Primary spontaneous pneumothorax in a term neonate

Pneumothorax is a rare but recognized cause of respiratory distress in the newborn. It can occur spontaneously or post-traumatic.We report our experience in a term male neonate who had primary spontaneous pneumothorax. He had no surgical intervention but completely recovered with conservative management and supplemental oxygen

Višestruko otporni verotoksični sojevi bakterije Escherichia coli O157:H7 u pasa s proljevom i bez proljeva u Abeokuti, Nigerija.

Verocytotoxin-producing Escherichia coli (VTEC) O157:H7 is a predominant cause of haemorrhagic colitis (HC) and haemolytic uraemic syndrome (HUS) in humans. To assess the role of dogs as a possible source of transmission of VTEC O157:H7 to humans, the faeces of diarrhoeic (31) and non-diarrhoeic (63) dogs were examined for the presence of the organism. Escherichia coli O157:H7 was isolated from 22 (23.4%) out of 94 samples examined. The organism was detected in 5 (16.1%) out of 31 diarrhoeic faeces and 17 (26.9%) out of 63 non-diarrhoeic faeces, but the difference was not statistically significant (P>0.05). All the E. coli O157:H7 isolates produced one or both of verocytotoxin 1 and 2 (VT1 and VT2). Verocytotoxin 1 (VT1) was detected in 10 (45.5%) out of 22 isolates, VT2 in 8 (36.4%), while both toxin types were detected in four (18.2%) isolates. Sixteen (72.7%) out of 22 isolates were resistant to at least three antimicrobials from different classes, while 18 distinct antimicrobial resistance patterns were observed among the isolates. The isolates showed resistance to ampicillin (86.4%), chloramphenicol (36.4%), ciprofloxacin (4.5%), gentamicin (18.2%), kanamycin (68.2%), nalidixic acid (22.7%), neomycin (40.9%), norfl oxacin (9.1%), streptomycin (63.6%), sulphamethoxazole/trimethoprim (63.6%) and tetracycline (77.3%). The present study showed that diarrhoeic and non-diarrhoeic dogs may serve as potential sources of multi-drug resistant VTEC O157:H7 transmissible to humans.Verotoksični sojevi bakterije Escherichia coli (VTEC) O157:H7 pretežito uzrokuju hemoragijski kolitis (HC) i hemolitičko-uremijski sindrom (HUS) u ljudi. Radi procjene uloge pasa kao mogućeg izvora prijenosa VTEC O157:H7 na ljude, pretraženi su uzorci njihova proljeva (31) i normalno formiranog fecesa (63) na prisutnost te bakterije. Escherichia coli O157:H7 bila je izdvojena iz 22 (23,4%) od 94 pretražena uzorka. Bila je dokazana u 5 (16,1%) od 31 uzorka proljeva i 17 (26,9%) od 63 uzorka normalno formiranog izmeta. Nije bila ustanovljena statistički značajna razlika (P>0,05). Svi izolati bakterije E. coli O157:H7 proizvodili su jedan ili oba verotoksina: 1 i 2 (VT1 i VT2). Verotoksin 1 bio je dokazan u 10 (45,5%) od 22 izolata, VT2 u osam (36,4%), dok su oba tipa toksina bila dokazana u četiri (18,2%) izolata. Šesnaest (72,7%) od 22 izolata bilo je otporno na najmanje tri antimikrobne tvari različitih skupina. Među izolatima je bilo ustanovljeno 18 različitih obrazaca otpornosti na antimikrobne tvari. Izolati su pokazivali otpornost na ampicilin (86,4%), kloramfenikol (36,4%), ciprofl oksacin (4,5%), gentamicin (18,2%), kanamicin (68,2%), nalidiksičnu kiselinu (22,7%), neomicin (40,9%), norfl oksacin (9,1%), streptomicin (63,6%), sulfametoksazol/trimetoprim (63,6%) i tetraciklin (77,3%). Istraživanje je pokazalo da psi s proljevom i bez proljeva mogu biti izvor multiplorezistentne VTEC O157:H7 za ljude

Bot Canker Pathogens Could Complicate the Management of \u3ci\u3ePhytophthora\u3c/i\u3e Black Pod of Cocoa

Black pod is a major hindrance to cocoa production in Nigeria. It is caused by three different Phytophthora species with Phytophthora megakarya as the most important species in Nigeria and West African subregion. Phytophthora spp. may enhance infections by opportunistic pathogens such as members of the Botryosphaeriacea that cause branch and trunk cankers in many woody plants across the world. Botryosphaeriacea has not been reported in cocoa nor in any woody plants in Nigeria to our knowledge. In the cocoa belt of Nigeria, research and understanding on cocoa black pod and Phytophthora is limited partly because of delayed or no access to some culture media, including required antibiotics. The objectives of this study were to: (1) use locally available materials to develop media for Phytophthora isolation from infected cocoa trees and pods samples and (2) to determine if members of Botryosphaeriaceae are associated with cankers of cocoa trees infected with black pod in Ondo State. The two formulated media, clarified tomato juice agar and cocoa pod agar supported the growth of Phytophthora spp. and were used for isolation from five cocoa- producing local government areas, spanning all three senatorial districts of Ondo State. Based on morphological characteristics, four different species of Botryosphaeriaceae were identified from infected cocoa trees/pods but also from citrus and kola trees, which are similar to cocoa and usually planted in the same orchard with cocoa in Nigeria. These findings of new pathogens in cocoa and other hosts in Ondo State indicated the need for new strategies in the management of cocoa diseases in the State and across cocoa-producing areas of Nigeria

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Global economic burden of unmet surgical need for appendicitis

Background: There is a substantial gap in provision of adequate surgical care in many low-and middle-income countries. This study aimed to identify the economic burden of unmet surgical need for the common condition of appendicitis. Methods: Data on the incidence of appendicitis from 170 countries and two different approaches were used to estimate numbers of patients who do not receive surgery: as a fixed proportion of the total unmet surgical need per country (approach 1); and based on country income status (approach 2). Indirect costs with current levels of access and local quality, and those if quality were at the standards of high-income countries, were estimated. A human capital approach was applied, focusing on the economic burden resulting from premature death and absenteeism. Results: Excess mortality was 4185 per 100 000 cases of appendicitis using approach 1 and 3448 per 100 000 using approach 2. The economic burden of continuing current levels of access and local quality was US $92 492 million using approach 1 and$73 141 million using approach 2. The economic burden of not providing surgical care to the standards of high-income countries was $95 004 million using approach 1 and$75 666 million using approach 2. The largest share of these costs resulted from premature death (97.7 per cent) and lack of access (97.0 per cent) in contrast to lack of quality. Conclusion: For a comparatively non-complex emergency condition such as appendicitis, increasing access to care should be prioritized. Although improving quality of care should not be neglected, increasing provision of care at current standards could reduce societal costs substantially

Pooled analysis of WHO Surgical Safety Checklist use and mortality after emergency laparotomy

Background The World Health Organization (WHO) Surgical Safety Checklist has fostered safe practice for 10 years, yet its place in emergency surgery has not been assessed on a global scale. The aim of this study was to evaluate reported checklist use in emergency settings and examine the relationship with perioperative mortality in patients who had emergency laparotomy. Methods In two multinational cohort studies, adults undergoing emergency laparotomy were compared with those having elective gastrointestinal surgery. Relationships between reported checklist use and mortality were determined using multivariable logistic regression and bootstrapped simulation. Results Of 12 296 patients included from 76 countries, 4843 underwent emergency laparotomy. After adjusting for patient and disease factors, checklist use before emergency laparotomy was more common in countries with a high Human Development Index (HDI) (2455 of 2741, 89.6 per cent) compared with that in countries with a middle (753 of 1242, 60.6 per cent; odds ratio (OR) 0.17, 95 per cent c.i. 0.14 to 0.21, P <0001) or low (363 of 860, 422 per cent; OR 008, 007 to 010, P <0.001) HDI. Checklist use was less common in elective surgery than for emergency laparotomy in high-HDI countries (risk difference -94 (95 per cent c.i. -11.9 to -6.9) per cent; P <0001), but the relationship was reversed in low-HDI countries (+121 (+7.0 to +173) per cent; P <0001). In multivariable models, checklist use was associated with a lower 30-day perioperative mortality (OR 0.60, 0.50 to 073; P <0.001). The greatest absolute benefit was seen for emergency surgery in low- and middle-HDI countries. Conclusion Checklist use in emergency laparotomy was associated with a significantly lower perioperative mortality rate. Checklist use in low-HDI countries was half that in high-HDI countries.Peer reviewe

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Global variation in anastomosis and end colostomy formation following left-sided colorectal resection

Background End colostomy rates following colorectal resection vary across institutions in high-income settings, being influenced by patient, disease, surgeon and system factors. This study aimed to assess global variation in end colostomy rates after left-sided colorectal resection. Methods This study comprised an analysis of GlobalSurg-1 and -2 international, prospective, observational cohort studies (2014, 2016), including consecutive adult patients undergoing elective or emergency left-sided colorectal resection within discrete 2-week windows. Countries were grouped into high-, middle- and low-income tertiles according to the United Nations Human Development Index (HDI). Factors associated with colostomy formation versus primary anastomosis were explored using a multilevel, multivariable logistic regression model. Results In total, 1635 patients from 242 hospitals in 57 countries undergoing left-sided colorectal resection were included: 113 (6·9 per cent) from low-HDI, 254 (15·5 per cent) from middle-HDI and 1268 (77·6 per cent) from high-HDI countries. There was a higher proportion of patients with perforated disease (57·5, 40·9 and 35·4 per cent; P < 0·001) and subsequent use of end colostomy (52·2, 24·8 and 18·9 per cent; P < 0·001) in low- compared with middle- and high-HDI settings. The association with colostomy use in low-HDI settings persisted (odds ratio (OR) 3·20, 95 per cent c.i. 1·35 to 7·57; P = 0·008) after risk adjustment for malignant disease (OR 2·34, 1·65 to 3·32; P < 0·001), emergency surgery (OR 4·08, 2·73 to 6·10; P < 0·001), time to operation at least 48 h (OR 1·99, 1·28 to 3·09; P = 0·002) and disease perforation (OR 4·00, 2·81 to 5·69; P < 0·001). Conclusion Global differences existed in the proportion of patients receiving end stomas after left-sided colorectal resection based on income, which went beyond case mix alone

Global burden of 288 causes of death and life expectancy decomposition in 204 countries and territories and 811 subnational locations, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021

BACKGROUND Regular, detailed reporting on population health by underlying cause of death is fundamental for public health decision making. Cause-specific estimates of mortality and the subsequent effects on life expectancy worldwide are valuable metrics to gauge progress in reducing mortality rates. These estimates are particularly important following large-scale mortality spikes, such as the COVID-19 pandemic. When systematically analysed, mortality rates and life expectancy allow comparisons of the consequences of causes of death globally and over time, providing a nuanced understanding of the effect of these causes on global populations. METHODS The Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2021 cause-of-death analysis estimated mortality and years of life lost (YLLs) from 288 causes of death by age-sex-location-year in 204 countries and territories and 811 subnational locations for each year from 1990 until 2021. The analysis used 56 604 data sources, including data from vital registration and verbal autopsy as well as surveys, censuses, surveillance systems, and cancer registries, among others. As with previous GBD rounds, cause-specific death rates for most causes were estimated using the Cause of Death Ensemble model-a modelling tool developed for GBD to assess the out-of-sample predictive validity of different statistical models and covariate permutations and combine those results to produce cause-specific mortality estimates-with alternative strategies adapted to model causes with insufficient data, substantial changes in reporting over the study period, or unusual epidemiology. YLLs were computed as the product of the number of deaths for each cause-age-sex-location-year and the standard life expectancy at each age. As part of the modelling process, uncertainty intervals (UIs) were generated using the 2·5th and 97·5th percentiles from a 1000-draw distribution for each metric. We decomposed life expectancy by cause of death, location, and year to show cause-specific effects on life expectancy from 1990 to 2021. We also used the coefficient of variation and the fraction of population affected by 90% of deaths to highlight concentrations of mortality. Findings are reported in counts and age-standardised rates. Methodological improvements for cause-of-death estimates in GBD 2021 include the expansion of under-5-years age group to include four new age groups, enhanced methods to account for stochastic variation of sparse data, and the inclusion of COVID-19 and other pandemic-related mortality-which includes excess mortality associated with the pandemic, excluding COVID-19, lower respiratory infections, measles, malaria, and pertussis. For this analysis, 199 new country-years of vital registration cause-of-death data, 5 country-years of surveillance data, 21 country-years of verbal autopsy data, and 94 country-years of other data types were added to those used in previous GBD rounds. FINDINGS The leading causes of age-standardised deaths globally were the same in 2019 as they were in 1990; in descending order, these were, ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and lower respiratory infections. In 2021, however, COVID-19 replaced stroke as the second-leading age-standardised cause of death, with 94·0 deaths (95% UI 89·2-100·0) per 100 000 population. The COVID-19 pandemic shifted the rankings of the leading five causes, lowering stroke to the third-leading and chronic obstructive pulmonary disease to the fourth-leading position. In 2021, the highest age-standardised death rates from COVID-19 occurred in sub-Saharan Africa (271·0 deaths [250·1-290·7] per 100 000 population) and Latin America and the Caribbean (195·4 deaths [182·1-211·4] per 100 000 population). The lowest age-standardised death rates from COVID-19 were in the high-income super-region (48·1 deaths [47·4-48·8] per 100 000 population) and southeast Asia, east Asia, and Oceania (23·2 deaths [16·3-37·2] per 100 000 population). Globally, life expectancy steadily improved between 1990 and 2019 for 18 of the 22 investigated causes. Decomposition of global and regional life expectancy showed the positive effect that reductions in deaths from enteric infections, lower respiratory infections, stroke, and neonatal deaths, among others have contributed to improved survival over the study period. However, a net reduction of 1·6 years occurred in global life expectancy between 2019 and 2021, primarily due to increased death rates from COVID-19 and other pandemic-related mortality. Life expectancy was highly variable between super-regions over the study period, with southeast Asia, east Asia, and Oceania gaining 8·3 years (6·7-9·9) overall, while having the smallest reduction in life expectancy due to COVID-19 (0·4 years). The largest reduction in life expectancy due to COVID-19 occurred in Latin America and the Caribbean (3·6 years). Additionally, 53 of the 288 causes of death were highly concentrated in locations with less than 50% of the global population as of 2021, and these causes of death became progressively more concentrated since 1990, when only 44 causes showed this pattern. The concentration phenomenon is discussed heuristically with respect to enteric and lower respiratory infections, malaria, HIV/AIDS, neonatal disorders, tuberculosis, and measles. INTERPRETATION Long-standing gains in life expectancy and reductions in many of the leading causes of death have been disrupted by the COVID-19 pandemic, the adverse effects of which were spread unevenly among populations. Despite the pandemic, there has been continued progress in combatting several notable causes of death, leading to improved global life expectancy over the study period. Each of the seven GBD super-regions showed an overall improvement from 1990 and 2021, obscuring the negative effect in the years of the pandemic. Additionally, our findings regarding regional variation in causes of death driving increases in life expectancy hold clear policy utility. Analyses of shifting mortality trends reveal that several causes, once widespread globally, are now increasingly concentrated geographically. These changes in mortality concentration, alongside further investigation of changing risks, interventions, and relevant policy, present an important opportunity to deepen our understanding of mortality-reduction strategies. Examining patterns in mortality concentration might reveal areas where successful public health interventions have been implemented. Translating these successes to locations where certain causes of death remain entrenched can inform policies that work to improve life expectancy for people everywhere. FUNDING Bill & Melinda Gates Foundation

Višestruko otporni verotoksični sojevi bakterije Escherichia coli O157:H7 u pasa s proljevom i bez proljeva u Abeokuti, Nigerija.

Verocytotoxin-producing Escherichia coli (VTEC) O157:H7 is a predominant cause of haemorrhagic colitis (HC) and haemolytic uraemic syndrome (HUS) in humans. To assess the role of dogs as a possible source of transmission of VTEC O157:H7 to humans, the faeces of diarrhoeic (31) and non-diarrhoeic (63) dogs were examined for the presence of the organism. Escherichia coli O157:H7 was isolated from 22 (23.4%) out of 94 samples examined. The organism was detected in 5 (16.1%) out of 31 diarrhoeic faeces and 17 (26.9%) out of 63 non-diarrhoeic faeces, but the difference was not statistically significant (P>0.05). All the E. coli O157:H7 isolates produced one or both of verocytotoxin 1 and 2 (VT1 and VT2). Verocytotoxin 1 (VT1) was detected in 10 (45.5%) out of 22 isolates, VT2 in 8 (36.4%), while both toxin types were detected in four (18.2%) isolates. Sixteen (72.7%) out of 22 isolates were resistant to at least three antimicrobials from different classes, while 18 distinct antimicrobial resistance patterns were observed among the isolates. The isolates showed resistance to ampicillin (86.4%), chloramphenicol (36.4%), ciprofloxacin (4.5%), gentamicin (18.2%), kanamycin (68.2%), nalidixic acid (22.7%), neomycin (40.9%), norfl oxacin (9.1%), streptomycin (63.6%), sulphamethoxazole/trimethoprim (63.6%) and tetracycline (77.3%). The present study showed that diarrhoeic and non-diarrhoeic dogs may serve as potential sources of multi-drug resistant VTEC O157:H7 transmissible to humans.Verotoksični sojevi bakterije Escherichia coli (VTEC) O157:H7 pretežito uzrokuju hemoragijski kolitis (HC) i hemolitičko-uremijski sindrom (HUS) u ljudi. Radi procjene uloge pasa kao mogućeg izvora prijenosa VTEC O157:H7 na ljude, pretraženi su uzorci njihova proljeva (31) i normalno formiranog fecesa (63) na prisutnost te bakterije. Escherichia coli O157:H7 bila je izdvojena iz 22 (23,4%) od 94 pretražena uzorka. Bila je dokazana u 5 (16,1%) od 31 uzorka proljeva i 17 (26,9%) od 63 uzorka normalno formiranog izmeta. Nije bila ustanovljena statistički značajna razlika (P>0,05). Svi izolati bakterije E. coli O157:H7 proizvodili su jedan ili oba verotoksina: 1 i 2 (VT1 i VT2). Verotoksin 1 bio je dokazan u 10 (45,5%) od 22 izolata, VT2 u osam (36,4%), dok su oba tipa toksina bila dokazana u četiri (18,2%) izolata. Šesnaest (72,7%) od 22 izolata bilo je otporno na najmanje tri antimikrobne tvari različitih skupina. Među izolatima je bilo ustanovljeno 18 različitih obrazaca otpornosti na antimikrobne tvari. Izolati su pokazivali otpornost na ampicilin (86,4%), kloramfenikol (36,4%), ciprofl oksacin (4,5%), gentamicin (18,2%), kanamicin (68,2%), nalidiksičnu kiselinu (22,7%), neomicin (40,9%), norfl oksacin (9,1%), streptomicin (63,6%), sulfametoksazol/trimetoprim (63,6%) i tetraciklin (77,3%). Istraživanje je pokazalo da psi s proljevom i bez proljeva mogu biti izvor multiplorezistentne VTEC O157:H7 za ljude