A large outbreak of enterohaemorrhagic Escherichia coli (EHEC) infections occurred in southern Sweden during autumn 2002. A matched case-control study was performed and indicated an association between consumption of fermented sausage and EHEC infection (odds ratio 5.4, P<0.002). Pulsed-field gel electrophoresis analysis identified a strain of E. coli O157:H7 in clinical faecal isolates, which was identical to a strain isolated from sausage samples obtained from households of infected individuals. A combination of microbiological and epidemiological results established a link between sausage consumption and the outbreak in 30 out of a total of 39 investigated cases. Contaminated beef was suspected to be the source of infection. Delayed start of fermentation, lack of heat-treatment and a short curing period in cold temperature were identified as the main factors enabling EHEC survival. EHEC can survive throughout the entire production process of fermented sausage if curing conditions are inadequate.
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.
An outbreak caused by a multiresistant Escherichia coli producing CTX-M-15 ESBL occurred during autumn 2005 and spring 2006 in Kristianstad, a town in southern Sweden. The outbreak comprised 27 cases and was related to an infectious diseases ward and a neighbouring long-term care facility. Our primary objective was to investigate the epidemiology in order to control the outbreak. In addition, we studied the time of carriage of multiresistant ESBL-producing Escherichia coli by follow-up samples and measured the frequency of carriage of ESBL-producing bacteria in the patient population admitted to the infectious diseases ward during autumn 2006. The outbreak described is one of the first caused by ESBL-producing Escherichia coli in Sweden. The source of the outbreak was not found. Infection control measures were reinforced in the outbreak situation, and epidemiological and microbiological methods, including PFGE typing, were used for analysis. The carriage time of multiresistant Escherichia coli was longer in several of the affected patients than has previously been reported. The longest carriage time to date is 33 months. This demonstrates the risk for new outbreaks unless strict infection control measures are implemented. Among the patients admitted to the ward during autumn 2006, 2.5% carried ESBL-producing enterobacteria.
During the weekend of 5-7 April, a Chinese style buffet was served to passengers booked on a cruise on the ferry M/S Polonia, which sails a regular route between Sweden and Poland. After the cruise, several of the passengers reported having fallen ill. Around 800 Swedish passengers travelled on the cruise, and to date there have been reports of 352 laboratory verified cases of salmonellosis in people who were on the ferry on 5-7 April.
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