Pseudomonas aeruginosa countrywide outbreak in hospitals linked to pre-moistened non-sterile washcloths, Norway, October 2021 to April 2022.

In November 2021, a clonal outbreak of Pseudomonas aeruginosa of novel sequence type ST3875 was detected in three patients who died of bloodstream infections in one hospital. By 25 April 2022, the outbreak included 339 cases from 38 hospitals across Norway. Initial hospital reports indicate Pseudomonas infection as the main contributing cause in seven deaths. In March 2022, the outbreak strain was identified in non-sterile pre-moistened disposable washcloths, used to clean patients, from three lots from the same international manufacturer.

Does a history of cardiovascular disease or cancer affect mortality after SARS-CoV-2 infection? / Hva betyr tidligere hjerte- og karsykdom eller kreft for risiko for død etter påvist SARS-CoV-2?

BACKGROUND: Cardiovascular disease and cancer have been described as possible risk factors for COVID-19 mortality. The purpose of this study was to investigate whether a history of cardiovascular disease or cancer affects the risk of dying after a COVID-19 diagnosis in Norway. MATERIAL AND METHOD: Data were compiled from the Norwegian Surveillance System for Communicable Diseases, the Norwegian Cardiovascular Disease Registry and the Cancer Registry of Norway. Univariable and multivariable regression models were used to calculate both relative and absolute risk. RESULTS: In the first half of 2020, 8 809 people tested positive for SARS-CoV-2 and 260 COVID-19-associated deaths were registered. Increasing age, male sex (relative risk (RR): 1.5; confidence interval (CI): 1.2-2.0), prior stroke (RR: 1.5; CI: 1.0-2.1) and cancer with distant metastasis at the time of diagnosis (RR: 3.0; CI: 1.1-8.2) were independent risk factors for death after a diagnosis of COVID-19. After adjusting for age and sex, myocardial infarction, atrial fibrillation, heart failure, hypertension, and non-metastatic cancer were no longer statistically significant risk factors for death. INTERPRETATION: The leading risk factor for death among individuals who tested positive for SARS-CoV-2 was age. Male sex, and a previous diagnosis of stroke or cancer with distant metastasis were also associated with an increased risk of death after a COVID-19 diagnosis.

Use of video directly observed treatment for tuberculosis in Northern Norway. / Bruk av videosamtale i behandling av tuberkulose-sykdom i Nord-Norge.

BACKGROUND: In 2017, a total of 261 patients with tuberculosis were reported in Norway, whereof 90 % completed their therapy. Anti-tuberculosis drugs are administered as daily directly observed treatment (DOT) to all patients. We investigated whether this could be done by video conference. MATERIAL AND METHOD: We conducted a clinical observation study at the University Hospital of North Norway in the period 2016-2019, in which patients ≥ 16 years with tuberculosis after a minimum of two weeks of daily DOT during home visits continued their treatment through video conference (video DOT). The password-protected and encrypted video conference service provided by Norwegian Healthnet was used. The home care service contacted the patient by video conference in real time and observed the intake of drugs via a tablet computer, smartphone or PC. RESULTS: 20 out of 30 patients met the inclusion criteria, whereof 17 patients (15 foreign-born) with a median age of 32 (17-74) were included. The average observed drug intake per patient was 86.1 % in the period with home-based DOT and 75.9 % in the period with video DOT. The median daily time spent by the home care service was 17 (2-40) minutes for home visits and 3 (1-8) minutes for video conferences. Fourteen out of 17 patients and 14 out of 17 home nurses preferred video conferencing over home visits. Fifteen patients and all home care nurses would recommend video conferencing to others. Technical problems (8.9 %) were the most common reason for directly observed treatment not being undertaken during the period with video conferencing. INTERPRETATION: Video DOT was feasible for the selected patients. Video conferencing was time-efficient for the home care service and was preferable to home visits.

Deaths after confirmed SARS-CoV-2 in Norway. / Dødsfall etter påvist SARS-CoV-2 i Norge.

BACKGROUND: Advanced age is the most important risk factor for death as a result of COVID-19, but there is a dearth of knowledge regarding the impact of chronic diseases. Using health registry data, we describe the disease profiles of persons who died after a confirmed infection with SARS-CoV-2 during the first three months of the pandemic in Norway. MATERIAL AND METHOD: Data from the specialist health service (Norwegian Patient Registry, NPR) and the primary health service (Norwegian Registry for Primary Health Care, NRPHC) were linked to information on positive tests for SARS-CoV-2 from the Norwegian Surveillance System for Communicable Diseases (MSIS) and on deaths from the National Population Register. The data retrieval included the Norwegian population as of 1 March 2020 with data for confirmed infections, hospitalisations and deaths until 31 May 2020. RESULTS: Of 8 412 persons with a confirmed SARS-CoV-2 infection, altogether 244 (2.9 %) died, whereof 133 (55 %) were men. Among those with a confirmed infection, the proportion who died varied from 0.2 % (age < 60 years) to 52 % (age ≥ 90 years). Altogether 92 (38 %) patients died in hospital. 25 (16 %) of those who died elsewhere had previously been hospitalised for COVID-19. The proportion with no registered chronic disease was 39 % in the age group < 70 years and 26 % in the age group ≥ 70 years. The disease distribution varied between those patients who had died in and outside of hospital, especially for diagnoses of diabetes, renal failure and dementia. INTERPRETATION: Among those who had a SARS-CoV-2 infection confirmed during the first three months of the pandemic in Norway, only a small proportion died. The majority of those who died were 70 years or older and had at least one chronic disease, but the disease profile varied between patients who died in and outside of hospital. Health registry data can help provide a better overview of and advice to risk groups in the population during an ongoing pandemic.

Finding sexual partners online: prevalence and associations with sexual behaviour, STI diagnoses and other sexual health outcomes in the British population.

OBJECTIVES: Online venues might facilitate sexual encounters, but the extent to which finding partners online is associated with sexual risk behaviour and sexual health outcomes is unclear. We describe use of the internet to find sexual partners in a representative sample in Britain. METHODS: The third National Survey of Sexual Attitudes and Lifestyles (Natsal-3) was a cross-sectional probability survey of 15 162 adults (aged 16-74 years) undertaken 2010-2012. We estimated prevalence of, and identified factors associated with, finding sexual partners online among those reporting ≥1 new sexual partners in the past year. RESULTS: Finding sexual partners online in the past year was reported by 17.6% (95% CI 15.6 to 19.9) of men and 10.1% (8.5-11.9) of women, and most common among those aged 35-44 years. After age-adjustment, those reporting a non-heterosexual identity were more likely to report this. Finding partners online was also associated with reporting sexual risk behaviours: condomless sex with ≥2 partners (adjusted OR (aOR) men: 1.52 (1.03 to 2.23); women: 1.62 (1.06 to 2.49)), concurrent partnerships (aOR men: 2.33 (1.62 to 3.35); women: 2.41 (1.49 to 3.87)) and higher partner numbers (reporting ≥5 partners aOR men: 5.95 (3.78 to 9.36); women: 7.00 (3.77 to 13.00)) (all past year). STI diagnoses and HIV testing were more common among men reporting finding partners online (adjusted for age, partner numbers, same-sex partnerships), but not women. CONCLUSIONS: Finding partners online was associated with markers of sexual risk, which might be important for clinical risk assessment, but this was not matched by uptake of sexual health services. Online opportunities to find partners have increased, so these data might underestimate the importance of this social phenomenon for public health and STI control.

Self-perceived risk and prevalent chlamydia infection among adolescents in Norway: a population-based cross-sectional study.

OBJECTIVES: Risk judgements are key factors in adolescents' decisions related to sexual health. We examine the associations between self-perceived risk and prevalent chlamydia infection, and sexual behaviours related to risk perception in a general adolescent population in Norway. METHODS: Population-based cross-sectional study among 1028 sexually experienced girls and boys, age 15-20 years (85% participation), including web questionnaires and urine samples for Chlamydia trachomatis PCR testing. Participants rated self-perceived risk as: no/low/medium/high/very high. We used binary and ordinal logistic regressions to examine associations with chlamydia prevalence and self-perceived risk, respectively, adjusting for potentially confounding variables. RESULTS: Chlamydia prevalence increased with increasing risk perception. Although girls had twice the chlamydia prevalence of boys (7.3% vs 3.9%), their risk distribution was similar and 65% of both genders rated their risk as no/low with half of infections detected in this group. In multivariable analyses, reporting multiple sexual risk behaviours, non-steady relationship, previous chlamydia testing and treatment, and urogenital symptoms increased self-perceived risk. More boys overestimated their personal risk whereas more girls underestimated it (52% vs 30%, respectively, and 15% vs 31%, p<0.001). The main reasons for perceiving no/low risk were: 'I have a steady partner' and 'I trust my partner will tell me about an infection'. CONCLUSIONS: These sexually experienced adolescents acknowledged their chlamydia infection risk, but wrong beliefs were incorporated in their assessments, and more than half had incorrect risk perception. We suggest that sexually transmitted infection prevention programmes should be directed at closing the gap between perceived and actual risk and focus on how context may bias personal judgement.

Meeting sexual partners online: associated sexual behaviour and prevalent chlamydia infection among adolescents in Norway: a cross-sectional study.

OBJECTIVES: Evidence is mixed as to whether meeting sexual partners online ('internet-partners') is associated with risky sexual behaviour and/or sexually transmitted infection transmission. Accordingly, we sought to estimate the prevalence of reporting various online romantic and sexual activities among Norwegian adolescents, including internet-partners, and the reason for meeting them and to examine differences in sexual behaviour, partnership characteristics and chlamydia infection prevalence among those reporting internet-partners versus those reporting only offline partners. METHODS: Population-based cross-sectional survey among sexually experienced girls and boys, 15-20 years, using electronic questionnaires and collecting urine samples for Chlamydia trachomatis PCR testing (79% provided both, n=1023). We used logistic regression to examine associations, adjusting for potentially confounding variables. RESULTS: Overall, 30% of both genders reported internet-partners (ever). Boys (but not girls) with internet-partners had higher chlamydia prevalence than those reporting meeting sexual partners only offline (8.1%, 95% CI 4.3% to 13.7% vs 1.6%, 0.5% to 3.7%). Two-thirds of girls and 37% of boys reported meeting their most recent internet-partner to start a romantic relationship, while the remainder did so with the specific intention of having sex. Among both genders, reporting sexual (vs romantic) reasons for meeting their most recent internet-partners was associated with reporting several risky sexual behaviours, including multiple recent sex partners (adjusted OR girls: 3.27, boys: 2.48) and three-fold higher chlamydia prevalence. CONCLUSIONS: This population-based study suggests that internet-partners are common among adolescents in Norway, and the reason for meeting them was more strongly associated with additionally reporting sexual risk behaviours and prevalent chlamydia infection than the internet itself as a meeting venue.

Global Multilocus Sequence Type Analysis of Chlamydia trachomatis Strains from 16 Countries.

The Uppsala University Chlamydia trachomatis multilocus sequence type (MLST) database (http://mlstdb.bmc.uu.se) is based on five target regions (non-housekeeping genes) and the ompA gene. Each target has various numbers of alleles-hctB, 89; CT058, 51; CT144, 30; CT172, 38; and pbpB, 35-derived from 13 studies. Our aims were to perform an overall analysis of all C. trachomatis MLST sequence types (STs) in the database, examine STs with global spread, and evaluate the phylogenetic capability by using the five targets. A total of 415 STs were recognized from 2,089 specimens. The addition of 49 ompA gene variants created 459 profiles. ST variation and their geographical distribution were characterized using eBURST and minimum spanning tree analyses. There were 609 samples from men having sex with men (MSM), with 4 predominating STs detected in this group, comprising 63% of MSM cases. Four other STs predominated among 1,383 heterosexual cases comprising, 31% of this group. The diversity index in ocular trachoma cases was significantly lower than in sexually transmitted chlamydia infections. Predominating STs were identified in 12 available C. trachomatis whole genomes which were compared to 22 C. trachomatis full genomes without predominating STs. No specific gene in the 12 genomes with predominating STs could be linked to successful spread of certain STs. Phylogenetic analysis showed that MLST targets provide a tree similar to trees based on whole-genome analysis. The presented MLST scheme identified C. trachomatis strains with global spread. It provides a tool for epidemiological investigations and is useful for phylogenetic analyses.

Factors associated with Chlamydia trachomatis testing in a high school based screening and previously in clinical practice: a cross-sectional study in Norway.

BACKGROUND: High school based chlamydia screening has been shown to increase uptake and detect hidden infections among sexually active adolescents. Our study aimed to: i) examine the proportions of 15-20 year-olds tested in a high school based screening and previously in clinical practice, ii) determine chlamydia prevalence according to testing pattern, and iii) examine factors associated with testing in the two settings. METHODS: A population based cross-sectional study was conducted in 5 high schools in Norway in 2009, using web-questionnaires and Chlamydia trachomatis PCR in first-void urine (800 girls/818 boys, mean age 17.2 years). Only sexually active participants at risk for chlamydia infections were included in the analyses. Crude and multivariable logistic regression models were applied with 'clinic based testing' and 'school based screening' as outcome variables. RESULTS: 56% of girls and 21% of boys reported previous clinic based testing. In the school based screening, 93% were tested with no gender difference. 42% of girls and 74% of boys were tested for the first time at school ('school-only test'). Both girls with clinic based testing and girls with school-only test had high chlamydia prevalence (7.3% vs 7.2%). Boys with clinic based testing had twice the prevalence of those with school-only test (6.2% vs 3.0%, p = 0.01). Half of infections were detected in participants with school-only test. One-fifth were repeat infections. In multivariable analysis of girls and boys combined, female gender, older age, early sexual debut, no condom use at first and last intercourse, steady relationship, and higher number of lifetime partners increased the odds of clinic based testing. The odds of school based screening increased with male gender, academic affiliation, later sexual debut, condom use at first intercourse, and current urogenital symptoms in multivariable analysis. CONCLUSIONS: More than half the girls had been tested prior to the school based screening and had high prevalence independent of previous clinic based testing. School screening was mostly associated with factors unknown to increase chlamydia infection risk, while clinic based testing was associated with traditional risk factors. The unusually high and equal participation between genders and the detection of a large chlamydia reservoir confirms the value of school based screening suggesting this approach to be further explored in Norway.

A new automated national register-based surveillance system for outbreaks in long-term care facilities in Norway detected three times more severe acute respiratory coronavirus virus 2 (SARS-CoV-2) clusters than traditional methods.

OBJECTIVE: To develop and test a new automated surveillance system that can detect, define and characterize infection clusters, including coronavirus disease 2019 (COVID-19), in long-term care facilities (LTCFs) in Norway by combining existing national register data. BACKGROUND: The numerous outbreaks in LTCFs during the COVID-19 pandemic highlighted the need for accurate and timely outbreak surveillance. As traditional methods were inadequate, we used severe acute respiratory coronavirus virus 2 (SARS-CoV-2) as a model to test automated surveillance. METHODS: We conducted a nationwide study using data from the Norwegian preparedness register (Beredt C19) and defined the study population as an open cohort from January 2020 to December 2021. We analyzed clusters (≥3 individuals with positive SARS-CoV-2 test ≤14 days) by 4-month periods including cluster size, duration and composition, and residents' mortality associated with clusters. RESULTS: The study population included 173,907 individuals; 78% employees and 22% residents. Clusters were detected in 427 (43%) of 993 LTCFs. The median cluster size was 4-8 individuals (maximum, 50) by 4-month periods, with a median duration of 9-17 days. Employees represented 60%-82% of cases in clusters and were index cases in 60%-90%. In the last 4-month period of 2020, we detected 107 clusters (915 cases) versus 428 clusters (2,998 cases) in the last period of 2021. The 14-day all-cause mortality rate was higher in resident cases from the clusters. Varying the cluster definitions changed the number of clusters. CONCLUSION: Automated national surveillance for SARS-CoV-2 clusters in LTCFs is possible based on existing data sources and provides near real-time detailed information on size, duration, and composition of clusters. Thus, this system can assist in early outbreak detection and improve surveillance.

Community carriage of ESBL-producing Escherichia coli and Klebsiella pneumoniae: a cross-sectional study of risk factors and comparative genomics of carriage and clinical isolates.

The global prevalence of infections caused by extended-spectrum ß-lactamase-producing Enterobacterales (ESBL-E) is increasing, and for Escherichia coli, observations indicate that this is partly driven by community-onset cases. The ESBL-E population structure in the community is scarcely described, and data on risk factors for carriage are conflicting. Here, we report the prevalence and population structure of fecal ESBL-producing E. coli and Klebsiella pneumoniae (ESBL-Ec/Kp) in a general adult population, examine risk factors, and compare carriage isolates with contemporary clinical isolates. Fecal samples obtained from 4,999 participants (54% women) ≥40 years in the seventh survey of the population-based Tromsø Study, Norway (2015, 2016), were screened for ESBL-Ec/Kp. In addition, we included 118 ESBL-Ec clinical isolates from the Norwegian surveillance program in 2014. All isolates were whole-genome sequenced. Risk factors associated with carriage were analyzed using multivariable logistic regression. ESBL-Ec gastrointestinal carriage prevalence was 3.3% [95% confidence interval (CI) 2.8%-3.9%, no sex difference] and 0.08% (0.02%-0.20%) for ESBL-Kp. For ESBL-Ec, travel to Asia was the only independent risk factor (adjusted odds ratio 3.46, 95% CI 2.18-5.49). E. coli ST131 was most prevalent in both collections. However, the ST131 proportion was significantly lower in carriage (24%) versus clinical isolates (58%, P < 0.001). Carriage isolates were genetically more diverse with a higher proportion of phylogroup A (26%) than clinical isolates (5%, P < 0.001), indicating that ESBL gene acquisition occurs in a variety of E. coli lineages colonizing the gut. STs commonly related to extraintestinal infections were more frequent in clinical isolates also carrying a higher prevalence of antimicrobial resistance, which could indicate clone-associated pathogenicity.IMPORTANCEESBL-Ec and ESBL-Kp are major pathogens in the global burden of antimicrobial resistance. However, there is a gap in knowledge concerning the bacterial population structure of human ESBL-Ec/Kp carriage isolates in the community. We have examined ESBL-Ec/Kp isolates from a population-based study and compared these to contemporary clinical isolates. The large genetic diversity of carriage isolates indicates frequent ESBL gene acquisition, while those causing invasive infections are more clone dependent and associated with a higher prevalence of antibiotic resistance. The knowledge of factors associated with ESBL carriage helps to identify patients at risk to combat the spread of resistant bacteria within the healthcare system. Particularly, previous travel to Asia stands out as a major risk factor for carriage and should be considered in selecting empirical antibiotic treatment in critically ill patients.

Early sexual behaviour and Chlamydia trachomatis infection - a population based cross-sectional study on gender differences among adolescents in Norway.

BACKGROUND: Early sexual behaviour has been shown to differ significantly between genders, but few studies have addressed this topic to explain the commonly observed differences in chlamydia rates between adolescent girls and boys. Our study aimed to determine chlamydia prevalence in adolescents aged 15-20 years in a high-incidence area in Norway, and to identify gender-specific early sexual behaviours associated with infection. METHODS: A population based cross-sectional study was conducted among all high school students in five towns in Finnmark county in 2009, using a web-based questionnaire and real-time Chlamydia trachomatis PCR in first-void urine samples (participation rate 85%, 800 girls/818 boys, mean age 17.2 years). Crude and multivariable logistic regression models were applied with chlamydia test result as dependent variable. RESULTS: Prevalence of chlamydia infection was 5.7% (95% confidence interval, CI, 4.4-7.3%). Girls were twice as likely to be infected as boys (7.3%, 5.3-9.7 vs 3.9%, 2.3-6.0). Girls reported earlier sexual debut, older partners, higher lifetime number of partners, and were poorer condom users. In girls, higher maternal education (odds ratio, OR, 2.2, 95% CI 1.1-4.4), ≥2 sexual partners past 6 months (OR 3.6, 1.8-7.3), and partner meeting venue at a private party, bar or disco (OR 5.0, 1.1-22.7) increased the odds of infection in the multivariable model. In boys, condom use at first intercourse (OR 0.06, 0.01-0.42) decreased the odds of infection, while having an older last sexual partner (OR 3.7, 1.3-11.0) increased the odds. In all participants, the risk of infection increased if residence outside the family home during school year (OR 2.0, 1.2-3.6), and decreased if condom was used at last intercourse (OR 0.2, 0.1-0.8). CONCLUSIONS: We detected significant gender differences in chlamydia prevalence and sexual behaviours, and accordingly differing independent risk factors for chlamydia infection. We suggest that accumulation of essentially different experiences in the early sexually active years contribute to gender disparities in chlamydia risk in individuals this age. Gender-specific approaches may be the best alternative to control chlamydia infection in age group 15-20 years.

Risk factors, immune response and whole-genome sequencing of SARS-CoV-2 in a cruise ship outbreak in Norway.

OBJECTIVE: To improve understanding of SARS-CoV-2-transmission and prevention measures on cruise ships, we investigated a Norwegian cruise ship outbreak from July to August 2020 using a multidisciplinary approach after a rapid outbreak response launched by local and national health authorities. METHODS: We conducted a cross-sectional study among crew members using epidemiologic data and results from SARS-CoV-2 polymerase chain reaction (PCR) of nasopharynx-oropharynx samples, antibody analyses of blood samples, and whole-genome sequencing. RESULTS: We included 114 multinational crew members (71% participation), median age 36 years, and 69% male. The attack rate was 33%; 32 of 37 outbreak cases were seropositive 5-10 days after PCR. One PCR-negative participant was seropositive, suggesting a previous infection. Network-analysis showed clusters based on common exposures, including embarkation date, nationality, sharing a cabin with an infected cabin-mate (adjusted odds ratio [AOR] 3.27; 95% confidence interval [CI] 0.97-11.07, p = 0.057), and specific workplaces (mechanical operations: 9.17 [1.82-45.78], catering: 6.11 [1.83-20.38]). Breaches in testing, quarantine, and isolation practices before/during expeditions were reported. Whole-genome sequencing revealed lineage B.1.36, previously identified in Asia. Despite extensive sequencing, the continued transmission of B.1.36 in Norway was not detected. CONCLUSIONS: Our findings confirm the high risk of SARS-CoV-2-transmission on cruise ships related to workplace and cabin type and show that continued community transmission after the outbreak could be stopped by implementing immediate infection control measures at the final destination.

High-resolution genotyping of Chlamydia trachomatis by use of a novel multilocus typing DNA microarray.

Typing of Chlamydia trachomatis is important to understanding its epidemiology. Currently used methods such as DNA sequencing of the ompA gene and multilocus sequence typing (MLST) either offer limited epidemiological resolution or are laborious and expensive, or both. DNA microarray technology using the ArrayStrip format is an affordable alternative for genotyping. In this study, we developed a new multilocus typing (MLT) DNA microarray, based on the target regions of a high-resolution MLST system as well as software for easy analysis. Validation of the array was done by typing 80 previously MLST-typed clinical specimens from unselected adolescents in school. The MLT array showed 100% specificity and provided 2.4-times-higher resolution than ompA sequencing, separating the commonly predominating ompA E/Bour genotype into 7 MLT array genotypes. The MLT array reproduced epidemiological findings revealed by the MLST system and showed sufficient sensitivity to work with clinical specimens. Compared to MLST analysis, the expenses needed for testing a sample with the MLT array are considerably lower. Moreover, testing can be completed within 1 working day rather than 3 or 4 days, with data analysis not requiring highly specialized personnel. The present MLT array represents a powerful alternative in C. trachomatis genotyping.

Nationwide audit and feedback on implementation of antibiotic stewardship programmes in Norwegian hospitals.

BACKGROUND: Implementation of antibiotic stewardship programmes (ASPs) in hospitals is challenging and there is a knowledge gap on how to pursue this process efficiently. OBJECTIVES: To evaluate whether audit and feedback (A&F) is a feasible and useful methodology to assess and support the implementation of ASPs in hospitals. METHODS: A multidisciplinary team performed document reviews and on-site interviews with professionals involved in the implementation of ASPs. Oral feedback on preliminary findings and areas of improvement were provided on-site, followed by feedback reports summarizing major findings and recommendations. Descriptive statistics were used to present number of hospital trusts, interviewees, professions, disciplines, workload and costs. RESULTS: All 22 hospital trusts in Norway participated in the A&F conducted October 2017 to April 2019. Altogether, 446 leaders and healthcare workers were interviewed: 110 leaders, 336 health professionals of whom 89 were antimicrobial stewardship team members. Median number of days from audits were performed till reporting were 36 (IQR 30-49). Median workload for auditors per visit was 7 days (6-8). Total costs were €133 952. Main audit findings were that ASP structures were established in most hospital trusts, but leadership commitment and implementation of interventions were often lacking. The hospital trusts received feedback on establishing governance structures, setting local targets, implementing interventions and increased involvement of nurses. CONCLUSIONS: Nationwide A&F provides a unique and comprehensive insight into the implementation of ASPs in hospitals and is feasible with a reasonable amount of resources. This approach can identify targets for improved implementation of ASPs in hospitals.

Clinical course, treatment and visual outcome of an outbreak of Burkholderia contaminans endophthalmitis following cataract surgery.

BACKGROUND: Postoperative endophthalmitis is a rare but dreaded complication of intraocular surgery and often results in severe visual impairment or blindness. The present study describes the clinical course, treatment and visual outcome of an outbreak of Burkholderia contaminans endophthalmitis following cataract surgery. METHODS: Among 290 patients who underwent uneventful phacoemulsification cataract surgery at one outpatient clinic between January 4th and 28th 2019, 6 cases developed Burkholderia contaminans endophthalmitis. Clinical data were collected by retrospective review of patient records. Microbiological samples from vitreous aspirates, intraocular lenses (IOL) and lens capsules were cultured, and recA and draft whole genome sequences analysed. RESULTS: The recA sequences of all Burkholderia contaminans isolates and the allelic profile of the isolates were identical. All cases had a similar clinical presentation with rapid development of endophthalmitis symptoms with variable time to onset. The mean time to admission was 34 days (12-112 days). All cases had a seemingly favourable response to intravitreal antibiotics. However, acute recurrences occurred after long time periods (12-71 days). The cases experienced between 0 and 3 recurrences. Due to persistent infection, the cases received between 5 and 15 treatments (mean 7.8) including IOL and lens capsule explantation in 5 of 6 cases. Burkholderia contaminans was detected in all explanted lens capsules. The final corrected distance visual acuity (CDVA, Snellen chart) was between 0.8 and 1.2 and all cases had final CDVA ≥0.8. CONCLUSIONS: A persistent and intensive treatment approach including total lens capsule and IOL explantation is recommended for Burkholderia contaminans endophthalmitis following cataract surgery and may lead to a favourable visual result.

Birthing parents had a lower risk of testing positive for SARS-CoV-2 in the peripartum period in Norway, 15th of February 2020 to 15th of May 2021.

Hospital infection control measures against COVID-19 may come into conflict with patients' need for support. In Norway, some hospitals have restricted access for partners of women giving birth. We investigated the incidence rate of SARS-CoV-2 among birthing parents compared to similarly aged women and men in the general population; and the additional risk posed by allowing partners in. Birthing parents often shared infection status and had a slightly lower incidence rate than the general population in the peripartum period. They should not be considered a high-risk group for SARS-CoV-2 infections.

Gastrointestinal carriage of Klebsiella pneumoniae in a general adult population: a cross-sectional study of risk factors and bacterial genomic diversity.

Antibiotic resistant Klebsiella pneumoniae is a leading public health threat and gastrointestinal carriage is an established risk factor for subsequent infections during hospitalization. Our study contributes new knowledge of risk factors for gastrointestinal carriage and the genomic population structure of K. pneumoniae colonizing humans in a representative sample of a general population in a community setting. Altogether, 2,975 participants (54% women) >40 y in the population-based Tromsø Study: Tromsø7, Norway (2015-2016) were included. Fecal samples were screened for K. pneumoniae, which were characterized using whole-genome sequencing. Risk factors for carriage were analyzed using multivariable logistic regression on data from questionnaires and the Norwegian Prescription Database. Prevalence of K. pneumoniae gastrointestinal carriage was 16.3% (95% CI 15.0-17.7, no gender difference). Risk factors associated with carriage included age ≥60 y, travel to Greece or Asia past 12 months (adjusted odds ratio 1.49, 95% CI 1.11-2.00), Crohn's disease/ulcerative colitis (2.26, 1.20-4.27), use of proton pump inhibitors (1.62, 1.18-2.22) and non-steroidal anti-inflammatory drugs past 6 months (1.38, 1.04-1.84), and antibiotic use the last month (1.73, 1.05-2.86). Prevalence was higher among those having used combinations of drug classes and decreased over time with respect to preceding antibiotic use. The K. pneumoniae population was diverse with 300 sequence types among 484 isolates distributed across four phylogroups. Only 5.2% of isolates harbored acquired resistance and 11.6% had virulence factors. Identification of risk factors for gastrointestinal carriage allows for identification of individuals that may have higher risk of extraintestinal infection during hospitalization. The findings that specific diseases and drugs used were associated with carriage show an impact of these possibly through modulating the human gut microbiota promoting colonization. The diverse population structure of carriage isolates reflects the ecologically adaptive capacity of the bacterium and challenges for vaccine prospects and the identification of reservoirs as a potential source for human colonization.

Non-prescription purchase of antibiotics during travel abroad among a general adult population in Norway: Findings from the seventh Tromsø Study.

BACKGROUND: Non-prescription purchase of antibiotics is undesirable and has not recently been investigated in a representative population in a high-income low-use country during travel abroad. This study examined self-reported prevalence of antibiotic purchase abroad with and without prescription among participants reporting international travel in a general adult population in Norway, and the associations with socio-demographic, lifestyle and health factors. METHODS: We analysed questionnaire-data from 19995 participants (10470 women) ≥40 years in the population-based Tromsø Study 7, 2015-2016. Data from the Norwegian Prescription Database were used to examine antibiotic use in Norway. We calculated adjusted odds ratios (AOR) for "travel abroad", "any antibiotic purchase abroad", and "antibiotic purchase abroad with" and "without prescription" using multivariable logistic regression. RESULTS: Over half (55.0%, 95%CI 54.3-55.7%) participants reported travel abroad of >1 week duration in the past year. Travelers were more likely than non-travelers to be women (AOR = 2.02, 95%CI 1.42-2.88%) and report high education/income, childhood mostly lived abroad, healthy lifestyle, and good/excellent self-rated health. In total, 17904 travel episodes to 148 countries were reported. Altogether, 3.7% (95% CI 3.4%-4.1%) of travelers had purchased antibiotic abroad in the past year. Non-prescription purchase (1.5%, 95% CI 1.3-1.7) was associated with younger age, being female (AOR 1.41, 1.0-1.97), number of travels (reference: one episode, two: AOR = 1.82, 1.25-2.67, three: 2.60, 1.58-4.28, four: 3.10, 1.40-6.36 and ≥five: 4.70, 2.30-9.62), occurrences of diarrhoea (one: 2.42, 1.50-3.93 and ≥two: 3.08, 1.29-7.35), and antibiotic use in Norway in the past year (1.84, 1.29-2.62), whereas purchase with prescription (2.4%, 2.1-2.7) was associated with low income, growing-up abroad, recent hospital admission, additionally including number of travels/diarrhoea, and antibiotic use in Norway. Thailand (10.7%, 95% CI 7.8-14.3), Turkey (5.5%, 3.8-7.8) and Spain (3.6%, 3.0-4.3) were the countries most commonly associated with any antibiotic purchase. About two in five travelers who bought antibiotics in Thailand had done so without prescription, three in five in Turkey, and less than one in three in Spain. CONCLUSION: Overall, a small proportion of travelers had bought antibiotics abroad in the past year. Low prevalence of non-prescription purchase may be explained by awareness of the risks associated with self-medication, cultural views, unawareness of the non-prescription availability, and/or few infections. Divergent predictors for purchase abroad with versus without prescription may suggest different reasons for these practices.