A Call for Action: The Application of the International Health Regulations to the Global Threat of Antimicrobial Resistance

Stephen Harbarth and colleagues argue that the International Health Regulations (IHR) should be applied to the global health threat of antimicrobial resistance

A systematic review on integration mechanisms in human and animal health surveillance systems with a view to addressing global health security threats

Lymphatic filariasis and onchocerciasis are neglected tropical diseases (NTDs) targeted for elimination by mass (antifilarial) drug administration. These drugs are predominantly active against the microfilarial progeny of adult worms. New drugs or combinations are needed to improve patient therapy and to enhance the effectiveness of interventions in persistent hotspots of transmission. Several therapies and regimens are currently in (pre-)clinical testing. Clinical trial simulators (CTSs) project patient outcomes to inform the design of clinical trials but have not been widely applied to NTDs, where their resource-saving payoffs could be highly beneficial. We demonstrate the utility of CTSs using our individual-based onchocerciasis transmission model (EPIONCHO-IBM) that projects trial outcomes of a hypothetical macrofilaricidal drug. We identify key design decisions that influence the power of clinical trials, including participant eligibility criteria and post-treatment follow-up times for measuring infection indicators. We discuss how CTSs help to inform target product profiles

Estudo comparativo da análise de ciclo de vida de concretos geopoliméricos e de concretos à base de cimento Portland composto (CP II)

A Análise de Ciclo de Vida (ACV) é um método que inclui a compilação e avaliação das entradas, saídas e dos impactos de um produto ao longo do seu ciclo de vida. Os resultados desta análise são utilizados para escolher alternativas favoráveis para uma aplicação específica. Este artigo utilizou as ferramentas de ACV, apoiada pelo software Umberto, para comparar o processo de obtenção de concretos de cimento Portland com o de concretos geopoliméricos, obtidos da ativação alcalina de aluminossilicatos. O impacto ambiental foi avaliado considerando 1 m³ de cada concreto, sendo (i) as emissões de CO2 (kg CO2/ m³) e (ii) a demanda energética (MJ/m³) as variáveis para determinar o potencial sustentável de ambos materiais. O objetivo principal foi avaliar se os concretos geopoliméricos são mais sustentáveis do que os concretos tradicionais. Os resultados obtidos mostraram que o consumo energético é reduzido em 45,8% na produção do concreto geopolimérico, quando comparado à produção do concreto de cimento Portland de desempenho mecânico equivalente. Com relação às emissões de CO2, o concreto geopolimérico reduz as emissões em 72,4%, em comparação ao concreto tradicional de cimento Portland CPII. Assim, o primeiro se mostra uma alternativa a ser considerada, na produção de materiais de construção de menor impacto ambiental

Burkholderia cenocepacia bacteremia without respiratory colonization in an adult intensive care unit: epidemiological and molecular investigation of an outbreak

Abstract Background: To investigate an outbreak of Burkholderia cenocepacia bacteremia. Observational study and chart review in a multidisciplinary adult Intensive Care Unit (ICU) at a tertiary care hospital. Methods: Patients' demographic variables, comorbid conditions, ICU admission diagnosis, disease severity and outcome were analyzed. In case-patients, time and possible sources of bacteremia, molecular assays, antimicrobial susceptibility and response to therapy were also recorded. Results: During a 9-month period, 30 episodes of B. cenocepacia bacteremia were diagnosed in 21 patients. Median time for a positive blood culture was 9 days after admission. None of the case-patients had respiratory colonization prior to onset of bacteremia. Pathogen was susceptible to meropenem, piperacillin/tazobactam, ciprofloxacin and trimethoprim /sulphamethoxazole. Surveillance involved environmental and patient/personnel cultures. All samples were negative for B. cenocepacia. However, extensive assessment revealed lapses in infection control procedures. PFGE molecular typing showed that all isolates were indistinguishable. Prior surgery and septic shock on ICU admission were significantly more frequent among case-patients. These patients needed significantly prolonged mechanical ventilation, central venous catheterization and ICU hospitalization. All patients responded to antimicrobial therapy and the attributed mortality was zero. Complete elimination of the outbreak was achieved only after strict enforcement of infection control policies and ICU disinfection. Conclusions: The outbreak influenced ICU morbidity but it did not affect mortality. Although extensive environmental investigations failed to identify the source of infection, B.cenocepacia disappeared after implementation of control measures. Effective outbreak elimination cannot be limited to offending reservoir removal but needs to extend to efficient infection control practices. Hippokratia 2012, 16, 4: 317-32

Resistant Shigella strains in refugees, August-October 2015, Greece

Shigellosis is endemic in most developing countries and thus a known risk in refugees and internally displaced persons. In 2015, a massive influx of refugees into Greece, due to the political crisis in the Middle East, led to the development of appropriate conditions for outbreaks of communicable diseases as shigellosis. We present a cluster of 16 shigellosis cases in refugees, detected by the implementation of a syndromic notification system in one transit centre in Athens, between 20 August and 7 October 2015. Both Shigella flexneri (n = 8) and S. sonnei (n = 8) were identified, distributed in various serotypes. All tested isolates (n = 13) were multidrug resistant; seven were CTX-M-type extended-spectrum β-lactamase producers. Our results indicate lack of a potential common source, although pulsed-field gel electrophoresis typing results revealed small clusters in isolates of the same serotype indicating possible limited person-to-person transmission without identifying secondary community cases related to the refugees. To prevent the spread of shigellosis, empirical antibiotic treatment as well as environmental hygiene measures were implemented. The detection of multi-drug resistance is important for determining the appropriate empirical antibiotic treatment for the more severe cases, while at the same time real-time typing is useful for epidemiological investigation and control measures. © Cambridge University Press 2016

An update of the evolving epidemic of blaKPC-2-carrying Klebsiella pneumoniae in Greece (2009-10)

Objectives: To follow the epidemic of KPC-2-producing Klebsiella pneumoniae in Greece. Methods: KPC-2-producing isolates (n = 378) were collected during January 2009-April 2010 in 40 Greek hospitals. blaKPC and blaVIM were detected by PCR. Carbapenemase production was confirmed by spectrophotometry. Sequences flanking blaKPC-2 and their plasmid carriers were studied. Isolates were typed by PFGE and multilocus sequence typing (MLST). Results: All 378 isolates were blaKPC-2 positive; 18 also carried blaVIM-1/VIM-4. Higher isolation frequencies were observed in Athens and Crete. Isolates were classified into 13 PFGE types and 11 sequence types (STs). ST258 was predominant (n = 322), followed by ST147 (n = 20), ST383 (n = 9), ST133 (n = 6), ST274 (n = 4) and ST323 (n = 3). Of the remaining isolates, seven were distributed into five STs (11, 17, 340 and the novel 494 and 495) and seven were not typed. blaKPC-2 could not be transferred from ST258 isolates, in contrast to isolates of ST17, ST133, ST147, ST274, ST494 and ST495. All blaKPC-2-encoding plasmids were of similar size (~100 kb) and showed indistinguishable restriction fragment length polymorphism (RFLP) patterns except those from the ST340 isolates. Sequences flanking blaKPC-2 revealed that the Tn4401a isoform was present in plasmids from all STs except ST340 containing Tn4401b. Co-production of VIM enzymes was observed in isolates of ST147, ST323 and ST383. Conclusions: Apart from the epidemic of KPC-2-producing K. pneumoniae belonging to ST258 in Greece, diffusion of blaKPC-2 to at least 10 additional STs has taken place. Notably, strains from three of the latter STs (147, 323 and 383) were found to carry both blaKPC-2 and blaVIM. © The Author 2011. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved

Cave cyanobacteria showing antibacterial activity

Cave Cyanobacteria. - thriving in an 'extreme' environment with interesting species biodiversity. - are supposed to be a potential source of bioactive compounds. Lipid extracts from pure cultures of two recently established Cyanobacteria from Greek caves, Toxopsis calypsus and Phormidium melanochroun, were used for antibacterial screening against human pathogenic bacteria (reference and clinical isolates). Antimicrobial Susceptibility testing for both taxa was carried out using the disc-diffusion (Kirby Bauer) method, while preliminary data applying the standard broth microdilution method for the determination of the Minimal Inhibitory Concentration (MIC) are given only for T. calypsus. Antibacterial activity was demonstrated against the Gram-positive clinical and reference bacteria, mostly pronounced in enterococci; no activity was observed against the Gram-negative bacteria. The above screening is the first record of antibacterial activity from lipid extracts of cave Cyanobacteria enhancing the importance of cave microbiota and the necessity for cave conservation. © 2015, Societa Speleologica Italiana. All rights reserved