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J K Møller

Publications and source records attributed to J K Møller.

At least 19 recordsLinked to original sources
PubMed2005

Surveillance of hospital-acquired infections based on electronic hospital registries.

Computer-assisted surveillance of hospital-acquired infections (HAIs) was compared with conventional manual registration (our gold standard i.e. reference method) by chart reviews of nosocomial infections in patients from surgical and medical departments. By combining selected infection parameters from various electronic hospital registries, the computer detected general HAIs with a sensitivity of 94% and a specificity of 47%. However, defining septicaemia, urinary tract infection (UTI), pneumonia and postoperative wound infection (PWI) specifically by sets of simplified criteria (infection parameters), computer-assisted surveillance was able to detect these infections with a sensitivity ranging between 82% (UTI) and 100% (septicaemia), and a specificity ranging between 91% (PWI) and 100% (septicaemia) compared with conventional manual registration. We conclude that computer surveillance based on data collected for other purposes in electronic hospital registries is an effective method for monitoring HAIs.

Cross Infection↗
PubMed2003

Reasons for Chlamydia trachomatis testing and the associated age-specific prevalences.

OBJECTIVE: to assess the age- and sex-specific prevalence of Chlamydia trachomatis infection according to the indications for testing. This was done as part of a health technology assessment to identify the populations that would benefit most from universal screening, and to identify ongoing potential superfluous testing that could liberate resources to be used for targeted screening programs. METHODS: In Aarhus County, Denmark, population of 630,000, data were collected on 11,423 persons who were being tested for C. trachomatis (10,351 females and 1072 males). Indicated on the request slip were: the sex, the age and the reasons for testing (infected partner; planned transcervical procedure; symptoms consistent with C. trachomatis infection; or routine testing). All samples were analyzed by the Ligase Chain Reaction. RESULTS: More than 90% of all the tests were conducted in women. The majority of tests were performed in the 21-25 years age group but the prevalence was highest in the 16-20 years age group (7.2%; 95% CI: 5.4%-9.3%). A total of 25% of all tests were carried out in asymptomatic women above the age of 30 in whom the prevalence was only 1.3% (95% CI: 0.8%-1.9%). More than three times as many women (5.8%) than men (1.7%) were tested as sexual partners to C. trachomatis-infected index patients but the risk of infection was highest among men. In women who were tested prior to a transcervical procedure, the prevalence was highest (5.5%; 95% CI: 1.8%-12.4%) in the 16-20 years age group, whereas most samples were obtained in women aged 31-35 years in whom the prevalence was only 0.8% (0.2%-2.3%). CONCLUSIONS: The prevalence of C. trachomatis infection justifies the screening of asymptomatic individuals below 30 years of age. At present, however, 25% of all tests are requested in asymptomatic women above the age of 30. It might be advisable to use the resources for systematic universal screening of younger individuals rather than to continue the current opportunistic screening of older women.

Adolescent↗
PubMed2003

Prevalence of resistance to ampicillin, gentamicin and vancomycin in Enterococcus faecalis and Enterococcus faecium isolates from clinical specimens and use of antimicrobials in five Nordic hospitals.

We determined the species distribution and prevalence of ampicillin resistance, high-level gentamicin resistance (HLGR) and vancomycin resistance among clinical enterococcal isolates from five Nordic laboratories (Bergen, Tromsø, Uppsala, Aarhus and Reykjavik). Isolates represented three different groups: (i) all blood culture isolates from 1999; (ii) consecutive in-patient isolates (maximum 40); and (iii) consecutive outpatient isolates (maximum 40) collected during March to May 2000. Antimicrobial use data were collected at the national and hospital level. A high proportion (31.4%) of Enterococcus faecium was detected among blood culture isolates, in contrast to only 4.2% among isolates from outpatients. Ampicillin resistance was not found in Enterococcus faecalis, in contrast to 48.8% in E. faecium isolates. HLGR rates varied considerably between laboratories (1.1-27.6%). Acquired vancomycin resistance was not detected. There were no significant differences in the prevalences of HLGR between in-patient and outpatient isolates at individual hospitals. A cluster of clonally related ampicillin-resistant and HLGR E. faecium isolates was demonstrated in one of the hospitals. The lowest level of hospital antimicrobial use, the lowest proportion of E. faecium and the lowest prevalence of resistance were observed in Reykjavik. The study showed a relatively low level of resistance in enterococci, as compared with most European countries and the USA. However, there were large differences between hospitals with regard to the relative proportion of E. faecium isolates, their susceptibility to ampicillin and gentamicin, as well as the prevalence of HLGR in E. faecalis isolates. This indicates a potential for further improvement of antibiotic policies, and possibly hospital infection control, to maintain the low resistance levels observed in these countries.

Ampicillin Resistance↗
PubMed2003

Managing partners of people diagnosed with Chlamydia trachomatis: a comparison of two partner testing methods.

OBJECTIVE: To compare the effectiveness of "home sampling" with that of "office sampling" for testing partners to men and women infected with Chlamydia trachomatis. METHOD: A randomised controlled effectiveness trial took place in the general community in Denmark. 1300 index women and 526 index men (>/=18 years) with a positive test result for C trachomatis were identified. Of these, 414 index women and 148 index men gave implied consent. Index patients were randomly assigned to provide their partner(s) through the past 12 months with either (1) a kit by which partner(s) could be tested by home sampling, or (2) a kit by which partner(s) could only be tested by seeing a healthcare professional (office sampling). The mainoutcome measure was the proportion of index patients who had at least one partner tested for C trachomatis. RESULTS: The proportion of index women with at least one partner tested was higher in the home sampling group (0.26) than in the office group (0.12) (difference 0.14; 95% CI 0.10 to 0.19; p<0.0001) and so it was for index men (0.15 v 0.03; difference 0.12; 95% CI 0.07 to 0.16; p<0.0001). Also the proportion of index women for whom at least one partner was identified as infected was higher in the home sampling group compared with the office group (0.11 v 0.07, p=0.01). The corresponding figures for index men were 0.06 v 0.01, p=0.02. CONCLUSION: The effectiveness of partner testing is higher when partners of C trachomatis infected patients are offered home sampling than when they are offered office sampling.

Adult↗
PubMed2002

Intensified microbiological investigations in adult patients admitted to hospital with lower respiratory tract infections.

The objective of this study was to investigate the diagnostic yield of a programme with intensified microbiological investigations in immunocompetent adult patients with lower respiratory tract infections (LRTI). Patients in the study group were included prospectively and consecutively from September 1st 1997 to May 31st 1998 and were compared with a control group from the preceding year. A total of 67 adult patients were included in the study group and they were compared with 122 adult patients in the control group. The study group underwent fibre-optic bronchoscopy (FOB) with bronchoalveolar lavage (BAL). Only 7% in the historic control group were discharged with an aetiological diagnosis of their infections; while the diagnostic yield in the study group increased to 51% of patients. In the study group the presence of new infiltrates on chest X-ray increased the detection of a microbiological aetiology from 37% with no infiltrates to 62% with infiltrates and recent antibiotic therapy reduced the detection of a microbiological cause of infection from 61% in 36 patients who had not received antibiotic therapy to 39% in 31 patients who had received recent antibiotic therapy prior to microbiological sampling. Patients in the study group with known aetiology had higher values of inflammatory markers than patients with unknown aetiology. For Streptococcus pneumoniae infection culture and urine antigen detection were complimentary depending on recent antibiotic therapy since seven of eight culture-positive patients had not received antibiotic therapy within 72 h prior to investigation, while all four patients positive for urine antigens from S. pneumoniae had received antibiotic therapy within 72 h of urine sampling. In conclusion intensified microbiologic investigations increase the diagnostic yield from 7% to 51% of patients in the study group with an aetiologic diagnosis. Routine FOB with BAL had no apparent effect on clinical outcome and seems only justified in selected patients with severe LRTI with infiltrates on chest X-ray and signs of severe inflammation where a high diagnostic yield is achieved.

Aged↗
PubMed2001

[The value of vaginal swabs].

INTRODUCTION: The use of culture of vaginal secretions by physicians and their use of microscopy of vaginal secretions were assessed. METHODS: The study was conducted partly as a registration of all microbiological requests and reports from the Department of Clinical Microbiology in a selected period, and partly as a questionnaire sent to all general practitioners (GPs) and specialists in obstetrics and gynaecology in the county of Arhus. RESULTS: In only 19% of 1,354 vaginal swabs received in a month could the findings lead to a specific antimicrobial treatment; 48% of these cases could be diagnosed by microscopy of vaginal secretions alone. Sixty-four per cent of the physicians returned the questionnaire. Half of the specialists and 60% of the GPs performed microscopy. Twenty-five per cent of the physicians treated patients solely on the basis of clinical symptoms. DISCUSSION: General culture of vaginal secretions has a limited clinical value. The diagnosis in patients complaining of vaginal discharge can often be made by microscopy. There is, however, a need for training GPs in microscopy, as well as specialists.

Denmark↗
PubMed2001

Quantitative culture of bronchoalveolar lavage fluid in community-acquired lower respiratory tract infections.

To evaluate the diagnostic value of quantitative bacterial culture of bronchoalveolar lavage (BAL) fluid obtained by fibreoptic bronchoscopy, 67 consecutive immunocompetent adult patients admitted to hospital with community-acquired lower respiratory tract infections from September 1997 to May 1998 were investigated. Results were compared to the findings in eight healthy control persons investigated in February 1998. There was no difference between study patients and control persons when quantitative culture of total cumulative bacterial findings or bacteria categorized as members of the oropharyngeal normal flora were compared. The culture of normal flora in bronchial washings probably reflects contamination of the lower airways with secretions from upper arways by the fibreoptic procedure itself, as fractionated sampling showed a 10-fold reduct on in quantitative culture results when a primary bronchial washing was compared to a secondary sampling from the same bronchus in the control group. Twenty-four (36%) of 67 patients were cultured as positive in the study group while all control persons were cultured as negative for bacteria categorized as potential pathogens. With a threshold value for positive culture of 10(4) cfu ml(-1) the specificity of lavage culture of potential pathogenic bacteria in relation to actual lower airway infection was 100%. Therefore, quantitative bacterial culture of potential pathogenic bacteria in BAL fluid is very specific but only positive in about one-third of unselected immunocompetent adult patients with a lower respiratory tract infection.

Adult↗
PubMed2001

A procedure for evaluation and documentation of susceptibility test methods using the susceptibility of Klebsiella pneumoniae to ciprofloxacin as a model.

A new procedure for the evaluation and documentation of susceptibility test methods is described. To illustrate the procedure, four basically different susceptibility test methods were examined in a routine laboratory. The test parameter detection of decreased susceptibility to ciprofloxacin (breakpoint MIC 0.25 mg/L) among 94 selected isolates of Klebsiella pneumoniae was used. In addition to comparison of frequency histograms and regression analysis, the accuracies of the susceptibility test methods were determined using the receiver operating characteristic procedure. For each of the methods, the sensitivity (SN), specificity (SP), positive predictive value (PV+) and negative predictive value (PV-) for detection of decreased susceptibility to ciprofloxacin were calculated and plotted against a range of ciprofloxacin inhibition zones determined by the various susceptibility test methods or MICs determined by the Etest (Etest MICs). The results illustrate the accuracy and the robustness of the methods, which can be used to expose the need for training and instruction of laboratory staff. It becomes possible to optimize and justify the choice of inhibition zone breakpoints or Etest MIC breakpoints according to the SN and SP of the method employed. Furthermore, the consequences of adjustments of these breakpoints on the PV+ and PV- can be analysed and related to different clinical and epidemiological situations. We believe that our approach can be used as a model for the evaluation and documentation of susceptibility test methods in general.

Anti-Infective Agents↗
PubMed2001

Effectiveness of a mass media campaign to recruit young adults for testing of Chlamydia trachomatis by use of home obtained and mailed samples.

OBJECTIVE: To evaluate the effectiveness of a structured information campaign aiming to recruit young adults for a Chlamydia trachomatis test by use of a non-invasive, home obtained and mailed sample. METHODS: All individuals aged 21-23 living in Aarhus county, Denmark (30 000 young adults) were offered a mailed home sampling test for C trachomatis as part of a structured 14 week information campaign on chlamydia. The kit for home sampling could be requested by leaving a message on an answering machine or through a website on the internet. RESULTS: During the campaign 119 of 15 000 women (0.8%) and 64 of 15 000 men (0.4%) were tested. Prevalence of infection was 8.4% (10/119) and 7.8% (5/64) in females and males, respectively. Four infections in women (4/10=40%) and three infections in men (3/5=60%) were asymptomatic. CONCLUSIONS: The mass media campaign had only a limited effect, and there is a need for more effective outreach programmes to recruit young asymptomatic individuals for C trachomatis testing.

Adult↗
PubMed2000

Population-based study of the risk and short-term prognosis for bacteremia in patients with liver cirrhosis.

We examined the risk of bacteremia in patients with liver cirrhosis (compared with the risk for all Danish citizens >20 years of age who were living in North Jutland County, Denmark), as well as the type of bacteremia and the 30-day case-fatality rate. We used the Danish National Registry of Patients to identify 1339 patients with liver cirrhosis, and we used the North Jutland County Bacteremia Database to identify episodes of bacteremia. We observed 117 cases of bacteremia in patients with liver cirrhosis (11.0 cases were expected), which yielded a standardized incidence ratio of 10.5 (95% confidence interval [CI], 8.8-12.7). Sixty-two cases of bacteremia were nosocomial infections. There were 53 cases of gram-positive bacteremia, 55 cases of gram-negative bacteremia, and 8 cases of polymicrobial bacteremia (1 case of candidemia was excluded from the analysis). The most common cause of death was bleeding from gastroesophageal varices; the second most common cause of death was infection in the respiratory system. The 30-day case-fatality rate was 0.53 (95% CI, 0.39-0.73). Patients with liver cirrhosis had an increased risk of bacteremia and a poor prognosis.

Adult↗
PubMed2000

Home sampling versus conventional swab sampling for screening of Chlamydia trachomatis in women: a cluster-randomized 1-year follow-up study.

We compared the efficacy of a screening program for urogenital Chlamydia trachomatis infections based on home sampling with that of a screening program based on conventional swab sampling performed at a physician's office. Female subjects, comprising students at 17 high schools in the county of Aarhus, Denmark, were divided into a study group (tested by home sampling) and a control group (tested in a physician's office). We assessed the number of new infections and the number of subjects who reported being treated for pelvic inflammatory disease (PID) at 1 year of follow-up; 443 (51.1%) of 867 women in the intervention group and 487 (58.5%) of 833 women in the control group were available for follow-up. Thirteen (2.9%) and 32 (6.6%) new infections were identified in the intervention group and the control group, respectively (Wilcoxon exact value, P=.026). Nine (2.1%) women in the intervention group and 20 (4.2%) in the control group reported being treated for PID (P=.045), indicating that a screening strategy involving home sampling is associated with a lower prevalence of C. trachomatis and a lower proportion of reported cases of PID.

Adolescent↗
PubMed2000

[Microbiological examination of patients hospitalized in Aarhus municipal hospital].

The purpose of this retrospective study was to evaluate 1) the nature, extent and relevance of the microbiological examination performed before institution of antibiotic treatment, 2) the relevance of the instituted treatment in the light of the microbiological findings or clinical diagnosis of infection. A minimum of requirements concerning microbiological examination was put forward for each clinical diagnosis of infection. Among patients with the diagnosis of sepsis, cystitis or pneumonia, 33%, 80% and 6.5%, respectively, fulfilled the minimum requirements, no attempt at microbiological examination was performed in 4.8%, 10%, and 32%, respectively. There is a need for education in relevant use of clinical microbiology e.g. samples related to focus of infection, and more consistency in the use of microbiological results.

Anti-Bacterial Agents↗
PubMed2000

Prolonged persistence on the ocular surface of fortified gentamicin ointment as compared to fortified gentamicin eye drops.

PURPOSE: A comparative study on the elimination of gentamicin from the ocular surface and the concentration of gentamicin in the anterior chamber following application of either an ointment or eye drops containing equal concentrations (1.5%) of gentamicin. METHODS: A disc-diffusion test was used to determine the concentration of gentamicin in fornix inferior of 10 persons. The anterior chamber concentration of gentamicin was determined in 5 cataract patients by the TDX analyzer, Abbot Laboratories, II., USA. RESULTS: Ten minutes following application, the concentration of gentamicin was significantly higher in the eyes receiving ointment (310.6 mg/L) compared to drops (45 mg/L) (p<0.01). Furthermore, gentamicin could be detected 40 minutes after application in the eyes receiving ointment compared to 10 minutes in the eyes receiving drops. The anterior chamber concentration of gentamicin after application of either drops or ointment was lower than 0.6 mg/L and thus below detection limit. CONCLUSIONS: The persistence of gentamicin ointment was significantly longer on the ocular surface as compared to gentamicin eye drops. Gentamycin ointment may thus provide a means to reduce the high application frequency presently in use with eye drops to treat bacterial keratitis and thereby reduce patient inconvenience, especially during nighttime.

Adult↗
PubMed2000

Bacteraemia caused by hospital-type micro-organisms during hospital stay.

A sharp transition between community-type and hospital-type pathogens at the second or third day of hospital stay is often assumed. This study aimed to test whether such a threshold phenomenon exists for bloodstream infections and to examine the relationship between the proportion of infections caused by hospital-type pathogens and length of stay in the hospital. Blood stream infections were studied in a referral and a university hospital in west Denmark, and a university hospital in central Israel during three study periods (1994-1996, 1992-1995, 1989-1995 in the three hospitals respectively). No threshold effect at 2-3 days stay in the hospital could be demonstrated. However the percentage of Pseudomonas aeruginosa bloodstream infections increased constantly in the three hospitals from 1%, 1% and 7% during the first 2 days to 7%, 4%, and 14% during the third week of hospital stay (P<0.01 for all three comparisons-chi(2)for linear trends). For Candida sp. the increase was from 0%, 2%, 1% during the first 2 days to 3%, 4%, and 9% during the third week, P<0.05. Methicillin-resistant Staphylococcus aureus in Israel increased from 26% of the total number of S. aureus during the first 2 days to 69% during the third week, P<0.0001. For penicillin-resistant S. aureus in Denmark, the percentages were 84% and 100%, P<0.05.The percentage of infections caused by hospital-type pathogens increased almost linearly during the first 3 weeks of hospital stay, with no threshold effect. This trend should be taken into account when prescribing empirical therapy for nosocomial infections.

Bacteremia↗
PubMed2000

High-resolution genotyping of Chlamydia trachomatis from recurrent urogenital infections.

A method for Chlamydia trachomatis restriction fragment length polymorphism (RFLP) analysis and complete sequencing of omp1 was developed for use on samples collected at home, and results were compared. Genotyping by sequencing was superior to RFLP analysis. The omp1 gene in 31 clinical strains harbored few mutations compared to the same gene in ATCC reference strains. Follow-up samples obtained during a 24-week period from 31 patients showed recurrence with the same genotype in five cases and a new genotype in one case.

Bacterial Outer Membrane Proteins↗
PubMed1999

[Detection of Chlamydia trachomatis infection among young people. The effect of home-sampling and mailing the samples].

Genital Chlamydia trachomatis infection is common and treatable, but often asymptomatic. New diagnostic strategies targeting healthy individuals are therefore needed. The 17 high schools in Aarhus County, Denmark, comprising 8909 students, were cluster-randomized into an intervention group which was offered examination by mailing a urine sample (males and females) and a vaginal flush sample (females) directly to the laboratory, and a control group who were offered examination by a physician. Ninety-three percent (867/928) of the sexually experienced female responders underwent examination in the intervention group, compared with 8% (63/833) in the control group (p < 0.001). The corresponding figures for males were 97%, (430/442) and 2% (4/246), respectively (p < 0.001). Also statistically significantly more infected females and males were found in the intervention group (43 females and 11 males in the intervention group vs. five females and one male in the control group). Home sampling improves the diagnosis of C trachomatis infection among apparently healthy young individuals.

Adolescent↗
PubMed1999

Impact of menstrual cycle on the diagnostic performance of LCR, TMA, and PCE for detection of Chlamydia trachomatis in home obtained and mailed vaginal flush and urine samples.

OBJECTIVES: To assess the impact of the menstrual cycle on the diagnostic performance of various assays for detection of Chlamydia trachomatis in home obtained and mailed vaginal flush and urine specimens. METHODS: A ligase chain reaction assay (LCR; Abbott Laboratories), a transcription mediated amplification assay (TMA; Gen-Probe), and an enzyme amplified immunoassay (PCE; Dako Diagnostics) were evaluated for their validity in detecting C trachomatis in vaginal flush, first void urine, and midstream urine specimens obtained by female high school students at home and mailed directly to the diagnostic laboratory. RESULTS: C trachomatis was detected in 45 of 889 females (5.1%). The vaginal flush material was positive by TMA and LCR in 84% and 82% of the chlamydia positive females, respectively. First void urine was positive by TMA in 73% and by LCR in 49% of the cases. Midstream urine was positive by TMA and LCR in 69% and 42% of the females, respectively. On a pool of first void and midstream urine, PCE detected 49% of the chlamydia positive females. The overall prevalence of C trachomatis increased with increasing time after the last menstrual bleeding. In urine samples, but not vaginal flush specimens, obtained 3 weeks after the last menstrual bleeding, the sensitivities of TMA, LCR, and PCE decreased markedly suggesting that inhibitors to the assays are excreted in the urine but not in vaginal secretions at this time. CONCLUSION: Vaginal flush samples are superior to urines for detection of chlamydia infections in females. In screening of young asymptomatic females, samples should be obtained in the latter part of the menstrual cycle.

Adolescent↗