Intensive care patients with influenza A (H1N1) infection in Iceland 2009

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)BACKGROUND: We describe the main characteristics of patients that required intensive care due to the influenza (H1N1) outbrake in 2009. METHODS: Retrospective and prospective analysis of medical records from patients admitted to ICU with positive RT-PCR for (H1N1). RESULTS: During a six week period in the fall of 2009, 16 patients were admitted to intensive care in Iceland with confirmed H1N1 infection. Mean age was 48 years (range 1-81). Most patients were considered quite healthy but the majority had risk factors such as smoking, obesity or hypertension. All but one had fever, cough, dyspnea and bilateral infiltrates on chest x-ray and developed any organ failures (mean SOFA score 7). 12 needed mechanical ventilation and two extra corporeal membrane oxygenation (ECMO). Mean APACHE II score was 20. No patient died in the ICU but one elderly patient with multiple underlying diseases died a few days after being discharged from the ICU. CONCLUSIONS: (1) The incidence of severe influenza A (H1N1) that leads to ICU admission appears to be high in Iceland. (2) Many patients developed acute respiratory distress syndrome in addition to other organ failures, and required additional measures for oxygenation such as prone position, nitric oxide inhalation and ECMO. (3) 28 day mortality was low. (4) This study will aid in future outbreak planning in Iceland. Key words: influenza A, pneumonia, multiple organ failure, death rate, intensive care, ventilator therapy, ECMO.Tilgangur: Að lýsa helstu einkennum og afdrifum þeirra sem lögðust inn á gjörgæsludeildir á Íslandi vegna inflúensusýkingar af A stofni (H1N1) haustið 2009. Aðferðir: Aflað var upplýsinga um sjúklinga sem lögðust inn á gjörgæsludeildir á Íslandi með staðfesta H1N1 2009 sýkingu. Niðurstöður: 16 sjúklingar lögðust inn á gjörgæsludeildir vegna inflúensu A (H1N1) sýkingar, meðalaldur 48 ár (1-81). Flestir töldust vera tiltölulega frískir fyrir, en 13 höfðu þó sögu um reykingar, offitu eða háþrýsting. 15 höfðu hita, hósta, öndunarþyngsli og dreifðar íferðir í báðum lungum á lungnamynd og margir fengu fjöllíffærabilun. Allir fengu veirulyf og 12 voru meðhöndlaðir í öndunarvél, þar af tveir einnig í hjarta- og lungnavél. Enginn sjúklingur lést á gjörgæsludeild, en einn fjölveikur aldraður sjúklingur lést síðar á legudeild. Ályktanir: (1) Tíðni alvarlegra sjúkdómseinkenna af völdum inflúensu A (H1N1) sem leiða til gjörgæslumeðferðar er há á Íslandi. (2) Þessir sjúklingar fá flestir, auk annarra líffæratruflana, mjög alvarlega öndunarbilun sem oft lætur ekki undan hefðbundinni öndunarvélameðferð. (3) Árangur meðferðar á íslenskum gjörgæsludeildum hefur verið góður. (4) Niðurstöður þessarar rannsóknar geta nýst yfirvöldum við mat á meðferðarmöguleikum og fyrirbyggjandi aðgerðum gegn þessum lífshættulega sjúkdómi

Development of a prognostic model of COVID-19 severity : a population-based cohort study in Iceland

© 2022. The Author(s).BACKGROUND: The severity of SARS-CoV-2 infection varies from asymptomatic state to severe respiratory failure and the clinical course is difficult to predict. The aim of the study was to develop a prognostic model to predict the severity of COVID-19 in unvaccinated adults at the time of diagnosis. METHODS: All SARS-CoV-2-positive adults in Iceland were prospectively enrolled into a telehealth service at diagnosis. A multivariable proportional-odds logistic regression model was derived from information obtained during the enrollment interview of those diagnosed between February 27 and December 31, 2020 who met the inclusion criteria. Outcomes were defined on an ordinal scale: (1) no need for escalation of care during follow-up; (2) need for urgent care visit; (3) hospitalization; and (4) admission to intensive care unit (ICU) or death. Missing data were multiply imputed using chained equations and the model was internally validated using bootstrapping techniques. Decision curve analysis was performed. RESULTS: The prognostic model was derived from 4756 SARS-CoV-2-positive persons. In total, 375 (7.9%) only required urgent care visits, 188 (4.0%) were hospitalized and 50 (1.1%) were either admitted to ICU or died due to complications of COVID-19. The model included age, sex, body mass index (BMI), current smoking, underlying conditions, and symptoms and clinical severity score at enrollment. On internal validation, the optimism-corrected Nagelkerke's R2 was 23.4% (95%CI, 22.7-24.2), the C-statistic was 0.793 (95%CI, 0.789-0.797) and the calibration slope was 0.97 (95%CI, 0.96-0.98). Outcome-specific indices were for urgent care visit or worse (calibration intercept -0.04 [95%CI, -0.06 to -0.02], Emax 0.014 [95%CI, 0.008-0.020]), hospitalization or worse (calibration intercept -0.06 [95%CI, -0.12 to -0.03], Emax 0.018 [95%CI, 0.010-0.027]), and ICU admission or death (calibration intercept -0.10 [95%CI, -0.15 to -0.04] and Emax 0.027 [95%CI, 0.013-0.041]). CONCLUSION: Our prognostic model can accurately predict the later need for urgent outpatient evaluation, hospitalization, and ICU admission and death among unvaccinated SARS-CoV-2-positive adults in the general population at the time of diagnosis, using information obtained by telephone interview.Peer reviewe

Contaminated dicloxacillin capsules as the source of an NDM-5/OXA-48-producing Enterobacter hormaechei ST79 outbreak, Denmark and Iceland, 2022 and 2023

Publisher Copyright: © 2023 European Centre for Disease Prevention and Control (ECDC). All rights reserved.From October 2022 through January 2023, nine patients with NDM-5/OXA-48-carbapenemase-producing Enterobacter hormaechei ST79 were detected in Denmark and subsequently one patient in Iceland. There were no nosocomial links between patients, but they had all been treated with dicloxacillin capsules. An NDM-5/OXA-48-carbapenemase-producing E. hormaechei ST79, identical to patient isolates, was cultured from the surface of dicloxacillin capsules in Denmark, strongly implicating them as the source of the outbreak. Special attention is required to detect the outbreak strain in the microbiology laboratory.Peer reviewe

Development of antibiotic resistance and ways to fight back [editorial]

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenSýklalyf eru líklega ein merkasta uppgötvun læknavísindanna. Sýkingar sem áður drápu fjölmarga urðu undan að láta fyrir kraftaverkalyfjum. Sjúkdómar sem fólu í sér dauðadóm urðu meðhöndlanlegir. Með sýklalyfjum og bóluefnum virtist sigur gegn bakteríum og sjúkdómum tengdum þeim í höfn. Sýklalyf eru samsafn efna, flest framleidd af sveppum eða bakteríum. Hlutverk þeirra eru misjöfn, frá því að hafa áhrif á keppinauta, til samskipta eða jafnvel í metabolisma (1). Mörg efnin hafa fundist í lífverum sem eru hluti af jarðvegs- og umhverfisflóru. Þær lífverur sem framleiða efnin vilja ekki skaða sjálfar sig og hafa því leiðir til að gera þau óvirk. Áhrif sýklalyfja eru upphafin af ensímum sem er skráð fyrir með genum. Genin geta borist á milli baktería og ónæmi þannig flust í aðrar bakteríur með nokkrum sérhæfðum aðferðum (2)

Malaria in Iceland, a rare but looming threat for travelers

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access

Ampicillin resistant enterococci at Landspítalinn University Hospital and antimicrobial susceptibilities of enterococci in Iceland

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenHospital acquired infections caused by enterococci are an increasing problem, due to an increased number of infections and increasing bacterial resistance to antibiotics. During 1994 ampicillin resistant enterococci were discovered in specimens from three patients in one ward over a short time period. The patients were isolated and stool cultures were taken from everyone in the ward for selective culture for enterococci and subsequent antimicrobial susceptibility tests. Additional screening cultures were taken from patients in the intensive care unit, the oncology ward, one surgical and one paediatric ward. Cultures were also taken from the hospital sewage system. Antibiotic susceptibility of enterococci isolated from urine samples submitted to the Microbiology Department, Landspitalinn, during 1994 and 1995 were reviewed. In the index ward, specimens were obtained from 30 individuals for culture. One additional patient and one staff member were found to be colonised with ampicillin resistant enterococci. In the other wards a total of 23 samples were taken from selected patients for culture, but none of these cultures yielded ampicillin resistant enterococci. No ampicillin resistant enterococci were found in the sewage system of the hospital. Of a total of 41,181 urine specimens cultured at the Microbiology Department, 1,513 contained enterococci of which five were resistant to ampicillin (0.3%, all from 1994). We conclude that ampicillin resistant enterococci have not become established at Landspitalinn. It may be difficult to maintain a susceptible enterococcal population, however isolation of carriers and sensible use of broad spectrum antibiotics are likely to delay the establishment of multiresistant enterococci in Iceland.Spítalasýkingar af völdum enterókokka eru vaxandi vandamál vegna aukinnar tíðni þeirra og minnkandi næmis fyrir sýklalyfjum. Árið 1994 fundust ampicillin ónæmir enterókokkar hjá þremur sjúklingum á sömu deild Landspítalans á stuttum tíma. Slíkir stofnar voru nær óþekktir á Íslandi og því talið mikilvægt að koma í veg fyrir frekari útbreiðslu. Sjúklingarnir voru einangraðir og teknar skimræktanir frá öðrum sjúklingum deildarinnar og starfsfólki, þar sem leitað var að ampicillin ónæmum enterókokkum. Síðan voru gerðar skimræktanir á völdum sjúklingum annarra deilda spítalans svo og farið yfir næmi innsendra þvagsýna sem enterókokkar höfðu ræktast úr. Einangrunin var samkvæmt leiðbeiningum Bandarísku sjúkdómavarnarstofnunarinnar (Centers for Disease Control). Saurræktanir voru teknar frá öllum sjúklingum og starfsfólki sjúkradeildarinnar. Skimræktanir voru einnig teknar frá sjúklingum á gjörgæsludeild, skurðdeild, barnadeild og krabbameinslækningadeild. Ræktanir voru teknar úr holræsum hverrar álmu Landspítalans. Farið var yfir næmi allra enterókokka sem ræktast höfðu úr innsendum þvagsýnum á árunum 1994 og 1995. Á sjúkradeildinni voru tekin samtals 30 sýni. Þar reyndist enn einn sjúklingur og einn starfsmaður vera með ampicillín ónæma enterókokka í saur. Á öðrum sjúkradeildum voru teknar samtals 23 ræktanir sem allar voru neikvæðar. Engir ónæmir enterókokkar fundust í holræsum spítalans. Á árunum 1994 og 1995 voru 41.181 þvagsýni send til ræktunar og fundust enterókokkar í 1.513, þar af voru fimm ampicillín ónæmir (0,3%, allir frá árinu 1994). Ónæmir enterókokkar hefa enn ekki náð fótfestu á Landspítalanum. Þróunin erlendis sýnir þó, að ólíklegt er að við sleppum alveg. Hinsvegar benda niðurstöðurnar til þess að við getum ennþá haft áhrif á útbreiðslu ónæmra baktería með einangrunaraðgerðum og takmörkun á notkun vankómýcíns og annarra breiðvirkra sýklalyfja svo sem cefalóspórínsambanda

Epidemiology of needlesticks at Landspítali University Hospital during the years 1986-2011. A descriptive study.

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn.Verði heilbrigðisstarfsmenn fyrir stunguóhappi, líkamsvessamengun eða biti (óhappi) tengt smitandi sjúklingi (áhættuóhappi) geta þeir smitast af lifrarbólguveiru B (HBV), lifrarbólguveiru C (HCV) eða HIV. Smithættan er mest í tengslum við stunguóhöpp af völdum holra nála. Markmið rannsóknarinnar var að lýsa faraldsfræði tilkynntra óhappa starfsmanna Landspítala og greina vanskráningu þeirra. Afturskyggn lýsandi rannsókn.Unnið var úr tilkynningum óhappa frá starfsmönnum Landspítala tímabilið 1986-2011. Hlutfall óhappa var reiknað eftir aldri og starfsstéttum og dreifing óhappa eftir tildrögum og deildum fundin. Hlutfall áhættuóhappa var fundið og hlutfall starfsmanna sem voru bólusettir gegn HBV þegar óhapp varð. Hlutfall vanskráðra óhappa var áætlað fyrir tímabilið 01.01.2005-31.12.2011. Á tímabilinu urðu að minnsta kosti 4089 óhöpp en 3587 þeirra voru tilkynnt og blóðrannsókn framkvæmd hjá 2578 starfsmönnum. Nálægt þriðjungur óhappa tengdist því að ekki var unnið samkvæmt grundvallarsmitgát og holar nálar tengdust stunguóhöppum í 54,7% tilvika. Hlutfall tilkynninga frá læknum og læknanemum var lágt, eða 17,9%. Á tímabilinu reyndust 50,3% starfsmanna bólusettir gegn HBV þegar óhapp varð. Áhættuóhöpp voru 2,6% tilkynntra óhappa, oftast tengd sjúklingi með HCV. Tveir starfsmenn smituðust af HCV á tímabilinu. Áætluð vanskráning óhappa reyndist 28,0% á árunum 2005-2011. Þar sem mörg óhöpp tengjast röngum vinnubrögðum má vænta þess að fræðsla um grundvallarsmitgát og rétta umgengni við beitta og oddhvassa hluti fækki óhöppum. Þar sem holar nálar tengdust rúmlega helmingi stunguóhappa má vænta þess að innleiðing öryggisnála og öryggishluta fækki stunguóhöppum tengdum holum nálum. Hvetja þarf enn frekar til HBV-bólusetningar og tilkynninga á óhöppum. --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Needlesticks, bodyfluid exposure and bites (incident) put healthcare workers (HCWs) at risk of hepatitis B, C and HIV particularly if patients are infected (high risk incident). The risk of infection is greatest from bore-hollow needles. The aim of the study was to describe the epidemiology of reported incidents and evaluate underreporting by HCWs at Landspítali University Hospital (LUH). A retrospective descriptive study of reported incidents during 1986-2011. The ratio of incidents was calculated according to the HCWs age and profession and distribution by source and wards. The ratio of high risk incidents and vaccination status against HBV at time of incident was determined as well as underreporting during 01.01.2005-31.12.2011. Results: At least 4089 incidents occured during the study period but 3587 were reported and blood samples taken from 2578 patients. Approximately a third of the incidents were associated with non-compliance with standard precaution and 54,7% of needlesticks were associated with bore-hollow needles. Few reports came from physicians and medical students (17,9%). During the study period 50,3% HCWs were vaccinated against HBV at time of incident. High risk incidents were 94 (2.6%), mostly related to hepatitis C (64,9%). Two HCWs became infected with HCV. During 2005-2011 underreporting was estimated to be 28,0%. Conclusion: Improved education of standard precaution when handling needles and sharps at LUH may reduce the number of incidents. Introduction of safety-needles and safety-devices may greatly reduce needlesticks as a large number of incidents were associated with hollow needles. Improved HBV vaccination among HCWs and reporting incidents should be encouraged

Lyme disease in Iceland - Epidemiology from 2011 to 2015

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked DownloadInngangur: Lyme-sjúkdómur stafar af sýkingu með Borrelia burgdorferi sensu latu (B. burgdorferi sl.) og smitast með biti Ixodes mítla. Sjúkdómurinn hefur ekki verið talinn landlægur á Íslandi og aldrei hefur verið lýst tilfelli af innlendum uppruna. Engar rannsóknir hafa verið gerðar á Lyme-sjúkdómi hérlendis. Markmið rannsóknarinnar var að skoða faraldsfræði Lyme-sjúkdóms á Íslandi með sérstakri áherslu á það hvort innlent smit hafi átt sér stað. Efniviður og aðferðir: Rannsóknin náði til allra einstaklinga á Íslandi sem áttu mælingu á mótefnum gegn B. burgdorferi sl. eða höfðu fengið greininguna Lyme-sjúkdómur (ICD-10, A69.2) á Landspítala á árunum 2011-2015. Klínískum upplýsingum var safnað úr rafrænni sjúkraskrá og gagnagrunni sýkla- og veirufræðideildar Landspítala. Niðurstöður: 501 einstaklingur átti mælingu á mótefnum gegn B. burgdorferi sl. á rannsóknartímabilinu og 11 einstaklingar voru greindir með Lyme-sjúkdóm á klínískum forsendum eingöngu. 33 einstaklingar uppfylltu greiningarskilmerki fyrir staðfestu tilfelli af Lyme-sjúkdómi. 32 (97%) einstaklingar voru með erythema migrans og einn (3%) einstaklingur var með Lyme-sjúkdóm í taugakerfi. Að meðaltali greindust 6,6 tilfelli á ári (tvö tilfelli á 100.000 íbúa/ári) og áttu öll tilfellin sér erlendan uppruna. Ályktanir: Lyme-sjúkdómur er sjaldgæfur á Íslandi. Árlega greinast að meðaltali 6-7 tilfelli af sjúkdómnum hérlendis og er fyrst og fremst um að ræða staðbundnar sýkingar með erythema migrans útbrotum. Ekki fannst neitt tilfelli sem hægt er að segja að eigi sér innlendan uppruna og virðist tilfellum af sjúkdómnum ekki hafa farið fjölgandi seinustu árin.Introduction: Lyme disease is caused by an infection with Borrelia burgdorferi sensu latu (B. burgdorferi sl.) which is carried by Ixodes ticks. The disease has not been considered to be endemic in Iceland and no cases of Icelandic origin have been published. The epidemiology of Lyme disease in Iceland has never been studied. The objective of this study was to provide basic epidemiological information about Lyme disease in Iceland. Material and methods: Included in the study were all pa­­tients who had a measurement of serum antibodies against B. burgdorferi sl. or were diagnosed with Lyme disease (ICD-10, A69.2) at Landspítali University Hospital in Iceland from 2011-2015. Clinical data regarding these patients was retrospectively collected from medical records and the database of the Department of clinical microbiology at Landspítali University Hospital. Results: 501 patient had a measurement of serum antibodies against B. burgdorferi sl. and 11 patients were clinically diag­nosed with Lyme disease during the study period. 33 patients fulfilled criteria for a confirmed diagnosis of Lyme disease. 32 (97%) patients had erythema migrans and one (3%) patient had neuroborreliosis. An average of 6.6 cases were diagnosed a year (two cases per 100,000 persons/year). All cases originated abroad. Conclusions: Lyme disease is rare in Iceland. On average around 6 to 7 cases are diagnosed every year, primarily localised infec­tions presenting as erythema migrans. None of the cases had a definitive Icelandic origin and the yearly number of cases has not been increasing