Meningokokkitaudin monet kasvot

Meningokokki (Neisseria meningitidis) aiheuttaa vaarallisia yleisinfektioita. Tyypillinen taudinkuva on aivokalvontulehdus tai sepsis. Tyyppioireita ovat korkea kuume, niskajäykkyys, petekiat ja sokkioireet. Kuolleisuus aivokalvotulehduksessa on 7 % ja septisessä sokissa jopa 50 %. Aikainen antibioottihoito on tärkein ennusteeseen vaikuttava tekijä. Joskus taudinkuva salakavala tai epätyypillinen, erityisesti seroryhmä W saattaa aiheuttaa märkäisiä ­niveltulehduksia, keuhkokuumeita tai nielun alueen tulehduksia (epiglottiitteja tai supraglottiitteja).Peer reviewe

Myös vasta-ainepuutokset on huomioitava

Vastine Seppo Merin kommenttiin SLL 71(44):2783, 2016Non peer reviewe

Clinical characteristics and population-based attack rates of respiratory syncytial virus versus influenza hospitalizations among adults—An observational study

Publisher Copyright: © 2021 The Authors. Influenza and Other Respiratory Viruses published by John Wiley & Sons Ltd.Background: The clinical significance of respiratory syncytial virus (RSV) among adults remains underinvestigated. We compared the characteristics and population-based attack rates of RSV and influenza hospitalizations. Methods: During 2018–2020, we recruited hospitalized adults with respiratory infection to our prospective substudy at a tertiary care hospital in Finland and compared the characteristics of RSV and influenza patients. In our retrospective substudy, we calculated the attack rates of all RSV and influenza hospitalizations among adults in the same geographic area during 2016–2020. Results: Of the 537 prospective substudy patients, 31 (6%) had RSV, and 106 (20%) had influenza. Duration of hospitalization, need for intensive care or outcome did not differ significantly between RSV and influenza patients. RSV was more often missed or its diagnosis omitted from medical record (13% vs. 1%, p = 0.016 and 52% vs. 85%, p < 0.001). In the retrospective substudy, the mean attack rates of RSV, influenza A, and influenza B hospitalizations rose with age from 4.1 (range by season 1.9–5.9), 15.4 (12.3–23.3), and 4.7 (0.5–16.2) per 100,000 persons among 18- to 64-year-olds to 58.3 (19.3–117.6), 204.1 (31.0–345.0), and 60.4 (0.0–231.0) per 100,000 persons among 65+-year-olds and varied considerably between seasons. Discussion: While the attack rates of influenza hospitalizations were higher compared with RSV, RSV and influenza hospitalizations were similar in severity. Missing or underreporting of RSV infections may lead to underestimating its disease burden. Both RSV and influenza caused a substantial amount of hospitalizations among the elderly, stressing the need for more effective interventions.Peer reviewe

Early deaths associated with community-acquired and healthcare-associated bloodstream infections : a population-based study, Finland, 2004 to 2018

Publisher Copyright: © 2022 European Centre for Disease Prevention and Control (ECDC). All rights reserved.Background: Bloodstream infections (BSI) cause substantial morbidity and mortality. Aim: We explored the role of causative pathogens and patient characteristics on the outcome of community-acquired (CA) and healthcare-associated (HA) BSI, with particular interest in early death. Methods: We used national register data to identify all BSI in Finland during 2004–18. We determined the origin of BSI, patients´ underlying comorbidities and deaths within 2 or 30 days from specimen collection. A time-dependent Cox model was applied to evaluate the impact of patient characteristics and causative pathogens on the hazard for death at different time points. Results: A total of 173,715 BSI were identified; 22,474 (12.9%) were fatal within 30 days and, of these, 6,392 (28.4%) occurred within 2 days (7.9 deaths/100,000 population). The 2-day case fatality rate of HA-BSI was higher than that of CA-BSI (5.4% vs 3.0%). Patients who died within 2 days were older than those alive on day 3 (76 vs 70 years) and had more severe comorbidities. Compared with other BSI, infections leading to death within 2 days were more often polymicrobial (11.8% vs 6.3%) and caused by Pseudomonas aeruginosa (6.2% vs 2.0%), fungi (2.9% vs 1.4%) and multidrug-resistant (MDR) pathogens (2.2% vs 1.8%), which were also predictors of death within 2 days in the model. Conclusions: Overrepresentation of polymicrobial, fungal, P. aeruginosa and MDR aetiology among BSI leading to early death is challenging concerning the initial antimicrobial treatment. Our findings highlight the need for active prevention and prompt recognition of BSI and appropriate antimicrobial treatment.Peer reviewe

Population-Based Study of Bloodstream Infection Incidence and Mortality Rates, Finland, 2004-2018

We evaluated the incidence, outcomes, and causative agents of bloodstream infections (BSI) in Finland during 2004-2018 by using data from the national registries. We identified a total of 173,715 BSIs; annual incidence increased from 150 to 309 cases/100,000 population. BSI incidence rose most sharply among persons >= 80 years of age. The 1-month case-fatality rate decreased from 13.0% to 12.6%, but the 1-month all-cause mortality rate rose from 20 to 39 deaths/100,000 population. BSIs caused by Escherichia coli increased from 26% to 30% of all BSIs. BSIs caused by multidrug-resistant microbes rose from 0.4% to 2.8%, mostly caused by extended-spectrum beta-lactamase-producing E. coli. We observed an increase in community-acquired BSIs, from 67% to 78%. The proportion of patients with severe underlying conditions rose from 14% to 23%. Additional public health and healthcare prevention efforts are needed to curb the increasing trend in community-acquired BSIs and antimicrobial drug-resistant E. coli.Peer reviewe

The outcome and timing of death of 17,767 nosocomial bloodstream infections in acute care hospitals in Finland during 1999-2014

Few studies covering all patient groups and specialties are available regarding the outcome of nosocomial bloodstream infections (BSI). We analyzed the role of patient characteristics and causative pathogens of nosocomial BSIs reported by the hospitals participating in national surveillance in Finland during 1999-2014, in terms of outcome, with particular interest in those leading to death within 2 days (i.e. early death). National nosocomial BSI surveillance was laboratory-based and hospital-wide. Data on nosocomial BSIs was collected by infection control nurses, and dates of death were obtained from the national population registry with linkage to national identity codes. A total of 17,767 nosocomial BSIs were identified; 557 BSIs (3%) were fatal within 2 days and 1150 (6%) within 1 week. The 1-month case fatality was 14% (2460 BSIs), and 23% of the deaths occurred within 2 days and 47% within 1 week. The patients who died early were older than those who survived > 28 days, and their BSIs were more often related to intensive care. Gram-positive bacteria caused over half of the BSIs of patients who survived, whereas gram-negative bacteria, especially Pseudomonas aeruginosa, caused more often BSIs of patients who died early, and fungi BSIs of patients who died within 1 week. A significant portion of patients with nosocomial BSIs died early, which underlines the importance of rapid recognition of BSI. Hospital-wide surveillance data of causative pathogens can be utilized when composing recommendations for empiric antimicrobial treatment in collaboration with clinicians, as well as when promoting infection prevention.Peer reviewe

Penisilliinit kunniaan : perus- ja stafylokokkipenisilliinien käyttö aikuispotilaiden sairaalahoidossa

Vertaisarvioitu.Suomalaisissa sairaaloissa kefalosporiinien ja muiden beetalaktaamimikrobilääkkeiden käyttö on penisilliineihin verrattuna 1,4-kertaista ja huomattavasti yleisempää kuin useimmissa muissa EU- tai EEA-maissa. Laajakirjoisten mikrobilääkkeiden käyttö voi lisätä resistenttien mikrobikantojen ja Clostridioides difficile -infektioiden ilmaantuvuutta. HUS:n Penisilliinit kunniaan -kampanjalla pyritään lisäämään perus- ja stafylokokkipenisilliinien käyttöä sekä aloitus- että kohdennusmikrobilääkkeinä. Empiirisen hoidon aiheita ovat potilaiden, joilla on vähän riskitekijöitä, avohoitokeuhkokuumeet, ruusut ja akuutit haavainfektiot erityisesti raajojen ja ylävartalon alueella. Penisilliinit ovat tehokkaita täsmämikrobilääkkeitä erityisesti Staphylococcus aureuksen, streptokokkien ja pneumokokkien aiheuttamiin infektioihin. Esittelemme myös perus- ja stafylokokkipenisilliinin jatkuvan annostelun kotisairaalassa elastomeerisen pumpun avulla. Lisäksi kannustamme epätyypillisten penisilliiniallergioiden sekä yli kymmenen vuotta sitten ilmaantuneiden ihoreaktioiden uudelleenarviointiin ja testaamiseen.Peer reviewe

Cross-sectional study of the proportion of antibiotic use during childbirth in full-term deliveries in Finland

Peer reviewe