An exploratory study about contamination of pens of finishing pigs by ubiquitous Salmonella

Salmonella is one of the most common food-borne pathogens transmitted to humans and human salmonellosis is primarily caused by contaminated food. Porcine products have been identified as important food vehicles in outbreaks of salmonellosis (I, 2, 3). In France, the majority of Salmonella infected pig herds are sub-clinically infected. S. Choleraesuis does not occur and only ubiquitous serotypes are isolated (4). Sub-clinically infection is characterized by intermittent shedding of small numbers of Salmonella. In these sub-clinically infected pig herds, an infectioncontamination-infection cycle is maintained with mainly an endemic house flora of Salmonella enterica (5). When contaminated batches from these farms are processed on the slaughter line, slaughtering practices contribute to Salmonella dissemination and carcass contamination. Within batches, there is a strong correlation between the proportion of animals with Salmonella spp. in their feces and the proportion of contaminated carcasses at the end of the line (6, 7). As a result of subclinical Salmonella infection in pig herds, Salmonella contamination of pork carcasses constitutes a threat to human health. The influence of a wide range of factors on subclinical Salmonella contamination of pig farms is not well known. A good understanding of risk factors for Salmonella contamination of pig herds is an essential stake in order to avoid Salmonella spread within herds and between herds and slaughterhouses. Thus, the aim of this study was to investigate potential risk factors for the presence of ubiquitous Salmonella in the finishing sheds of farrow-to-finish farms in France

Multicentre, prospective, double-blind, randomised controlled clinical trial comparing different non-opioid analgesic combinations with morphine for postoperative analgesia: the OCTOPUS study

BACKGROUND: Head-to-head comparisons of combinations of more than one non-opioid analgesic (NOA) with morphine alone, for postoperative analgesia, are lacking. The objective of this multicentre, randomised, double-blind controlled trial was to compare the morphine-sparing effects of different combinations of three NOAs-paracetamol (P), nefopam (N), and ketoprofen (K)-for postoperative analgesia. METHODS: Patients from 10 hospitals were randomised to one of eight groups: control (C) received saline as placebo, P, N, K, PN, PK, NK, and PNK. Treatments were given intravenously four times a day during the first 48 h after surgery, and morphine patient-controlled analgesia was used as rescue analgesia. The outcome measures were morphine consumption, pain scores, and morphine-related side-effects evaluated 24 and 48 h after surgery. RESULTS: Two hundred and thirty-seven patients undergoing a major surgical procedure were included between July 2013 and November 2016. Despite a failure to reach a calculated sample size, 24 h morphine consumption [median (inter-quartile range)] was significantly reduced in the PNK group [5 (1-11) mg] compared with either the C group [27 (11-42) mg; P<0.05] or the N group [21 (12-29) mg; P<0.05]. Results were similar 48 h after surgery. Patients experienced less pain in the PNK group compared with the C, N, and P groups. No difference was observed in the incidence of morphine-related side-effects. CONCLUSIONS: Combining three NOAs with morphine allows a significant morphine sparing for 48 h after surgery associated with superior analgesia the first 24 h when compared with morphine alone. CLINICAL TRIAL REGISTRATION: EudraCT: 2012-004219-30; NCT01882530

Development of an ELISA test to assess Salmonella status of pig herds

A total of 70 herds were characterized by serology with an indirect ELISA and bacteriology on environmental swabs. Then they were classified according to a factorial analysis followed by a hierarchical clustering into 3 classes, negative, intermediate and strongly positive. Serological and bacteriological methods were correlated for extreme herds but the results were not so clear for intermediate herds. Nevertheless the correlation between the mean calibrated optical density (mean COD) obtained by serology and the percentage of positive herds obtained by bacteriology was high

Phenylephrine increases cardiac output by raising cardiac preload in patients with anesthesia induced hypotension

Induction of general anesthesia frequently induces arterial hypotension, which is often treated with a vasopressor, such as phenylephrine. As a pure -agonist, phenylephrine is conventionally considered to solely induce arterial vasoconstriction and thus increase cardiac afterload but not cardiac preload. In specific circumstances, however, phenylephrine may also contribute to an increase in venous return and thus cardiac output (CO). The aim of this study is to describe the initial time course of the effects of phenylephrine on various hemodynamic variables and to evaluate the ability of advanced hemodynamic monitoring to quantify these changes through different hemodynamic variables. In 24 patients, after induction of anesthesia, during the period before surgical stimulus, phenylephrine 2 mu gkg(-1) was administered when the MAP dropped below 80% of the awake state baseline value for >3min. The mean arterial blood pressure (MAP), heart rate (HR), end-tidal CO2 (EtCO2), central venous pressure (CVP), stroke volume (SV), CO, pulse pressure variation (PPV), stroke volume variation (SVV) and systemic vascular resistance (SVR) were recorded continuously. The values at the moment before administration of phenylephrine and 5(T-5) and 10(T-10)min thereafter were compared. After phenylephrine, the mean(SD) MAP, SV, CO, CVP and EtCO2 increased by 34(13)mmHg, 11(9)mL, 1.02(0.74)Lmin(-1), 3(2.6)mmHg and 4.0(1.6)mmHg at T-5 respectively, while both dynamic preload variables decreased: PPV dropped from 20% at baseline to 9% at T-5 and to 13% at T-10 and SVV from 19 to 11 and 14%, respectively. Initially, the increase in MAP was perfectly aligned with the increase in SVR, until 150s after the initial increase in MAP, when both curves started to dissociate. The dissociation of the evolution of MAP and SVR, together with the changes in PPV, CVP, EtCO2 and CO indicate that in patients with anesthesia-induced hypotension, phenylephrine increases the CO by virtue of an increase in cardiac preload

Increasing arterial blood pressure with norepinephrine does not improve microcirculatory blood flow: a prospective study

Introduction Our goal was to assess the effects of titration of a norepinephrine infusion to increasing levels of mean arterial pressure (MAP) on sublingual microcirculation. Methods Twenty septic shock patients were prospectively studied in two teaching intensive care units. The patients were mechanically ventilated and required norepinephrine to maintain a mean arterial pressure (MAP) of 65 mmHg. We measured systemic hemodynamics, oxygen transport and consumption (DO2 and VO2), lactate, albumin-corrected anion gap, and gastric intramucosal-arterial PCO2 difference (Delta PCO2). Sublingual microcirculation was evaluated by sidestream darkfield (SDF) imaging. After basal measurements at a MAP of 65 mmHg, norepinephrine was titrated to reach a MAP of 75 mmHg, and then to 85 mmHg. Data were analyzed using repeated measurements ANOVA and Dunnett test. Linear trends between the different variables and increasing levels of MAP were calculated. Results Increasing doses of norepinephrine reached the target values of MAP. The cardiac index, pulmonary pressures, systemic vascular resistance, and left and right ventricular stroke work indexes increased as norepinephrine infusion was augmented. Heart rate, DO2 and VO2, lactate, albumin-corrected anion gap, and Delta PCO2 remained unchanged. There were no changes in sublingual capillary microvascular flow index (2.1 +/- 0.7, 2.2 +/- 0.7, 2.0 +/- 0.8) and the percent of perfused capillaries (72 +/- 26, 71 +/- 27, 67 +/- 32%) for MAP values of 65, 75, and 85 mmHg, respectively. There was, however, a trend to decreased capillary perfused density (18 +/- 10,17 +/- 10,14 +/- 2 vessels/mm(2), respectively, ANOVA P = 0.09, linear trend P = 0.045). In addition, the changes of perfused capillary density at increasing MAP were inversely correlated with the basal perfused capillary density (R-2 = 0.95, P < 0.0001). Conclusions Patients with septic shock showed severe sublingual microcirculatory alterations that failed to improve with the increases in MAP with norepinephrine. Nevertheless, there was a considerable interindividual variation. Our results suggest that the increase in MAP above 65 mmHg is not an adequate approach to improve microcirculatory perfusion and might be harmful in some patient

Global patient outcomes after elective surgery: prospective cohort study in 27 low-, middle- and high-income countries.

BACKGROUND: As global initiatives increase patient access to surgical treatments, there remains a need to understand the adverse effects of surgery and define appropriate levels of perioperative care. METHODS: We designed a prospective international 7-day cohort study of outcomes following elective adult inpatient surgery in 27 countries. The primary outcome was in-hospital complications. Secondary outcomes were death following a complication (failure to rescue) and death in hospital. Process measures were admission to critical care immediately after surgery or to treat a complication and duration of hospital stay. A single definition of critical care was used for all countries. RESULTS: A total of 474 hospitals in 19 high-, 7 middle- and 1 low-income country were included in the primary analysis. Data included 44 814 patients with a median hospital stay of 4 (range 2-7) days. A total of 7508 patients (16.8%) developed one or more postoperative complication and 207 died (0.5%). The overall mortality among patients who developed complications was 2.8%. Mortality following complications ranged from 2.4% for pulmonary embolism to 43.9% for cardiac arrest. A total of 4360 (9.7%) patients were admitted to a critical care unit as routine immediately after surgery, of whom 2198 (50.4%) developed a complication, with 105 (2.4%) deaths. A total of 1233 patients (16.4%) were admitted to a critical care unit to treat complications, with 119 (9.7%) deaths. Despite lower baseline risk, outcomes were similar in low- and middle-income compared with high-income countries. CONCLUSIONS: Poor patient outcomes are common after inpatient surgery. Global initiatives to increase access to surgical treatments should also address the need for safe perioperative care. STUDY REGISTRATION: ISRCTN5181700

Editorials Controlling Salmonella along the food chain in the European Union- progress over the last ten years

Salmonella has long been recognised as an important food-borne zoonotic pathogen of economic significance in animals and in humans. The main reservoir of Salmonella is the intestinal tract of a wide range of domestic and wild animals, which may result in contamination of a variety of foodstuffs of both animal and plant origin. This risk has been taken seriously by food business operators (FBO) and policy makers in the European Union (EU). The incremental implementation of an integrated legislative approach to monitor and control Salmonella along the food chain, from primary production to consumption, over the last ten years has thus brought about important progress, however, challenges remain as a paper by Kinross et al. about an ongoing EU-wide outbreak of S. Stanley in this issu

An exploratory study about contamination of pens of finishing pigs by ubiquitous Salmonella

Salmonella is one of the most common food-borne pathogens transmitted to humans and human salmonellosis is primarily caused by contaminated food. Porcine products have been identified as important food vehicles in outbreaks of salmonellosis (I, 2, 3). In France, the majority of Salmonella infected pig herds are sub-clinically infected. S. Choleraesuis does not occur and only ubiquitous serotypes are isolated (4). Sub-clinically infection is characterized by intermittent shedding of small numbers of Salmonella. In these sub-clinically infected pig herds, an infectioncontamination-infection cycle is maintained with mainly an endemic "house flora" of Salmonella enterica (5). When contaminated batches from these farms are processed on the slaughter line, slaughtering practices contribute to Salmonella dissemination and carcass contamination. Within batches, there is a strong correlation between the proportion of animals with Salmonella spp. in their feces and the proportion of contaminated carcasses at the end of the line (6, 7). As a result of subclinical Salmonella infection in pig herds, Salmonella contamination of pork carcasses constitutes a threat to human health. The influence of a wide range of factors on subclinical Salmonella contamination of pig farms is not well known. A good understanding of risk factors for Salmonella contamination of pig herds is an essential stake in order to avoid Salmonella spread within herds and between herds and slaughterhouses. Thus, the aim of this study was to investigate potential risk factors for the presence of ubiquitous Salmonella in the finishing sheds of farrow-to-finish farms in France.</p