Temporal and spatial distribution of human cryptosporidiosis in the west of Ireland 2004-2007

<p>Abstract</p> <p>Background</p> <p>Cryptosporidiosis is increasingly recognised as a cause of gastrointestinal infection in Ireland and has been implicated in several outbreaks. This study aimed to investigate the spatial and temporal distribution of human cryptosporidiosis in the west of Ireland in order to identify high risk seasons and areas and to compare Classically Calculated (CC) and Empirical Bayesian (EB) incidence rates. Two spatial scales of analysis were used with a view to identifying the best one in assessing geographical patterns of infection. Global Moran's I and Local Moran's I tests of autocorrelation were used to test for evidence of global and local spatial clustering.</p> <p>Results</p> <p>There were statistically significant seasonal patterns of cryptosporidiosis with peaks in spring and an increasing temporal trend. Significant (p < 0.05) global spatial clustering was observed in CC rates at the Electoral Division (ED) level but not in EB rates at the same level. Despite variations in disease, ED level was found to provide the most accurate account of distribution of cryptosporidiosis in the West of Ireland but required spatial EB smoothing of cases. There were a number of areas identified with significant local clustering of cryptosporidiosis rates.</p> <p>Conclusion</p> <p>This study identified spatial and temporal patterns in cryptosporidiosis distribution. The study also showed benefit in performing spatial analyses at more than one spatial scale to assess geographical patterns in disease distribution and that smoothing of disease rates for mapping in small areas enhances visualisation of spatial patterns. These findings are relevant in guiding policy decisions on disease control strategies.</p

Molecular epidemiology of extended-spectrum beta-lactamase-producing Escherichia coli

ABSTRACT Objectives: E. coli O25b-ST131 has disseminated worldwide in hospitals and the community. The objective of this study was to determine the extent to which E. coli O25b-ST131 accounts for extended-spectrum beta-lactamase (ESBL)-producing E. coli from clinical samples from all sources in this region. Methods: Between January and June 2010 ESBL-producing E. coli were collected from 94 routine samples including 47 from residents of 25 nursing homes, 15 categorized as hospital acquired and 32 others. PCR was performed for detection of bla CTX-M , bla OXA-1 , bla TEM , bla SHV and for the identification of members of the E. coli O25b:ST131 clonal group. PFGE was carried out using XbaI in accordance with PulseNet protocols. Results: The majority (97%) of isolates harbored a bla CTX-M gene. E. coli O25b-ST131 accounted for 87% of all ESBLproducing E. coli and for 96% of isolates from nursing home residents. Sonuç: E. coli O25b-ST131 klonal grubu bakımevi kaynaklı olanlarda daha belirgin olmak üzere toplanan ESBL üreten E. coli suşları arasında baskındı. Conclusion Anahtar kelimeler: Escherichia coli, O25b-ST131, Direnç, Sağlık hizmeti, Bakımevi Ludden C

Opt-out as an acceptable method of obtaining consent in medical research: a short report

<p>Abstract</p> <p>Background</p> <p>A prospective cohort study was set up to investigate a possible association between antibiotic prescribing and antibiotic resistance of <it>E. coli </it>urinary tract infection in the community. Participation of patients with urinary tract infection was obtained through an opt-out methodology. This short paper reports on the acceptability of the opt-out recruitment approach.</p> <p>Methods</p> <p>Participating practices (22) were requested to send a urine sample from all patients presenting with symptoms of urinary tract infection. Upon receipt of the sample in the laboratory, a letter explaining the study, an opt-out form and a freepost envelope were sent to all adult patients. A website with additional information and including an 'opt-out' button was set up for the study.</p> <p>Results</p> <p>A total of 1362 urine samples were submitted by the 22 participating practices representing 1178 adult patients of whom 193 actively responded to the letter: 142 opted out by letter, 15 through the website, 2 by phone and 12 sent the letter back without indication, making a total of 171 patients or 14.5% opt-out; the remaining 22 patients (1.9%) explicitly opted in. The total group consisted of 80% women and the mean age was 50.9 years (sd 20.8). No significant differences were found between patients who participated and those who opted out in terms of age, gender or whether the urine sample was positive or not.</p> <p>Conclusions</p> <p>Overall the opt-out method was well received and participation in the study reached 85.5%. The low number of complaints (2) indicates that this is a generally acceptable method of patient recruitment. The 14.5% opt-out shows that it effectively empowers patients to decline participation. The similarity between patients opting out and the rest of the patients is reassuring for extrapolation of the results of the study.</p

Antimicrobial management and appropriateness of treatment of urinary tract infection in general practice in Ireland

<p>Abstract</p> <p>Background</p> <p>Urinary tract infections (UTIs) are the second most common bacterial infections in general practice and a frequent indication for prescription of antimicrobials. Increasing concern about the association between the use of antimicrobials and acquired antimicrobial resistance has highlighted the need for rational pharmacotherapy of common infections in general practice.</p> <p>Methods</p> <p>Management of urinary tract infections in general practice was studied prospectively over 8 weeks. Patients presenting with suspected UTI submitted a urine sample and were enrolled with an opt-out methodology. Data were collected on demographic variables, previous antimicrobial use and urine samples. Appropriateness of different treatment scenarios was assessed by comparing treatment with the laboratory report of the urine sample.</p> <p>Results</p> <p>A total of 22 practices participated in the study and included 866 patients. Bacteriuria was established for 21% of the patients, pyuria without bacteriuria for 9% and 70% showed no laboratory evidence of UTI. An antimicrobial agent was prescribed to 56% (481) of the patients, of whom 33% had an isolate, 11% with pyuria only and 56% without laboratory evidence of UTI. When taking all patients into account, 14% patients had an isolate identified and were prescribed an antimicrobial to which the isolate was susceptible. The agents most commonly prescribed for UTI were co-amoxyclav (33%), trimethoprim (26%) and fluoroquinolones (17%). Variation between practices in antimicrobial prescribing as well as in their preference for certain antimicrobials, was observed. Treatment as prescribed by the GP was interpreted as appropriate for 55% of the patients. Three different treatment scenarios were simulated, i.e. if all patients who received an antimicrobial were treated with nitrofurantoin, trimethoprim or ciprofloxacin only. Treatment as prescribed by the GP was no more effective than treatment with nitrofurantoin for all patients given an antimicrobial or treatment with ciprofloxacin in all patients. Prescribing cost was lower for nitrofurantoin. Empirical treatment of all patients with trimethoprim only was less effective due to the higher resistance levels.</p> <p>Conclusions</p> <p>There appears to be considerable scope to reduce the frequency and increase the quality of antimicrobial prescribing for patients with suspected UTI.</p

Predictive value of antimicrobial susceptibility from previous urinary tract infection in the treatment of re-infection

Recurrent urinary tract infections are often re-infections; therefore, antimicrobial susceptibility test results from a previous episode may guide the empiric therapy in subsequent episbdes. This analysis provides predictive values of the antimicrobial susceptibility of previous Escherichia coli isolates for the treatment of re-infections in routine clinical practice. If resistance to ampicillin, trimethoprim, or ciprofloxacin is detected, re-prescription within 3 months is imprudent. Susceptibility to nitrofurantoin, ciprofloxacin, or trimethoprim in a previous sample supports their prescription for a re-infection within 3 months and up to a year. Resistance to nitrofurantoin is low and, once detected, decays relatively quickly. Nitrofurantoin should be considered as a first-line agent for initial and repeat treatment

Opt-out as an acceptable method of obtaining consent in medical research: a short report

Background A prospective cohort study was set up to investigate a possible association between antibiotic prescribing and antibiotic resistance of E. coli urinary tract infection in the community. Participation of patients with urinary tract infection was obtained through an opt-out methodology. This short paper reports on the acceptability of the opt-out recruitment approach. Methods Participating practices (22) were requested to send a urine sample from all patients presenting with symptoms of urinary tract infection. Upon receipt of the sample in the laboratory, a letter explaining the study, an opt-out form and a freepost envelope were sent to all adult patients. A website with additional information and including an 'opt-out' button was set up for the study. Results A total of 1362 urine samples were submitted by the 22 participating practices representing 1178 adult patients of whom 193 actively responded to the letter: 142 opted out by letter, 15 through the website, 2 by phone and 12 sent the letter back without indication, making a total of 171 patients or 14.5% opt-out; the remaining 22 patients (1.9%) explicitly opted in. The total group consisted of 80% women and the mean age was 50.9 years (sd 20.8). No significant differences were found between patients who participated and those who opted out in terms of age, gender or whether the urine sample was positive or not. Conclusions Overall the opt-out method was well received and participation in the study reached 85.5%. The low number of complaints (2) indicates that this is a generally acceptable method of patient recruitment. The 14.5% opt-out shows that it effectively empowers patients to decline participation. The similarity between patients opting out and the rest of the patients is reassuring for extrapolation of the results of the study.peer-reviewe

Predictive value of antimicrobial susceptibility from previous urinary tract infection in the treatment of re-infection

Recurrent urinary tract infections are often re-infections; therefore, antimicrobial susceptibility test results from a previous episode may guide the empiric therapy in subsequent episbdes. This analysis provides predictive values of the antimicrobial susceptibility of previous Escherichia coli isolates for the treatment of re-infections in routine clinical practice. If resistance to ampicillin, trimethoprim, or ciprofloxacin is detected, re-prescription within 3 months is imprudent. Susceptibility to nitrofurantoin, ciprofloxacin, or trimethoprim in a previous sample supports their prescription for a re-infection within 3 months and up to a year. Resistance to nitrofurantoin is low and, once detected, decays relatively quickly. Nitrofurantoin should be considered as a first-line agent for initial and repeat treatment