Emergence of quinolone resistance among extended-spectrum beta-lactamase-producing Enterobacteriaceae in the Central African Republic: genetic characterization

<p>Abstract</p> <p>Background</p> <p>Cross-resistance to quinolones and beta-lactams is frequent in <it>Enterobacteriaceae</it>, due to the wide use of these antibiotics clinically and in the food industry. Prescription of one of these categories of antibiotic may consequently select for bacteria resistant to both categories. Genetic mechanisms of resistance may be secondary to a chromosomal mutation located in quinolone resistance determining region of DNA gyrase or topoisomerase IV or to a plasmid acquisition. The insertion sequence IS<it>CR1 </it>is often associated with <it>qnr </it>and may favour its dissemination in Gram-negative bacteria. The aim of this study was to determine the genetic mechanism of quinolone resistance among extended-spectrum beta-lactamase-producing <it>Enterobacteriaceae </it>strains in the Central African Republic.</p> <p>Findings</p> <p>Among seventeen ESBL-producing <it>Enterobacteriaceae </it>isolated from urine, pus or stool between January 2003 and October 2005 in the Central African Republic, nine were resistant to ciprofloxacin (seven from community patients and two from hospitalized patients). The ESBL were previously characterized as CTX-M-15 and SHV-12. Susceptibility to nalidixic acid, norfloxacin and ciprofloxacin, and the minimal inhibitory concentrations of these drugs were determined by disc diffusion and agar dilution methods, respectively. The presence of plasmid-borne IS<it>CR1-qnrA </it>region was determined by PCR and amplicons, if any, were sent for sequencing. Quinolone resistance determining region of DNA gyrase <it>gyrA </it>gene was amplified by PCR and then sequenced for mutation characterization. We found that all CTX-M-producing strains were resistant to the tested quinolones. All the isolates had the same nucleotide mutation at codon 83 of <it>gyrA</it>. Two <it>Escherichia coli </it>strains with the highest MICs were shown to harbour an IS<it>CR1-qnrA1 </it>sequence. This genetic association might favour dissemination of resistance to quinolone and perhaps other antibiotics among <it>Enterobacteriaceae</it>.</p> <p>Conclusions</p> <p>This study shows that at least two mechanisms might explain the emerging resistance of <it>Enterobacteriaceae </it>to quinolones in the CAR. Beside the classical topoisomerase mutation, the cause may be acquisition of a plasmid-borne <it>qnrA1</it>. Clinicians and bacteriologists should be made aware of possible dissemination of IS<it>CR1-qnrA1 </it>among <it>Enterobacteriacae</it>.</p

Terrestrial biosphere changes over the last 120 kyr

A new global synthesis and biomization of long (> 40 kyr) pollen-data records is presented and used with simulations from the HadCM3 and FAMOUS climate models and the BIOME4 vegetation model to analyse the dynamics of the global terrestrial biosphere and carbon storage over the last glacial–interglacial cycle. Simulated biome distributions using BIOME4 driven by HadCM3 and FAMOUS at the global scale over time generally agree well with those inferred from pollen data. Global average areas of grassland and dry shrubland, desert, and tundra biomes show large-scale increases during the Last Glacial Maximum, between ca. 64 and 74 ka BP and cool substages of Marine Isotope Stage 5, at the expense of the tropical forest, warm-temperate forest, and temperate forest biomes. These changes are reflected in BIOME4 simulations of global net primary productivity, showing good agreement between the two models. Such changes are likely to affect terrestrial carbon storage, which in turn influences the stable carbon isotopic composition of seawater as terrestrial carbon is depleted in 13C

Mixed-effects models for health care longitudinal data with an informative visiting process: A Monte Carlo simulation study.

Electronic health records are being increasingly used in medical research to answer more relevant and detailed clinical questions; however, they pose new and significant methodological challenges. For instance, observation times are likely correlated with the underlying disease severity: Patients with worse conditions utilise health care more and may have worse biomarker values recorded. Traditional methods for analysing longitudinal data assume independence between observation times and disease severity; yet, with health care data, such assumptions unlikely hold. Through Monte Carlo simulation, we compare different analytical approaches proposed to account for an informative visiting process to assess whether they lead to unbiased results. Furthermore, we formalise a joint model for the observation process and the longitudinal outcome within an extended joint modelling framework. We illustrate our results using data from a pragmatic trial on enhanced care for individuals with chronic kidney disease, and we introduce user-friendly software that can be used to fit the joint model for the observation process and a longitudinal outcome

Revista de Vertebrados de la Estación Biológica de Doñana

Descripción de una nueva subespecie de lagarto ágil (Lacerta agilis garzoni) de los PirineosDiet of the Montagu's Harrier (Circus pygargus) in southwestern Spain SpainObservaciones ornitológicas en la Guayana francesaDaily feeding rhythm of ducks on the marismas of the Guadalquivir and their responses to birds of preyA note on the emetic technique for obtaining food samples from passerine birds.Distribución de contaminantes organoclorados en tejidos de garza imperial (Ardea purpurea) y pato cuchara (Anas clypeata) de la Reserva Biológica de Doñana.Etograma cuantificado del gamo (Dama dama) en libertad.Peer reviewe