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A Ortqvist

Publications and source records attributed to A Ortqvist.

At least 37 records · Page 2Linked to original sources
PubMed2000

Prospective study of prognostic factors in community-acquired bacteremic pneumococcal disease in 5 countries.

To define the influence of prognostic factors in patients with community-acquired pneumococcal bacteremia, a 2-year prospective study was performed in 5 centers in Canada, the United States, the United Kingdom, Spain, and Sweden. By multivariate analysis, the independent predictors of death among the 460 patients were age >65 years (odds ratio [OR], 2.2), living in a nursing home (OR, 2.8), presence of chronic pulmonary disease (OR, 2.5), high acute physiology score (OR for scores 9-14, 7.6; for scores 15-17, 22; and for scores >17, 41), and need for mechanical ventilation (OR, 4.4). Of patients with meningitis, 26% died. Of patients with pneumonia without meningitis, 19% of those with >/=2 lobes and 7% of those with only 1 lobe involved (P=.0016) died. The case-fatality rate differed significantly among the centers: 20% in the United States and Spain, 13% in the United Kingdom, 8% in Sweden, and 6% in Canada. Differences of disease severity and of frequencies and impact of underlying chronic conditions were factors of probable importance for different outcomes.

Aged↗
PubMed2000

Molecular epidemiology of Streptococcus pneumoniae causing invasive disease in 5 countries.

A multicenter study was done during 1993-1995 to investigate prospectively the influence of several prognostic factors for predicting the risk of death among patients with pneumococcal bacteremia. Five centers located in Canada, the United Kingdom, Spain, Sweden, and the United States participated. Clinical parameters were correlated to antibiotic susceptibility and serotyping of the 354 invasive pneumococcal isolates collected and to molecular typing of 173 isolates belonging to the 5 most common serotypes (14, 9V, 23F, 3, and 7F). Serotype 14 was the most common among all isolates, but serotype 3 dominated in fatal cases and in isolates from Spain and the United States, the countries with the highest case-fatality rates. Fewer different patterns were found among the type 3 isolates, which suggests a closer clonal relationship than that among isolates belonging to other serotypes. Of type 3 isolates from fatal cases, 1 clone predominated. Other penicillin-susceptible invasive clones were also shown to spread in and between countries.

Adult↗
PubMed2000

Recurrence of pneumonia in relation to the antibody response after pneumococcal vaccination in middle-aged and elderly adults.

We have recently studied the efficacy of pneumococcal vaccine in preventing pneumonia recurrences after hospital treatment for community-acquired pneumonia in non-immunocompromised patients aged 50-85 y. Among these patients, we have now compared the antibody response to the pneumococcal vaccine between patients who developed pneumonia (n = 50) and patients without pneumonia recurrences (n = 100), during a mean follow-up period of 32 months after vaccination. The antibody levels of 5 pneumococcal serotypes were measured before, and 4 weeks, 1 y and 3 y after vaccination. A lower risk of pneumonia recurrences was seen in patients with antibody fold increases (FIs) > 4 from pre-vaccination to post-vaccination compared with patients with lower FIs (p = 0.02). The results suggest that in this patient category, the antibody response to pneumococcal vaccination is of importance for the risk of pneumonia recurrence.

Aged↗
PubMed1999

Pneumococcal disease in Sweden: experiences and current situation.

During the last decade, the incidence of invasive pneumococcal disease in Sweden has risen, seemingly due chiefly to an increasing incidence of pneumococcal bacteremia among the elderly. On the other hand, mortality due to invasive disease in Sweden is low, approximately 10% for bacteremic pneumococcal pneumonia. Beta-lactam resistance in Streptococcus pneumoniae is still a relatively minor problem in Sweden, with only 3%-4% of strains demonstrating decreased susceptibility to penicillin. However, local outbreaks of pneumococcal disease with up to 10% resistance have occurred among children, especially in southern Sweden.

Adolescent↗
PubMed1999

[The elderly should be vaccinated against pneumococci].

Invasive pneumococcal diseases are associated with substantial mortality in the elderly. The incidence of such diseases, particularly that of bacteraemic pneumococcal pneumonia, has increased in Sweden during the past decade. At the same time, there is a growing problem with beta-lactam-resistant and multiresistant pneumococci in many nearlying countries. Although pneumococcal vaccine probably provides only limited protection against pneumococcal pneumonia in the elderly, it yields approximately 70 per cent protection against invasive pneumococcal disease. Pneumococcal vaccination should therefore be recommended to all those 65 years old and above, and a nationwide strategy developed to implement good coverage in the age group.

Aged↗
PubMed1999

In-hospital management of adults who have community-acquired pneumonia.

The initial in-hospital management of adult patients with community-acquired pneumonia can be divided into five major steps: an early recognition of the patient with presumptive pneumonia, assessment of the severity of illness, establishment of an etiologic diagnosis, supportive therapy, and decision regarding initiation of empirical therapy. In most European recommendations, the empirical antibiotic treatment is directed against "the most likely pathogen," based on epidemiological, clinical, and laboratory data, and on the severity of illness. In contrast, newer North American guidelines have focused on the severity of illness of community-acquired pneumonia. As a consequence, the use of a broader initial antibiotic coverage, including extended-spectrum cephalosporins and combinations, seems to be more common in North America than in Europe.

Adult↗
PubMed1998

Randomised trial of 23-valent pneumococcal capsular polysaccharide vaccine in prevention of pneumonia in middle-aged and elderly people. Swedish Pneumococcal Vaccination Study Group.

BACKGROUND: We assessed the effectiveness of a 23-valent pneumococcal vaccine in the prevention of pneumococcal pneumonia and of pneumonia overall in non-immunocompromised middle-aged and elderly people. METHODS: The prospective, multicentre, double-blind, randomised, placebo-controlled trial was carried out across departments of infectious diseases at six tertiary-care or university hospitals in Sweden. 691 non-immunocompromised patients aged 50-85 years who had been treated as inpatients for community-acquired pneumonia (CAP) were randomly assigned either 23-valent pneumococcal capsular polysaccharide vaccine or placebo (sodium chloride). We used Cox regression models to estimate the relative risks of pneumonia overall and pneumococcal pneumonia for the placebo group compared with the vaccine group. FINDINGS: 63 (19%) of 339 patients in the vaccine group and 57 (16%) of 352 patients in the placebo group developed a new pneumonia, corresponding to a relative risk over time for the placebo group compared with the vaccine group of 0.83 (95% CI 0.58-1.12, p=0.31). Pneumococcal pneumonia was diagnosed in 16 (4.5%) patients in the placebo group and in 19 (5.6%) in the vaccine group, corresponding to a relative risk for the placebo group of 0.78 (95% CI 0.40-1.51, p=0.45). We found no difference in the death rate between the two study groups. INTERPRETATION: The 23-valent pneumococcal polysaccharide vaccine did not prevent pneumonia overall or pneumococcal pneumonia in middle-aged and elderly individuals.

Aged↗
PubMed1997

Contribution of novel choline-binding proteins to adherence, colonization and immunogenicity of Streptococcus pneumoniae.

The surface of Streptococcus pneumoniae is decorated with a family of choline-binding proteins (CBPs) that are non-covalently bound to the phosphorylcholine of the teichoic acid. Two examples (PspA, a protective antigen, and LytA, the major autolysin) have been well characterized. We identified additional CPBs and characterized a new CBP, CbpA, as an adhesin and a determinant of virulence. Using choline immobilized on a solid matrix, a mixture of proteins from a pspA-deficient strain of pneumococcus was eluted in a choline-dependent fashion. Antisera to these proteins passively protected mice challenged in the peritoneum with a lethal dose of pneumococci. The predominant component of this mixture, CbpA, is a 75-kDa surface-exposed protein that reacts with human convalescent antisera. The deduced sequence from the corresponding gene showed a chimeric architecture with a unique N-terminal region and a C-terminal domain consisting of 10 repeated choline-binding domains nearly identical to PspA. A cbpA-deficient mutant showed a >50% reduction in adherence to cytokine-activated human cells and failed to bind to immobilized sialic acid or lacto-N-neotetraose, known pneumococcal ligands on eukaryotic cells. Carriage of this mutant in an animal model of nasopharyngeal colonization was reduced 100-fold. There was no difference between the parent strain and this mutant in an intraperitoneal model of sepsis. These data for CbpA extend the important functions of the CBP family to bacterial adherence and identify a pneumococcal vaccine candidate.

Amino Acid Sequence↗
PubMed1997

Recurrence of pneumonia in middle-aged and elderly adults after hospital-treated pneumonia: aetiology and predisposing conditions.

In order to investigate the predisposing conditions and aetiologic agents in patients with recurrent pneumonia, we prospectively studied 653 immunocompetent patients, 50-85 years of age, who had been treated in hospital for community-acquired pneumonia. After an average patient follow-up period of 32 months, 11 variables were examined for association with the following end points: death, recurrence of pneumonia and recurrence of pneumococcal pneumonia. During the follow-up period there were 171 episodes of pneumonia in 115 of the 653 patients, and 52 deaths (all causes). Multivariate analysis showed that age, male sex, congestive heart failure and presence of other chronic diseases were significantly associated with higher mortality. Age and chronic pulmonary disease were associated with recurrence of pneumonia. The major aetiologic agents were Streptococcus pneumoniae (26%), Haemophilus influenzae (11%) and Moraxella catarrhalis (6%). We conclude that pneumonia recurrences are common in middle-aged and elderly patients after treatment in hospital for community-acquired pneumonia. The recurrence risk is higher in elderly patients, and in those with chronic pulmonary diseases. Given the prominence of H. influenzae and M. catarrhalis found in the present study, these organisms should always be considered when choosing the initial antibiotic in patients with recurrent pneumonia.

Age Factors↗
PubMed1996

Oral empiric treatment of community-acquired pneumonia. A multicenter, double-blind, randomized study comparing sparfloxacin with roxithromycin. The Scandinavian Sparfloxacin Study Group.

STUDY OBJECTIVE: Comparison of efficacy and safety of sparfloxacin (Spfx) vs roxithromycin (ROXI) for treatment of community-acquired pneumonia (CAP). DESIGN: Multicenter, double-blind, randomized study. SETTING: Twenty-three university and community hospitals in Scandinavia. PATIENTS: Three hundred four adults (> or = 18 years of age) with CAP treated as outpatients (25%) or inpatients (75%). INTERVENTIONS: Randomization 1:1 to Spfx, 400 mg on day 1, then 200 mg once daily, or ROXI, 150 mg twice daily, 10 to 14 days. Safety and efficacy analyses in intention-to-treat (ITT) and evaluable populations. RESULTS: Three hundred three of 304 patients were included in the ITT and safety analyses and 260 (86%) were evaluable at the end of follow-up. Streptococcus pneumoniae was the cause of pneumonia in 62 (20%) patients (11 with bacteremia), Chlamydia pneumoniae in 40 (13%), and Mycoplasma pneumoniae in 38 (13%) patients. The success rates for Spfx and ROXI at the end of follow-up were 82% and 72%, respectively, in the ITT population, and 94% and 79%, respectively, in the evaluable population. The odds ratio Spfx/ROXI for success was 4.5 (95% confidence interval, 1.9, 10.8) for the evaluable population. Both drugs were, overall, equally safe. GI symptoms were the most common adverse experiences in both groups. Prolongation of QTc, without clinical symptoms, was seen in 3% of Spfx patients and in 1% of ROXI patients, and photosensitivity, mostly mild to moderate, was seen in 5% of the Spfx group. CONCLUSIONS: Oral treatment with Spfx was superior to ROXI for the treatment of moderately severe CAP. Spfx was effective for all isolated pathogens, including S pneumoniae, and may be an alternative for empiric treatment of CAP, especially in areas with a high incidence of beta-lactam-resistant pneumococci.

Administration, Oral↗
PubMed1996

Severe varicella pneumonia in adults in Stockholm County 1980-1989.

Varicella pneumonia in adults is considered to be a serious complication, with mortality rates of 9-50%, but the true incidence and clinical course is not known. We therefore studied all adult patients in Stockholm County hospitalized during the period 1980-1989 with varicella. 36/305 (12%) varicella patients admitted to hospital were diagnosed as having pneumonia, corresponding to a mean incidence of 0.32/100,000 inhabitants per year. In most patients the pneumonia had a mild to moderate clinical course and no deaths occurred (mortality rate 0%, CI95 [0, 9.7]). However, 13 patients had a severe tachypnoea (> or = 30 breaths/min) and 4 of these required intensive-care treatment. Ten patients were treated with acyclovir, in most cases combined with corticosteroids. We conclude that the incidence of severe varicella pneumonia is low in the adult population, and that the mortality rate of this complication is probably lower than previously described.

Acyclovir↗
PubMed1995

Diagnosis of bacteremic pneumococcal pneumonia by amplification of pneumolysin gene fragment in serum.

A polymerase chain reaction (PCR) assay based on the amplification of pneumolysin gene fragments in patient sera was developed for the etiologic diagnosis of acute pneumococcal pneumonia. Two pairs of oligonucleotide primers were designed to amplify a 348-bp and a 208-bp fragment of the pneumolysin gene. Amplified products were analyzed by agarose gel electrophoresis and hybridization using a 24-mer probe internal to the amplified DNA. The nested PCR could detect 10 organisms as determined by serial dilutions of DNA from Streptococcus pneumoniae. All 20 serum samples from patients with acute pneumococcal pneumonia (confirmed by blood culture) were positive. Among 100 serum samples from healthy elderly controls, 94 were negative and 6 were positive by PCR. Thus, PCR may be a novel diagnostic method for pneumococcal pneumonia.

Adult↗
PubMed1995

Antibiotic treatment of community-acquired pneumonia in clinical practice: a European perspective.

The prescription pattern of empirical antibiotic treatment of community-acquired pneumonia (CAP) in seven European countries was studied based on data from published studies and prescription surveys. Overall, the three most commonly used compounds for outpatient treatment were aminopenicillins, aminopenicillins with clavulanic acid, macrolides and cephalosporins. The relative order of these three compounds varied very much between the different countries. Aminopenicillin was the first or second choice in four of seven countries. Cephalosporins were used mainly in Germany and in Southern Europe. In Italy parenteral treatment with third-generation cephalosporins or imipenem was the commonest choice (nearly 40%). Tetracyclines were used most in Northern and Central Europe. In contrast to the others, penicillin was the commonest choice in Sweden. Also for hospitalised patients the choice of initial antibiotic, as well as the use of mono- or combination therapy, varied significantly between countries. The varying treatment policies cannot be explained by scientific reason, such as differences in the aetiology of infection, frequency of penicillin-resistant pneumococci, pharmacokinetics, safety, nor by ecological or economic considerations. It is probable that local therapy traditions, and marketing factors, are equally important as the scientific rationale for the doctors' choice of empirical therapy for CAP.

Anti-Bacterial Agents↗
PubMed1995

Short- and long-term prognosis for middle-aged and elderly patients hospitalized with community-acquired pneumonia: impact of nutritional and inflammatory factors.

To investigate the impact of nutritional and inflammatory factors on short- and long-term prognosis for patients hospitalized for community-acquired pneumonia (CAP), 97 patients, 50-85 years old, admitted to the Department of Infectious Diseases at Danderyd Hospital were enrolled in a prospective study. 13 enrolment variables were examined for association with 6 outcome variables. Serum orosomucoid concentration, acute physiology and chronic health evaluation (APACHE) II score, body mass index (BMI) and triceps skinfold (TSF) were each associated with duration of hospital stay. A low TSF and BMI, and a high APACHE II score were all associated with death. A high APACHE II score and a high TSF were both associated with readmission within 6 months of discharge. The alfa-1-antitrypsin concentration was the most closely correlated with duration of fever. We conclude that the admission concentrations of alfa-1-antitrypsin and orosomucoid are better predictors of hospital morbidity than the more commonly used albumin and C-reactive protein (CRP) levels. Measurement of APACHE II and TSF on admission may give additional prognostic information on the interval from admission to 6 months after discharge.

APACHE↗
PubMed1995

Diagnostic and prognostic value of interleukin-6 and C-reactive protein in community-acquired pneumonia.

The diagnostic and prognostic value of admission serum levels of interleukin-6 (IL-6) and C-reactive protein (CRP) was investigated in 203 hospital-treated patients with community-acquired pneumonia (CAP). In serum samples obtained during the first 24 h after admission, IL-6 was detectable in 198 patients (98%), with a median value of 50 ng/l. Ten % of the patients had IL-6 values of 1000 ng/l. A clear positive correlation between IL-6 and CRP was found (r = 0.29, p < 0.0001). Patients with high IL-6 or CRP levels had longer duration of fever, longer hospital stay, and had less often recovered clinically or radiographically on follow-up weeks after discharge. A high IL-6, but not a high CRP, also seemed to be associated with a higher mortality. Bacteremic pneumococcal pneumonia had the highest levels of IL-6 (mean 2852 and median 420 ng/l) and CRP (mean 292 and median 285 mg/l). High IL-6 values were also seen in patients with non-bacteremic pneumococcal pneumonia, while all patients with pneumonia due to other bacterial, or viral, aetiology had IL-6 levels of < or = 300 ng/l. In conclusion, IL-6 and CRP are promising diagnostic and prognostic tools in the management of CAP. Further studies are needed to establish the usefulness of repeated measurements early in the hospital course of the disease.

Bacteremia↗
PubMed1994

The role of IgA determination by ELISA in the early serodiagnosis of Mycoplasma pneumoniae infection, in relation to IgG and mu-capture IgM methods.

Enzyme-linked immunosorbent assay (ELISA) for IgA, IgG and IgM was evaluated with sera from 50 adult patients with pneumonia, selected on the basis of a positive complement fixation (CF) test for diagnosis of Mycoplasma pneumoniae infection and with sera from 105 healthy blood donors. The ELISA antigen for IgG and IgA was a sonicated suspension of M. pneumoniae solubilised by deoxycholate. For the IgM assay, the same antigen was directly conjugated to alkaline phosphatase and used in a mu-capture format. ELISA gave positive results with high or rising titres for one or several antibody classes in 47 (94%) patients. In two of the three ELISA-negative cases, the diagnosis of M. pneumoniae infection indicated by the CF test seemed unlikely on clinical grounds. Specific IgA antibodies was developed more regularly and more rapidly than IgM. IgA titres also started to decrease earlier than IgM or the late-peaking IgG response. Thus, the determination of IgA antibodies was found to be valuable for the early diagnosis of M. pneumoniae infection. The study also demonstrated that the determination of all three antibody classes is necessary to obtain an optimal level of serodiagnosis.

Adolescent↗