Browsing by Author "Jacobsson, Gunnar"

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Invasive Staphylococcus aureus infections
(2009-11-27T07:06:55Z) Jacobsson, Gunnar
Staphylococcus aureus is a leading cause of septicaemia-related death. The aims of this thesis were to describe the epidemiology of invasive Staphylococcus aureus infections (ISA), the clinical course, and serological response in ISA in a prospective, population-based study. The antibody response was compared with the serological findings in healthy individuals. During two years 170 episodes of ISA were registered, with an incidence of 33.9 cases/100,000/year. Haemodialysis (relative risk 291) and peritoneal dialysis (relative risk 204) patients were at the highest risk. Soft tissue infections, bacteraemia without focus, infections of intravenous lines, and joint/bone infections were the most common diagnoses. The spectrum of signs and symptoms was wide, with nearly a quarter of the patients being afebrile. The mortality rate was 19.1% (28-day mortality), with an annual population mortality of 5.9/100,000. Patients with complicated bacteraemia (32% of all episodes) had a mortality rate of 32%, and patients with severe sepsis (30% of all episodes) 54%. Patients with bacteraemia without focus, patients with respiratory infections, and patients with endovascular infections had the highest mortality figures . Only severe sepsis and low systolic blood pressure were independent factors for mortality in a multivariable regression model. We found a relapse rate of 9.3%, and a rate of remaining symptoms after the antibiotic treatment had ended of 34%. Sequelae were seen among 60% of the patients with arthritis. The frequency of different agr, accessory gene regulator, groups was not correlated to the disease entities. The antibody response in ISA showed a great variability. Patients with a fatal outcome produced lower amounts of antibodies to all antigens, and significantly to four antigens (teichoic acid, lipase, enterotoxin A, and scalded skin syndrome toxin). The same trend was noted for patients with a complicated course of infection. Healthy carriers of S. aureus in the nares had higher levels of antibodies to all eleven tested antigens, and significantly to five, than non-carriers. Ages over 65y showed only slightly lower levels.
Peers, policy, and attitudes as drivers of antibiotic prescribing
(University of Gothenburg, 2021-05) Carlsson, Fredrik; Jacobsson, Gunnar; Lampi, Elina; Rönnerstrand, Björn; Department of Economics, University of Gothenburg
In this study we investigated how treatment norms about antibiotic use affect a doctor´s decision to prescribe antibiotics. We also investigated the attitudes and behavior of the same physicians as private persons. We find that compared with ordinary citizens, physicians are more worried and more well-informed about antibiotic resistance and use, yet they consume more antibiotics and are less willing to limit their personal use of antibiotics. There is a strong correlation between a doctor´s decision not to prescribe and the treatment norms, i.e., the perception of the common choice among physicians considering antibiotics prescription and the guidelines of antibiotics use. We also find a strong connection between professional and private attitudes: Although physicians themselves on average use more antibiotics than the general public, those who are willing to abstain from using antibiotics as a private person are also more willing not to prescribe antibiotics to their patients.
Who is willing to stay sick for the collective? – Individual characteristics, experience, and trust
(2019-05) Carlsson, Fredrik; Jacobsson, Gunnar; Jagers, Sverker C.; Lampi, Elina; Robertsson, Felicia; Rönnerstrand, Björn; Department of Economics, University of Gothenburg
This paper deals with the collective action dilemma of antibiotic resistance. Despite the collective threat posed by antibiotic resistance, there are limited incentives for individuals to consider the contribution of their decisions to use antibiotics to the spread of resistance. Drawing on a novel survey of Swedish citizens (n=1,906), we study factors linked to i) willingness to accept a physician’s decision not to prescribe antibiotics and ii) willingness to limit personal use of antibiotics voluntary. In our study, 53 percent of the respondents stated that they would be willing to accept the physician’s decision despite disagreeing with it, and trust in the healthcare sector is significantly associated with acceptance. When it comes to people’s willingness to voluntarily abstain from using antibiotics, a majority stated that they are willing or very willing not to take antibiotics. The variation in willingness is best explained by concerns about antibiotic resistance and experience of antibiotic therapy, especially if a respondent has been denied antibiotics. Generalized trust seems to be unrelated to willingness to abstain, but the perception that other people limit their personal use of antibiotics is linked to respondents’ own willingness to do so. Few of the individual characteristics can explain the variation in that decision.