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  • 1.
    Starlander, Gustaf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology.
    Dissemination of Multiresistant Bacteria: Their Selection, Transmission, Virulence and Resistance2019Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Multiresistant bacteria are an emerging threat in modern medicine. Consumption of antimicrobial agents among humans, animals and in agriculture causes a selection of resistance genes. Dissemination of bacteria carrying resistance genes occurs both globally and locally, and hospital settings pose a special risk for spread when staff, environment and vulnerable patients interact. The overall aim of this thesis was to analyse underlying factors that facilitate the dissemination of multiresistant pathogenic bacteria in hospital settings.

    Clusters of resistant bacteria from six occasions were investigated. Vancomycin-Resistant Enterococci (VRE), Methicillin-Resistant Staphylococcus pseudintermedius (MSRP), ESBL-producing Escherichia coli and Klebsiella pneumoniae, and carbapenemase-producing Pseudomonas aeruginosa were analysed by a range of methods, from cultures on broth to PCR and whole genome sequencing. Type of resistance, clonality, virulence factors, mobile genetic elements, epidemiology, survival in the environment, and patient history were examined variously depending on study.

    The results showed that VRE resistance genes can be acquired during treatment with vancomycin. Furthermore, contamination of the hospital environment could quickly cause an outbreak, when patients are frequently relocated and exposition to contaminated rooms increase. Resistant bacteria emerging among companion animals, such as the dog-associated MRSP, can pose a zoonotic threat, when a virulent clone finds a new niche in humans.

    The ability of Gram-negative bacteria to survive in a hospital environment is probably better than expected, given the right prerequisites; incorrect use of sinks enabled the spread of ESBL-producing K. pneumoniae and carbapenemase-producing P. aeruginosa. Additionally, the survival on hospital associated materials was longer for ESBL-producing E. coli than the AmpC-producing counterpart, which could tell part of why ESBL-producing E. coli is increasing. Hence, the survival in the environment calls for consideration when choosing materials and equipment for hospitals and nursing homes.

    Exchange of bacteria occurs continuously between humans and our surroundings. Outbreaks of multiresistant bacteria are rare in Sweden but expose the weaknesses in healthcare when occurring. The organization, materials and equipment of hospitals facilitate the dissemination of resistant bacteria, as does animals and humans around us and even the genes in our own microbiota.

  • 2.
    Starlander, Gustaf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Borjesson, Stefan
    Gronlund-Andersson, Ulrika
    Tellgren-Roth, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Melhusa, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Cluster of Infections Caused by Methicillin-Resistant Staphylococcus pseudintermedius in Humans in a Tertiary Hospital2014In: Journal of Clinical Microbiology, ISSN 0095-1137, E-ISSN 1098-660X, Vol. 52, no 8, p. 3118-3120Article in journal (Refereed)
    Abstract [en]

    The dog-associated Staphylococcus pseudintermedius is a rare pathogen in humans. Here we describe a cluster of infections caused by the methicillin-resistant S. pseudintermedius clone ST71-J-t02-II-III. It involved four elderly patients at a tertiary hospital. Three patients had wound infections, and the strain had a tendency to cause bullous skin lesions.

  • 3.
    Starlander, Gustaf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Fraenkel, Carl-Johan
    Tano, Eva
    Klintstedt, Markus
    Sütterlin, Susanne
    Melhus, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    The first Swedish outbreak with VIM-2-producing Pseudomonas aeruginosa was prolonged and probably due to contaminated hospital sinksManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Metallo-β-lactamase (MBL)-producing Pseudomonas aeruginosa is an increasing clinical problem worldwide. VIM-2 is the predominant enzyme, and it has been linked to several outbreaks. During the spring of 2006, a cluster of patients were colonized or infected with multiresistant Pseudomonas aeruginosa at two neighbouring hospitals in southeast Sweden.

    Aim: To describe the first documented outbreak of a VIM-2-producing P. aeruginosa strain in Sweden.

    Methods: The isolates were characterized with PCR, pulse-field gel electrophoresis (PFGE), and whole genome sequencing. Patient charts, laboratory records and hygiene routines were reviewed, and patients, staff and the environment were screened.

    Findings: The investigation revealed that it was a clonal outbreak of a VIM-2-producing P. aeruginosa strain susceptible only to gentamicin and colistin. It belonged to the high-risk clonal complex 111. No direct contact between patients could be established, but most of them had stayed in the same room/wards with weeks to months apart. Environmental cultures from two sinks yielded growth of P. aeruginosa with the same PFGE-pattern as the patient isolates. The outbreak ended when control measures against the sinks were taken.

    Conclusions: Contaminated hospital sinks were the probable reservoir in the first nosocomial outbreak of MBL-producing P. aeruginosa in Sweden. When facing prolonged outbreaks with this bacterium, sinks and other water sources in the hospital environment should be considered. By implementing proactive control measures to limit the bacterial load in sinks and plumbing systems, the waterborne transmission of P. aeruginosa could probably be reduced.

  • 4.
    Starlander, Gustaf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Melhus, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Minor outbreak of extended-spectrum beta-lactamase-producing Klebsiella pneumoniae in an intensive care unit due to a contaminated sink2012In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 82, no 2, p. 122-124Article in journal (Refereed)
    Abstract [en]

    During a period of seven months four patients on the neurosurgical intensive care unit at a tertiary care hospital in Sweden became infected or colonized by an extended-spectrum beta-lactamase-producing Klebsiella pneumoniae strain. The investigation revealed that the source of the outbreak was a contaminated sink. By replacing the sink and its plumbing and improving routines regarding sink practices, the outbreak was successfully controlled.

  • 5.
    Starlander, Gustaf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Sütterlin, Susanne
    Tellgren-Roth, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Melhus, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Biochemistry and Microbiology.
    The Initial Epidemiology of a Major Clonal Outbreak Caused by VanB-Carrying Enterococcus faecium Clone ST192Manuscript (preprint) (Other academic)
  • 6.
    Starlander, Gustaf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Tellgren-Roth, Christian
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Melhus, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Infectious Diseases.
    Fatal acquisition of vanD gene during vancomycin treatment of septicaemia caused by Enterococcus faecium2016In: Journal of Hospital Infection, ISSN 0195-6701, E-ISSN 1532-2939, Vol. 92, no 4, p. 409-410Article in journal (Refereed)
  • 7.
    Starlander, Gustaf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Wirén, Marcus
    Melhus, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    First documented case of a Staphylococcus lugdunensis strain carrying the mecA gene in Northern Europe2011In: Infection Ecology & Epidemiology, ISSN 2000-8686, E-ISSN 2000-8686, Vol. 1, p. 8410-Article in journal (Refereed)
    Abstract [en]

    Staphylococcus lugdunensis is a clinically common wound pathogen belonging to coagulase-negative staphylococci. We herein report the first case of a S. lugdunensis isolate carrying the mecA gene in Northern Europe.

  • 8.
    Starlander, Gustaf
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Yin, Hong
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Edquist, Petra
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Melhus, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical Microbiology and Infectious Medicine, Clinical Bacteriology.
    Survival in the environment is a possible key factor for the expansion of Escherichia coli strains producing extended-spectrum beta-lactamases2014In: Acta Pathologica, Microbiologica et Immunologica Scandinavica (APMIS), ISSN 0903-4641, E-ISSN 1600-0463, Vol. 122, no 1, p. 59-67Article in journal (Refereed)
    Abstract [en]

    Acquired resistance to cephalosporins in Enterobacteriaceae is a global problem. After an outbreak at Uppsala University Hospital of extended-spectrum -lactamase (ESBL)-positive Klebsiella pneumoniae producing CTX-M-15, there was a shift from AmpC to ESBL production among Escherichia coli isolates. To explore the basis for this epidemiological shift, 46 E. coli isolates (ESBLs, n=23; AmpC, n=23) were characterized with regard to genetic relatedness, -lactamase, replicon and integron types, antibiotic resistance profiles, and genes encoding virulence factors. In addition, the survival in the environment and on hospital-associated materials was analysed. CTX-M-15 was the most frequent ESBL (78%). Only three (13%) of the AmpC enzymes were harboured on plasmids (CMY-2, DHA-1). Independent of plasmid-mediated beta-lactamase, IncF plasmids predominated and only class I integrons were detected. The ESBL producers carried more virulence genes (p=0.04), exhibited a broader resistance phenotype (p=0.01) and survived significantly longer (p=0.03) on different materials than the AmpC-producing isolates. In conclusion, ESBL-producing isolates had properties which are likely to augment their competitiveness. Apart from antibiotic resistance and virulence factors, extended survival in the environment could be a selective trait for successful ESBL-producing E. coli strains.

1 - 8 of 8
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