Only about 40% in special accommodations and hospital care have a BMI within the recommended limits. As both low and high BMI are frequent in both settings, the focus of care should not only be on undernutrition but also on overweight. Using the Swedish criteria for defining risk of undernutrition seems to give a slightly lower prevalence than has been shown in previous Swedish studies, but this can be due to an underestimation of the occurrence of eating difficulties.

BackgroundDisease-related malnutrition is a major health problem in the elderly population, but it has until recently received very little attention, especially are management issues under-explored. By identifying residents at the risk of undernutrition (UN), appropriate nutritional care can be provided.ObjectiveTo investigate if study circles and policy documents improve the precision in nutritional care and decrease the prevalence of low or high body mass index (BMI).DesignPre and post-intervention study.SettingSpecial accommodations (nursing homes) within six municipalities were involved.ParticipantsIn 2005, 1,726 (90.4%) of 1,910 residents agreed to participate and in 2007, 1,526 (81.8%) of 1,866 residents participated.InterventionStudy circles in one municipality, having a policy document in one municipality and no intervention in four municipalities.MeasurementsRisk of UN was defined as involving any of: involuntary weight loss; low BMI; and/or eating difficulties. Overweight was defined as high BMI.ResultsIn 2005 and 2007, 64% and 66% of residents, respectively, were at the risk of UN. In 2007, significantly more patients in the study circle municipality were accurately provided protein and energy enriched food (PE-food) compared to the no intervention municipalities. There was a decrease between 2005 and 2007 in the prevalence of low BMI in the study circle municipality, but the prevalence of overweight increased in the policy document municipality.ConclusionsStudy circles improve the provision of PE-food for residents at the risk of UN and can possibly decrease the prevalence of low BMI. It is likely that a combination of study circles and implementation of a policy document focusing on screening and on actions to take if the resident is at UN risk can give even better results.

Background: To explore the point prevalence of the risk of malnutrition and the targeting of nutritional interventions in relation to undernutrition risk and hospital volume.

Introduction: For fast and effective antibiotic therapy of serious infections like sepsis, it is crucial with rapid information about antibiotic susceptibility, especially in a time when the number of infections caused by multi resistant bacteria has escalated in the world. Methods: Here, we have used a semi-quantitative MALDI-TOF-MS based method for antibiotic resistance detection, MBT-ASTRA TM , which is based on the comparison of growth rate of the bacteria cultivated with and without antibiotics. We demonstrate a new protocol where several parameters have been optimized and automated leading to reduced hands-on time and improved capacity to simultaneously analyse multiple clinical samples and antibiotics. Results: Ninety minutes of incubation at 37 C with agitation was sufficient to differentiate the susceptible and resistant strains of E. coli and K. pneumoniae, for the antibiotics cefotaxime, meropenem and ciprofloxacin. In total, 841 positive blood culture analyses of 14 reference strains were performed. The overall sensitivity was 99%, specificity 99% and the accuracy 97%. The assay gave no errors for cefotaxime (n ¼ 263) or meropenem (n ¼ 289) for sensitive and resistant strains, whilst ciprofloxacin (n ¼ 289) gave six (0.7%) major errors (false resistance) and four (0.5%) very major errors (false susceptibility). The intermediate strains showed a larger variety compared to the E-test MIC values. Conclusions: The hands-on time and the analysis time to detect antibiotic resistance of clinical blood samples can be substantially reduced and the sample capacity can be increased by using automation and this improved protocol.

In 2009 we described an outbreak caused by extended-spectrum beta-lactamase (ESBL)-producing Escherichia coli in southern Sweden that occurred during 2005-2006. An important finding from the investigation was the long carriage times of the ESBL-producing E. coli in several of the patients, which in some cases exceeded 30 months. Here we report findings from the continued follow-up of bacterial carriage. In September 2010, 5 of the 42 patients still carried the bacteria after a median of 58 months (range 41-59 months), 18 had had repeatedly negative cultures after shedding bacteria for a median of 7.5 months (range 0-39 months), 16 had died while still shedding the bacteria for a median of 9 months (range 0-38 months), and 3 had been lost to follow-up.

Greater efforts need to be taken to increase the precision of nutritional care among patients at moderate/high undernutrition risk and among those with appetite and energy problems.

No abstract

Objectives Due to the rise in antimicrobial resistance worldwide, it is becoming increasingly important to rapidly receive information on the antimicrobial susceptibility of isolated bacteria. Traditional phenotypic methods are slow but remain useful and have advantages such as low cost, as well as being easy to perform and having established analysis criteria. The objective of this study was to develop and evaluate a rapid assay that can detect antibiotic resistant bacteria phenotypically in less than 2 hours. Methods The microplate assay is based on absorbance measurements of bacterial strains grown in liquid media with and without antibiotics (cefotaxime, meropenem and ciprofloxacin). The absorbance was measured at the beginning of the assay, and after 90 minutes of incubation. If a bacterial isolate in absence of antibiotic had more than a 50% growth increase after 90 minutes, then the susceptibility/resistance was calculated by comparing the absorbance value of the culture in the presence of antibiotic at 90 minutes with the initial absorbance value. Results Here we show that it is possible to phenotypically screen antibiotic susceptibility of both clinical and environmental Enterobacteriaceae isolates in 90 minutes for three different antibiotics. The test showed an accuracy of 98,5%, a sensitivity of 97,4%, and a specificity of 99,3%. False susceptibility rates were 0,4% and false resistance rates were 1,2%. Conclusion This rapid and simple absorbance test has proven suitable for screening of antibiotic susceptibility for a large number of Enterobacteriaceae strains with high accuracy and sensitivity. The method can be performed without specialized and costly materials and/or equipment, which makes it highly suitable for laboratories with limited resources and might be especially important in laboratories situated in low income countries.