Johan Struwe group

Epidemiology of health-care associated infections, antibiotic resistance and antibiotic use

The rapid increase of antibiotic resistance is, in the absence of development of new drugs, posing an increasing threat to modern medicine, which in many situations is depending on effective antibiotics. The emergence of resistant bacteria, which cause a majority of health-care associated infections, is the result of induction and selection of resistance due to antibiotic (mis)use and spread of resistant organisms, particularly in the hospital environment.

The aims are to describe the problem in Stockholm county in relation to the surrounding world and to define and develop relevant methods and indicators to monitor effect of interventions. Experiences from infection control programmes in Sweden are applied in collaborative research and projects on patient safety in developing countries.

The research group has close collaboration mainly with Strama Stockholm and the Swedish Center for Infectious Disease control and also with the department for intensive care at Karolinska University Hospital and university hospitals and national institutes in Riga (Latvia) and Vilnius (Lithuania). Some studies are at the European level in collaboration with the European Centre for Disease Prevention and Control, ECDC. Finally, the group leader is consultant for projects in Ujjain, India, and Addis Abbeba, Ethiopia.

Keywords: health-care associated infections, surgical site infection, antibiotic resistance, antibiotic use, prudent use, infection control


Patterns for antibiotic perscriptions in primary care in four regions around the Baltic

Aim: To escribe antibiotic use in general practice o identify areas for improvement.

Method: General practitioners (GPs) from Latvia (LV), Lithuania (LT), and two study sites in Sweden (SE) recorded data on patients with infection who were consulted during one week in November, 2010. Data was collected on demographic factors, diagnose based on pre-defined list, and in a case of antibiotic prescription, substance, dose, dosing interval and route of administration.

Collaborations: Stradins University Hospital, Riga, Latvia, Institute of Hygiene, Vilnius, Lithuania, Latvian Family physicians society, Vilnius University, Umeå University, Strama Stockholm,

Funding: None

Morbidity and mortality from C. difficile in Sweden

Aim: To describe morbidity and mortality of C. difficile infection in Sweden

Method: Register based study based of data on discharge diagnoses and death certificates from EpC, National Board of Health and Welfare

Collaborations: National Board of Health and Welfare, Swedish Center for Infectíous Disease Control, Communicable diseases officer in Stockholm

Funding: None

Transmission of MRSA between staff and dogs in Swedish small animal hospitals

Aim: To describe and investigate possible transmission of MRSA in three Swedish veterinary hospitals

Methods: Screening of staff and environment for MRSA, epidemiological typing of positive isolates.

Collaboration: County Medical Officers for Communicable Disease Control and Prevention in Stockholm, Västmanland, Östergötland, National Veterinary Institute, Uppsala, Swedish Center for Infectious Disease Control, Solna, Department of Infection Control, Karolinska University Hospital, Huddinge

Pathogens in the lower respiratory tract of ICU patients: Impact of duration of hospital care and mechanical ventilation

Aim: To study bacteriological yield in samples from lower airways in patients with or without ventilator associated pneumonia

Methods: Results based on prospective registration of all patients admitted to intensive care unit at tertiary hospital.

Collaboration: Karolinska University Hospital, Solna, Swedish Center for Infectious Disease Control, Solna

Selected publications

Geographical clustering of cases of infection with moxifloxacin-resistant Clostridium difficile PCR-ribotypes 012, 017 and 046 in Sweden, 2008 and 2009.
Akerlund T, Alefjord I, Dohnhammar U, Struwe J, Noren T, Tegmark-Wisell K, et al
Euro Surveill. 2011 Mar;16(10):

National surveillance of surgical-site infection through register-based analysis of antibiotic use after inguinal hernia repair.
Stridh Ekman G, Ringbäck Weitoft G, Nyrén O, Dickman P, Ericsson O, Struwe J
Br J Surg 2010 Nov;97(11):1722-9

Alarming spread of vancomycin resistant enterococci in Sweden since 2007.
Soderblom T, Aspevall O, Erntell M, Hedin G, Heimer D, Hokeberg I, et al
Euro Surveill. 2010 Jul;15(29):

[Antibiotics or not--procalcitonin can guide therapeutic choices. At least at the emergency department for adults with lower respiratory tract infection].
Ternhag A, Cars O, Norman C, Struwe J
Lakartidningen ;107(15):985-8

Strama--a Swedish working model for containment of antibiotic resistance.
Molstad S, Cars O, Struwe J
Euro Surveill. 2008 Nov;13(46):

Fighting antibiotic resistance in Sweden--past, present and future.
Struwe J
Wien. Klin. Wochenschr. 2008 ;120(9-10):268-79

Extended spectrum beta-lactamase-producing Enterobacteriaceae: the first six months of notifications according to the Swedish communicable disease act.
Soderblom T, Struwe J
Euro Surveill. 2007 Oct;12(10):E071018.1

Differences in antibiotic prescribing in three university hospitals in the Baltic region revealed by a simple protocol for quality assessment of therapeutic indications.
Dumpis U, Gulbinovic J, Struwe J, Lagergren A, Griskevicius L, Bergman U
Int J Clin Pharmacol Ther 2007 Oct;45(10):568-76

Benchmarking antimicrobial drug use at university hospitals in five European countries.
Vlahović-Palcevski V, Dumpis U, Mitt P, Gulbinovic J, Struwe J, Palcevski G, et al
Clin. Microbiol. Infect. 2007 Mar;13(3):277-83

Healthcare associated infections in university hospitals in Latvia, Lithuania and Sweden: a simple protocol for quality assessment.
Struwe J, Dumpis U, Gulbinovic J, Lagergren A, Bergman U
Euro Surveill. 2006 Jul;11(7):167-71

ICU stay promotes enrichment and dissemination of multiresistant coagulase-negative staphylococcal strains.
Agvald-Ohman C, Lund B, Hjelmqvist H, Hedin G, Struwe J, Edlund C
Scand. J. Infect. Dis. 2006 ;38(6-7):441-7

Molecular epidemiological analysis of Escherichia coli isolates producing extended-spectrum beta-lactamases for identification of nosocomial outbreaks in Stockholm, Sweden.
Fang H, Lundberg C, Olsson-Liljequist B, Hedin G, Lindbäck E, Rosenberg A, et al
J. Clin. Microbiol. 2004 Dec;42(12):5917-20

Hepatitis B virus (HBV) and hepatitis C virus (HCV) infections in health care workers (HCWs): guidelines for prevention of transmission of HBV and HCV from HCW to patients.
Gunson R, Shouval D, Roggendorf M, Zaaijer H, Nicholas H, Holzmann H, et al
J. Clin. Virol. 2003 Aug;27(3):213-30

Epidemiology and molecular characterization of Clostridium difficile strains from patients with diarrhea: low disease incidence and evidence of limited cross-infection in a Swedish teaching hospital.
Svenungsson B, Burman L, Jalakas-Pörnull K, Lagergren A, Struwe J, Akerlund T
J. Clin. Microbiol. 2003 Sep;41(9):4031-7

Marked differences in antibiotic use and resistance between university hospitals in Vilnius, Lithuania, and Huddinge, Sweden.
Gulbinovic J, Myrbäck K, Bytautienĕ J, Wettermark B, Struwe J, Bergman U
Microb. Drug Resist. 2001 ;7(4):383-9

[Every tenth hospitalized patient is given antibiotics for a nosocomial infection].
Struwe J, Sjögren A
Lakartidningen 2002 Aug;99(32-33):3211-3