Bloodstream infections following different types of surgery in a Finnish tertiary care hospital, 2009-2014.

The risk and outcome of bloodstream infections (BSIs) were evaluated following surgery. BSIs were identified in Helsinki University Hospital during 2009-2014 as part of the national surveillance. Of 711 BSIs identified, 51% were secondary and 49% primary. The rate was highest after cardiovascular surgery (8.7 per 1000 procedures) and lowest after gynaecologic (1.0 per 1000). Surgical site infection was the most frequent source of secondary BSIs (34%) and 45% of primary BSIs were central-line-associated. The 28-day case fatality ranged from zero in gynaecology/obstetrics to 21% in cardiovascular surgery. Besides BSIs related to surgical site infections, half of BSIs were primary, providing additional foci for prevention.

Coincidental detection of the first outbreak of carbapenemase-producing Klebsiella pneumoniae colonisation in a primary care hospital, Finland, 2013.

In Finland, occurrence of Klebsiella pneumoniae carbapenemase-producing K. pneumoniae (KPC-KP) has previously been sporadic and related to travel. We describe the first outbreak of colonisation with KPC-KP strain ST512; it affected nine patients in a 137-bed primary care hospital. The index case was detected by chance when a non-prescribed urine culture was taken from an asymptomatic patient with suprapubic urinary catheter in June 2013. Thereafter, all patients on the 38-bed ward were screened until two screening rounds were negative and extensive control measures were performed. Eight additional KPC-KP-carriers were found, and the highest prevalence of carriers on the ward was nine of 38. All other patients hospitalised on the outbreak ward between 1 May and 10 June and 101 former roommates of KPC-KP carriers since January had negative screening results. Two screening rounds on the hospital's other wards were negative. No link to travel abroad was detected. Compared with non-carriers, but without statistical significance, KPC-KP carriers were older (83 vs 76 years) and had more often received antimicrobial treatment within the three months before screening (9/9 vs 90/133). No clinical infections occurred during the six-month follow-up. Early detection, prompt control measures and repetitive screening were crucial in controlling the outbreak.

Travellers returning with measles from Thailand to Finland, April 2012: infection control measures.

Countries with no autochthonous measles run the risk of the virus being imported by travellers and transmitted to unprotected citizens. In April 2012, two travellers from Finland and one from Estonia were diagnosed with measles after returning from Phuket, Thailand. They were contagious on their return flights and subsequently exposed several individuals, prompting extensive infection control measures. Two secondary cases were detected: one child who had received one vaccine dose and another who was fully vaccinated.

Population-based burden of bloodstream infections in Finland.

Bloodstream infections (BSI) are a major cause of mortality, morbidity and medical cost, but few population-based studies have concomitantly evaluated BSI incidence and mortality. Data on BSI episodes reported to national, population-based surveillance by all clinical microbiology laboratories in Finland during 2004-07 were linked to vital statistics. Age-, sex and microbe-specific incidence and mortality rates were calculated. During 2004-07, 33 473 BSI episodes were identified; BSI incidence increased from 147 to 168 per 100 000 population (average annual increase, 4.4%; p <0.001). Rates were highest among persons ≥65 years and <1 year, and higher among male patients than female patients (166 versus 152 per 100 000). The most common aetiologies were Escherichia coli (27%) and Staphylococcus aureus (13%). Among male patients, 52% of BSI were caused by gram-positive bacteria compared with 42% among female patients (p <0.001). The overall 30-day case-fatality was 13%. Of the deaths, 32% occurred within 2 days, 70% were among people aged 65 years or more and 33% were caused by E. coli or S. aureus infections. The BSI mortality rate increased from 19 to 22 per 100 000 (average annual increase: 4.0%, p 0.01). Among people aged 25 years or more, the mortality rate was 1.4-fold higher in men than women (34 versus 25 per 100 000 population). Overall excess annual mortality from BSI in the population was 18 per 100 000. The substantial BSI burden among the elderly and among adult men highlights the need for developing and implementing effective interventions, particularly for BSI caused by E. coli and S. aureus. One-third of BSI deaths occurred early, emphasizing the importance of early identification and treatment.

Increase in bloodstream infections in Finland, 1995-2002.

A national, population-based laboratory surveillance of bloodstream infections (BSI) in Finland was performed. Blood-culturing rates were determined from data from clinical microbiology laboratories and trends in rates were evaluated using Poisson regression. During 1995-2002, 51,510 cases of BSI were notified; the annual incidence increased from 104 to 145 cases/100,000 (40%). Rates increased in all age groups but persons aged >or= 75 years accounted for 28% of cases and showed the largest rate increase. Escherichia coli, coagulase-negative staphylococci, Staphylococcus aureus and Streptococcus pneumoniae accounted for 58% of isolates and their relative proportions were unchanged over time. The annual blood-culturing rate increased by one-third during the study period but the number of BSI detected per blood cultures remained unchanged. Regional BSI incidence was significantly associated with blood-culturing rates. We conclude that the increase in BSI rates may have been due to more frequent blood culturing but was not associated with changes in the reporting system or aetiology of BSI.

Nontuberculous mycobacterial infection in HIV-negative patients receiving immunosuppressive therapy.

The clinical significance of nontuberculous mycobacterial isolates and presentation of mycobacteriosis was compared in HIV-negative patients with or without preceding immunosuppression. Patients with nontuberculous mycobacterial isolates (n = 139), mainly from the respiratory system, were divided into three groups: those who had had previous immunosuppressive treatment (24%), those with other underlying diseases (54%) and those without predisposing factors (22%). The distribution of mycobacterial species among the various patient groups was similar. The immunosuppressed patients fulfilled the criteria of the American Thoracic Society for clinical mycobacteriosis less frequently (18%) than those with other underlying diseases (32%) or without predisposing factors (45%), p = 0.07, the difference being more striking for patients with Mycobacterium avium complex isolates. This was partly due to the difficulty in distinguishing the relevant symptoms from those caused by the underlying disease. The proportion of patients receiving antimycobacterial therapy differed similarly (18%, 21%, 45%, respectively). Among the immunosuppressed patients, positive acid-fast smears were significantly less common and polymicrobial infections, initial lymphocytopenia, fever and fatal outcome significantly more common. About half of the immunosuppressed patients died within one year. In order to better define patients requiring treatment, the criteria for localized mycobacteriosis among immunosuppressed patients should be reevaluated.

Effect of immunosuppressive therapy on the clinical presentation of legionellosis.

To determine whether the clinical course of legionellosis in patients treated with immunosuppressive agents differs from that seen in other patient groups, data on 52 Finnish patients with legionellosis confirmed by culture or by the direct immunofluorescent antibody test was reviewed. Of these patients 44% were immunosuppressed, 23% had other underlying diseases and 33% had no predisposing conditions. Among those without predisposing conditions, only Legionella pneumophila serogroup 1 was observed, whereas among the immunosuppressed patients, serogroup 6 dominated. Legionellosis was nosocomial in 73% of the immunosuppressed patients and in 33% of the patients with other underlying diseases but was travel-associated in 76% of those without predisposing factors. The case fatality rate (37%) was high but was not associated with preceding immunosuppression. These results indicate that although the serogroups and the sources of legionellosis differ in immunosuppressed patients compared with other groups, the clinical presentation is not more severe.

Effect of immunosuppressive therapy on the clinical presentation and outcome of tuberculosis.

A total of 177 tuberculosis cases of individuals not infected with human immunodeficiency virus diagnosed during the years 1984-1990 at the Helsinki University Central Hospital were reviewed retrospectively to compare the clinical presentation of tuberculosis in patients immunocompromised because of treatment (n = 35) with patients with other underlying conditions (n = 60) and with those without known predisposing factors (n = 82). In immunosuppressed patients compared with other patients, tuberculosis was more frequently disseminated (40% vs. 12%, P < 0.001), lung infiltrations were more often miliary (44% vs. 13%, P < 0.001), and the sputum smears were less often positive (30% vs. 62%, P < 0.05). In addition, the age-adjusted odds ratio for the risk of dying was higher among immunosuppressed patients than among the two other groups. The low rate of positive sputum smears and the high rate of atypical presentation and mortality stress the importance of a high index of suspicion and early institution of empirical antituberculosis therapy in immunosuppressed patients.

Clinical presentation and outcome of listeriosis in patients with and without immunosuppressive therapy.

Seventy-four cases of systemic listeriosis occurring from 1971 to 1989 in the greater Helsinki area in Finland are reviewed with a special interest in the effect of preceding immunosuppressive therapy on the clinical presentation. Of these patients, 66% had an underlying disease, most commonly malignancy, diabetes mellitus, or renal transplantation, and 43% had received immunosuppressive therapy within 1 week before onset of listeriosis. Bacteremia and central nervous system infections (both in 43% of cases) were the most common clinical entities. The percentage of patients with meningitis was not greater among immunosuppressed patients (13/32, 41%) than among patients with underlying diseases not treated with immunosuppressive agents (9/16, 56%) or among previously healthy nonpregnant hosts (7/11, 64%). Immunosuppressed patients did not die more frequently than did those with underlying diseases not treated with immunosuppressive therapy (case fatality rate, 29% vs. 38%, respectively). However, all previously healthy non-neonatal patients survived, whereas 32% (15/47) of those with any kind of underlying disease succumbed.

Beta-haemolytic group A, B, C and G streptococcal septicaemia: a clinical study.

87 beta-haemolytic streptococcal septicaemias in adult patients during 1979-86 in a university hospital were reviewed. 25% were caused by group A streptococcus, 17% by group B, 14% by group C and 44% by group G streptococcus. 67% of the septicaemias due to group B streptococcus were nosocomial, whereas the group A, C or G septicaemias were in most cases community-acquired. Alcoholism was the most common underlying disease in group A (32%) and malignancy in group G streptococcal septicaemias (45%). The most common origin and focus of infection in group A, C and G streptococcal septicaemias was the skin. The total mortality in beta-haemolytic streptococcal septicaemias was 20%, higher in septicaemias caused by group A (32%) and group B (33%) than by group C (17%) and group G (8%) streptococci. Nevertheless, there were more patients in group G streptococcal septicaemias with severe underlying diseases than in other groups of beta-haemolytic streptococci. The present data seem to indicate that a septicaemia due to group G is a more benign disease than a septicaemia due to group A streptococcus.