Import and spread of extended-spectrum beta-lactamase-producing Enterobacteriaceae by international travellers (COMBAT study): a prospective, multicentre cohort study

BACKGROUND: International travel contributes to the dissemination of antimicrobial resistance. We investigated the acquisition of extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) during international travel, with a focus on predictive factors for acquisition, duration of colonisation, and probability of onward transmission. METHODS: Within the prospective, multicentre COMBAT study, 2001 Dutch travellers and 215 non-travelling household members were enrolled. Faecal samples and questionnaires on demographics, illnesses, and behaviour were collected before travel and immediately and 1, 3, 6, and 12 months after return. Samples were screened for the presence of ESBL-E. In post-travel samples, ESBL genes were sequenced and PCR with specific primers for plasmid-encoded β-lactamase enzymes TEM, SHV, and CTX-M group 1, 2, 8, 9, and 25 was used to confirm the presence of ESBL genes in follow-up samples. Multivariable regression analyses and mathematical modelling were used to identify predictors for acquisition and sustained carriage, and to determine household transmission rates. This study is registered with ClinicalTrials.gov, number NCT01676974. FINDINGS: 633 (34·3%) of 1847 travellers who were ESBL negative before travel and had available samples after return had acquired ESBL-E during international travel (95% CI 32·1-36·5), with the highest number of acquisitions being among those who travelled to southern Asia in 136 of 181 (75·1%, 95% CI 68·4-80·9). Important predictors for acquisition of ESBL-E were antibiotic use during travel (adjusted odds ratio 2·69, 95% CI 1·79-4·05), traveller's diarrhoea that persisted after return (2·31, 1·42-3·76), and pre-existing chronic bowel disease (2·10, 1·13-3·90). The median duration of colonisation after travel was 30 days (95% CI 29-33). 65 (11·3%) of 577 remained colonised at 12 months. CTX-M enzyme group 9 ESBLs were associated with a significantly increased risk of sustained carriage (median duration 75 days, 95% CI 48-102, p=0·0001). Onward transmission was found in 13 (7·7%) of 168 household members. The probability of transmitting ESBL-E to another household member was 12% (95% CI 5-18). INTERPRETATION: Acquisition and spread of ESBL-E during and after international travel was substantial and worrisome. Travellers to areas with a high risk of ESBL-E acquisition should be viewed as potential carriers of ESBL-E for up to 12 months after return. FUNDING: Netherlands Organisation for Health Research and Development (ZonMw)

Prevalence and risk factors for carriage of ESBL-producing Enterobacteriaceae in a population of Dutch travellers: A cross-sectional study

Background: We investigated prevalence and predictive factors for ESBL-E carriage in a population of mostly travellers prior to their travel (n = 2216). In addition, we examined ESBL genotype before travel and compared these to returning travellers. Method: A questionnaire and faecal sample were collected before travel, and a second faecal sample was collected immediately after travel. Faecal samples were analysed for ESBL-E, with genotypic characterization by PCR and sequencing. Risk factors for ESBL-E carriage prior to travel were identified by logistic regression analyses. Results: Before travel, 136 participants (6.1%) were colonized with ESBL-E. Antibiotic use in the past three months (ORadjusted 2.57; 95% CI 1.59–4.16) and travel outside of Europe in the past year (1.92, 1.28–2.87) were risk factors for ESBL-E colonisation prior to travel. Travel outside of Europe carried the largest attributable risk (39.8%). Prior to travel 31.3% (40/128) of participants carried blaCTX-M 15 and 21.9% (28/128) blaCTX-M 14/18. In returning travellers 633 acquired ESBL-E of who 53.4% (338/633) acquired blaCTX-M 15 and 17.7% (112/633) blaCTX-M 14/18. Conclusion: In our population of Dutch travellers we found a pre-travel ESBL-E prevalence of 6.1%. Prior to travel, previous antibiotic use and travel outside of Europe were the strongest independent predictors

Potential climatic transitions with profound impact on Europe

We discuss potential transitions of six climatic subsystems with large-scale impact on Europe, sometimes denoted as tipping elements. These are the ice sheets on Greenland and West Antarctica, the Atlantic thermohaline circulation, Arctic sea ice, Alpine glaciers and northern hemisphere stratospheric ozone. Each system is represented by co-authors actively publishing in the corresponding field. For each subsystem we summarize the mechanism of a potential transition in a warmer climate along with its impact on Europe and assess the likelihood for such a transition based on published scientific literature. As a summary, the ‘tipping’ potential for each system is provided as a function of global mean temperature increase which required some subjective interpretation of scientific facts by the authors and should be considered as a snapshot of our current understanding. <br/

Gender differences in the use of cardiovascular interventions in HIV-positive persons; the D:A:D Study

Peer reviewe

Consumption of atmospheric methane by tundra soils

EMISSION of methane from tundra soil contributes about 10% of the global atmospheric methane budget1. Moreover, tundra soils contain 15% of global soil carbon2, so the response of this large carbon reservoir to projected global warming3,4 could be important. Coupled biological models3-6 predict that a warmer climate will increase methane emission through increased rates of methanogenesis. Microbial oxidation of methane is, however, a possible control on emissions that has previously been overlooked. Here we report the results of field and laboratory experiments on methane consumption by tundra soils. For methane concentrations ranging from below to well above ambient, moist soils were found to consume methane rapidly; in non-waterlogged soils, equilibration with atmospheric methane was fast relative to microbial oxidation. We conclude that lowering of the water table in tundra as a result of a warmer, drier climate will decrease methane fluxes and could cause these areas to provide a negative feedback for atmospheric methane. © 1990 Nature Publishing Group

Covalent modification of reduced graphene oxide with piperazine as a novel nanoadsorbent for removal of H2S gas

In the present research, piperazine grafted-reduced graphene oxide RGO-N-(piperazine) was synthesized through a three-step reaction and employed as a highly efficient nanoadsorbent for H2S gas removal. Temperature optimization within the range of 30–90 °C was set which significantly improved the adsorption capacity of the nanoadsorbent. The operational conditions including the initial concentration of H2S (60,000 ppm) with CH4 (15 vol%), H2O (10 vol%), O2 (3 vol%) and the rest by helium gas and gas hour space velocity (GHSV) 4000–6000 h−1 were examined on adsorption capacity. The results of the removal of H2S after 180 min by RGO-N-(piperazine), reduced graphene oxide (RGO), and graphene oxide (GO) were reported as 99.71, 99.18, and 99.38, respectively. Also, the output concentration of H2S after 180 min by RGO-N-(piperazine), RGO, and GO was found to be 170, 488, and 369 ppm, respectively. Both chemisorption and physisorption are suggested as mechanism in which the chemisorption is based on an acid–base reaction between H2S and amine, epoxy, hydroxyl functional groups on the surface of RGO-N-(piperazine), GO, and RGO. The piperazine augmentation of removal percentage can be attributed to the presence of amine functional groups in the case of RGO-N-(piperazine) versus RGO and GO. Finally, analyses of the equilibrium models used to describe the experimental data showed that the three-parameter isotherm equations Toth and Sips provided slightly better fits compared to the three-parameter isotherms

Origin and fate of methane in the Eastern Tropical North Pacific oxygen minimum zone

This work was funded by the Natural Environment Research Council (grant NE/E01559X/1)