Turning the tide of antimicrobial resistance: Europe shows the way

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldTen years ago, European officials, experts and other stakeholders met in Copenhagen, Denmark, at the invitation of the Danish Ministry of Health and the Danish Ministry of Food, Agriculture and Fisheries. This European conference on "The Microbial Threat" due to antimicrobial resistance resulted in the publication of "Copenhagen Recommendations" calling for action to limit the emerging problem of antimicrobial-resistant microorganisms [1]. Following the conference, the European Commission prepared a comprehensive Community strategy against antimicrobial resistance, which was published in 2001 [2] and presented in Eurosurveillance [3]. Later the same year, European Union (EU) Health Ministers adopted a Council Recommendation on the prudent use of antimicrobial agents in human medicine with a series of specific measures aimed at containing the spread of antimicrobial resistance by prudent use of antimicrobial agents [4

Utility of oropharyngeal real-time PCR for S. pneumoniae and H. influenzae for diagnosis of pneumonia in adults.

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn To access publisher's full text version of this article click on the hyperlink at the bottom of the pageor click on the hyperlink at the To access publisher's full text version of this article, please click on the hyperlink in Additional Links field top of the page marked FilesA lack of sensitive tests and difficulties obtaining representative samples contribute to the challenge in identifying etiology in pneumonia. Upper respiratory tract swabs can be easily collected and analyzed with real-time PCR (rtPCR). Common pathogens such as S. pneumoniae and H. influenzae can both colonize and infect the respiratory tract, complicating the interpretation of positive results. Oropharyngeal swabs were collected (n = 239) prospectively from adults admitted to hospital with pneumonia. Analysis with rtPCR targeting S. pneumoniae and H. influenzae was performed and results compared with sputum cultures, blood cultures, and urine antigen testing for S. pneumoniae. Different Ct cutoff values were applied to positive tests to discern colonization from infection. Comparing rtPCR with conventional testing for S. pneumoniae in patients with all tests available (n = 57) resulted in: sensitivity 87 %, specificity 79 %, PPV 59 % and NPV 94 %, and for H. influenzae (n = 67): sensitivity 75 %, specificity 80 %, PPV 45 % and NPV 94 %. When patients with prior antimicrobial exposure were excluded sensitivity improved: 92 % for S. pneumoniae and 80 % for H. influenzae. Receiver operating characteristic curve analysis demonstrated for S. pneumoniae: AUC = 0.65 (95 % CI 0.51-0.80) and for H. influenzae: AUC = 0.86 (95 % CI 0.72-1.00). Analysis of oropharyngeal swabs using rtPCR proved both reasonably sensitive and specific for diagnosing pneumonia caused by S. pneumoniae and H. influenzae. This method may be a useful diagnostic adjunct to other methods and of special value in patients unable to provide representative lower airway samples.Icelandic Center for Research Rannis Landspitali University Hospital Science Fund University of Iceland Research Fun

Bactrial osteomyelitis and arthritis in Icelandic children 1996-2005

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn Skoða/Opna(view/open)Objective: The main objective was to determine the incidence and causative pathogens of osteomyelitis and septic arthritis in Icelandic children, as well as presenting symptoms and diagnosis. Methods: A nationwide retrospective review was done of all children <18 year old, 1996-2005. Subjects were divided into three equal age groups, 0-5, 6-11 and 12-17 years old. Cultures were reviewed and postive and negative cases compared. Results: Over the study period 220 cases were identified, 161 osteomyelitis and 59 septic arthritis cases. The incidence increased significantly over the period (p=0.019), mostly in the youngest age group (p<0.001) with osteomyelitis. Incidence of cases with a pathogen identified was unchanged over the period while culture negative cases increased significantly (p<0.001). Median age for osteomyelitis (6,1 years) was higher than in cases of septic arthitis (1,8 years) (p=0.003). A pathogen was identified in 59% of cases with osteomyelitis and 44% with septic arthritis. S. aureus was most common (65% and 27%, respectively) and K. kingae was second most common pathogen (7% and 11%, respectively). Methicillin resistant S. aureus was not identified. The tibia and knee were the predominant sites for osteomyelitis and septic arthritis respectively. Conclusions: An increased incidence was found in the youngest age group with osteomyelitis, especially in cases without a pathogen identified. The most commonly cultured pathogen was S. aureus, followed by K. kingae. A more sensitive technique to identify pathogens might be indicated in culture negative cases.Tilgangur: Markmið rannsóknarinnar var að kanna nýgengi, sýkingarvalda, einkenni og greiningaraðferðir beina- og liðasýkinga í börnum á Íslandi. Efniviður og aðferðir: Rannsóknin var afturskyggn og náði til barna yngri en 18 ára sem lögðust inn vegna sýkinganna á tímabilinu 1996-2005. Upplýsingum var safnað úr sjúkraskrám. Tilfellum var skipt í þrjá jafna aldurshópa, 0-5 ára, 6-11 ára og 12-17 ára. Niðurstöður ræktana voru metnar og einnig breytingar á nýgengi á tímabilinu. Niðurstöður: Á tímabilinu greindust 220 tilfelli, 161 með beinasýkingu og 59 með liðasýkingu. Nýgengi jókst marktækt á tímabilinu (p=0,019). Nýgengisaukningin var nær eingöngu bundin við beinasýkingar hjá yngsta aldurshópnum. Nýgengi þar sem ræktun var jákvæð breyttist ekki en nýgengi með neikvæða ræktun jókst marktækt (p<0,001). Miðgildi aldurs sjúklinga með beinasýkingar (6,1 ára) var hærri en þeirra með liðasýkingar (1,8 ára) (p=0,003). Í 59% beinasýkinga og 44% liðasýkinga greindist baktería, S. aureus var algengust (65% beinasýkinga og 27% liðasýkinga), því næst K. kingae (7% beinasýkinga og 11% liðasýkinga). Methicillin- ónæmir S. aureus greindust ekki. Sköflungur (20%) og hnéliður (47%) voru algengustu staðir sýkinganna. Ályktanir: Rannsóknin varpar ljósi á mikilvæga þætti beina- og liðasýkinga á Íslandi. Nýgengið vex í yngsta aldurshópnum, einkum þar sem ræktun er neikvæð. Algengasti orsakavaldur er S. aureus,svo K. kingae. Meðalaldur, kynjahlutfall og staðsetning sýkinga er sambærilegt við erlendar rannsóknir. Þörf er á næmari sýklafræðilegum greiningaraðferðum hjá þeim sem eru með neikvæðar ræktanir

Invasive infections due to Streptococcus pyogenes: seasonal variation of severity and clinical characteristics, Iceland, 1975 to 2012.

To access publisher's full text version of this article click on the hyperlink at the bottom of the pageEpidemiology and clinical characteristics of invasive Group A streptococcal infections (IGASI) are highly variable. Long-term studies are needed to understand the interplay between epidemiology and virulence. In a population-based study of IGASI in Iceland from 1975 to 2012, 288 cases were identified by positive cultures from normally sterile body sites. Charts were reviewed retrospectively and emm-types of viable Streptococcus pyogenes isolates (n=226) determined. Comparing the first and last decade of the study period, IGASI incidence increased from 1.09 to 3.96 cases per 100,000 inhabitants per year. The most common were emm types 1 (25%), 28 (11%) and 89 (11%); emm1 strains were most likely to cause severe infections. Infections in adults were significantly more likely to be severe during the seasonal peak from January to April (risk ratio: 2.36, 95% confidence interval: 1.34–4.15). Significant seasonal variability in severity was noted among patients with diagnosis of sepsis, respiratory infection and cellulitis, with 38% of severe infections in January to April compared with 16% in other months (p<0.01). A seasonal increase in severity of IGASI suggested that generalised seasonal increase in host susceptibility, rather than introduction of more virulent strains may play a role in the pathogenesis of these potentially fatal infections.Icelandic Center for Research, Rannis/100436021 Landspitali University Hospital Science Fun

New Delhi metallo-beta-lactamase 1-producing Enterobacteriaceae: emergence and response in Europe

To access publisher full text version of this article. Please click on the hyperlink in Additional Links fieldAcquired carbapenemases confer extensive antibiotic resistance to Enterobacteriaceae and represent a public health threat. A novel acquired carbapenemase, New Delhi metallo-beta-lactamase 1 (NDM-1), has recently been described in the United Kingdom and Sweden, mostly in patients who had received care on the Indian subcontinent. We conducted a survey among 29 European countries (the European Union Member States, Iceland and Norway) to gather information on the spread of NDM-1-producing Enterobacteriaceae in Europe, on public health responses and on available national guidance on detection, surveillance and control. A total of 77 cases were reported from 13 countries from 2008 to 2010. Klebsiella pneumoniae was the most frequently reported species with 54%. Among 55 cases with recorded travel history, 31 had previously travelled or been admitted to a hospital in India or Pakistan and five had been hospitalised in the Balkan region. Possible nosocomial acquisition accounted for 13 of 77 cases. National guidance on NDM-1 detection was available in 14 countries and on NDM-1 control in 11 countries. In conclusion, NDM-1 is spreading across Europe, where it is frequently linked to a history of healthcare abroad, but also to emerging nosocomial transmission. National guidance in response to the threat of carbapenemase-producing Enterobacteriaceae is available in approximately half of the surveyed European countries. Surveillance of carbapenemase- producing Enterobacteriaceae must be enhanced in Europe and effective control measures identified and implemented

A critique of neo-mercantilist analyses of Icelandic political economy and crisis

Iceland’s journey from rags to riches in the 20th century is related, in the dominant discourse, to its gaining independence in 1944. This discourse played a significant role in both the legitimation of the finance-dominated growth model in the 1990s and 2000s and in the latter’s defence as it came under scrutiny before its collapse in October 2008. It is therefore ironic – or perhaps, in some sense, logical – to find dominant analyses of the crisis arising from the neo-mercantilist tradition. Drawing on Marxist critiques of neo-mercantilism, we challenge these interventions and thus seek to redress the neglect of social struggle in the dominant discourse

Effects of dietary plant-derived phytonutrients on the genome-wide profiles and coccidiosis resistance in the broiler chickens

<p>Abstract</p> <p>Background</p> <p>The present study was conducted to investigate the effects of dietary plant-derived phytonutrients, carvacrol, cinnamaldehyde and Capsicum oleoresin, on the translational regulation of genes associated with immunology, physiology and metabolism using high-throughput microarray analysis and <it>in vivo</it> disease challenge model of avian coccidiosis.</p> <p>Methods</p> <p>In this study, we used nutrigenomics technology to investigate the molecular and genetic mechanisms of dietary modulation of host innate immunity and metabolism by three phytonutrients. To validate their immunomodulatory effects in a disease model, young broiler chickens fed a standard diet supplemented with three phytochemicals (carvacrol, cinnamaldehyde, and Capsicum oleoresin) from one day post-hatch were orally challenged with <it>E. acervulina</it>. The body weight gain and fecal oocyst production were used to evaluate coccidiosis disease parameters.</p> <p>Results</p> <p>Analysis of global gene expression profiles of intestinal tissues from phytonutrient-fed birds indicated that Capsicum oleoresin induced the most gene changes compared to the control group where many of these genes were associated with those of metabolism and immunity. The most reliable network induced by dietary cinnamaldehyde treatment was related with the functions of antigen presentation, humoral immune response, and inflammatory disease. Furthermore, dietary supplementation with these phytonutrients significantly protected broiler chickens against live coccidiosis challenge infection based on body weight and parasite fecundity.</p> <p>Conclusions</p> <p>The results of this study provide clear evidence to support the idea that plant-derived phytochemicals possess immune-enhancing properties in chickens and these new findings create a new possibility to develop effective drug-free alternative strategies for disease control for poultry infectious diseases.</p