Colonisation with pathogenic drug-resistant bacteria and Clostridioides difficile among residents of residential care facilities in Cape Town, South Africa

Objectives Residential care facilities (RCFs) act as reservoirs for multidrug-resistant organisms (MDRO). There are scarce data on colonisation with MDROs in Africa. We aimed to determine the prevalence of MDROs and C. difficile and risk factors for carriage amongst residents of RCFs in Cape Town, South Africa. Methods We performed a cross-sectional surveillance study at three RCFs. Chromogenic agar was used to screen skin swabs for methicillin-resistant Staphylococcus aureus (MRSA) and stool samples for extended-spectrum beta-lactamase-producing Enterobacterales (ESBL-E). Antigen testing and PCR was used to detect Clostridiodes difficile. Risk factors for colonisation were determined with logistic regression. Results One hundred fifty-four residents were enrolled, providing 119 stool samples and 152 sets of skin swabs. Twenty-seven (22.7%) stool samples were positive for ESBL-E, and 13 (8.6%) residents had at least one skin swab positive for MRSA. Two (1.6%) stool samples tested positive for C. difficile. Poor functional status (OR 1.3 (95% CI, 1.0 – 1.6)) and incontinence (OR 2.9 (95% CI, 1.2 – 6.9)) were significant predictors for ESBL-E colonisation. There was a trend towards higher MRSA colonisation in frail care areas. Conclusion There was high prevalence of colonisation with MDROs but low C. difficile carriage, with implications for antibiotic prescribing and infection control practice

An association between polymorphisms within the APOE gene and concussion aetiology in rugby union players

OBJECTIVES: Concussion refers to changes in neurological function due to biomechanical forces transmitted to the head. The APOE ε4 allele is associated with brain injury severity. The objective was to determine if APOE gene variants are associated with concussion history and severity in rugby players. DESIGN: In total, 128 non-concussed controls and 160 previously concussed participants (all cases N = 160; diagnosed N = 139) were recruited from high school (junior, N = 121), club (N = 116) and professional rugby teams (N = 51). METHODS: Participants were genotyped for rs405509 (G > T), rs429358 (T > C) and rs7412 (C > T) APOE variants. Statistical analyses were performed using the R environment. RESULTS: The rs405509 TT genotype was over-represented in controls compared to all cases (P = 0.043; control: 29%, all cases: 18%; odds ratio: 0.55, 95% confidence interval 0.31–0.98). The APOE-ε isoform frequencies were not significantly different between groups (P > 0.05). Additionally, the inferred APOE (rs405509-ε2/ε3/ε4) T-ε3 haplotype was over-represented in controls (41%) compared to diagnosed (32%, P = 0.042). The G-ε3 haplotype was under-represented in controls (36%) compared to all cases (44%, P = 0.019) and diagnosed (44%, P = 0.021). The TT genotype was significantly associated with rapid recovery (P = 0.048, <1 week: 51%, N = 70, ≥1 week: 36%, N = 29; odds ratio: 0.55, 95% confidence interval 0.30–1.01). CONCLUSIONS: These findings support the further elucidation of the APOE gene or closely-related genes in concussion aetiology. Although similar preliminary results were found when juniors were separately analysed, the under-powered sample size for junior subgroup requires future investigation in larger cohorts of junior-level athletes.The National Research Foundation (A.V.S., grant number 90942), (M.P., grant numbers 93416:2015, 85534:2015). The National Research Foundation of South Africa, the Deutscher Akademischer Austausch Dienst (DAAD) and the University of Cape Town funded S.A. and S.M.http://www.elsevier.com/locate/jsam2019-02-01hj2017Sports Medicin

Colonisation with pathogenic drug-resistant bacteria and Clostridioides difficile among residents of residential care facilities in Cape Town, South Africa: a cross-sectional prevalence study

Abstract Background Residential care facilities (RCFs) act as reservoirs for multidrug-resistant organisms (MDRO). There are scarce data on colonisation with MDROs in Africa. We aimed to determine the prevalence of MDROs and C. difficile and risk factors for carriage amongst residents of RCFs in Cape Town, South Africa. Methods We performed a cross-sectional surveillance study at three RCFs. Chromogenic agar was used to screen skin swabs for methicillin-resistant S. aureus (MRSA) and stool samples for extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E). Antigen testing and PCR was used to detect Clostridiodes difficile. Risk factors for colonisation were determined with logistic regression. Results One hundred fifty-four residents were enrolled, providing 119 stool samples and 152 sets of skin swabs. Twenty-seven (22.7%) stool samples were positive for ESBL-E, and 13 (8.6%) residents had at least one skin swab positive for MRSA. Two (1.6%) stool samples tested positive for C. difficile. Poor functional status (OR 1.3 (95% CI, 1.0–1.6)) and incontinence (OR 2.9 (95% CI, 1.2–6.9)) were significant predictors for ESBL-E colonisation. MRSA colonization appeared higher in frail care areas (8/58 v 5/94, p = 0.07). Conclusions There was a relatively high prevalence of colonisation with MDROs, particularly ESBL-E, but low C. difficile carriage, with implications for antibiotic prescribing and infection control practice

Inflammatory and apoptotic signalling pathways and concussion severity : a genetic association study

The objective was to investigate the relationship between IL-1B rs16944, IL-6 rs1800795, and CASP8 rs3834129 genetic polymorphisms and concussion severity. Rugby players from high school, senior amateur, and professional teams completed a concussion severity questionnaire and donated a DNA sample. Participants (n = 163) were split into symptom severity groups around the median number and duration of symptoms. The frequency of participants with high symptom counts (more than five symptoms) increased across the IL-1B (C/C: 35%; C/T: 51%; T/T: 56%; P = 0.047) and the IL-6 (C/C: 31%; C/G: 44%; G/G: 58%; P = 0.027) genotypes. The C–C inferred interleukin allele construct frequency, created from combining the IL-1B and IL-6 genotype data, was lower in participants reporting a high symptom count (18%), compared to those with a low symptom count (fewer than six symptoms, 36%, P = 0.002). Similarly, the C–C inferred interleukin allele construct frequency was lower in those reporting prolonged symptom duration (more than one week, 16%), as opposed to short symptom duration (less than one week, 34%, P = 0.015). This study provides evidence of novel inflammatory pathway genetic associations with concussion severity, which supports the hypothesis implicating neuroinflammation in the development of concussion symptoms.The National Research Foundation funded the study (A.V.S., grant number 90942), (M.P., grant numbers 93416:2015, 85534:2015). The National Research Foundation and the University of Cape Town funded S.A. and S.M.https://www.tandfonline.com/loi/rjsp202019-03-06hj2019Sports Medicin

The association between COMT rs4680 and 5-HTTLPR genotypes and concussion history in South African rugby union players

The objective was to investigate the relationship between Catechol-O-methyltransferase (COMT) rs4680 and serotonin-transporter-linked polymorphic region (5-HTTLPR) genotypes with concussion history and personality traits. Rugby players (“all levels”: n = 303), from high schools (“junior”, n = 137), senior amateur, and professional teams (“senior”, n = 166), completed a self-reported concussion history questionnaire, Cloninger’s Tridimensional Personality Questionnaire, and donated a DNA sample. Participants were allocated into control (non-concussed, n = 140), case (all) (previous suspected or diagnosed concussions, n = 163), or case (diagnosed only) (previous diagnosed concussion, n = 140) groups. COMT rs4680 Val/Val genotypes were over-represented in controls in all levels (P = 0.013, OR:2.00, 95% CI:1.15–3.57) and in juniors (P = 0.003, OR:3.57, 95% CI:1.45–9.09). Junior Val/Val participants displayed increased “anticipatory worry” (P = 0.023). The 5-HTTLPR low expressing group was under-represented in controls when all levels were considered (P = 0.032; OR:2.02, 95% CI:1.05–3.90) and in juniors (P = 0.021; OR:3.36, 95% CI:1.16–9.72). Junior 5-HTTLPR low and intermediate expressing groups displayed decreased “harm avoidance” (P = 0.009), “anticipatory worry” (P = 0.041), and “fear of uncertainty” (P < 0.001). This study provides preliminary indications that personality associated genetic variants can influence concussion in rugby.The South African National Research Foundation (A.V.S., grant number 90942), (M.P., grant numbers 93416:2015, 85534:2015). The South African National Research Foundation and the University of Cape Town funded S.A. and S.M.http://www.tandfonline.com/loi/rjsp202019-10-01hj2017Sports Medicin

The association between harm avoidance personality traits and self-reported concussion history in South African rugby union players

OBJECTIVES : Personality traits have been proposed to affect the risk of sports concussion, but evidence is limited. Cloninger’s Tridimensional Personality Questionnaire (TPQ) measures novelty seeking, harm avoidance (HA), and reward dependence traits. The aim of this study was to investigate the relationship between TPQ scores and concussion history in rugby union players. DESIGN : Cross-sectional study. METHODS : Rugby players from high schools, senior amateur clubs, and professional teams provided a self-reported concussion history and completed the TPQ. Participants reporting no previous concussions formed the control group, while participants reporting concussion formed the case group. A one-way analysis of covariance, with age as a covariate, was used to examine the differences in TPQ scores between groups. RESULTS : Of the 309 participants, 54% reported a minimum of one concussion (junior: 47%; amateur: 52%; professional: 72%). HA scores were significantly higher in junior players without a history of concussion compared to cases (p = 0.006). Specifically, the junior control group had higher “anticipatory worry” (p = 0.009) and “fear of uncertainty” (p = 0.008). In contrast, the professional control group had lower HA scores than cases (p = 0.009), while the amateur cohort displayed no differences between control and case groups. CONCLUSIONS : This study identified a novel association between HA and concussion in rugby players, adding evidence to the role of personality in a multifactorial risk-model of concussion. The findings suggest that lower HA may lead to increased dangerous play in youth rugby, influencing concussion susceptibility. Contrasting associations in the professional cohort suggest further research is required to understand the role of personality in concussion. Remove selectedSM and SA were funded by the South African National Research Foundation and the University of Cape Town. MP was funded by the Thembakazi Trust. This study was in part funded by the South African National Research Foundation and the University of Cape Town.http://www.elsevier.com/locate/jsam2019-01-01hj2017Sports Medicin

Unravelling the interaction between the DRD2 and DRD4 genes, personality traits and concussion risk

CITATION: Abrahams, S., et 2019. Unravelling the interaction between the DRD2 and DRD4 genes, personality traits and concussion risk. BMJ Open Sport and Exercise Medicine, 5(1):e000465, doi:10. 1136/bmjsem- 2018- 000465).The original publication is available at https://bmjopensem.bmj.comBackground: Concussion occurs when biomechanical forces transmitted to the head result in neurological deficits. Personality may affect the balance between safe and dangerous play potentially influencing concussion risk. Dopamine receptor D2 (DRD2) and dopamine receptor D4 (DRD4) genetic polymorphisms were previously associated with personality traits. Objectives: This case–control genetic association study investigated the associations of (1) DRD2 and DRD4 genotypes with concussion susceptibility and personality, (2) personality with concussion susceptibility and (3) the statistical model of genotype, personality and concussion susceptibility. Methods: In total, 138 non-concussed controls and 163 previously concussed cases were recruited from high school (n=135, junior), club and professional rugby teams (n=166, senior). Participants were genotyped for DRD2 rs12364283 (A>G), DRD2 rs1076560 (C>A) and DRD4 rs1800955 (T>C) genetic variants. Statistical analyses including structural equation modelling were performed using the R environment and STATA. Results: The rs1800955 CC genotype (p=0.014) and inferred DRD2 (rs12364283–rs1076560)–DRD4 (rs1800955) A–C–C allele combination (p=0.019) were associated with decreased concussion susceptibility in juniors. The rs1800955 TT and CT genotypes were associated with low reward dependence in juniors (p<0.001) and seniors (p=0.010), respectively. High harm avoidance was associated with decreased concussion susceptibility in juniors (p=0.009) and increased susceptibility in seniors (p=0.001). The model showed that a genetic variant was associated with personality while personality was associated with concussion susceptibility. Conclusion: These findings highlight the linear relationship between genetics, personality and concussion susceptibility. Identifying a genetic profile of ‘high risk’ behaviour, together with the development of personalised behavioural training, can potentially reduce concussion risk.https://bmjopensem.bmj.com/content/5/1/e000465Publisher's versio