Multidrug-Resistant Bacteria in the Community

Multidrug resistant (MDR) bacteria are one of the most important current threats to public health. Typically, MDR bacteria are associated with nosocomial infections. However, some MDR bacteria have become quite prevalent causes of community-acquired infections. The spread of MDR bacteria into the community is a crucial development, and is associated with increased morbidity, mortality, healthcare costs and antibiotic use. Factors associated with community dissemination of MDR bacteria overlap but are distinct from those associated with nosocomial spread. Community-associated (CA) MDR bacteria have an antibiotic resistance phenotype that is stable in the absence of antibiotic pressure of the type normally observed in hospitals or nursing homes. An exception to this rule may be those CA-MDR bacteria, of which the prevalence is driven by the presence of antibiotics in the food chain. Additionally, the colonization of otherwise healthy hosts is a common characteristic of CA-MDR bacteria. However, subtle immune deficiencies may still be present in the subjects colonized with specific CA-MDR bacteria. Methicillin-resistant S. aureus (MRSA) is the most prevalent of CA-MDR bacteria. CA-MRSA also has the greatest impact on morbidity and mortality. The main threat on the horizon is represented by Enterobacteriaceae. The production of extended spectrum β-lactamases in Enterobacteriaceae encountered in the community is becoming increasingly prevalent. Of great concern is the potential for the acquisition of carbapenemase genes in CA-Enterobacteriaceae. Prevention of further community spread of MDR bacteria is of the utmost importance, and will require a multi-disciplinary approach involving all stakeholders

Does Money Talk Equate to Class Talk? Audience Responses to Poverty Porn in Relation to Money and Debt

This chapter focuses on transcripts collected for the Benefits Street project at Sheffield Hallam University, which elicited audience responses to clips of poverty porn programming. We conducted four focus groups with members of the public from different social backgrounds across the north and Midlands of England and asked our participants what they thought of the representations of the working class that were shown on screen. Using techniques from corpus linguistics (specifically the use of semantic tagging software) and discourse analysis, we focus here on how our participants used terms associated with money and debt. Our analysis aims to ascertain whether talk of money in relation to benefits claimants actually equates to talk about their social class

End-of-Life decision tool with emphasis on remanufacturing

Remanufacturing is a product recovery strategy resulting in end-of-life products being returned to as new condition or better and receiving a warranty at least equivalent to the original. To differentiate remanufacturing from other forms of product recovery, a clear definition of a remanufactured product is essential. At present two distinct methods for understanding end-of-life recovery strategies exist; a) the use of tools and b) definitions. These current methods fall short however of categorically stating what is and what is not a remanufactured product. Therefore, the responsibility of classifying a product as remanufactured is left to individuals and organizations and so potential exists for products to be incorrectly labelled. By firstly examining the problems associated with using existing methods to determine the status of end-of-life product, and why product identification is important, this paper then goes on to present a new simple innovative method to quickly and accurately determine the status of a product which has undergone an end-of-life recovery strategy, by virtue of a bespoke tool. The tool presented is the result of two rounds of academic and industrial feedback; an initial tool was presented, and underwent critique, at the International Conference on Remanufacturing 2015 with an updated tool then subject to another independent review from academic and industrial stakeholders. The main benefits associated with this tool are, a) a quick way to identify the status of a product, b) a method for researchers to quickly determine the best terminology for end-of-life products which have received a recovery treatment, c) a quick and reliable method to check whether a remanufactured product is labelled as something else, d) an additional way to ensure compliance with existing legislation and standards, and e) an identification of only the essential characteristics of a remanufactured product

RNA Sequencing Reveals Novel Transcripts from Sympathetic Stellate Ganglia During Cardiac Sympathetic Hyperactivity.

Cardiovascular disease is the most prevalent age-related illness worldwide, causing approximately 15 million deaths every year. Hypertension is central in determining cardiovascular risk and is a strong predictive indicator of morbidity and mortality; however, there remains an unmet clinical need for disease-modifying and prophylactic interventions. Enhanced sympathetic activity is a well-established contributor to the pathophysiology of hypertension, however the cellular and molecular changes that increase sympathetic neurotransmission are not known. The aim of this study was to identify key changes in the transcriptome in normotensive and spontaneously hypertensive rats. We validated 15 of our top-scoring genes using qRT-PCR, and network and enrichment analyses suggest that glutamatergic signalling plays a key role in modulating Ca2+ balance within these ganglia. Additionally, phosphodiesterase activity was found to be altered in stellates obtained from the hypertensive rat, suggesting that impaired cyclic nucleotide signalling may contribute to disturbed Ca2+ homeostasis and sympathetic hyperactivity in hypertension. We have also confirmed the presence of these transcripts in human donor stellate samples, suggesting that key genes coupled to neurotransmission are conserved. The data described here may provide novel targets for future interventions aimed at treating sympathetic hyperactivity associated with cardiovascular disease and other dysautonomias

A case of IMP-4-, OXA-421-, OXA-96-, and CARB-2-producing acinetobacter pittii sequence type 119 in Australia

An IMP-4-producing Acinetobacter pittii strain coproducing oxacillinases was isolated from a leg wound of a 67-year-old female patient. Identification to the species level by rpoB and gyrB sequencing and multiplex-PCR-based analysis revealed that the isolate was A. pittii. Whole-genome sequencing of this A. pittii isolate determined the presence of bla(OXA-96), bla(CARB-2), and a novel bla(OXA-421) gene. The position of this novel bla(OXA-421) gene was similar to that of bla(OXA-51) in A. baumannii, downstream of the phosphinothricin N-acetyltransferase gene and upstream of fxsA in the chromosome. This A. pittii isolate was found to belong to sequence type 119 (ST119). Here, we report the first isolation of IMP-4-producing A. pittii ST119 with a novel bla(OXA-421) gene from a patient in Australia and characterize its draft genome

Draft Genome Sequence of NDM-5-Producing Escherichia coli Sequence Type 648 and Genetic Context of blaNDM-5 in Australia

We report here the draft genome sequence of uropathogenic Escherichia\ua0coli sequence type 648 (ST648) possessing blaNDM-5 from a 55-year-old female in Australia with a history of travel to India. The plasmid-mediated blaNDM-5 was in a genetic context nearly identical to that of the GenBank entry of an IncX3 blaNDM-5 plasmid previously reported from India (Klebsiella\ua0pneumoniae MGR-K194)

Cost effectiveness of antimicrobial catheters in the intensive care unit: addressing uncertainty in the decision

Introduction: Some types of antimicrobial-coated central venous catheters (A-CVC) have been shown to be cost-effective in preventing catheter-related bloodstream infection (CR-BSI). However, not all types have been evaluated, and there are concerns over the quality and usefulness of these earlier studies. There is uncertainty amongst clinicians over which, if any, antimicrobial-coated central venous catheters to use. We re-evaluated the cost-effectiveness of all commercially available antimicrobialcoated central venous catheters for prevention of catheter-related bloodstream infection in adult intensive care unit (ICU) patients. Methods: We used a Markov decision model to compare the cost-effectiveness of antimicrobial-coated central venous catheters relative to uncoated catheters. Four catheter types were evaluated; minocycline and rifampicin (MR)-coated catheters; silver, platinum and carbon (SPC)-impregnated catheters; and two chlorhexidine and silver sulfadiazine-coated catheters, one coated on the external surface (CH/SSD (ext)) and the other coated on both surfaces (CH/SSD (int/ext)). The incremental cost per qualityadjusted life-year gained and the expected net monetary benefits were estimated for each. Uncertainty arising from data estimates, data quality and heterogeneity was explored in sensitivity analyses. Results: The baseline analysis, with no consideration of uncertainty, indicated all four types of antimicrobial-coated central venous catheters were cost-saving relative to uncoated catheters. Minocycline and rifampicin-coated catheters prevented 15 infections per 1,000 catheters and generated the greatest health benefits, 1.6 quality-adjusted life-years, and cost-savings, AUD $130,289. After considering uncertainty in the current evidence, the minocycline and rifampicin-coated catheters returned the highest incremental monetary net benefits of$948 per catheter; but there was a 62% probability of error in this conclusion. Although the minocycline and rifampicin-coated catheters had the highest monetary net benefits across multiple scenarios, the decision was always associated with high uncertainty. Conclusions: Current evidence suggests that the cost-effectiveness of using antimicrobial-coated central venous catheters within the ICU is highly uncertain. Policies to prevent catheter-related bloodstream infection amongst ICU patients should consider the cost-effectiveness of competing interventions in the light of this uncertainty. Decision makers would do well to consider the current gaps in knowledge and the complexity of producing good quality evidence in this area