Evaluation of the One Health-Ness of 20 Years of Antimicrobial Resistance Surveillance in Norway

We evaluated the One Health-ness (OH-ness) of the surveillance system for antimicrobial resistance (AMR) in Norway by using the recently developed “Evaluation tool for One Health epidemiological surveillance capacities and capabilities” (OH–EpiCap tool). First, we defined the Norwegian AMR surveillance system that we would evaluate. The tool was applied by a group of stakeholders (key persons in the Norwegian AMR surveillance programmes and authors of this paper). The evaluation was performed using a consensus approach. The evaluation resulted in an overall OH-ness score of 68% across all three dimensions included in the tool: Organisation, Operation, and Impact. Suggestions for improvement were only indicated within the areas of internal evaluation and operational costs, whereas most of the indicators included in the tool showed good adherence to the One Health principles. By performing this internal evaluation, we recognized that AMR surveillance in the environment needs to be included in a more systematic and standardized way to improve the OH-ness as defined by the quadripartite organisations. Last but not least, it was beneficial to bring key stakeholders together to conduct the evaluation. It increased a joint perception of the OH-ness of AMR surveillance in Norway and encouraged further collaboration in the future

From tide to table: A whole-year, coastal-wide surveillance of antimicrobial resistance in Escherichia coli from marine bivalves

This work is the first of its kind to report a whole-year and coastal-wide surveillance of antimicrobial resistance (AMR) of Escherichia coli with samples from the EU imposed Norwegian surveillance programme for marine bivalves. In total, 390 bivalve samples collected from January to December in 2016 at 59 different harvest locations, were examined. The occurrence of resistant E. coli in relation to the concentration of E. coli was also analysed. From each sample with E. coli (n = 261), one isolate was susceptibility tested against a panel of 14 antimicrobials from ten classes. The occurrence of resistance to at least one antimicrobial was 8.4 %. Resistance to tetracycline was most commonly detected (5.7 %), followed by resistance to ampicillin (4.6 %) and sulfamethoxazole (3.1 %). The occurrence of extended spectrum cephalosporin (ESC)-resistant E. coli, quinolone-resistant E. coli (QREC) and carbapenem-resistant Enterobacteriaceae (CRE) were detected through selective screening in 3.3 %, 12.8 % and none of the samples, respectively. Among the ESC-resistant E. coli, the blaCTX-M-15 gene was detected in nine isolates, where two isolates also carried the blaCMY-42 gene, followed by blaCTX-M-3 in two and blaCTX-M-1 in one. One isolate was resistant to ESC due to the n.-42C>T mutation in the AmpC gene. Only the presence of QREC clustered significantly (p < 0.013) in space including nine harvest locations. An increased risk (OR 9.4) of detecting ESC-resistant E. coli or QREC was found for samples with E. coli concentrations above the threshold of Class A for direct distribution to the market (i.e. 230 E. coli/100 g). However, five of the ESC-resistant E. coli and 26 of the QREC positive samples, had levels of E. coli below the threshold, thus from areas cleared for sale. Among the 17 ESC-resistant E. coli subjected to whole genome sequencing, two originated from two samples of great scallops and two samples of flat oysters, which are often consumed raw or lightly processed. One of these isolates belonged to the high-risk clone sequence type 131 and carried a plasmid born senB gene encoding the Shigella enterotoxin 2 (ShET2) attributed to cause watery diarrhoea in infections caused by Enteroinvasive E. coli (EIEC). Thus, our study shows that there is a potential risk for transmission of resistant and pathogenic E. coli to the consumers from these products.publishedVersio

Screening for antimicrobial- and heavy metal resistant bacteria in copper contaminated areas

A One heath approach is essential to examine the role of the marine environment in the selection and spread of antimicrobial resistance. Norwegian aquaculture used high amounts of antimicrobials during the 80s and 90s, which facilitated widespread resistance among fish pathogens. Moreover, fish farms have since their beginning used copper containing coating as anti-fouling agents on the fish nets, in addition to copper supplements in the fish feed. Consequently, some fish farms have high concentrations of copper in det sediments beneath the pens. Several studies have reported that even sublethal concentrations of heavy metals can facilitate co-selection of antimicrobial resistance and heavy metal resistance. This study applied Vibrio spp. as indicator of antimicrobial- and heavy metal resistance in copper contaminated areas. Six different locations were sampled twice. These represented four different areas in regard of aquaculture activity; Active aquaculture, Non-active aquaculture, Non-aquaculture and Unpolluted. In total, 70 samples, including sediments, seawater, marine fauna and marine algae, were examined for the presence of Vibrio spp. and Escherichia coli. The sediments were examined for heavy metals, where sediments from Active aquaculture areas held exstensively toxic mean concentration with 272.3 mg/kg dry weight (d.w.) copper, significant higher than Non active (24.4 mg/kg d.w.), Non-aquaculture (34.8 mg/kg d.w.) and Unpolluted (2.28 mg/kg d.w.), and moderate toxic mean concentration with 424.6 mg/kg d.w. zinc, also significant higher than Non-active (70.7 mg/kg d.w.), Non-aquaculture (144.6 mg/kg d.w.) and Unpolluted (16.4 mg/kg d.w.). The majority of the retrieved 350 Vibrio splendidus and 72 Vibrio anguillarum isolates were susceptible to all the antimicrobials tested for. Increased minimum inhibition concentrations (MIC) to oxytetracycline and copper were seen for some isolates from Active aquaculture, however only one- to two-fold higher than from Non-active and Non-aquaculture areas. Several antimicrobial- and heavy metal resistance genes were found across the different examined areas, with exception of the nlpE gene encoding a copper sensing lipoprotein inducing efflux pumps, that were only found in one isolate from one location with aquaculture. The majority of the 336 E. coli isolates were susceptible to all antimicrobial tested for. The Active aquaculture areas conferred highest number of E. coli, and most of the resistant E. coli. Many factors, such as weather and topography, can influence the inflow of E. coli from sewage and run-offs from land. No association was found between the detected phenotypic and genotypic resistance traits in V. splendidus and in E. coli in any of the examined areas. Importantly, a higher sample size including more locations is needed to determine whether any possible indicated differences are significant. In conclusion, the high proportion of susceptible isolates found in this project, indicates that the prevalence of selectable resistance mechanisms in the examined marine vibrios from copper contaminated areas are low.publishedVersio

Defining the scope of the European Antimicrobial Resistance Surveillance network in Veterinary medicine (EARS-Vet): a bottom-up and One Health approach

Background Building the European Antimicrobial Resistance Surveillance network in Veterinary medicine (EARS-Vet) was proposed to strengthen the European One Health antimicrobial resistance (AMR) surveillance approach. Objectives To define the combinations of animal species/production types/age categories/bacterial species/specimens/antimicrobials to be monitored in EARS-Vet. Methods The EARS-Vet scope was defined by consensus between 26 European experts. Decisions were guided by a survey of the combinations that are relevant and feasible to monitor in diseased animals in 13 European countries (bottom-up approach). Experts also considered the One Health approach and the need for EARS-Vet to complement existing European AMR monitoring systems coordinated by the ECDC and the European Food Safety Authority (EFSA). Results EARS-Vet plans to monitor AMR in six animal species [cattle, swine, chickens (broilers and laying hens), turkeys, cats and dogs], for 11 bacterial species (Escherichia coli, Klebsiella pneumoniae, Mannheimia haemolytica, Pasteurella multocida, Actinobacillus pleuropneumoniae, Staphylococcus aureus, Staphylococcus pseudintermedius, Staphylococcus hyicus, Streptococcus uberis, Streptococcus dysgalactiae and Streptococcus suis). Relevant antimicrobials for their treatment were selected (e.g. tetracyclines) and complemented with antimicrobials of more specific public health interest (e.g. carbapenems). Molecular data detecting the presence of ESBLs, AmpC cephalosporinases and methicillin resistance shall be collected too. Conclusions A preliminary EARS-Vet scope was defined, with the potential to fill important AMR monitoring gaps in the animal sector in Europe. It should be reviewed and expanded as the epidemiology of AMR changes, more countries participate and national monitoring capacities improve.Peer reviewe

Pilot testing the EARS-Vet surveillance network for antibiotic resistance in bacterial pathogens from animals in the EU/EEA

IntroductionAs part of the EU Joint Action on Antimicrobial Resistance (AMR) and Healthcare-Associated Infections, an initiative has been launched to build the European AMR Surveillance network in veterinary medicine (EARS-Vet). So far, activities included mapping national systems for AMR surveillance in animal bacterial pathogens, and defining the EARS-Vet objectives, scope, and standards. Drawing on these milestones, this study aimed to pilot test EARS-Vet surveillance, namely to (i) assess available data, (ii) perform cross-country analyses, and (iii) identify potential challenges and develop recommendations to improve future data collection and analysis.MethodsEleven partners from nine EU/EEA countries participated and shared available data for the period 2016–2020, representing a total of 140,110 bacterial isolates and 1,302,389 entries (isolate-antibiotic agent combinations).ResultsCollected data were highly diverse and fragmented. Using a standardized approach and interpretation with epidemiological cut-offs, we were able to jointly analyze AMR trends of 53 combinations of animal host-bacteria–antibiotic categories of interest to EARS-Vet. This work demonstrated substantial variations of resistance levels, both among and within countries (e.g., between animal host species).DiscussionKey issues at this stage include the lack of harmonization of antimicrobial susceptibility testing methods used in European surveillance systems and veterinary diagnostic laboratories, the absence of interpretation criteria for many bacteria–antibiotic combinations of interest, and the lack of data from a lot of EU/EEA countries where little or even surveillance currently exists. Still, this pilot study provides a proof-of-concept of what EARS-Vet can achieve. Results form an important basis to shape future systematic data collection and analysis

Adsorption of Silane Coupling Agents on Glass Fibre Surfaces

Commercial glass fibres are commonly used in reinforced composites. The importance of such composites is apparent in a number of areas and applications. Composites have maintained their popularity during several decades, as the products offered give both strength and modulus at a reduced weight. Glass fibres used in composites are almost always pre-treated with coupling agents. Coupling agents are capable of interacting with both the organic polymer resin as well as the inorganic glass surface. These coupling agents play a key role in the strength of a composite. The overall objective of this work was to characterize glass fibre surfaces after surface treatment with silane and to gain better understanding of surface processes at the silane-glass interface of a composite. Another goal was to investigate how the solvent used in the surface treatment process affected silane adsorption on the glass fibre surface. Adsorption of silane coupling agents from water and organic media on a glass fibre surface were determined with several analysis methods. The results indicate that adsorption is dependent on different factors affecting the monomer dispersion and the formation of a polymer layer on the glass fibre surface. If the silane adsorbs only physically on the fibre surface it can lead to a break in the reinforced product. In order to avoid a breakage the silane treatment must be performed in a way, that only chemical adsorption of the silane can take place on the fibre surface. In this study, adsorption mechanisms of silanes on both pure silica powders as well as glass fibre surfaces were examined. The experimental adsorption processes on a silica powder could be described by a combination of the Henry and Langmuir adsorption isotherms. Important information on changes in electrokinetic parameters of heterogeneous glass fibre surfaces was obtained with streaming potential measurements. The changes introduced by silane adsorption on glass fibre surface affected the streaming potential and a clear change in the surface charge was detected. The adsorption was further confirmed by ESCA measurements by following the carbonyl C3 signal. Information of the pH dependence of adsorption was detected by streaming potential measurements. Furthermore, it was found that treatment of glass fibres with acids and bases resulted in leaching ions from both the fibre surface as well as from the fibre bulk. Part of the ions being leached out from the glass fibre surface were replaced by ions originating from the bulk of the fibre. This created an ion gradient from the fibre bulk to the surface

Methodological perspectives on the study of the health effects of unemployment – reviewing the mode of unemployment, the statistical analysis method and the role of confounding factors

Introduction: Studying the relationship between unemployment and health raises many methodological challenges. In the current study, the aim was to evaluate the sensitivity of estimates based on different ways of measuring unemployment and the choice of statistical model. Methods: The Northern Swedish cohort was used, and two follow-up surveys thereof from 1995 and 2007, as well as register data about unemployment. Self-reported current unemployment, self-reported accumulated unemployment and register-based accumulated unemployment were used to measure unemployment and its effect on self-reported health was evaluated. Analyses were conducted with G-computation, logistic regression and three estimators for the inverse probability weighting propensity scores, and 11 potentially confounding variables were part of the analyses. Results were presented with absolute differences in the proportion with poor self-reported health between unemployed and employed individuals, except when logistic regression was used alone. Results: Of the initial 1083 pupils in the cohort, our analyses vary between 488–693 individuals defined as employed and 61–214 individuals defined as unemployed. In the analyses, the deviation was large between the unemployment measures, with a difference of at least 2.5% in effect size when unemployed was compared with employed for the self-reported and register-based unemployment modes. The choice of statistical method only had a small influence on effect estimates and the deviation was in most cases lower than 1%. When models were compared based on the choice of potential confounders in the analytical model, the deviations were rarely above 0.6% when comparing models with 4 and 11 potential confounders. Our variable for health selection was the only one that strongly affected estimates when it was not part of the statistical model. Conclusions: How unemployment is measured is highly important when the relationship between unemployment and health is estimated. However, misspecifications of the statistical model or choice of analytical method might not matter much for estimates except for the inclusion of a variable measuring health status before becoming unemployed. Our results can guide researchers when analysing similar research questions. Model diagnostics is commonly lacking in publications, but they remain very important for validation of analyses