Scandinavia is considered a region with a low prevalence of antimicrobial resistance. However, the number of multidrug-resistant (MDR) Gram-negative bacteria is increasing, including metallo-␤-lactamase (MBL)-producing Pseudomonas aeruginosa. In this study MBL-producing P. aeruginosa isolates identified in Norway (n ‫؍‬ 4) and Sweden (n ‫؍‬ 9) from 1999 to 2007 were characterized. Two international clonal complexes (CC), CC111 (n ‫؍‬ 8) and CC235 (n ‫؍‬ 2), previously associated with MBL-producing isolates, were dominant. CC111 isolates (ST111/229; serotype O12; bla VIM-2 ) included clonally related isolates identified in Skåne County, Sweden (n ‫؍‬ 6), and two isolates associated with importation from Greece and Denmark. In all CC111 isolates, bla VIM-2 was located in integron In59.2 or In59 variants. The two CC235 isolates (ST235/ST230; serotype O11; bla VIM-4 ) were imported from Greece and Cyprus, were possibly clonally related, and carried bla VIM-4 in two different integron structures. Three isolates imported from Ghana (ST233; serotype O6; bla VIM-2 ), Tunisia (ST654; serotype O11; bla VIM-2 ), and Thailand (ST260; serotype O6; bla IMP-14 ) were clonally unrelated. ST233 was part of a new CC (CC233) that included other MBL-producing isolates, while ST654 could also be part of a new CC associated with MBL producers. In the isolates imported from Ghana and Tunisia, bla VIM-2 was part of unusual integron structures lacking the 3 conserved segment and associated with transposons. The bla VIM gene was found to be located on the chromosome in all isolates. Known risk factors for acquisition of MBL were reported for all patients except one. The findings suggest that both import of successful international clones and local clonal expansion contribute to the emergence of MBL-producing P. aeruginosa in Scandinavia.

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Compared to truly negative cultures, false-positive blood cultures not only increase laboratory work but also prolong lengths of patient stay and use of broad-spectrum antibiotics, both of which are likely to increase antibiotic resistance and patient morbidity. The increased patient suffering and surplus costs caused by blood culture contamination motivate substantial measures to decrease the rate of contamination, including the use of dedicated phlebotomy teams. The present study evaluated the effect of a simple informational intervention aimed at reducing blood culture contamination at Skåne University Hospital (SUS), Malmö, Sweden, during 3.5 months, focusing on departments collecting many blood cultures. The main examined outcomes of the study were pre-and postintervention contamination rates, analyzed with a multivariate logistic regression model adjusting for relevant determinants of contamination. A total of 51,264 blood culture sets were drawn from 14,826 patients during the study period (January 2006 to December 2009). The blood culture contamination rate preintervention was 2.59% and decreased to 2.23% postintervention (odds ratio, 0.86; 95% confidence interval, 0.76 to 0.98). A similar decrease in relevant bacterial isolates was not found postintervention. Contamination rates at three auxiliary hospitals did not decrease during the same period. The effect of the intervention on phlebotomists' knowledge of blood culture routines was also evaluated, with a clear increase in level of knowledge among interviewed phlebotomists postintervention. The present study shows that a relatively simple informational intervention can have significant effects on the level of contaminated blood cultures, even in a setting with low rates of contamination where nurses and auxiliary nurses conduct phlebotomies.Blood cultures are commonly contaminated, with contaminated cultures representing as many as 50% of positive cultures (1). Compared to truly negative cultures, false-positive (contaminated) blood cultures not only increase laboratory work but also prolong lengths of patient stay and increase the use of broad-spectrum antibiotics, with negative consequences for antibiotic resistance and patient morbidity. Furthermore, false-positive results can cause confusion regarding antibiotic regimens, endangering patient safety (2, 5, 16).The dominating organism in blood culture contamination, coagulase-negative staphylococcus (CoNS), is also an increasingly important pathogen, which is a significant clinical problem because there is no true "gold standard" for determining contamination from relevant pathogens (1, 8, 13, 22). Although not applicable for clinical use for individual patients, a laboratory assessment definition of contamination for comparison of rates between institutions has been developed. Target rates should not exceed 3% (7), but many teaching hospitals have contamination rates exceeding 6% or more (2,17,21).Considering the potential savings in resource utilization, it is justified to invest considerable reso...

One HPV generator was more effective than 2 aHP machines for the inactivation of G. stearothermophilus BIs, and cycle times were faster for the HPV system.