Incidence, risk factors and outcomes of Escherichia coli bloodstream infections in a large Canadian region

ABSTRACTAlthough Escherichia coli is the most common cause of bloodstream infection, its epidemiology has not been well defined in non-selected populations. We sought to describe the incidence of risk factors for, and outcomes associated with, E. coli bacteraemia. Population-based surveillance for E. coli bacteraemia was conducted in the Calgary Health Region (population 1.2 million) during the period 2000–2006. In total, 2368 episodes of E. coli bacteraemia were identified for an overall annual population incidence of 30.3/100 000; 15% were nosocomial, 32% were healthcare-associated community-onset and 53% were community-acquired bacteraemias. The very young and the elderly were at highest risk for E. coli bacteraemia. Sixty per cent of the episodes occurred in females (relative risk 1.5; 95% CI 1.4–1.6). Dialysis, solid organ transplantation and neoplastic disease were the most important risk factors for acquiring E. coli bacteraemia. Rates of resistance to ampicillin, trimethoprim–sulphamethoxazole, gentamicin, ciprofloxacin, cefazolin and ceftriaxone increased significantly during the period 2000–2006. The case-fatality rate was 11% and the annual population mortality rate was 2.9/100 000. Increasing age, ciprofloxacin resistance, non-urinary focus and a number of comorbid illnesses were independently associated with an increased risk of death, and community acquisition and urinary focus were associated with a lower risk of death. This study documents the major burden of illness associated with E. coli bacteraemia and identifies groups at increased risk for acquiring and dying from these infections. The emergence of ciprofloxacin resistance and its adverse effect on patient outcome is a major concern

Molecular evolution of Klebsiella pneumoniae ST278 harboring blaNDM-7 involved in nosocomial transmission

During 2013, ST278 Klebsiella pneumoniae with blaNDM-7 was isolated from the urine (KpN01) and rectum (KpN02) of a patient in Calgary, Canada. The same strain (KpN04) was subsequently isolated from another patient in the same unit. Interestingly, a carbapenem-susceptible ST278 (KpN06) was obtained one month later from the blood of the second patient. Next generation sequencing (NGS) revealed that the loss of carbapenem-resistance in KpN06 was due to a 5-kb deletion on the blaNDM-7-harboring IncX3 plasmid. In addition, an IncFIB plasmid in KpN06 had a 27 kb deletion that removed genes encoding for heavy metal resistance. Phylogenetic analysis showed that the ST278 K. pneumoniae from patient 2 were likely descendants of KpN02 and that KpN06 was a close progenitor of an environmental ST278. It is unclear whether KpN06 lost the blaNDM-7 gene in vivo. This study detailed the remarkable plasticity and speed of evolutionary changes in multidrug resistance K. pneumoniae demonstrating the highly recombinant nature of this species. It also highlights the ability of NGS to clarify molecular micro-evolutionary events within antibiotic-resistant organisms.This work was supported in part by a research grant from the Calgary Laboratory Services (#10009392) and grants from the National Institutes of Health (1R01AI090155 to B.N.K, and R21AI117338 to L.C).http://jid.oxfordjournals.org2017-06-30hb2016Medical Microbiolog

Molecular characterization by using next generation sequencing of plasmids containing blaNDM-7 in Enterobacteriaceae from Calgary, Canada

Enterobacteriaceae with blaNDM-7 is relatively uncommon and had previously been described in Europe, India, USA and Japan. This study describes the characteristics of Enterobacteriaceae [Klebsiella pneumoniae (n=2), Escherichia coli (n=2), Serratia marcescens (n=1), Enterobacter hormaechei (n=1)] with blaNDM-7 obtained in 4 patients from Calgary, Canada during 2013-4. The 46,161 bp IncX3 plasmids with blaNDM-7 are highly similar to other blaNDM-harboring IncX3 plasmids and interestingly, showed identical structures within the different isolates. This finding may indicate horizontal transmission within our health region or may indicate contact with individuals from endemic areas within the hospital setting. Patients infected or colonized with bacteria containing blaNDM-7 IncX3 plasmids will generate infection control challenges. Epidemiological and molecular studies are required to better understand the dynamics of transmission, risk factors and reservoirs for bacteria harboring blaNDM-7. To the best of our knowledge, this is the first report of S. marcescens, and E. hormaechei with blaNDM-7.Calgary Laboratory Services (#10006465) and in part by a grant (to B.N.K.) from the National Institutes of Health (1R01AI090155).http://aac.asm.org2016-09-30hb201

A Model for the Stray Light Contamination of the UVCS Instrument on SOHO

We present a detailed model of stray-light suppression in the spectrometer channels of the Ultraviolet Coronagraph Spectrometer (UVCS) on the SOHO spacecraft. The control of diffracted and scattered stray light from the bright solar disk is one of the most important tasks of a coronagraph. We compute the fractions of light that diffract past the UVCS external occulter and non-specularly pass into the spectrometer slit. The diffracted component of the stray light depends on the finite aperture of the primary mirror and on its figure. The amount of non-specular scattering depends mainly on the micro-roughness of the mirror. For reasonable choices of these quantities, the modeled stray-light fraction agrees well with measurements of stray light made both in the laboratory and during the UVCS mission. The models were constructed for the bright H I Lyman alpha emission line, but they are applicable to other spectral lines as well.Comment: 19 pages, 5 figures, Solar Physics, in pres

Anti-counterfeiting: Mixing the Physical and the Digital World

In this paper, we overview a set of desiderata for building digital anti-counterfeiting technologies that rely upon the difficulty of manufacturing randomized complex 3D objects. Then, we observe how this set is addressed by RF-DNA, an anti-counterfeiting technology recently proposed by DeJean and Kirovski. RF-DNA constructs certificates of authenticity as random objects that exhibit substantial uniqueness in the electromagnetic domain

Lost in space? The role of place in the delivery of social welfare law advice over the telephone and face-to-face

Advice that is provided exclusively over the telephone has been promoted by government as more convenient and accessible than face-to-face appointments. The resulting push towards telephone-only provision, as implemented by the Legal Aid, Sentencing and Punishment of Offenders Act 2012, challenges the long history of association between social welfare law advice and local delivery within disadvantaged communities. This article reports on qualitative research comparing telephone and face-to-face advice which uncovers the continuing relevance of place in the dynamics and mechanics of social welfare law provision. Familiarity with the geographical location, knowledge of local policies and procedures, relationships with opponents and allies, and an understanding of the ‘local legal culture’ mean that face-to-face advisers are often able to conduct their legal casework more effectively. Conversely, local knowledge is unlikely to be available to Community Legal Advice telephone advisers. This research suggests that, in addition, telephone-only advisers may be developing a more narrow understanding of the essential qualities of casework. These findings are particularly significant in view of the likely future expansion of remote methods of delivery in legal aid work

The Hague declaration on peace and justice in the twenty first century

English/Welsh text on inverted pages. Originally printed July 2000SIGLEAvailable from British Library Document Supply Centre-DSC:m00/46304 / BLDSC - British Library Document Supply CentreGBUnited Kingdo