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Search Results: 1 - 10 of 224777 matches for " Henrik C Sch nheyder "
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Existing data sources for clinical epidemiology: The North Denmark Bacteremia Research Database
Henrik C Sch nheyder, Mette S gaard
Clinical Epidemiology , 2010, DOI: http://dx.doi.org/10.2147/CLEP.S10139
Abstract: ting data sources for clinical epidemiology: The North Denmark Bacteremia Research Database Methodology (3520) Total Article Views Authors: Henrik C Sch nheyder, Mette S gaard Published Date June 2010 Volume 2010:2 Pages 171 - 178 DOI: http://dx.doi.org/10.2147/CLEP.S10139 Henrik C Sch nheyder1, Mette S gaard1,2 1Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark; 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark Abstract: Bacteremia is associated with high morbidity and mortality. Improving prevention and treatment requires better knowledge of the disease and its prognosis. However, in order to study the entire spectrum of bacteremia patients, we need valid sources of information, prospective data collection, and complete follow-up. In North Denmark Region, all patients diagnosed with bacteremia have been registered in a population-based database since 1981. The information has been recorded prospectively since 1992 and the main variables are: the patient’s unique civil registration number, date of sampling the first positive blood culture, date of admission, clinical department, date of notification of growth, place of acquisition, focus of infection, microbiological species, antibiogram, and empirical antimicrobial treatment. During the time from 1981 to 2008, information on 22,556 cases of bacteremia has been recorded. The civil registration number makes it possible to link the database to other medical databases and thereby build large cohorts with detailed longitudinal data that include hospital histories since 1977, comorbidity data, and complete follow-up of survival. The database is suited for epidemiological research and, presently, approximately 60 studies have been published. Other Danish departments of clinical microbiology have recently started to record the same information and a population base of 2.3 million will be available for future studies.
Blood culture status and mortality among patients with suspected community-acquired bacteremia: a population-based cohort study
Mette S?gaard, Mette N?rgaard, Lars Pedersen, Henrik T S?rensen, Henrik C Schnheyder
BMC Infectious Diseases , 2011, DOI: 10.1186/1471-2334-11-139
Abstract: This cohort study included 29,273 adults with blood cultures performed within the first 2 days following hospital admission to an internal medical ward in northern Denmark during 1995-2006. We computed product limit estimates and used Cox regression to compute adjusted mortality rate ratios (MRRs) within 0-2, 3-7, 8-30, and 31-180 days following admission for bacteremia patients compared to culture-negative patients.Mortality in 2,648 bacteremic patients and 26,625 culture-negative patients was 4.8% vs. 2.0% 0-2 days after admission, 3.7% vs. 2.7% 3-7 days after admission, 5.6% vs. 5.1% 8-30 days after admission, and 9.7% vs. 8.7% 31-180 days after admission, corresponding to adjusted MRRs of 1.9 (95% confidence interval (CI): 1.6-2.2), 1.1 (95% CI: 0.9-1.5), 0.9 (95% CI: 0.8-1.1), and 1.0 (95% CI: 0.8-1.1), respectively. Mortality was higher among patients with Gram-positive (adjusted 0-2-day MRR 1.9, 95% CI: 1.6-2.2) and polymicrobial bacteremia (adjusted 0-2-day MRR 3.5, 95% CI: 2.2-5.5) than among patients with Gram-negative bacteremia (adjusted 0-2-day MRR 1.5, 95% CI 1.2-2.0). After the first 2 days, patients with Gram-negative bacteremia had the same risk of dying as culture-negative patients (adjusted MRR 0.8, 95% CI: 0.5-1.1). Only patients with polymicrobial bacteremia had increased mortality within 31-180 days following admission (adjusted MRR 1.3, 95% CI: 0.8-2.1) compared to culture-negative patients. The association between blood culture status and mortality did not differ substantially by level of comorbidity.Community-acquired bacteremia was associated with an increased risk of mortality in the first week of medical ward admission. Higher mortality among patients with Gram-positive and polymicrobial bacteremia compared with patients with Gram-negative bacteremia and negative cultures emphasizes the prognostic importance of these infections.Community-acquired bacteremia is a serious condition with a hospitalization rate of approximately 80 per 100,000
Stable incidence and continued improvement in short term mortality of Staphylococcus aureus bacteraemia between 1995 and 2008
Mejer Niels,Westh Henrik,Schnheyder Henrik C,Jensen Allan G
BMC Infectious Diseases , 2012, DOI: 10.1186/1471-2334-12-260
Abstract: Background The objective of this study was to assess temporal changes in incidence and short term mortality of Staphylococcus aureus bacteraemia (SAB) from 1995 through 2008. Methods The study was conducted as a nation-wide observational cohort study with matched population controls. The setting was hospitalized patients in Denmark 1995-2008. Uni- and multivariate analyses were used to analyze the hazard of death within 30 days from SAB. Results A total of 16 330 cases of SAB were identified: 57% were hospital-associated (HA), 31% were community-acquired (CA) and 13% were of undetermined acquisition. The overall adjusted incidence rate remained stable at 23 per 100 000 population but the proportion of SAB cases older than 75 years increased significantly. Comorbidity in the cohort as measured by Charlson comorbidity index (CCI) score and alcohol-related diagnoses increased over the study period. In contrast, among the population controls the CCI remained stable and alcohol-related diagnoses increased slightly. For HA SAB crude 30-day mortality decreased from 27.8% to 21.8% (22% reduction) whereas the change for CA SAB was small (26.5% to 25.8%). By multivariate Cox regression, age, female sex, time period, CCI score and alcohol-related diagnoses were associated with increased mortality regardless of mode of acquisition. Conclusions Throughout a 14-year period the overall incidence of SAB remained stable while the overall short term prognosis continued to improve despite increased age and accumulation of comorbidity in the cohort. However, age and comorbidity were strong prognostic indicators for short term mortality.
Clinical features and predictors of mortality in admitted patients with community- and hospital-acquired legionellosis: A Danish historical cohort study
Sanne Jespersen, Ole S S?gaard, Henrik C Schnheyder, Michael J Fine, Lars ?stergaard
BMC Infectious Diseases , 2010, DOI: 10.1186/1471-2334-10-124
Abstract: We identified hospitalized cases of legionellosis in 4 Danish counties from January 1995 to December 2005 using the Danish national surveillance system and databases at departments of clinical microbiology. Clinical and laboratory data were retrieved from medical records; vital status was obtained from the Danish Civil Registration System. We calculated 30- and 90-day case fatality rates and identified independent predictors of mortality using logistic regression analyses.We included 272 cases of CAL and 60 cases of HAL. Signs and symptoms of HAL were less pronounced than for CAL and time from in-hospital symptoms to legionellosis diagnosis was shorter for CAL than for HAL (5.5 days vs. 12 days p < 0.001). Thirty-day case fatality was 12.9% for CAL and 33.3% for HAL; similarly 90-day case fatalities in the two groups were 15.8% and 55.0%, respectively. In a logistic regression analysis (excluding symptoms and laboratory tests) age >65 years (OR = 2.6, 95% CI: 1.1-5.9) and Charlson comorbidty index ≥2 (OR = 2.7, 95% CI: 1.1-6.5) were associated with an increased risk of death in CAL. We identified no statistically significant predictors of 30-day mortality in HAL.Signs and symptoms were less pronounced in HAL compared to CAL. Conversely, 30-day case fatality was almost 3 times higher. Clinical awareness is important for the timely diagnosis and treatment especially of HAL. There is a need for further studies of prognostic factors in order to improve the therapeutic approach to legionellosis and potentially reduce mortality.Legionellosis is caused by exposure to the small intracellular gram-negative bacterium Legionella from water sources in the indoor or outdoor environment [1]. Two to fifteen percent of all hospitalizations for community-acquired pneumonias in Europe and North America are caused by Legionella and recent studies suggest that rates of legionellosis may be increasing [2]. The optimal antibiotic treatment of legionellosis has never been investigated in
Utilization of serology for the diagnosis of suspected Lyme borreliosis in Denmark: Survey of patients seen in general practice
Ram B Dessau, Jette M Bangsborg, Tove Ejlertsen, Sigurdur Skarphedinsson, Henrik C Schnheyder
BMC Infectious Diseases , 2010, DOI: 10.1186/1471-2334-10-317
Abstract: A survey was performed in order to characterize test utilization and clinical features of patients investigated for serum antibodies to Borrelia burgdorferi sensu lato. During one calendar year a questionnaire was sent to the general practitioners who had ordered LB serology from patients in three Danish counties (population 1.5 million inhabitants). Testing was done with a commercial ELISA assay with purified flagella antigen from a Danish strain of B. afzelii.A total of 4,664 patients were tested. The IgM and IgG seropositivity rates were 9.2% and 3.3%, respectively. Questionnaires from 2,643 (57%) patients were available for analysis. Erythema migrans (EM) was suspected in 38% of patients, Lyme arthritis/disseminated disease in 23% and early neuroborreliosis in 13%. Age 0-15 years and suspected EM were significant predictors of IgM seropositivity, whereas suspected acrodermatitis was a predictor of IgG seropositivity. LB was suspected in 646 patients with arthritis, but only 2.3% were IgG seropositive. This is comparable to the level of seropositivity in the background population indicating that Lyme arthritis is a rare entity in Denmark, and the low pretest probability should alert general practitioners to the possibility of false positive LB serology. Significant predictors for treating the patient were a reported tick bite and suspected EM.A detailed description of the utilization of serology for Lyme borreliosis with rates of seropositivity according to clinical symptoms is presented. Low rates of seropositivity in certain patient groups indicate a low pretest probability and there is a notable risk of false positive results. 38% of all patients tested were suspected of EM, although this is not a recommended indication due to a low sensitivity of serological testing.Lyme borreliosis (LB) is a diagnosis frequently considered in general practice and a large number of samples are submitted to the diagnostic laboratory for serological testing. The use of antibody
Existing data sources for clinical epidemiology: The North Denmark Bacteremia Research Database
Henrik C Schønheyder,Mette Søgaard
Clinical Epidemiology , 2010,
Abstract: Henrik C Sch nheyder1, Mette S gaard1,21Department of Clinical Microbiology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark; 2Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, DenmarkAbstract: Bacteremia is associated with high morbidity and mortality. Improving prevention and treatment requires better knowledge of the disease and its prognosis. However, in order to study the entire spectrum of bacteremia patients, we need valid sources of information, prospective data collection, and complete follow-up. In North Denmark Region, all patients diagnosed with bacteremia have been registered in a population-based database since 1981. The information has been recorded prospectively since 1992 and the main variables are: the patient’s unique civil registration number, date of sampling the first positive blood culture, date of admission, clinical department, date of notification of growth, place of acquisition, focus of infection, microbiological species, antibiogram, and empirical antimicrobial treatment. During the time from 1981 to 2008, information on 22,556 cases of bacteremia has been recorded. The civil registration number makes it possible to link the database to other medical databases and thereby build large cohorts with detailed longitudinal data that include hospital histories since 1977, comorbidity data, and complete follow-up of survival. The database is suited for epidemiological research and, presently, approximately 60 studies have been published. Other Danish departments of clinical microbiology have recently started to record the same information and a population base of 2.3 million will be available for future studies.Keywords: bloodstream infection, epidemiology, register, population-based
Venous Thromboembolism after Community-Acquired Bacteraemia: A 20-year Danish Cohort Study
Michael Dalager-Pedersen, Mette S?gaard, Henrik C. Schnheyder, Reimar W. Thomsen, John A. Baron, Henrik Nielsen
PLOS ONE , 2014, DOI: 10.1371/journal.pone.0086094
Abstract: Background Infections may increase the risk for venous thromboembolism (VTE), but little is known about VTE risk associated with community-acquired bacteraemia (CAB). We examined the risk for VTE within one year of CAB in comparison to that in matched controls. Methods We conducted a population-based cohort study in North Denmark 1992–2011, using data from high-quality health-care databases. We included 4,213 adult CAB patients who had positive blood cultures drawn on the day of hospital admission, 20,084 matched hospitalised controls admitted for other acute medical illness, and 41,121 matched controls from the general population. We computed 0–90 and 91–365 day absolute risks for hospital-diagnosed VTE and used regression analyses with adjustment for confounding factors to compare the risk for VTE in bacteraemia patients and controls. Results Among CAB patients, 1.1% experienced VTE within 90 days of admission and 0.5% during 91–365 days after admission. The adjusted 90-day odds ratio (OR) for VTE was 1.9 (95% CI 1.4–2.7) compared with hospitalised controls, and 23.4 (95% CI 12.9–42.6) compared with population controls. During 91–365 days after CAB admission, the VTE risk remained moderately increased (adjusted hazard ratio vs. hospitalised controls, 1.4; 95% CI 0.8–2.5, and vs. population controls, 1.9; 95% CI 1.0–3.3). Compared to hospitalised controls, the 90-day VTE risk increase was greater for Gram-positive infection (adjusted OR 2.5; 95% CI 1.6–4.1) than for Gram-negative infection (adjusted OR, 1.2; 95% CI 0.7–2.1), partly due to a high risk after Staphylococcus aureus infection (3.6%). Conclusion The risk for VTE is substantially increased within 90 days after community-acquired bacteraemia when compared to hospitalised controls and population controls. However, the absolute risk of VTE following CAB is low.
International travel and the risk of hospitalization with non-typhoidal Salmonella bacteremia. A Danish population-based cohort study, 1999-2008
Kristoffer Koch, Brian Kristensen, Hanne M Holt, Steen Ethelberg, K?re M?lbak, Henrik C Schnheyder
BMC Infectious Diseases , 2011, DOI: 10.1186/1471-2334-11-277
Abstract: We conducted a 10-year population-based cohort study of all patients hospitalized with non-typhoidal Salmonella bacteremia in three Danish counties (population 1.6 million). We used denominator data on Danish travellers to assess the risk per 100,000 travellers according to age and travel destination. We used patients contemporaneously diagnosed with travel-related Salmonella gastroenteritis as reference patients to estimate the relative risk of presenting with travel-related bacteremia as compared with gastroenteritis. To evaluate clinical outcomes, we compared patients with travel-related bacteremia and patients with domestically acquired bacteremia in terms of length of hospital stay, number of extraintestinal focal infections and mortality after 30 and 90 days.We identified 311 patients hospitalized with non-typhoidal Salmonella bacteremia of whom 76 (24.4%) had a history of international travel. The risk of travel-related bacteremia per traveller was highest in the age groups 15-24 years (0.8/100,000 travellers) and 65 years and above (1.2/100,000 travellers). The sex- and age-adjusted relative risk of presenting with bacteremia was associated with travel to Sub-Saharan Africa (odds ratio 18.4; 95% confidence interval [6.9-49.5]), the Middle East (10.6; [2.1-53.2]) and South East Asia (4.0; [2.2-7.5]). We found high-risk countries in the same three regions when estimating the risk per traveller according to travel destination. Patients hospitalized with travel-related bacteremia had better clinical outcomes than patients with domestically acquired bacteremia, they had a shorter length of hospital stay (8 vs. 11 days), less extraintestinal focal infections (5 vs. 31 patients) and a lower risk of death within both 30 days (relative risk 0.2; [0.1-0.7]) and 90 days (0.3; [0.1-0.7]). A healthy traveller effect was a plausible explanation for the observed differences in outcomes.International travel is a notable risk factor for being hospitalized with non-typhoidal
Rationale for and protocol of a multi-national population-based bacteremia surveillance collaborative
Kevin B Laupland, Henrik C Schnheyder, Karina J Kennedy, Outi Lyytik?inen, Louis Valiquette, John Galbraith, Peter Collignon, Deirdre L Church, Daniel B Gregson, Pamela Kibsey
BMC Research Notes , 2009, DOI: 10.1186/1756-0500-2-146
Abstract: The founding collaborative participants represent six regions in four countries in three continents with a combined annual surveillance population of more than 8 million residents.Future studies from this collaborative should lead to a better understanding of the epidemiology of bloodstream infections.Bloodstream infections are among the most important causes of death in developed countries and cause significant morbidity and healthcare cost [1-5]. Bloodstream infections may arise in community-based patients, or may complicate patients course admitted to hospital as nosocomial infections. Population-based studies conducted in Denmark (1981–1994), Finland (1995–2002), and the United States (2003–2005) have reported overall incidence rates ranging from 76 to 189 per 100,000/year with the highest rates observed in the most recent years [2,4,5]. One study from Canada reported that community-onset bloodstream had a similar acute burden of disease as each of major trauma, stroke, and myocardial infarction [1].Population-based surveillance has been recognized as an optimal means to define burden of disease, evaluate risk factors for acquiring infections, and for monitoring temporal trends in occurrence and resistance. Because all episodes of disease occurring in a defined population at risk are included in these designs, selection bias is minimized and calculation of incidence and mortality rates are facilitated [6]. Several regions worldwide have reported on population-based bloodstream infection surveillance data or systems including Australia [7,8], Canada [1,9-11], Denmark [12-15], Iceland [16,17], Finland [4,18-20], and the United States [2]. National programs with high coverage for selected blood culture pathogens are also operative in a number of European countries [21-24]. However, to date approaches between intercontinental regions have not been coordinated.A coordinated multi-national effort would have numerous potential benefits. First, inter-regional (national,
Salmonella enterica bacteraemia: a multi-national population-based cohort study
Kevin B Laupland, Henrik C Schnheyder, Karina J Kennedy, Outi Lyytik?inen, Louis Valiquette, John Galbraith, Peter Collignon, the International Bacteremia Surveillance Collaborative
BMC Infectious Diseases , 2010, DOI: 10.1186/1471-2334-10-95
Abstract: We conducted population-based laboratory surveillance for all salmonella bacteremias in six regions (annual population at risk 7.7 million residents) in Finland, Australia, Denmark, and Canada during 2000-2007.A total of 622 cases were identified for an annual incidence of 1.02 per 100,000 population. The incidence of typhoidal (serotypes Typhi and Paratyphi) and non-typhoidal (other serotypes) disease was 0.21 and 0.81 per 100,000/year. There was major regional and moderate seasonal and year to year variability with an increased incidence observed in the latter years of the study related principally to increasing rates of non-typhoidal salmonella bacteremias. Advancing age and male gender were significant risk factors for acquiring non-typhoidal salmonella bacteremia. In contrast, typhoidal salmonella bacteremia showed a decreasing incidence with advancing age and no gender-related excess risk.Salmonella enterica is an important emerging pathogen and regional determinants of risk merits further investigation.Salmonella enterica is a major cause of invasive infections worldwide [1-7]. Although a wide range of serotypes may cause human disease, they may be broadly grouped into the typhoidal species that are specific human pathogens and includes serotypes Typhi and Paratyphi, and other serotypes that are primarily spread to humans from animal sources (non-typhoidal). In high income countries, a major risk factor for acquiring typhoidal salmonella bacteremia is travel to an endemic region [8,9]. Foreign travel is also a risk factor for acquiring non-typhoidal salmonella infections, and several reports have highlighted the spread of resistant species globally [10,11]. However, non-typhoidal salmonella may frequently cause human disease in high income countries and in these cases risk factors include exposure to contaminated food, extremes of age, and the presence of a number of co-morbid illnesses [12-16].In order to best establish the distribution and determinants of a
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