Salmonella-associated Deaths, Sweden, 1997–2003

We examined excess deaths after infection with Salmonella in a registry-based matched cohort study of 25,060 persons infected abroad and 5,139 infected within Sweden. The domestically infected have an increased standardized mortality ratio, whereas those who acquired Salmonella infection abroad had no excess risk of death

Mortality following Campylobacter infection: a registry-based linkage study

BACKGROUND: Campylobacteriosis is one of the most commonly identified causes of bacterial diarrheal disease and a common cause of gastroenteritis in travellers from developed nations. Despite the widespread occurrence, there is little information on Campylobacter mortality. METHODS: Mortality among a cohort of Campylobacter cases were compared with the general population 0–1, 1–3, 3–12 and more than 12 month after the onset of the illness. The cases were sub-grouped according to if they had been infected domestically or abroad. RESULTS: The standardized mortality ratio for cases infected domestically was 2.9 (95% CI: 1.9–4.0) within the first month following the illness. The risk then gradually diminished and approached 1.0 after one year or more have passed since the illness. This initial excess risk was not attributable to any particular age group (such as the oldest). In contrast, for those infected abroad, a lower standardized mortality ratio 0.3 (95% CI: 0.04–0.8) was shown for the first month after diagnosis compared to what would be expected in the general population. CONCLUSION: Infection with Campylobacter is associated with an increased short-term risk of death among those who were infected domestically. On the contrary, for those infected abroad a lower than expected risk of death was evident. We suggest that the explanation behind this is a "healthy traveler effect" among imported cases, and effects of a more frail than average population among domestic cases

Mycoplasma pneumoniae infections, 11 countries in Europe and Israel, 2011 to 2016

Background: Mycoplasma pneumoniae is a leading cause of community-acquired pneumonia, with large epidemics previously described to occur every 4 to 7 years. Aim: To better understand the diagnostic methods used to detect M. pneumoniae; to better understand M. pneumoniae testing and surveillance in use; to identify epidemics; to determine detection number per age group, age demographics for positive detections, concurrence of epidemics and annual peaks across geographical areas; and to determine the effect of geographical location on the timing of epidemics. Methods: A questionnaire was sent in May 2016 to Mycoplasma experts with national or regional responsibility within the ESCMID Study Group for Mycoplasma and Chlamydia Infections in 17 countries across Europe and Israel, retrospectively requesting details on M. pneumoniae-positive samples from January 2011 to April 2016. The Moving Epidemic Method was used to determine epidemic periods and effect of country latitude across the countries for the five periods under investigation. Results: Representatives from 12 countries provided data on M. pneumoniae infections, accounting for 95,666 positive samples. Two laboratories initiated routine macrolide resistance testing since 2013. Between 2011 and 2016, three epidemics were identified: 2011/12, 2014/15 and 2015/16. The distribution of patient ages for M. pneumoniae-positive samples showed three patterns. During epidemic years, an association between country latitude and calendar week when epidemic periods began was noted. Conclusions: An association between epidemics and latitude was observed. Differences were noted in the age distribution of positive cases and detection methods used and practice. A lack of macrolide resistance monitoring was noted

Short and long term effects of bacterial gastrointestinal infection

The objectives of this thesis were to increase our understanding of the mortality and complications associated with bacterial gastrointestinal infections, with focus on Salmonella and Campylobacter enteritis. The effect of antibiotics vs. placebo on duration of diarrhea in Campylobacter enteritis was also examined. Persons reported with culture verified bacterial enteritis to the Swedish Institute of Infectious Disease Control 1997 2004 formed the base for three of the studies in this thesis. From the national database, case-based information on age, sex, type of bacteria, date of debut of illness, and country of infection were extracted. Each person in this retrospective cohort was followed until death, an event took place or until study termination. We used the National Tax Board registers to identify deaths in the cohort, and the national Hospital Discharge Register from the National Board of Health and Welfare to observe complications associated with bacterial gastrointestinal infection. Standardized mortality/incidence ratios (SMR/SIR) were used to estimate the relative risk of death or short and long term complications. For persons infected with Campylobacter, the SMR among those infected within Sweden was 2.9 with 95% confidence interval (CI) 1.9 4.0 during the first month after infection, and for those who had acquired Salmonella at home 5.6 (95% CI: 3.4 8.2). No increased SMR within the first 30 days after infection could be found among those infected with Campylobacter or Salmonella abroad: 0.3 (95% CI: 0.04 0.8) and 0.6 (95% CI: 0.2 1.2). We are probably observing a healthy traveler effect , i.e. persons who travel are healthier than the general population. The effect of antibiotics on Campylobacter infection has only been studied in quite small studies. This led us to conduct a quantitative summary analysis of all published randomized controlled trials (RCTs). Eleven RCTs which included a total of 479 study participants were included in a meta-analysis. The summary effect in our random effect model showed a reduction of 1.32 days (95% CI: 0.64 1.99) with symptoms in favor of antibiotics compared to placebo. If one had been infected at home or abroad did not have any interaction effect on the complications observed among patients in our cohorts. We could confirm the associations between EHEC and hemolytic uraemic syndrome, Campylobacter infection and Guillain-Barré syndrome, and Yersinia enteritis and reactive arthritis. We found evidence of an association between Salmonella enteritis and aortic aneurysm, SIR 6.4 (95% CI: 3.1 11.8). Transient bacteremia with non-typhoid Salmonella can probably cause a localized endothelial infection that result in an aneurysm or the enlargement of a pre-existing aneurysm. Salmonella infection was associated with an increased risk for ulcerative colitis, SIR 3.2 (95% CI: 2.2 4.6) and this was also found among those with campylobacterosis, SIR 2.8 (95% CI: 2.0 3.8). No significant increased risk for Crohns disease was shown in the Salmonella cohort, SIR 1.4 (95% CI: 0.8 2.3) or among those reported with Campylobacter enteritis, SIR 1.6 (95% CI: 1.0 2.3). Although similar results have been found elsewhere, more work is needed to refute or confirm our findings

A nationwide cohort study of mortality risk and long-term prognosis in infective endocarditis in Sweden.

OBJECTIVES: Infective endocarditis (IE) remains a serious disease with substantial mortality. In this study we investigated the incidence of IE, as well as its associated short and long term mortality rates. METHODS: The IE cases were identified in the Swedish national inpatient register using ICD-10 codes, and then linked to the population register in order to identify deaths in the cohort. Crude mortality rates among IE patients were obtained for different time intervals. These rates were directly standardized using sex- and age-matched mortality in the general population. RESULTS: The cohort consisted of 7603 individuals and 7817 episodes of IE during 1997-2007. The 30 days all-cause crude mortality rate was 10.4% and the standardized mortality ratio (SMR) was 33.7 (95% confidence interval [CI]: 31.0-36.6). Excluding the first year of follow-up, the long term mortality (1-5 years) showed an increased SMR of 2.2 (95% CI: 2.0-2.3) compared to the general population. Significantly higher SMR was found for cases of IE younger than 65 years of age with a 1-5 year SMR of 6.3, and intravenous drug-users with a SMR of 19.1. Native valve IE cases, in which surgery was performed had lower crude mortality rates and Mantel-Haenzel odds ratios of less than one compared to those with medical therapy alone during 30-day and 5-years follow-up. CONCLUSIONS: The 30-days crude mortality rate for IE was 10.4% and long-term relative mortality risk remains increased even up to 5 years of follow-up, therefore a close monitoring of these patients would be of value

Short- and Long-term Effects of Bacterial Gastrointestinal Infections

During 1997–2004, microbiologically confirmed gastrointestinal infections were reported for 101,855 patients in Sweden. Among patients who had Salmonella infection (n = 34,664), we found an increased risk for aortic aneurysm (standardized incidence ratio [SIR] 6.4, 95% confidence interval [CI] 3.1–11.8) within 3 months after infection and an elevated risk for ulcerative colitis (SIR 3.2, 95% CI 2.2–4.6) within 1 year after infection. We also found this elevated risk for ulcerative colitis among Campylobacter infections (n = 57,425; SIR 2.8, 95% CI 2.0–3.8). Within 1 year, we found an increased risk for reactive arthritis among patients with Yersinia enteritis (n = 5,133; SIR 47.0, 95% CI 21.5–89.2), Salmonella infection (SIR 18.2, 95% CI 12.0–26.5), and Campylobacter infection (SIR 6.3, 95% CI 3.5–10.4). Acute gastroenteritis is sometimes associated with disease manifestations from several organ systems that may require hospitalization of patients

Absolute Mortality Risks among Infective endocarditis (IE) Patients grouped by Native Valve IE surgery (n = 881), Native Valve IE non-surgery (n = 5257), Prosthetic Valve IE surgery (n = 109) and Prosthetic valve IE non-surgery (n = 781), 5-year Follow-up.

<p>Absolute Mortality Risks among Infective endocarditis (IE) Patients grouped by Native Valve IE surgery (n = 881), Native Valve IE non-surgery (n = 5257), Prosthetic Valve IE surgery (n = 109) and Prosthetic valve IE non-surgery (n = 781), 5-year Follow-up.</p

Comparison of Mortality Risks between Patients with Infective endocarditis treated with Medical Therapy Alone (n = 6613) and Valve Surgery (n = 990) using Mantel-Haenszel Statistics.

<p>Comparison of Mortality Risks between Patients with Infective endocarditis treated with Medical Therapy Alone (n = 6613) and Valve Surgery (n = 990) using Mantel-Haenszel Statistics.</p

Demographic data and All Cause 30-days Crude Mortality Rates (%) among Different Categories of Infective endocarditis (IE) Subjects (n = 7603).

<p>Individual who both have a current drug use and a prosthetic valve are categorized among drug-users.</p><p>IQR, Interquartile range.</p