Twenty-two years of candidaemia surveillance: results from a Norwegian national study.

Several studies have reported an increased incidence of candidaemia and a redistribution of species, with a decrease in the number of Candida albicans isolates. In Norway, a prospective, national surveillance study of candidaemia has been ongoing since 1991. Data from the period 1991-2003 have been published previously. The aim of this study was to follow up the incidence, species distribution and antifungal susceptibility of Candida species isolates from blood cultures in the period 2004-2012, and compare them with the corresponding findings from the period 1991-2003. Blood culture isolates of Candida species from all medical microbiological laboratories in Norway were identified and susceptibility tested at the Norwegian Mycological Reference Laboratory. A total of 1724 isolates were recovered from 1653 patients in the period 2004-2012. Comparison of the two periods showed that the average incidence of candidaemia episodes per 100 000 inhabitants increased from 2.4 (1991-2003) to 3.9 (2004-2012). The increase in incidence in the latter period was significantly higher in patients aged >40 years (p 0.001), and a marked increase was observed in patients aged >60 years (p < 0.001). In conclusion, the average incidence in Norway over a period of 22 years modestly increased from 2.4 to 3.9 per 100,000 inhabitants, this being mainly accounted for by candidaemia in the elderly. The species distribution was stable, and the rate of acquired resistance was low.

Low occurrence of antibiotic resistance in Escherichia coli and staphylococci isolated from blood cultures in two Norwegian hospitals in 1991-92 and 1995-96.

The aim of this study was to investigate the antibiotic resistance rates of major bacterial pathogens causing bloodstream infections in two very different types of hospital in Norway. We examined all Escherichia coli and staphylococci (330 isolates) causing bloodstream infections from one general county hospital and one specialist national cancer hospital during the periods 1991-92 and 1995-96. Minimal inhibitory concentrations (MICs) were determined using the E-test. E. coli and staphylococci constituted 46.7% of all isolates from bloodstream infections in the two hospitals. Overall, E. coli isolates were resistant to amoxicillin (21%), trimethoprim (21%), doxycycline (20%) and trimethoprim-sulphamethoxazole (17%), while Staphylococcus aureus strains were resistant to benzylpenicillin (66%). No methicillin-resistant S. aureus was detected. Coagulase-negative staphylococci were often multiresistant, but remained fully sensitive to vancomycin. For a few antibiotics, significantly more resistance was found in the specialist hospital. In our material we found no significant increase in resistance between 1991-92 and 1995-96. In conclusion, antimicrobial resistance still remains low in important bacterial pathogens causing bloodstream infections in Norway.

Environmental risk assessment of acrylamide and methylolacrylamide from a grouting agent used in the tunnel construction of Romeriksporten, Norway.

Increased focus on the possible evironmental risk associated with large-scale use of grouting agents has revealed that leakage of chemicals from grouting activities may cause harm to the environment. Chemical grouting agents are used to reduce water leakages in e.g. tunnel constructions. The present study focuses on monitoring results and environmental risk caused by releases of non-polymerised monomers during use of the acrylamide-based grouting agent Rhoca-Gil (Siprogel). Drainage water from the tunnel Romeriksporten was monitored with respect to acrylamide and methylolacrylamide, as leakage of these substances was observed earlier in connection with similar constructions where Rhoca-Gil was used. Concentrations of acrylamide and methylolacrylamide in the draining water showed that these substances leaked out both in connection with the injection of Rhoca-Gil and in connection with after-injection using other grouting agents. Gel formation studies with Rhoca-Gil showed that a low degree of polymerisation (and hence, large leakages of monomers) can be expected if the product is diluted with water. Results from investigation of the environmental fate of methylolacrylamide showed that this substance is chemically transformed at the high-pH conditions of the tunnel. Ecotoxicological testing of the substances and an environmental effects assessment for the receiving water (River Alna and the Oslofjord) showed that the discharge of acrylamide and methylolacrylamide may have caused effects on the aquatic life in the river and in a limited area of the fjord.

[Lyme neuroborreliosis in More and Romsdal]. / Lyme-nevroborreliose i Møre og Romsdal.

BACKGROUND: The broad variations in the clinical manifestation in Lyme borreliosis underline the importance of laboratory investigations in serum and cerebrospinal fluid. MATERIAL AND METHODS: We have studied patients with neurological signs compatible with Lyme neuroborreliosis, pleocytosis in cerebrospinal fluid and positive Borrelia serology in serum/cerebrospinal fluid analysed by ELISA. We have evaluated clinical characteristics, laboratory parameters, treatment effects, and incidence variations. RESULTS: We included 25 patients in the study. Isolated facial palsy was often seen, but clinical manifestations showed huge variation. Fourteen of 25 (56%) patients had positive Borrelia burgdorferi-IgM and IgG titres in cerebrospinal fluid despite negative tests in serum. The mean annual incidence rate in the county judged by notified cases to the Norwegian Surveillance System for Communicable Diseases (MSIS) was 4.4/100,000 in the period 1989-99 as compared to the national rate of 4.3/100,000 in the same period. In 1998, however, the annual incidence rate in the county was 8.8/100,000 as compared to the national rate of 4.1/100,000. INTERPRETATION: The diversity of symptoms and signs suggests a liberal attitude towards serological testing including CSF analyses. Møre and Romsdal is a high incidence region for Lyme borreliosis in Norway. The annual variation in incidence might reflect a changing prevalence of the tick vector along the Norwegian coastline.

Moraxella lacunata isolated from epidemic conjunctivitis among teen-aged females.

An epidemic follicular conjunctivitis affecting teen-aged females has been studied. Moraxella lacunata was isolated from 11% of the patients, a frequency far above the rate found in other types of chronic conjunctivitis. The condition is suggested to be the chronic follicular conjunctivitis (Axenfeld) due to Moraxella lacunata.