Thanks to penicillin the chicken is cheap

Dag Berild 2014

Dag Berild 2014

Evolution of resistance in tuberculosis

Resitance Year Number of cases

Monoresistant TB 1950-60 ?

Multi drug resistant TB 1990? 9-32% new pts>50% previously treated

Extensively resistant TB 2006, now in 84 countries 630 000, East-Europe, Asia

Totally resistant TB 2012 India, Iran, Poland

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Intervention to reduce macrolides

Dag Berild 2014

But, good things are happening i Norway too

Dag Berild 2014

Dag Berild 2014

Penetrerende abdominale skader 1. verdenskrig

• ”During World War I battlefield surgeons were reluctant to operate on the abdominal cavity when active sepsis was present. The accepted procedure for treating a penetrating abdominal wound was to use morphine for pain, prayers for the soul, and watchful waiting for the peritonitis to resolve.”

• Gorbach SL. Abdominal infections. Clin Infect Dis 1993; 17: 961–7.

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Doses the impact of interventions sustain?

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Until now, no visionary political leadership

Dag Berild 2014

Adjust therapy according to blood cultures Berild D, Jensenius M, Ringertz SH, Mohseni A. JAC 2006;57:326-30

354 episodesof positive

blood cultures

226 episodes of true bacteraemia Guidelines recommended adjustment of antibiotics

in 166 episodes

In 36 episodes the patients diedor were discharged before

the results of blood cultures

92 episodes with CNSand other contaminants

Treatment adjusted in 146 (88%) episodes

Not adjusted in 20 episodes

Appropriate antibiotic therapycontinued in 60 episodes

Cost reduction 19800 EUR (21%)

Dag Berild 2014

Dag Berild 2014

Dag Berild 2014

Clinical successes

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Pneumococcal infections

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Serumterapi (hesteserum)

Dag Berild 2014