Antimicrobial Susceptibility Testing of Leptospira spp. in the Lao People's Democratic Republic Using Disk Diffusion.

Leptospirosis is a global zoonotic disease caused by pathogenic bacteria of the Leptospira genus, which are fastidious, slow-growing organisms. Antimicrobial susceptibility data are limited; traditionally, the organisms have not been culturable on solid media. The recent development of Leptospira Vanaporn Wuthiekanun (LVW) agar, which facilitates rapid growth of Leptospira spp., provides the opportunity for antimicrobial susceptibility testing. Eighty-three Leptospira spp. clinical isolates originating from patients in Laos between 2006 and 2016 were tested against six antimicrobials (azithromycin, ceftriaxone, ciprofloxacin, doxycycline, gentamicin, and penicillin G) using disk diffusion on LVW agar. Quality control was undertaken using American Type Culture Collection (ATCC) reference strains with known susceptibilities on both standard media and LVW agar. All Leptospira spp. isolates produced large zones of inhibition around each of the six antimicrobials. All zones were greater than 25 mm: gentamicin produced the smallest zones (median 35 mm; interquartile range 30 mm-37 mm) and azithromycin produced the largest zones (median 85 mm; interquartile range 85 mm-85 mm). Zones produced by non-leptospiral ATCC reference strains on LVW agar were within 2 mm of accepted strain-specific quality control range on standard media. Antimicrobial activity on LVW agar appears to be similar to that on standard media. As there are no published susceptibility guidelines for the Leptospira genus, zone interpretation was subjective. Leptospira Vanaporn Wuthiekanun agar enabled antimicrobial susceptibility testing of multiple Leptospira isolates on solid media; the large zone sizes observed suggest that resistance has not emerged to these six antimicrobials in Lao Leptospira spp.

Pathways to prevention: A training and technical assistance initiative to increase program capacity to address infant mental health issues in Early Head Start.

This article provides an overview of a training and consultation program aimed at enhancing the capacity of Early Head Start (EHS) and Migrant and Seasonal Head Start (MSHS) programs to address infant mental health issues from a promotion, prevention, and treatment perspective. This program was implemented by the Early Head Start National Resource Center (EHS NRC), operated by ZERO TO THREE. The EHS NRC is funded by the Head Start Bureau to provide a diverse array of training and technical assistance support services to Early Head Start programs throughout the country. In the fall of 2001, ZERO TO THREE was funded to design and implement the Pathways Initiative. While ZERO TO THREE was not funded to test the efficacy of the Pathways Initiative as a research intervention similar to other papers described in this special issue, we worked creatively to identify resources that allowed us to engage an external evaluator to look at both process and outcome measures. This paper describes the consultation program, evaluation activities, and key lessons learned.