Whole genome sequencing identifies zoonotic transmission of MRSA isolates with the novel mecA homologue mecC

This work was supported by a Medical Research Council (MRC) Partnership Grant (G1001787/1) held between the Department of Veterinary Medicine, University of Cambridge (M. A. H.), the School of Clinical Medicine, University of Cambridge (S. J. P.), the Moredun Research Institute (R. N. Z.) and the Wellcome Trust Sanger Institute (J. P. and S. J. P.).Several methicillin-resistant Staphylococcus aureus (MRSA) lineages that carry a novel mecA homologue (mecC) have recently been described in livestock and humans. In Denmark, two independent human cases of mecC-MRSA infection have been linked to a livestock reservoir. We investigated the molecular epidemiology of the associated MRSA isolates using whole genome sequencing (WGS). Single nucleotide polymorphisms (SNP) were defined and compared to a reference genome to place the isolates into a phylogenetic context. Phylogenetic analysis revealed two distinct farm-specific clusters comprising isolates from the human case and their own livestock, whereas human and animal isolates from the same farm only differed by a small number of SNPs, which supports the likelihood of zoonotic transmission. Further analyses identified a number of genes and mutations that may be associated with host interaction and virulence. This study demonstrates that mecC-MRSA ST130 isolates are capable of transmission between animals and humans, and underscores the potential of WGS in epidemiological investigations and source tracking of bacterial infections. See accompanying article http://dx.doi.org/10.1002/emmm.201302622Publisher PDFPeer reviewe

Social disparities in diabetes care: a general population study in Denmark

<p><b>Objective:</b> We investigated the association between socioeconomic factors and the attainment of treatment goals and pharmacotherapy in patients with type 2 diabetes in Denmark.</p> <p><b>Design:</b> A cross-sectional population study.</p> <p><b>Setting:</b> The municipality of Naestved, Denmark.</p> <p><b>Subjects:</b> We studied 907 patients with type 2 diabetes identified from a random sample of 21,205 Danish citizens.</p> <p><b>Main outcome measures:</b> The proportion of patients who were not achieving goals for diabetes care based on their HbA_1c, LDL-cholesterol, blood pressure, and lifestyle, and the proportion of patients who were treated with antihypertensive and cholesterol- and glucose-lowering medication.</p> <p><b>Methods:</b> We investigated the association of the socioeconomic factors such as age, gender, education, occupation, income, and civil status and attainment of treatment goals and pharmacotherapy in logistic regression analyses. We investigated effect modification of cardiovascular disease and kidney disease.</p> <p><b>Results:</b> Middle age (40–65 years), low education level (i.e. basic schooling), and low household income (i.e. less than 21,400 € per year) were associated with nonattainment of goals for diabetes care. The association of socioeconomic factors with attainment of individual treatment goals varied. Patients with low socioeconomic status were more often obese, physically inactive, smoking, and had elevated blood pressure. Socioeconomic factors were not associated with treatment goals for hyperglycemia. Socioeconomic factors were inconsistently associated with pharmacotherapy. There was no difference in contacts to general practitioners according to SES.</p> <p><b>Conclusions:</b> In a country with free access to health care, the socioeconomic factors such as middle age, low education, and low income were associated with nonattainment of goals for diabetes care.KEY POINTS</p><p>Middle age, low education, and low income were associated with nonattainment of goals for diabetes care, especially for lifestyle goals.</p><p>Patients with low socioeconomic status were more often obese, physically inactive, smoking, and had elevated blood pressure.</p><p>Association of socioeconomic factors with pharmacotherapy was inconsistent.</p><p></p> <p>Middle age, low education, and low income were associated with nonattainment of goals for diabetes care, especially for lifestyle goals.</p> <p>Patients with low socioeconomic status were more often obese, physically inactive, smoking, and had elevated blood pressure.</p> <p>Association of socioeconomic factors with pharmacotherapy was inconsistent.</p

Additional file 3: of Socio-demographic determinants and effect of structured personal diabetes care: a 19-year follow-up of the randomized controlled study diabetes Care in General Practice (DCGP)

Table S2. The effect of structured personal care on behavioral, clinical, process of care and biochemical variables according to civil status (DOCX 37 kb

Additional file 1: of Socio-demographic determinants and effect of structured personal diabetes care: a 19-year follow-up of the randomized controlled study diabetes Care in General Practice (DCGP)

Definition of clinical outcomes in the 19-year registry-based monitoring of the DCGP study, any diabetes related endpoint (list). (DOCX 76 kb

Additional file 5: of Socio-demographic determinants and effect of structured personal diabetes care: a 19-year follow-up of the randomized controlled study diabetes Care in General Practice (DCGP)

Table S4. The effect of structured personal care on behavioral, clinical, process of care and biochemical variables according to residence (Rural vs. Urban) (DOCX 37 kb