Continued Low Rates of Transmission of Mycobacterium tuberculosis in Norway

In this study, we determined the genetic diversity of Mycobacterium tuberculosis isolated in Norway from 1999 to 2001. The results were compared to those for strains isolated from 1994 to 1998. A total of 818 patients were diagnosed with tuberculosis (TB) during the last 3-year period. Of these cases, 576 (70%) were verified by culturing, and strains from 551 patients (96%) were analyzed by the IS6110 restriction fragment length polymorphism (RFLP) method. We excluded 13 strains (2.4%) from the analyses, since they were found to represent false-positive samples. A total of 67 strains (12%) that carried fewer than five copies of IS6110 were analyzed by spoligotyping. The strains were from 157 patients (29%) of Norwegian origin and 381 patients (71%) of foreign origin. The rate of diversity among all of the strains was 90%, while in 1994 to 1998 it was 87%. Clusters were assumed to have arisen from recent transmission; the degree of such transmission was 10% in 1999 to 2001, while for the whole 8-year period (1994 to 2001), it was 11%. Of the 109 patients diagnosed as being part of a cluster in 1999 to 2001, 89 were infected with a strain that carried more than four copies of IS6110. Among these 89 patients, 52 (58%) were infected with a strain that had already been identified in 1994 to 1998. The results indicated that most cases of TB in Norway were due to the import of new strains rather than to transmission within the country. This finding demonstrates that screening of immigrants for TB upon arrival in Norway needs to be improved. Outbreaks, however, were caused mainly by strains that have been circulating in Norway for many years

Candidemia in Norway (1991 to 2003): Results from a Nationwide Study

A long-term, nationwide prospective candidemia study has been ongoing in Norway since 1991. All medical microbiological laboratories in the country have participated. During the period 1991 to 2003 a total of 1,393 episodes of candidemia occurred in 1,348 patients. The incidence of candidemia episodes per 100,000 inhabitants increased from approximately 2 episodes in the early 1990s to 3 episodes in 2001 to 2003. The average annual incidences varied markedly between the age groups. The incidence was high in patients aged <1 year and in patients aged ≥70 years. In patients ≥80 years of age, the incidence has increased during the last 3 years from an annual average of 6.5 to 15.6 cases/100,000 inhabitants in 2003. Four Candida species (C. albicans [70%], C. glabrata [13%], C. tropicalis [7%], and C. parapsilosis [6%]) accounted for 95.5% of the isolates. The species distribution has been constant during the 13-year study period. The distribution of the most important species varied with the age of the patient. In patients <1 year of age, the majority of episodes were caused by C. albicans (91%). The occurrence of C. glabrata increased with age. In patients ≥80 years of age, approximately 1/3 of all episodes were due to this species. All C. albicans strains were susceptible to fluconazole. The percentage of yeast isolates with decreased susceptibility to fluconazole (MICs ≥ 16 μg/ml) was 10.7% during the first period of this study (1991 to 1996) and 11.7% during the second period (1997 to 2003)

Overvåkning av problembakterier i sykehus

Det 26. strategimøtet i regi av Referansegruppen for eksterne kvalitetsvurderinger i bakteriologi, mykologi og parasittologi omhandlet «Overvåkning av problembakterier i sykehus» og ble avholdt 02.11.2012 i Oslo. På møtet deltok 54 representanter fra landets medisinsk-mikrobiologiske laboratorier. Methicillinresistente gule stafylokokker (MRSA), vankomycinresistente enterokokker (VRE) og gram negative bakterier med bredspektret betalaktam-resistens (ESBL) utgjør den største resistenstrusselen i norske sykehus. De medisinsk mikrobiologiske laboratoriene spiller en nøkkelrolle når det gjelder påvisning av denne type mikroorganismer. Det er viktig med gode indikasjoner for undersøkelser og at metodevalg er best mulig. Hensikten med strategimøtet var å komme frem til konkrete anbefalinger for de mikrobiologiske laboratoriene hva gjelder indikasjon for prøvetakning og metode for påvisning av MRSA, VRE og ESBL. Metoder for en løpende overvåkning for å fange opp utbrudd forårsaket av andre bakterier ble også diskutert