Læknablaðið : fylgirit - 05.01.2015, Blaðsíða 82

X V I I V Í S I N D A R Á Ð S T E F N A H Í
F Y L G I R I T 8 2
82 LÆKNAblaðið/Fylgirit 82 2015/101
V 79 Distribution of the 1637delC Allele among MBL2 Genotypes
Helga Bjarnadóttir1, Margrét Arnardóttir1,2, Björn Rúnar Lúðvíksson1,2
1Department of Immunology, Landspítali University Hospital, 2Faculty of Medicine, University
of Iceland.
hbjarna@landspitali.is
Introduction: Activation of complements via the lectin pathway (LP)
is mediated by five pattern recognition proteins (PRPs). These are
mannan-binding lectin (MBL), collectin-11 (CL-11), and ficolin-1-3. It is
not known why the LP is activated by five independant molecules, but
it has been suggested that they could be compensating for one another.
We have determined the prevalence of MBL deficiency genotypes to be
7.9 % in Icelandic blood donors. This is relatively high among healthy
individuals and suggests that MBL might be a redundant molecule.
Ficolin-3 is the most abundant of the PRPs in serum. The 1637delC
mutation in the FCN3 gene causes ficolin-3 deficiency in a gene doze
dependant manner. We hypothesize that combined ficolin-3 and MBL
deficiency is rare or detrimental in humans and that ficolin-3 compensa-
tes for MBL deficiency. The aim was to investigate the disribution of
the1637delC allele among MBL2 genotypes.
Materials and methods: The cohort consisted of blood donors and indi-
viduals that had been referred to our lab for MBL evaluations (N=637).
MBL deficiency variants in exon 1 were determined in addition to down-
regulating allele X in MBL2 promoter using melting curve analysis.The
1637delC allele was determined by RFLP-PCR.
Results: The MBL2 genotypes were grouped into deficient (N=106)
and sufficient (N=531) producers. Twenty 1637delC heterozygotes were
detected in the sufficient group, whereas the allele was not found in the
deficient group (p=0.0426).
Conclusions: The results support our hypothesis that MBL deficient
individuals are not carriers of the1637delC allele. The allele could have
been selected out through evolution in MBL deficient individuals.
V 80 Outbreak of a multiresistant Escherichia coli in the neonatal
intensive care unit at Landspítali
Hildur Byström Guðjónsdóttir1,3, Ásdís Elfarsdóttir2, Freyja Valsdóttir1,3, Ólafur
Guðlaugsson2, Ingibjörg Hilmarsdóttir1,3
1Department of Microbiology, Faculty of Medicine, University of Iceland, 2Department
of Quality and Infection Control, Landspítali University Hospital, 3Faculty of Medicine,
University of Iceland
rjhildur@gmail.com
Introduction: An outbreak caused by multidrug resistant E. coli that
produced extended-spectrum beta-lactamases (ESBL) occurred in the
neonatal intensive care unit (NICU) of Landspítali in March 2014. This
project describes the infection control measures and outbreak inve-
stigation.
Methods and data: Infection control measures consisted of cohorting
colonized patients, enhanced and improved cleaning, personal protec-
tion and hand disinfection and education for health care workers and
patients. Outbreak monitoring included continuous screening of all
admitted neonates in the NICU and of previously discharged infants as
well as environmental sampling for ESBL-producing E. coli which were
subsequently analyzed for clonal relatedness by enzyme restriction and
pulsed-field gel electrophoresis. Genotyping of common ESBL genes
was done by PCR and sequencing.
Results: ESBL-producing E. coli was found in 27 infants that had been
hospitalized from December 2013 to May 2014, and 22 of them shared
the outbreak clone. Eight of these were hospitalized in the NICU when
diagnosed and 14 had been discharged. The outbreak clone caused
septicemia in the index case and fecal colonization in the remaining
21 cases. It was resistant to three antibiotic classes. Results of the ESBL
genotyping will be presented.
Conclusions: Retrospective screening of discharged infants indicated
that the outbreak clone of ESBL-producing E. coli might have been
present in the NICU three months before the outbreak was noticed, but
remained undetected in the absence of systematic screening of neonates.
This study demonstrates the importance of rigorous infection control
precautions and the usefulness of molecular methods in outbreak inve-
stigations.
V 81 Umönnun í sængurlegu á stofnun og heima: Reynsla og
viðhorf kvenna
Hildur Sigurðardóttir
Hjúkrunarfræðideild Háskóla Íslands
hildusig@hi.is
Inngangur: Svokölluð heimaþjónusta ljósmæðra hefur verið í boði í 20
ár og notendum hennar stöðugt fjölgað samfara styttri sjúkrahúsvist.
Viðmið um heilsufar móður og barns sem forsendur fyrir snemmút-
skrift og aðgengi að heimaþjónustunni hafa einnig orðið sveigjanlegri.
Á niðurskurðartímum er mikilvægt að standa vörð um gæði og öryggi
þjónustunnar og meta árangur hennar markvisst meðal annars með
skoðun á viðhorfum notenda hennar. Tilgangur þessarar rannsóknar
var að kanna viðhorf og reynslu kvenna af þjónustu sem veitt er í sæng-
urlegu bæði á stofnun og heima.
Efniviður og aðferðir: Rannsóknin var með blönduðu sniði en notast
var við staðlaða spurningarkvarða upphafleg þróaða af Carty (1990)
og Hodnett (1998), og hins vegar opnar spurningar. Kvarðarnir mæla
viðhorf til veittrar fræðslu (FRÆÐSLA), ánægju/óánægju með þjón-
ustuna (ÁNÆGJA) og viðhorf til innihalds þjónustunnar (ÞJÓNUSTA).
Markhópur rannsóknarinnar voru konur sem fæddu börn á Landspítala
og á sjúkrahúsi Vesturlands á vormánuðum 2012. Þátttakendur fengu
spurningalista afhenta fyrir útskrift ásamt kynningarbréfi og þeir beðnir
um að svara listunum og póstsenda að heimaþjónustunni lokinni.
Gagnasöfnunin var framvirk en úrtaksvalið þægindaúrtak er náði til 62
kvenna (31% lista sem lagðir voru inn til sængurkvennadeilda).
Niðurstöður: Niðurstöður rannsóknarinnar styðja fyrri sambærilegar
rannsóknir og gefa til kynna almenna ánægju kvenna með sængurlegu-
þjónustuna, einkum heimaþjónustu ljósmæðra þar sem stærstur hluti
kvenna vill að þjónustunni sé viðhaldið og aðgengi að henni jafnvel
aukið. Heildarmeðalstig úr kvörðunum þremur sýndu að konurnar
voru marktækt jákvæðari gagnvart heimaþjónustunni (P<0,001).
Vísbendingar komu fram um að styrkja mætti enn frekar stuðning við
brjóstagjöf/næringu barns á stofnun fyrstu sólarhringana og stuðning
við feður.
V 82 Umfang og eðli lyfjagjafa hjúkrunarfræðinga án fyrirmæla
lækna á Landspítala
Hulda S. Gunnarsdóttir1,2, Ásta Thoroddsen1,2, Helga Bragadóttir1,2
1Hjúkrunarfræðideild Háskóla Íslands, 2Landspítala
huldsvgu@landspitali.is
Inngangur: Þekkt er að hjúkrunarfræðingar gefi sjúklingum lyf án þess
að skrifleg fyrirmæli læknis liggi fyrir. Á Landspítala er slík lyfjagjöf
skráð í rafræna lyfjaskráningarkerfið Therapy sem stök lyfjagjöf.