 women aged 18-25 years who for any reason had a gynaecological examination. INTERVENTIONS: Endocervical and urethral swabs were obtained by the women's general practitioners. The same women when at home then collected a first void urine sample, a midstream urine sample, and a vaginal flush sample (using a vaginal pipette) and mailed them to the laboratory. MAIN OUTCOME MEASURES: C trachomatis defected by the polymerase chain reaction and the ligase chain reaction. Eight tests for C trachomatis were performed for every woman. When two of the eight yielded positive results the patient was considered infected. RESULTS: The overall prevalence of C trachomatis infection was 11.2% (23/205 women). Test sensitivities in samples obtained by general practitioners, samples obtained at home subjected to polymerase chain reaction, and samples obtained at home subjected to ligase chain reaction were 91%, 96%, and 100% respectively. The corresponding specificities were 100%, 92.9%, and 99.5%. CONCLUSIONS: The diagnostic efficacy of samples obtained by women at home and mailed to the laboratory was as good as for samples obtained by a general practitioner when using the ligase chain reaction. This may have important implications for the practicability of screening for this common, often asymptomatic, and treatable infection.

Adolescent↗
PubMed1996

[Spread of an imported multiresistant Staphylococcus aureus to other hospitals via secondary colonized patients].

UNLABELLED: A secondary spread of an imported methicillin-resistant Staphylococcus aureus strain (MRSA) to two other patients occurred within a Danish surgical ward in spite of isolation of a multitraumatized index-patient immediately after arrival from a hospital in the Mediterranean area. The two other colonized patients were later transferred to other hospitals in Denmark where it became apparent that they had developed serious infections with the MRSA strain. IN CONCLUSION: to prevent spread of imported MRSA within Danish hospitals, strict adherence to isolation procedures and a high level of general hygiene is essential not only when patients are transferred from hospitals situated in endemic areas of MRSA abroad, but also when admitted from Danish hospital wards where known cases of colonisation or infection with MRSA exist.

Cross Infection↗
PubMed1996

[Peritonitis in continuous ambulatory peritoneal dialysis. An evaluation of the empiric initial antibiotic treatment].

Retrospectively, the clinical outcome and the initial empiric antibiotic treatment of peritonitis in 106 patients on continuous ambulatory peritoneal dialysis (CAPD) were evaluated during a two-year period. A mean frequency of 0.89 episodes of peritonitis per year of dialysis was found. There was a tendency towards an increased frequency of peritonitis in older patients. Diabetic patients constituted a younger age group and had a tendency towards having a lower risk of peritonitis. Patients with polycystic renal disease had a significantly increased risk. The risk of episodes with coagulase-negative staphylococci increased significantly with age. Repeated peritonitis episodes with coagulase-negative staphylococci was associated with a significant increase in the appearance of methicillin drug resistance. Carriers of Staphylococcus aureus had a significantly increased risk of Staphylococcus aureus peritonitis. Microorganisms were cultured in 94% of the episodes. The initial antibiotic therapy was only sufficient in 66% due to antimicrobial drug resistance. The initial antibiotic treatment was changed in 58% of the episodes. The treatment could have been changed to antibiotics with a narrower antimicrobial spectrum in 51% of the episodes. Relapse was seen in 11% of culture positive episodes. In 16% of the episodes (29% of patients with peritonitis) it was necessary to remove the dialysis catheter and transfer the patient to haemodialysis to clear the infection. Only 15% of these patients returned to CAPD again. We found that an initial empiric antibiotic regime of vancomycin combined with an aminoglycoside is to be recommended as achieving an antibiotic coverage of 88%, and this is now the standard regime in the department.

Adolescent↗
PubMed1996

[Peritonitis in continuous ambulatory peritoneal dialysis. Culture of peritoneal dialysate fluid].

Conventional aerobic and anaerobic culture of peritoneal dialysate effluent from patients in continuous peritoneal dialysis (CAPD) was compared to culture in a semiautomated blood culture system. During a two-year period 78 of 79 consecutive episodes of peritonitis among 45 Danish CAPD patients were cultured and the etiology of the infection found in 73 (94%). The sensitivity of the blood culture system was 88%, whereas the sensitivity of the conventional culture of the dialysate effluent was 81%. This difference is not significant (McNemar test; 0.5 > p > 0.3). The majority of isolates were Gram-positive bacteria dominated by coagulase-negative staphylococci (38%). In comparison, only 2% of the cultures of peritoneal dialysate effluent taken within the same period from patients without clinical signs of peritonitis were positive. All the Gram-positive aerobic bacteria were sensitive to vancomycin whereas 97% of the Gram-negative aerobic bacteria were sensitive to gentamicin. An initial empiric treatment of peritonitis with a combination of vancomycin and gentamicin is recommended.

Adolescent↗
PubMed1996

Coagulase-negative Staphylococci in Danish blood cultures: species distribution and antibiotic susceptibility.

The distribution and antibiotic susceptibility of coagulase-negative staphylococci (CoNS) isolated from blood cultures was examined in samples from hospitals covering most of Denmark. A total of 499 CoNS isolates were detected in 477 blood cultures from 340 patients and speciated as Staphylococcus epidermidis, 285; Staphylococcus hominis, 61; Staphylococcus haemolyticus, 43; Staphylococcus warneri, 12; Staphylococcus cohnii, 7; Staphylococcus saprophyticus, 4; Staphylococcus capitis, 2 and Staphylococcus lugdunensis, 1. Seventy-eight isolates could not be identified to species level and six were Micrococcus spp. In 108 (22.6%) blood culture sets, more than one CoNS strain were found, as detected by species identification, antibiogram and biotyping. Significantly more blood cultures from patients in university hospitals were drawn from central venous catheters. Comparing university and non-university hospitals, the overall antibiotic susceptibility among CoNS was only slightly different, except for methicillin and amikacin. The prevalence of methicillin-resistant strains was 35.1% in the university hospital strains vs. 25.3% in the non-university hospital strains. The overall prevalence of methicillin resistance was 32%. Great geographic variation in both species distribution and antibiotic resistance was observed. The high prevalence of S. epidermidis makes subtyping of this species important.

Blood↗
PubMed1995

Use of PCR and direct immunofluorescence microscopy for confirmation of results obtained by Syva MicroTrak Chlamydia enzyme immunoassay.

A procedure for use of the Amplicor Chlamydia PCR with the Syva MicroTrak enzyme immunoassay (EIA) medium was developed, and the performance of the Syva MicroTrak EIA was evaluated by use of PCR and the Syva MicroTrak direct immunofluorescence assay (DFA) as confirmatory methods. PCR detected Chlamydia organisms at a 10-fold greater dilution than did DFA. Of 366 specimens, 119 specimens were positive by both PCR and DFA, 6 specimens were positive only by PCR, and 241 specimens were negative by both PCR and DFA. Subsequently, DFA and the developed PCR procedure were used prospectively for confirmation of EIA results in a defined negative gray zone between the cutoff value and 30% of the cutoff value (70% below the cutoff value). All specimens with results above the EIA cutoff value were also subjected to confirmation with DFA and PCR. EIA was performed on 7,748 endocervical swab specimens, of which 494 (6.4%) were subjected to confirmation, and on 968 male urethral swab specimens, of which 185 (19.1%) were subjected to confirmation. A "gold standard" was based on the findings by DFA and PCR, and divergent results were resolved by a major outer membrane protein-based PCR. Forty-five of 160 female specimens (28.1%) and 11 of 93 male specimens (11.8%) within the defined negative gray zone were found to be positive. Of 334 female specimens having absorbance unit (AU) values above the EIA cutoff value, 258 could be confirmed, thereby giving a positive predictive value of 77% (258/334). Accordingly, the positive predictive value with male specimens was 95% (87/92). The prevalence of Chlamydia trachomatis-positive specimens was 3.9% (303/7,748) in females and 10.1% (98/968) in males. All male specimens having AU values above 1.0 in the EIA were confirmed positive. In contrast to this, 16 females with AU values above 1.0 in the EIA could not be confirmed positive with either DFA or PCR. The mean age of these females was higher than that of patients testing negative for C. trachomatis (P < 0.005). This might suggest an age-dependent change in vaginal colonization with an organism(s) crossreacting in the EIA. Thus, the PCR procedure developed can be used for confirmation of EIA results, testing specimens with AU values in the defined negative gray zone improves the sensitivity of EIA, and all specimens testing positive in EIA should be subjected to confirmation.

Cervix Uteri↗
PubMed1994

Changing etiology of bacteremia in patients with hematological malignancies in Denmark.

To ascertain whether the microbiological etiology of bacteremia among patients with hematological malignancies has changed in Denmark, the species distribution of clinically relevant blood culture isolates from the Hematological Department at Rigshospitalet, Copenhagen in 1990 was compared with 2 previous studies (1970-72; 1981-85). In addition, time trends of the etiology of bacteremia among hematological patients in Copenhagen (eastern Denmark) and in Arhus (western Denmark) were compared. In contrast to many other studies, a significant increase in the proportion of Gram-negative aerobes was observed in Copenhagen (from 43% in 1981-85 to 55% in 1990; p < 0.05), whereas in Arhus the proportion of Gram-positive aerobes increased steadily during the 1980s (from 34% to 51%; p < 0.05). In Copenhagen, non-hemolytic streptococci and Xanthomonas maltophilia increased significantly and accounted for 10% (p < 0.01) and 5% (p < 0.05) respectively, of all isolates in 1990, whereas Staphylococcus aureus during the 2 decades studied decreased from 25% to 8% (p < 0.001). In both regions, a decrease was observed in the proportion of Pseudomonas aeruginosa which accounted for only about 5% of all isolates in 1990. No changes were observed in the rates of anaerobes and yeasts. Several factors may contribute to the reported differences in the etiology of bacteremia among hematological patients, e.g. criteria used to assign the clinical significance of the isolate, blood culture system used, practice of using indwelling intravenous catheters, different policies with respect to antimicrobial treatment, and the degree of immunosuppression. A local surveillance of blood culture isolates is mandatory if changes in etiology and resistance development are to be detected.

Bacteremia↗
PubMed1990

Phage-typing of coagulase-negative staphylococci. Factors influencing typability.

Factors influencing the phage-typability of coagulase-negative Micrococcaceae have been studied in 2,778 clinical isolates comprising A) 209 consecutive isolates from one laboratory, B) 2,107 clinical strains submitted for phage-typing for epidemiological reasons, and C) 462 strains representing all isolates of presumed clinical significance found in two laboratories during one month. The reproducibility was acceptable at duplicate repeated typing of the same strains as well as by typing epidemiologically-related pairs of strains from the same patient. Strains of Staphylococcus haemolyticus were seldom typable, whereas strains of S. epidermidis and S. hominis had a higher typability. Methicillin-resistant strains and other multiple-resistant strains were rarely typable (11-13%). The typability was higher among susceptible strains (36%) and strains resistant to penicillin only (43-50%). The typability of strains of the same species and antibiotic-resistance pattern differed between hospitals compared and decreased markedly over the years for multiple-resistant S. epidermidis isolates.

Bacteriophage Typing↗
PubMed1990

Monitoring antimicrobial drug resistance in hospital microorganisms. Definition of problems and methods.

Hospital infections continue to be an important problem. Changes in patient categories and in the examinations and treatments offered at the hospital, probably constitute the basis upon which new types of infections and new groups of infecting microorganisms continually emerge. The treatment of patients with hospital infections may become complicated by the emergence of drug resistance in the infecting microorganisms. The situation varies between hospitals, and this necessitates a local microbiological monitoring. Prerequisites of a surveillance system in general are described and illustrated by a system monitoring antimicrobial resistance in a Danish county. A specific computer system (software) for the processing of clinical microbiological results was developed by the author to make the local microbiological monitoring possible. Computer-assisted analyses for an evaluation of the statistical association of drug resistance traits (phenotype) were also developed. Data on local drug resistance patterns were systematically obtained and analysed in a seven-year study comprising several hundred thousands specimens. Drug resistance genotypes were determined for selected groups of microorganisms (e.g. coagulase-negative staphylococci) in various periods. Data from these studies emphasize that it is important to correlate information about resistance phenotypes of all clinical isolates with the resistance genotypes of selected strains in the monitoring of plasmid mediated resistance and its dissemination. These findings agree well with the results of other but generally less comprehensive studies in the literature. In a study of outpatients treated with a particular antimicrobial (tetracycline), it was shown that this drug selected for plasmid mediated multiple drug resistance in the normal flora of the patients. On the basis of these results and the literature, a general model for the emergence and spread of antimicrobial drug resistance is discussed. Examinations of quantitative relationships between antimicrobial usage and microbial resistance are also reviewed. Analysis of the statistical correlation between various measures of antimicrobial use and the prevalence of microbial resistance in the Danish county corroborates the observation that general changes in prevalence of a particular resistance trait seem to be best explained by taking the mechanisms of co-selection by other antimicrobials into consideration.

Anti-Bacterial Agents↗
PubMed1989

[Accumulated microbiological data. Surveillance of infection/antibiotic policy].

Database reviews of the findings in bacteriological specimens from a period of six years from patients in a department of haematology are employed as a model of how cumulative data about the microorganisms isolated may be employed for surveillance of accumulated infections and in the organization of the antibiotic policy of a department. During the period of observation, the standard treatment with antibiotics for febrile episodes in granulocytopenic patients was altered to piperacillin and netilimicin on the basis of the frequent occurrence of Gram-negative rods including Pseudomonas aeruginosa in blood cultures. It is concluded that accumulated microbiological data is of value for a clinical department and that analysis of the data does not constitute an increased work-load provided that the microbiological reports are routinely registered in a database.

Anti-Bacterial Agents↗
PubMed1989

Antimicrobial usage and microbial resistance in a university hospital during a seven-year period.

The prevalence of antimicrobial resistance among Staphylococcus epidermidis, Staph. aureus and Escherichia coli isolated in a university hospital, and the usage of antimicrobial agents within and outside the hospital was established for a seven-year period. The overall resistance to antimicrobial agents increased markedly for Staph. epidermidis but remained constant for the two other species. In Staph. epidermidis, a pronounced increase was seen in prevalence of resistance to penicillin, sulphonamides, trimethoprim, erythromycin and chloramphenicol, whereas resistance to streptomycin and tetracycline decreased. The trends in usage of beta-lactam antibiotics were identical within and outside hospital as opposed to the use of erythromycin and sulphonamides. The highest degree of correlation between antimicrobial usage and resistance to an antimicrobial was obtained using a corrected figure for antimicrobial usage paying regard not only to the use of a particular antimicrobial agent but also to a fraction of the usage of other antimicrobials which may co-select for the resistance trait.

Anti-Infective Agents↗