Increased waterborne blaNDM-1 resistance gene abundances associated with seasonal human pilgrimages to the Upper Ganges River

Antibiotic resistance (AR) is often rooted in inappropriate antibiotic use, but poor water quality and inadequate sanitation exacerbate the problem, especially in emerging countries. An example is increasing multi-AR due to mobile carbapenemases, such as NDM-1 protein (coded by blaNDM-1 genes), which can produce extreme drug-resistant phenotypes. In 2010, NDM-1 positive isolates and blaNDM-1 genes were detected in surface waters across Delhi and have since been detected across the urban world. However, little is known about blaNDM-1 levels in more pristine locations, such as the headwaters of the Upper Ganges River. This area is of particular interest because it receives massive numbers of visitors during seasonal pilgrimages in May/June, including visitors from urban India. Here we quantified blaNDM-1 abundances, other AR genes (ARG) and coliform bacteria in sediments and water column samples from seven sites in the Rishikesh-Haridwar region of the Upper Ganges and five sites on the Yamuna River in Delhi to contrast blaNDM-1 levels and water quality conditions between season and region. Water quality in the Yamuna was very poor (e.g., anoxia at all sites), and blaNDM-1 abundances were high across sites in water (5.4 ± 0.4 log(blaNDM-1·mL-1); 95% confidence interval) and sediment (6.3 ± 0.7 log(blaNDM-1·mg-1)) samples from both seasons. In contrast, water column blaNDM-1 abundances were very low across all sites (2.1 ± 0.6 log(blaNDM-1·mL-1)) in February in the Upper Ganges and water quality was good (e.g., near saturation oxygen). However, per capita blaNDM-1 levels were 20 times greater in June in the Ganges water column relative to February and blaNDM-1 levels significantly correlated with fecal coliform levels (r=0.61; p=0.007). Given waste management infrastructure is limited in Rishikesh-Haridwar; data imply blaNDM-1 levels are higher in visitor's wastes than local residents, which results in seasonally higher blaNDM-1 levels in the river. Pilgrimage areas without adequate waste treatment are possible "hot spots" for AR transmission, and waste treatment must be improved to reduce broader AR dissemination via exposed returning visitors

High prevalence of fecal carriage of extended-spectrum β-lactamase-producing Escherichia coli and Klebsiella pneumoniae in a pediatric unit in Madagascar

<p>Abstract</p> <p>Background</p> <p>Extended-spectrum β-lactamase (ESBL)-producing <it>Enterobacteriaceae </it>have spread worldwide but there are few reports on carriage in hospitals in low-income countries. ESBL-producing <it>Enterobacteriaceae </it>(ESBL-PE) have been increasingly isolated from nosocomial infections in Antananarivo, Madagascar.</p> <p>Methods</p> <p>we conducted a prevalence survey in a pediatric unit from March to April 2008 Patient rectal swabs were sampled on the first and the last day of hospitalization. Medical staff and environment were also sampled. Rectal and environmental swabs were immediately plated onto Drigalski agar supplemented with 3 mg/liter of ceftriaxon.</p> <p>Results</p> <p>Fecal carriage was detected in 21.2% of 244 infants on admission and 57.1% of 154 on discharge, after more than 48 hours of hospitalization (p < 0.001). The species most frequently detected on admission were <it>Escherichia coli and Klebsiella pneumoniae </it>(36.9%), whereas, on discharge, <it>K. pneumoniae </it>was the species most frequently detected (52.7%). ESBL-associated resistances were related to trimethoprim-sulfamethoxazole (91.3%), gentamicin (76.1%), ciprofloxacin (50.0%), but not to amikacin and imipenem. The increased prevalence of carriage during hospitalization was related to standard antimicrobial therapy.</p> <p>Conclusion</p> <p>The significant emergence of multidrug-resistant enteric pathogens in Malagasy hospitals poses a serious health threat requiring the implementation of surveillance and control measures for nosocomial infections.</p

Human Salmonella and Concurrent Decreased Susceptibility to Quinolones and Extended-Spectrum Cephalosporins

For complicated infections, decreased susceptibility could compromise treatment with drugs from either antimicrobial class

Ang proseso ng pagliligawan

Ang deskriptibong pag-aaral na ito ay ukol sa proseso ng pagliligawan ayon sa pananaw ng mga magnobyo, bagong kasal, mag-asawang nasa gitnang gulang, mag-asawang nasa moyor-de edad, at mag-asawang nasa matandang gulang. Layunin ng pag-aaral na ito na mabigyan linaw ang mga paniniwala ukol sa simula ng pagliligawan, ang pagtatapos nito, ang mga desisyon at salik na kaugnay dito, at ang iniisip, kilos, nararamdaman ng manliligaw at nililigawan sa pagliligawan. Ang mga kalahok ay binuo ng sampung (10) pares ng magnobyo, pitong (7) bagong kasal, pitong (7) mag-asawang nasa gitnang gulang, pitong (7) mag-asawang nasa mayor-de-edad, at pitong (7) mag-asawang nasa matandang gulang. Nagmula ang mga ito sa kakilala\u27t kamag-anakan ng mga mananaliksik sa pamamagitan ng nilayong pagsampol o Purposive Sampling . Ang metodo ng pananaliksik na ginamit ay ang pakikipanayam. Mula sa mga nalikom na datos, nakabuo ng isang balangkas upang ipakita ang proseso ng pagliligawan. Lumabas na ang pagliligawan ay isang prosesong nagsisimula sa pagpapakita ng manliligaw ng kakaibang klase ng atensyon sa nililigawan. Hindi ito nagtatapos sa kahit anong yugto ng pagrerelasyon. Ang desisyon na ginagawa ay hindi gaanong naiiba sa bawat yugto ngunit ang salik na pumapaloob dito ay depende sa panahon na kinagisnan. Ang lalaking manliligaw ay lumalabas na mas aktibo ang papel sa yugto bago makuha ang Oo , ngunit ito ay nagiging two-way din naman pagkatapos ng panahong nabanggit