Isolation and Characterization of toxin A-negative, toxin B-positive Clostridium difficile in Dublin, Ireland

Clostridium difficile is a major cause of infectious diarrhoea in hospitalised patients. Most pathogenic C. difficile strains produce two toxins, A and B; however, clinically relevant toxin A-negative, toxin Bpositive (A– B+ ) strains of C. difficile that cause diarrhoea and colitis in humans have been isolated worldwide. The aims of this study were to isolate and characterise A– B+ strains from two university hospitals in Dublin, Ireland. Samples positive for C. difficile were identified daily by review of ELISA results and were cultured on selective media. Following culture, toxin-specific immunoassays, IMR-90 cytotoxicity assays and PCR were used to analyse consecutive C. difficile isolates from 93 patients. Using a toxin A-specific ELISA, 52 samples produced detectable toxin. All isolates were positive using a toxin A ⁄ B ELISA. Similarly, all isolates were positive with the cytoxicity assay, although variant cytopathic effects were observed in 41 cases. PCR amplification of the toxin A and toxin B genes revealed that 41 of the previous A– B+ strains had a c. 1.7-kb deletion in the 3¢-end of the tcdA gene. Restriction enzyme analysis of these amplicons revealed the loss of polymorphic restriction sites. These 41 A– B+ isolates were designated toxinotype VIII by comparison with C. difficile strain 1470. PCR ribotyping revealed that all A– B+ isolates belonged to PCR-ribotype 017. A– B+ C. difficile isolates accounted for 44% of the isolates examined in this study, and appeared to be isolated more frequently in Dublin, Ireland, than reported rates for other countries

Clostridium difficile Infection in Patients Discharged from US Short-stay Hospitals, 1996–20031

Clinicians should be aware of the increasing risk of C. difficile–associated disease and make efforts to control its transmission

CHIMERA: a wide-field, multi-colour, high-speed photometer at the prime focus of the Hale telescope

The Caltech HIgh-speed Multi-colour camERA (CHIMERA) is a new instrument that has been developed for use at the prime focus of the Hale 200-inch telescope. Simultaneous optical imaging in two bands is enabled by a dichroic beam splitter centred at 567 nm, with Sloan u′ and g′ bands available on the blue arm and Sloan r′, i′ and z_s bands available on the red arm. Additional narrow-band filters will also become available as required. An electron multiplying CCD (EMCCD) detector is employed for both optical channels, each capable of simultaneously delivering sub-electron effective read noise under multiplication gain and frame rates of up to 26 fps full frame (several 1000 fps windowed), over a fully corrected 5 × 5 arcmin field of view. CHIMERA was primarily developed to enable the characterization of the size distribution of sub-km Kuiper Belt Objects via stellar occultation, a science case that motivates the frame-rate, the simultaneous multi-colour imaging and the wide field of view of the instrument. In addition, it also has unique capability in the detection of faint near-Earth asteroids and will be used for the monitoring of short-duration transient and periodic sources, particularly those discovered by the intermediate Palomar Transient Factory (iPTF), and the upcoming Zwicky Transient Facility (ZTF)

Timing of Increment Formation in Atlantic Bluefin Tuna (Thunnus thynnus) Otoliths.

Controversies remain regarding the periodicity, or seasonality, of otolith growth band formation, which directly influences a correct age determination of Atlantic bluefin tuna using this structure. The aim of this work was to apply marginal increment analysis and marginal edge analysis to determine the timing of band deposition. The index of completion was analyzed using general additive models to evaluate the importance of variables, such as month, age/size, and reader. Results indicate that the opaque band formation begins in June and is completed by the end of November. From the end of the year to the beginning of the following year, there is minimal marginal edge growth as the translucent band begins to form. The translucent zone then reaches a maximum development in May. The results obtained in this study provide evidence that the annulus formation in the otoliths of Atlantic bluefin tuna are completed later in the calendar year than previously thought. This would mean it is necessary to delay the date of the current July 1st adjustment criterion to November 30

Hospital-acquired Clostridium difficile-associated disease in the intensive care unit setting: epidemiology, clinical course and outcome

<p>Abstract</p> <p>Background</p> <p><it>Clostridium difficile</it>-associated disease (CDAD) is a serious nosocomial infection, however few studies have assessed CDAD outcome in the intensive care unit (ICU). We evaluated the epidemiology, clinical course and outcome of hospital-acquired CDAD in the critical care setting.</p> <p>Methods</p> <p>We performed a historical cohort study on 58 adults with a positive <it>C. difficile </it>cytotoxin assay result occurring in intensive care units.</p> <p>Results</p> <p>Sixty-two percent of patients had concurrent infections, 50% of which were bloodstream infections. The most frequently prescribed antimicrobials prior to CDAD were anti-anaerobic agents (60.3%). Septic shock occurred in 32.8% of CDAD patients. The in-hospital mortality was 27.6%. Univariate analysis revealed that SOFA score, at least one organ failure and age were predictors of mortality. Charlson score ≥3, gender, concurrent infection, and number of days with diarrhea before a positive <it>C. difficile </it>toxin assay were not significant predictors of mortality on univariate analysis. Independent predictors for death were SOFA score at infection onset (per 1-point increment, OR 1.40; CI95 1.13–1.75) and age (per 1-year increment, OR 1.10; CI95 1.02–1.19).</p> <p>Conclusion</p> <p>In ICU patients with CDAD, advanced age and increased severity of illness at the onset of infection, as measured by the SOFA score, are independent predictors of death.</p

Aerial dissemination of Clostridium difficile spores

Background: Clostridium difficile-associated diarrhoea (CDAD) is a frequently occurring healthcare-associated infection, which is responsible for significant morbidity and mortality amongst elderly patients in healthcare facilities. Environmental contamination is known to play an important contributory role in the spread of CDAD and it is suspected that contamination might be occurring as a result of aerial dissemination of C. difficile spores. However previous studies have failed to isolate C. difficile from air in hospitals. In an attempt to clarify this issue we undertook a short controlled pilot study in an elderly care ward with the aim of culturing C. difficile from the air. Methods: In a survey undertaken during February (two days) 2006 and March (two days) 2007, air samples were collected using a portable cyclone sampler and surface samples collected using contact plates in a UK hospital. Sampling took place in a six bedded elderly care bay (Study) during February 2006 and in March 2007 both the study bay and a four bedded orthopaedic bay (Control). Particulate material from the air was collected in Ringer's solution, alcohol shocked and plated out in triplicate onto Brazier's CCEY agar without egg yolk, but supplemented with 5 mg/L of lysozyme. After incubation, the identity of isolates was confirmed by standard techniques. Ribotyping and REP-PCR fingerprinting were used to further characterise isolates. Results: On both days in February 2006, C. difficile was cultured from the air with 23 samples yielding the bacterium (mean counts 53 – 426 cfu/m3 of air). One representative isolate from each of these was characterized further. Of the 23 isolates, 22 were ribotype 001 and were indistinguishable on REP-PCR typing. C. difficile was not cultured from the air or surfaces of either hospital bay during the two days in March 2007. Conclusion: This pilot study produced clear evidence of sporadic aerial dissemination of spores of a clone of C. difficile, a finding which may help to explain why CDAD is so persistent within hospitals and difficult to eradicate. Although preliminary, the findings reinforce concerns that current C. difficile control measures may be inadequate and suggest that improved ward ventilation may help to reduce the spread of CDAD in healthcare facilities

Putting sharks on the map: A global standard for improving shark area-based conservation

Area-based conservation is essential to safeguard declining biodiversity. Several approaches have been developed for identifying networks of globally important areas based on the delineation of sites or seascapes of importance for various elements of biodiversity (e.g., birds, marine mammals). Sharks, rays, and chimaeras are facing a biodiversity crisis with an estimated 37% of species threatened with extinction driven by overfishing. Yet spatial planning tools often fail to consider the habitat needs critical for their survival. The Important Shark and Ray Area (ISRA) approach is proposed as a response to the dire global status of sharks, rays, and chimaeras. A set of four globally standardized scientific criteria, with seven sub-criteria, was developed based on input collated during four shark, biodiversity, and policy expert workshops conducted in 2022. The ISRA Criteria provide a framework to identify discrete, three-dimensional portions of habitat important for one or more shark, ray, or chimaera species, that have the potential to be delineated and managed for conservation. The ISRA Criteria can be applied to all environments where sharks occur (marine, estuarine, and freshwater) and consider the diversity of species, their complex behaviors and ecology, and biological needs. The identification of ISRAs will guide the development, design, and application of area-based conservation initiatives for sharks, rays, and chimaeras, and contribute to their recovery

Clostridium difficile infection among hospitalized HIV-infected individuals: epidemiology and risk factors: results from a case-control study (2002-2013).

BACKGROUND: HIV infection is a risk factor for Clostridium difficile infection (CDI) yet the immune deficiency predisposing to CDI is not well understood, despite an increasing incidence of CDI among such individuals. We aimed to estimate the incidence and to evaluate the risk factors of CDI among an HIV cohort in Italy. METHODS: We conducted a retrospective case-control (1:2) study. Clinical records of HIV inpatients admitted to the National Institute for Infectious Disease "L. Spallanzani", Rome, were reviewed (2002-2013). CASES: HIV inpatients with HO-HCFA CDI, and controls: HIV inpatients without CDI, were matched by gender and age. Logistic regression was used to identify risk factors associated with CDI. RESULTS: We found 79 CDI episodes (5.1 per 1000 HIV hospital admissions, 3.4 per 10000 HIV patient-days). The mean age of cases was 46 years. At univariate analysis factors associated with CDI included: antimycobacterial drug exposure, treatment for Pneumocystis pneumonia, acid suppressant exposure, previous hospitalization, antibiotic exposure, low CD4 cell count, high Charlson score, low creatinine, low albumin and low gammaglobulin level. Using multivariate analysis, lower gammaglobulin level and low serum albumin at admission were independently associated with CDI among HIV-infected patients. CONCLUSIONS: Low gammaglobulin and low albumin levels at admission are associated with an increased risk of developing CDI. A deficiency in humoral immunity appears to play a major role in the development of CDI. The potential protective role of albumin warrants further investigation

Can ecosystem-based deep-sea fishing be sustained?

Can there ever be a truly sustainable deep-sea fishery and if so, where and under what conditions? Ecosystembased fisheries management requires that this question be addressed such that habitat, bycatch species, and targeted fish populations are considered together within an ecosystem context. To this end, we convened the first workshop to develop an ecosystem approach to deep-sea fisheries and to ask whether deep-sea species could be fished sustainably. The workshop participants were able to integrate bycatch information into their framework but found it more difficult to integrate other ecosystem indicators such as habitat characteristics. (First two paragraphs from the Executive Summary

The association between histamine 2 receptor antagonist use and Clostridium difficile infection: a systematic review and meta-analysis.

Background Clostridium difficile infection (CDI) is a major health problem. Epidemiological evidence suggests that there is an association between acid suppression therapy and development of CDI. Purpose We sought to systematically review the literature that examined the association between histamine 2 receptor antagonists (H2RAs) and CDI. Data source We searched Medline, Current Contents, Embase, ISI Web of Science and Elsevier Scopus from 1990 to 2012 for all analytical studies that examined the association between H2RAs and CDI. Study selection Two authors independently reviewed the studies for eligibility. Data extraction Data about studies characteristics, adjusted effect estimates and quality were extracted. Data synthesis Thirty-five observations from 33 eligible studies that included 201834 participants were analyzed. Studies were performed in 6 countries and nine of them were multicenter. Most studies did not specify the type or duration of H2RAs therapy. The pooled effect estimate was 1.44, 95% CI (1.22–1.7), I2 = 70.5%. This association was consistent across different subgroups (by study design and country) and there was no evidence of publication bias. The pooled effect estimate for high quality studies was 1.39 (1.15–1.68), I2 = 72.3%. Meta-regression analysis of 10 study-level variables did not identify sources of heterogeneity. In a speculative analysis, the number needed to harm (NNH) with H2RAs at 14 days after hospital admission in patients receiving antibiotics or not was 58, 95% CI (37, 115) and 425, 95% CI (267, 848), respectively. For the general population, the NNH at 1 year was 4549, 95% CI (2860, 9097). Conclusion In this rigorous systematic review and meta-analysis, we observed an association between H2RAs and CDI. The absolute risk of CDI associated with H2RAs is highest in hospitalized patients receiving antibiotics