Emergence and dissemination of antimicrobial resistance in Escherichia coli causing bloodstream infections in Norway in 2002-17: a nationwide, longitudinal, microbial population genomic study

Background The clonal diversity underpinning trends in multidrug resistant Escherichia coli causing bloodstream infections remains uncertain. We aimed to determine the contribution of individual clones to resistance over time, using large-scale genomics-based molecular epidemiology. Methods This was a longitudinal, E coli population, genomic, cohort study that sampled isolates from 22 512 E coli bloodstream infections included in the Norwegian surveillance programme on resistant microbes (NORM) from 2002 to 2017. 15 of 22 laboratories were able to share their isolates, and the first 22·5% of isolates from each year were requested. We used whole genome sequencing to infer the population structure (PopPUNK), and we investigated the clade composition of the dominant multidrug resistant clonal complex (CC)131 using genetic markers previously reported for sequence type (ST)131, effective population size (BEAST), and presence of determinants of antimicrobial resistance (ARIBA, PointFinder, and ResFinder databases) over time. We compared these features between the 2002–10 and 2011–17 time periods. We also compared our results with those of a longitudinal study from the UK done between 2001 and 2011. Findings Of the 3500 isolates requested from the participating laboratories, 3397 (97·1%) were received, of which 3254 (95·8%) were successfully sequenced and included in the analysis. A significant increase in the number of multidrug resistant CC131 isolates from 71 (5·6%) of 1277 in 2002–10 to 207 (10·5%) of 1977 in 2011–17 (p<0·0001), was the largest clonal expansion. CC131 was the most common clone in extended-spectrum β-lactamase (ESBL)-positive isolates (75 [58·6%] of 128) and fluoroquinolone non-susceptible isolates (148 [39·2%] of 378). Within CC131, clade A increased in prevalence from 2002, whereas the global multidrug resistant clade C2 was not observed until 2007. Multiple de-novo acquisitions of both blaCTX-M ESBL-encoding genes in clades A and C1 and gain of phenotypic fluoroquinolone non-susceptibility across the clade A phylogeny were observed. We estimated that exponential increases in the effective population sizes of clades A, C1, and C2 occurred in the mid-2000s, and in clade B a decade earlier. The rate of increase in the estimated effective population size of clade A (Ne=3147) was nearly ten-times that of C2 (Ne=345), with clade A over-represented in Norwegian CC131 isolates (75 [27·0%] of 278) compared with the UK study (8 [5·4%] of 147 isolates). Interpretation The early and sustained establishment of predominantly antimicrobial susceptible CC131 clade A isolates, relative to multidrug resistant clade C2 isolates, suggests that resistance is not necessary for clonal success. However, even in the low antibiotic use setting of Norway, resistance to important antimicrobial classes has rapidly been selected for in CC131 clade A isolates. This study shows the importance of genomic surveillance in uncovering the complex ecology underlying multidrug resistance dissemination and competition, which have implications for the design of strategies and interventions to control the spread of high-risk multidrug resistant clones. Funding Trond Mohn Foundation, European Research Council, Marie Skłodowska-Curie Actions, and the Wellcome Trust

Analysis of Zero Waste Patternmaking Approaches for Application to Apparel

The apparel industry is a major contributor to environmental problems from textile manufacturing through garment production and distribution to consumer discard – donation, landfill, reuse, or otherwise (Gam, Cao, Farr, & Heine, 2009). In 2015, there were estimated 400 billion square meters of fabrics produced worldwide and 60 billion square meters wasted during apparel production. Vennström (2012) stated that in the United Kingdom around 2.35 million tons of waste comes from the clothing and textile industry per year, which estimates about 40 kilograms (kg) per person each year. Of the 40 kg (88 lbs.) of apparel waste each year, 74% ends up in landfills (Vennström, 2012). Even though the fashion industry applies a variety of technologies to minimize the fabric waste in pursuit of cost reductions, it is still far from eliminating the waste of fabric during the cutting process. On average, 15% of fabric is wasted during the cut-and-sew garment production process (Rissanen & McQuillan, 2016). Professionals and researchers in apparel design and product development discipline are facing a tremendous challenge of combining the innovative patternmaking methods, aesthetics of apparel design, and fabric waste reduction. Zero waste patternmaking offers a solution by utilizing the entire yardage of fabric, leaving no scrap left after the garment completion (Carrico & Kim, 2014). Further, zero waste has been touted as a means to more creative apparel design outcomes (Townsend & Mills, 2013). Many approaches to zero waste patternmaking have been proposed through a range of sources—blogs, websites, books, and articles (e.g. Townsend & Mills, 2013; Carrico and Kim, 2014; Fletcher, 2013; Antanavičiūtė & Dobilaitė, 2015). Unfortunately, many of these approaches are tied to the particular fabric width and finished garment size they are presented in. The aim of this chapter is to conduct a systematic review of these approaches. In so doing, we may understand the key principles and be able to apply them across a range of fabric widths and garment sizes. The main method will be to collect a representative sample of zero waste patternmaking approaches and analyze them. Approaches will be analyzed through visually for their pattern shapes, garment components, and three-dimensional finished garment shapes. Selected approaches will also be drafted, cut, and sewn to further understand the outcomes. Research questions include: (1) What are the major pattern design principles, (2) What outcomes do these results in? (3) What challenges exist with these approaches? These findings will provide information that will help designers successfully apply zero waste patternmaking methods in apparel design. Further, the research findings will provide focus for needed areas of future research