Novel insights into pivotal risk factors for rectal carriage of extended-spectrum-beta-lactamase-producing enterobacterales within the general population in Lower Saxony, Germany

AIMS: To estimate the prevalence of extended-spectrum-β-lactamase (ESBL)-producing enterobacterales (ESBL-E) carriage in the general population of Lower Saxony, Germany, and to identify risk factors for being colonised. METHODS AND RESULTS: Participants were recruited through local press and information events. Detection of ESBL-E by culture was conducted using ESBL-selective chromagar plates containing third generation cephalosporins. Identification of pathogens was performed using Matrix Assisted Laser Desorption Ionization Time-of-Flight-Technology on Vitek mass spectrometry. Antibiotic susceptibility testing was conducted by microdilution (Vitek II) and an ESBL confirmation assay was carried out using a combination disk test. Of 527 randomly collected stool samples from healthy volunteers, 5.5% were tested positive for ESBL-E. Post-stratification for age and gender yielded a similar population estimate (5.9%). People traveling abroad and taking antibiotics had the greatest rectal ESBL-E carriage. CONCLUSIONS: Potential risk factors (e.g., working in healthcare facilities, recent inpatient stay) did not attribute to rectal ESBL-E carriage as other factors (e.g., traveling, taking antibiotics). Rectal ESBL-E carriage within the general population seems to be high. SIGNIFICANCE AND IMPACT OF STUDY: The known risk factors for carriage with MDRO might not be fully applicable to ESBL-E and require further examination in order to develop effective strategies for the prevention of ESBL-E dissemination within the general population

Исследования гидравлических сопротивлений при движении в трубах золошлаковых тампонажно- закладочных суспензий

Експериментально досліджено залежність гідравлічного опору від швидкості руху та концентрації золошлакових суспензій при течії по трубах. Встановлена критична швидкість руху концентрованих гідросумішей.Dependence of hydraulic resistance is experimentally set from the rate of movement of ash-slag suspensions at a flow on pipes. The critical speed of motion of the concentrated slurries is set

Communicable Diseases Prioritized for Surveillance and Epidemiological Research: Results of a Standardized Prioritization Procedure in Germany, 2011

To establish strategic priorities for the German national public health institute (RKI) and guide the institute's mid-term strategic decisions, we prioritized infectious pathogens in accordance with their importance for national surveillance and epidemiological research.We used the Delphi process with internal (RKI) and external experts and a metric-consensus approach to score pathogens according to ten three-tiered criteria. Additional experts were invited to weight each criterion, leading to the calculation of a median weight by which each score was multiplied. We ranked the pathogens according to the total weighted score and divided them into four priority groups.., Respiratory syncytial virus or Hantavirus) indicate a possible under-recognised importance within the current German public health framework. A process to strengthen respective surveillance systems and research has been started. The prioritization methodology has worked well; its modular structure makes it potentially useful for other settings

New Immuno-PCR Assay for Detection of Low Concentrations of Shiga Toxin 2 and Its Variants▿

Shiga toxin (Stx)-producing Escherichia coli (STEC) strains secrete toxins that are major virulence factors and diagnostic targets, but some STEC strains secrete Stx in amounts that cannot be detected using conventional cell cytotoxicity or immunological assays. Therefore, there is an urgent need for more-sensitive Stx detection methods. We describe the development of an assay that can detect low concentrations of Stx2 and its variants. An immuno-PCR Stx2 assay was developed based on an enzyme immunoassay (EIA) combining antibody capture and DNA amplification to increase the signal. The immuno-PCR assay detected 10 pg/ml of purified Stx2, compared to 1 ng/ml Stx2 detected by commercial EIA. Consequently, immuno-PCR detected Stx2 and its variants in STEC strains that produce the toxins at levels that are nondetectable by using the EIA, as well as the Stx2 in EIA-negative enriched stool cultures from patients. Our data demonstrate that the immuno-PCR developed here is a highly sensitive and specific method for the detection of trace amounts of Stx2 and Stx2 variants. It is therefore suitable for use by clinical microbiological laboratories to improve the toxin detection in clinical samples

Comparison of a Shiga Toxin Enzyme-Linked Immunosorbent Assay and Two Types of PCR for Detection of Shiga Toxin-Producing Escherichia coli in Human Stool Specimens

Shiga toxin (Stx)-producing Escherichia coli (STEC) is a major cause of sporadic cases of disease as well as serious outbreaks worldwide. The spectrum of illnesses includes mild nonbloody diarrhea, hemorrhagic colitis, and hemolytic-uremic syndrome. STEC produces one or more Stxs, which are subdivided into two major classes, Stx1 and Stx2. The ingestion of contaminated food or water, person-to-person spread, and contact with animals are the major transmission modes. The infective dose of STEC may be less than 100 organisms. Effective prevention of infection is dependent on rapid detection of the causative bacterial pathogen. In the present study, we examined 295 stool specimens for the presence of Stx-producing E. coli by three different methods: an Stx enzyme-linked immunosorbent assay, a conventional PCR assay, and a LightCycler PCR (LC-PCR) assay protocol recently developed by our laboratory at the Institute of Medical Microbiology at Hannover Medical School. Our intent was to compare these three methods and to examine the utility of the STEC LC-PCR protocol in a clinical laboratory. The addition of a control DNA to each sample to clearly discriminate inhibited specimens from negative ones enhanced the accuracy of the LC-PCR protocol. From our results, it can be concluded that LC-PCR is a very useful tool for the rapid and safe detection of STEC in clinical samples

Surveillance Lebensmittel-übertragener Infektionserkrankungen durch das Infektionsschutzgesetz - Möglichkeiten und Anforderungen

Die Epidemiologie Lebensmittel-übertragener Erkrankungen hat sich verändert. Ausbrüche treten in zunehmendem Maße als Ansammlung räumlich oder zeitlich verteilter Einzelerkrankungen in Erscheinung und nicht mehr nur als leicht identifizierbare Gruppenerkrankungen. Dies erschwert und verzögert die Identifizierung des epidemiologischen Zusammenhangs. Die Surveillance (Überwachung) meldepflichtiger Infektionen muss sich diesen Veränderungen anpassen, um derartige Ausbrüche frühzeitig erkennen und nachfolgend deren Ursache identifizieren und ausschalten zu können. Mit In-Kraft-Treten des Infektionsschutzgesetzes (IfSG) 2001 ist dem öffentlichen Gesundheitsdienst v. a. durch die detaillierte Erfassung von Einzelfällen und deren zeitnahe elektronische Übermittlung ein wirksames Instrument an die Hand gegeben, um Infektionskrankheiten effektiver überwachen zu können. Nach dem IfSG besteht eine Meldepflicht für den Nachweis akuter Infektionen für die überwiegende Zahl der bekannten gastrointestinalen Infektionserreger (aber auch für Lebensmittelvergiftungen und akute infektiöse Gastroenteritiden). Eine erfolgreiche Surveillance Lebensmittel-übertragener Erkrankungen benötigt aber im Besonderen die Mitarbeit der niedergelassenen und klinisch tätigen Ärzte. Das Anfordern einer labordiagnostischen Untersuchung von Stuhlproben bei Patienten mit gastrointestinaler Symptomatik ist der Ausgangspunkt einer jeden Surveillance infektionsbedingter enteraler Erkrankungen. Die weiterführende Fein typisierung der Erreger ist ein wertvolles Instrument zur Erkennung von Infektionszusammenhängen. Jedoch ist ohne eine ausreichend große Zahl labordiagnostischer Erregernachweise die Möglichkeit zur Erkennung und Untersuchung Lebensmittel-übertragener Ausbrüche und damit auch für die Aufdeckung alter und neuer Gefahrenquellen bei der Herstellung und Lagerung von und beim Handel mit Lebensmitteln stark eingeschränkt.The epidemiology of infectious foodborne diseases has changed. Outbreaks more frequently occur geographically dispersed or protractedly over longer periods of time, and they often appear as a scatter of seemingly sporadic cases. This hampers and delays the identification of their epidemiological link. The surveillance of infectious foodborne diseases has to be refined accordingly to be able to detect these diffuse outbreaks. The German Protection against Infection Act, enacted in 2001, offers the potential of increased sensitivity due to timely electronic reporting of individual cases and detailed data accompanying each report. In addition to a timely and comprehensive reporting system, subtyping of pathogens has become an invaluable tool in identifying epidemiologically linked cases, i.e. outbreaks. Still, the sensitivity of foodborne disease surveillance still hinges on the willingness of physicians to order stool testing for enteric pathogens (and to report suspected outbreaks to local health departments). Without the active participation of physicians, the chance of detecting outbreaks and successfully investigating them is markedly reduced. Consequently, the general preventive strategy would be jeopardised, namely to understand the (often new) mechanisms by which contamination and disease transmission occur well enough to interrupt them