A decline in the occurrence of extended-spectrum ß-lactamase-producing Escherichia coli in retail chicken meat in the UK between 2013 and 2018.

AIMS: The aim of this study was to report on the occurrence of antimicrobial resistant (AMR) Escherichia coli from retail chicken meat samples in the UK, with particular focus on AmpC and extended spectrum beta-lactamase (ESBL) production and carbapenem resistance. METHODS AND RESULTS: Methods from EU protocols were used for selective isolation of AmpC-/ESBL-producing E. coli, carbapenem-resistant E. coli and for performing minimum inhibitory concentrations. Additional work not part of EU protocols included viable counts, detection by PCR of blaCTX-M , blaOXA, blaSHV and blaTEM genes in ESBL-phenotype E. coli and screening for mcr plasmid-mediated colistin resistance. From the 313/309 retail chicken meat samples tested in 2016/2018, carbapenem or mcr plasmid-mediated colistin-resistant E. coli were not detected. For 2016/2018 chicken samples, 141/42 (45·0%/13·6%), 90/23 (28·8%/7·4%), 48/16 (15·3%/5·2%) and 3/3 (1·0%/1·0%) were positive for ESBL- and/or AmpC-, ESBL- alone AmpC- alone and AmpC+ESBL-phenotype E. coli respectively. ESBL-producing E. coli were predominantly blaCTX-M-1 . All AmpC and/or ESBL-phenotype E. coli were sensitive to colistin, ertapenem, imipenem, meropenem, temocillin and tigecycline, applying epidemiological cut-off values. CONCLUSIONS: A previous study in 2013/14 showed that 65·4% of retail chicken meat samples tested in the UK were positive for ESBL-producing (mainly CTX-M) E. coli. Since then the proportion of samples positive in the UK has dropped significantly to 7·4% in 2018. SIGNIFICANCE AND IMPACT OF THE STUDY: Significant reductions in antimicrobials used in the UK poultry meat sector between 2012 and 2016 may be linked to significant reductions in AmpC/ESBL-phenotype E. coli in retail chicken between 2013/14 and 2018.

Detection of extended-spectrum ß-lactam, AmpC and carbapenem resistance in Enterobacteriaceae in beef cattle in Great Britain in 2015.

AIMS: This study investigated the occurrence and genetic diversity of Enterobacteriaceae with extended-spectrum ß-lactamase (ESBL)-, AmpC- and carbapenemase-mediated resistance in British beef cattle, and related risk factors. METHODS AND RESULTS: Faecal samples (n = 776) were obtained from farms in England and Wales (n = 20) and Scotland (n = 20) in 2015. Isolates from selective agars were identified by MALDI ToF mass spectrometry. Selected isolates were characterized by multiplex PCR (blaCTX -M, blaOXA , blaSHV and blaTEM genes), whole-genome sequencing (WGS), minimum inhibitory concentrations and pulsed-field gel electrophoresis. None of the faecal samples yielded carbapenem-resistant Escherichia coli. Ten (25%) of the farms tested positive for ESBL-producing CTX-M Enterobacteriaceae, 15 (37·5%) of the farms were positive for AmpC phenotype E. coli and none were positive for carbapenem-resistant E. coli. WGS showed a total of 30 different resistance genes associated with E. coli, Citrobacter and Serratia from ESBL agars, and colocation of resistance genes with blaCTX -M1 . Buying bulls and bringing in fattening cattle from another farm were identified as significant risk factors for positive samples harbouring CTX-M Enterobacteriaceae or AmpC phenotype E. coli respectively. CONCLUSIONS: Beef cattle on a proportion of farms in GB carry ESBL-producing Enterobacteriaceae. Factors, such as operating as a closed herd, may have an important role in reducing introduction and transmission of resistant Enterobacteriaceae. The results indicate management factors may play an important role in impacting ESBL prevalence. In particular, further study would be valuable to understand the impact of maintaining a closed herd on reducing the introduction of resistant Enterobacteriaceae. SIGNIFICANCE AND IMPACT OF THE STUDY: This is the first study showing the presence of ESBL-producing Enterobacteriaceae in British beef cattle.

Longitudinal study on the occurrence in pigs of colistin-resistant Escherichia coli carrying mcr-1 following the cessation of use of colistin.

AIMS: In 2015, colistin-resistant Escherichia coli and Salmonella with the mcr-1 gene were isolated from a pig farm in Great Britain. Pigs were subsequently monitored over a ~20-month period for the occurrence of mcr-1-mediated colistin resistance and the risk of mcr-1 E. coli entering the food chain was assessed. METHODS AND RESULTS: Pig faeces and slurry were cultured for colistin-resistant E. coli and Salmonella, tested for the mcr-1 gene by PCR and selected isolates were further analysed. Seventy-eight per cent of faecal samples (n = 275) from pigs yielded mcr-1 E. coli after selective culture, but in positive samples only 0·2-1·3% of the total E. coli carried mcr-1. Twenty months after the initial sampling, faecal samples (n = 59) were negative for E. coli carrying mcr-1. CONCLUSIONS: The risk to public health from porcine E. coli carrying mcr-1 was assessed as very low. Twenty months after cessation of colistin use, E. coli carrying mcr-1 was not detected in pig faeces on a farm where it was previously present. SIGNIFICANCE AND IMPACT OF THE STUDY: The results suggest that cessation of colistin use may help over time to reduce or possibly eliminate mcr-1 E. coli on pig farms where it occurs.

Prevalence of extended-spectrum-ß-lactamase-producing Escherichia coli from pigs at slaughter in the UK in 2013.

OBJECTIVES: To determine the prevalence and types of extended-spectrum ß-lactamase (ESBL)-producing Escherichia coli occurring in pigs at slaughter in the UK in 2013. METHODS: Caecal samples from 637 pigs, sampled via a UK-wide monitoring programme in 2013, were enriched overnight in buffered peptone water, before plating to CHROMagar CTX and Oxoid Brilliance ESBL agar. Presumptive ESBL-producing E. coli from both media were tested for ESBL phenotype using MAST ESßL ID discs. Isolates with an ESBL phenotype were examined for the presence of blaCTX-M, blaOXA, blaSHV and blaTEM genes using a multiplex PCR. All blaCTX-M and blaSHV genes identified by PCR were sequenced. RESULTS: A total of 23.4% (95% CI 19.2-27.6) of pigs were positive for ESBL-producing E. coli; 22% (95% CI 17.8-26.1) of the pigs carried E. coli producing CTX-M enzymes [comprising enzyme types 1 (18.7% of pigs), 3 (0.2%), 14 (0.5%), 15 (1.4%), 27 (0.5%), 32 (0.5%) and 55 (0.3%)] and 2.2% (95% CI 0.8-3.6) of the pigs carried E. coli producing SHV-12. Five pigs carried both CTX-M- and SHV-12-producing E. coli as different isolates. There were no statistically significant differences observed between the two medium types in terms of the proportions of each CTX-M enzyme type isolated. CONCLUSIONS: In this UK study, 23.4% of pigs were found to be positive for ESBL-producing E. coli using selective culture media. The use of two different commercially available ESBL isolation media was found to improve the detection of ESBL-producing E. coli.

Characteristics of ciprofloxacin and cephalosporin resistant Escherichia coli isolated from turkeys in Great Britain.

1. A field study was performed to investigate the presence and characteristics of ciprofloxacin-resistant, extended spectrum ß-lactamase (ESBL) and AmpC Escherichia coli from turkeys in Great Britain. E. coli were isolated from ~9000 boot swab samples from 27 different farms owned by four different companies. Between 1 and 14 visits were made to each farm (mean 3) at between 0 and 15 m intervals (mean ~5 m). 2. CHROMagar ECC with and without ciprofloxacin or cephalosporin antibiotics was used as selective isolation media. Representative isolates with different phenotypes were tested for mutations in gyrA and for: qnrA, B, S, qepA and aac(6')-Ib genes, for ESBL phenotype, the presence of bla genes and plasmid type, and for ampC genes Representative ciprofloxacin-resistant and CTX-M isolates were further tested for serotype and PFGE type. On ciprofloxacin selective media 55% of samples yielded ciprofloxacin resistant E. coli and of those further analysed, most had ciprofloxacin MICs >4 mg/l and mutations in gyrA. 3. For the different companies, the mean number of samples per farm with cefoxitin- or cefotaxime-resistant isolates ranged from 1·0% to 61·9% and 4·7% to 31·7% respectively. Cefotaxime-resistance was most commonly associated with an ESBL phenotype, a CTX-M-1 or CTX-M-14 sequence type and an I1-γ or K plasmid inc type. The mechanism of cefoxitin resistance was not determined for most isolates, but where determined it was bla . 4. PFGE and serotyping showed clonally-related isolates persisting over multiple visits suggesting both more prudent use of antibiotics and improved farm hygiene are needed to address the issue of antimicrobial resistance in isolates from turkeys.

[Acute neoplastic colic obstructions: therapy and postoperative complications. Our experience]. / Le occlusioni acute neoplastiche del colon: terapia e risoluzione di complicanze postoperatorie. Nostra esperienza.

Authors report their experience about neoplastic large bowel obstructions and present two cases of anastomotic leakage resolution by means of transtomy wash-out. They observe that the most important problem in this surgery is anastomotic leakage which, if small, can be solved in a non operative way. According with literature, they also point out anastomotic leakage is commonly due to the impossibility of a correct preparation of colon to operation in emergency. They conclude it is possible, in case of little leakages, to perform trans-stomy wash out which permits a good toilette and sterilization of the colon.

Evaluation of meat, fruit and vegetables from retail stores in five United Kingdom regions as sources of extended-spectrum beta-lactamase (ESBL)-producing and carbapenem-resistant Escherichia coli.

We determined the prevalence and types of extended-spectrum ß-lactamase (ESBL)-producing and carbapenem-resistant Escherichia coli in raw retail beef, chicken, pork, fruit and vegetables in five UK regions in 2013-14. Raw meat (n=397), and fruit and vegetable samples (n=400) were purchased from retail stores in London, East Anglia, North West England, Scotland and Wales. Samples were tested for the presence of ESBL-producing E. coli by plating enriched samples on CHROMagar CTX and CHROMagar ESBL, for AmpC-type E. coli by plating on "CHROMagar FOX" (CHROMagar ECC+16mg/L cefoxitin), and for carbapenem-resistant E. coli by plating on CHROMagar KPC. Additionally, pre-enrichment counts were performed on the above agars, and on CHROMagar ECC. Isolates of interest were characterised by MALDI-ToF to confirm identification, by PCR for blaCIT,blaCTX-M,blaOXA, blaSHV and blaTEM genes; ESBL or blaCIT genes were sequenced. Only 1.9% and 2.5% of beef and pork samples, respectively were positive for ESBL-producing E. coli after enrichment compared with 65.4% of chicken samples. 85.6% positive samples from chicken meat carried blaCTX-M-1; blaCTX-M-15 was not detected. None of the fruits or vegetables yielded ESBL-producing E. coli and none of the meat, fruit or vegetable samples yielded carbapenem-resistant E. coli. Retail chicken was more frequently a source of ESBL-producing E. coli than were beef, pork, fruit or vegetables. None of the foodstuffs yielded E. coli with CTX-M-15 ESBL, which dominates in human clinical isolates in the UK, and none yielded carbapenem-resistant E. coli.

Joint Raman spectroscopic and quantum chemical analysis of the vibrational features of Cs2RuO4.

The Raman spectroscopic characterization of the orthorhombic phase of Cs2RuO4 was carried out by means of group theory and quantum chemical analysis. Multiple models based on ruthenate (VI+) tetrahedra were tested, and characterization of all the active Raman modes was achieved. A comparison of Raman spectra of Cs2RuO4, Cs2MoO4, and Cs2WO4 was also performed. Raman laser heating induced a phase transition from an ordered to a disordered structure. The temperature-phase transition was calculated from the anti-Stokes/Stokes ratio and compared with the ones measured at macroscopic scale. The phase transition is connected with tilting and/or rotations of RuO4 tetrahedra, which lead to a disorder at the RuO4 sites. © 2015 The Authors. Journal of Raman Spectroscopy published by John Wiley & Sons Ltd.

The use of armspan measurement to assess the nutritional status of adults in four Ethiopian ethnic groups.

OBJECTIVES: To investigate the use of armspan as a proxy for height in the assessment of nutritional status using body mass index (BMI) for four ethnic groups in Ethiopia. DESIGN: Cross-sectional study. SETTING: Four regions in Ethiopia, namely Oromia, Amhara, Tigre and Somali Region. SUBJECTS: A total of 1706 (884 males and 822 females) Ethiopians aged 18-50 y from four different ethnic groups. METHODS: Anthropometric measurements (weight, height and armspan) were obtained using standard techniques. BMI using height (BMI-ht) and using armspan (BMI-as) were calculated, t-tests were used to compare means, and linear regression to investigate the relationship between BMI-ht and BMI-as. RESULTS: Ethnic and sex differences in the relationship between height and armspan, and their derived variables (BMI-ht and BMI-as), were found. Armspan and height (r=0.83-0.9), and BMI-ht and BMI-as (r=0.89-0.97), were highly correlated in all ethnic groups. BMI-as cut-offs equivalent to the conventional BMI-ht classification of chronic energy deficiency were similar in the Oromo, Amhara and Tigre, but substantially higher in the Somalis. CONCLUSION: Armspan can be used as a proxy for height to estimate BMI, but the relationship between the two measures varies considerably with ethnicity and sex. Unless sex- and ethnicity-specific cut-offs are applied, the use of BMI-as using conventional cut-offs will overestimate the prevalence of underweight in these populations. SPONSORSHIP: HelpAge International.

Helicobacter pylori: a comparison of some diagnostic methods.

We evaluated the performances of three methods (urease-test, cytology and culture) for the detection of Helicobacter pylori infection Fifty-five patients, 28 men and 27 women (ages, 19-77 years) were included in the study. Helicobacter pylori have been detected by urease-test in 41 patients (74.5%), by culture in 39 patients (70.9%), by cytology in 32 patients (58.1%). Urease-test and culture are direct and specific methods in diagnosing Helicobacter pylori infection.

Xerophthalmia and malnutrition among pre-school children in Agaro town south-west Ethiopia.

A community-based cross-sectional study was undertaken in Agaro town to determine the magnitude of xerophthalmia and malnutrition in January 1993. 434 children (aged six months to six years), were selected randomly and by using the proportionate probability sampling technique from the eight 'kebeles' of the town. Data were collected by interviewing mothers/ care-takers of index children and by ocular and anthropometric examinations. From the total subjects studied, the proportion of males (54.6%) was higher than females (45.3%). Few mothers/ care-takers (24.5%) were found to be illiterate. According to the Waterloo classification, 18.6% were either wasted, stunted or both. The overall prevalence of xerophthalmia was 6.2%. Being malnourished and earning less than 700 birr / year were significantly associated with xerophthalmia (chi 2 = 6.23; P < 0.05). Finally, children with clinical signs of xerophthalmia and other eye diseases were treated accordingly and advice was given to mothers/care-takers of malnourished children.

[Clinical remarks on acute volvulus of the cecum]. / Considerazioni cliniche sul volvolo acuto del cieco.

On the basis of a case of acute volvulus of the caecum, the rarity of the condition is stressed and its aetiopathogenetic and clinical aspects analysed, particular emphasis being laid on therapy.

[Gastric volvulus. Clinical contribution]. / Il volvolo gastrico. Contributo clinico.

After discussing the classification of the various types of gastric volvulus, the aetiopathogenetic factors that occur in this rare stomach pathology are reviewed. The personal series is reported and the clinical, radiological and above all therapeutic aspects connected with the pathology discussed. It is concluded that, in these cases too, the aims to pursue are the formulation of early diagnosis and implementation of quick, correct treatment for the purpose of eliminating the basic pathology and preventing necrosis of the gastric wall setting in.

[Use of mebendazole in the treatment of pulmonary hydatidosis]. / L'impiego del mebendazolo nel trattamento dell'idatidosi polmonare.

After recalling the various therapeutic aids proposed for the treatment of hydatid disease, personal experience in the use of mebendazole in patients suffering from pulmonary hydatidosis is reported. On the basis of the results obtained, it is concluded that mebendazole represents a useful therapeutic approach provided it is administered in full doses and for a long period in well selected cases, namely patients with cysts of limited dimension and, probably, of comparatively recent onset.

[Diagnostic and therapeutic considerations in early gastric cancer]. / Considerazioni diagnostiche e terapeutiche sull'early gastric cancer.

A ten-year series of early gastric cancer is reported, stress being laid on the diagnostic and therapeutic problems associated with the condition. The importance of intensified mass screening programmes, particularly in populations at risk, is underlined to enable these potentially dangerous conditions to be treated in time.

[Approach to male breast cancer. Our experience]. / L'approccio al cancro della mammella maschile. Nostra esperienza.

Male breast cancer is a rare neoplasia and represents only 1% of all forms of breast cancer. The etiopathogenesis of breast carcinoma is still unknown in both males and females, but an altered hormonal metabolism may play a role in its genesis. The prognosis of breast cancer is slightly worse in males, especially in cases with axillary lymph node metastases. The paper discusses the therapy administered to 8 patients with male breast cancer who were treated by the authors between January 1983 and April 1990.

[The usefulness of cytodiagnosis in nonpalpable breast lesions]. / Utilità della citodiagnostica nelle lesioni non palpabili della mammella.

The paper underlines the importance of early diagnosis in the treatment of breast tumours and emphasises the value of cytodiagnosis as a very sensitive and specific predictive method for detecting impalpable lesions. In conclusion, the Authors affirm that cytodiagnosis, together with the introduction of new diagnostic instruments such as the TRC Mammotest, allows the diagnostic and therapeutical approach to impalpable breast tumours to be improved. It adds to the already high sensitivity of mammography and to the high predictive specificity of cytology, thus contributing to the reduction of the so-called "bioptic cost".

[Indications and limitations of subcutaneous mastectomy in the treatment of breast carcinoma]. / Indicazioni e limiti della mastectomia sottocutanea nel trattamento del carcinoma mammario.

The reasons that led to subcutaneous mastectomy in some initial stage breast cancer patients are reported. After removal of the mammary gland, this surgical technique provides for prosthetic reconstruction and should therefore be confined to women with initial stage cancer who for psychological or aesthetic reasons refuse more destructive operations. The technique is described and results obtained discussed, recalling that this type of non-destructive operation will be increasingly in demand in the future but needs preclinical diagnosis of the local disease and its systemic diffusion.

[The inguinal hernia today. Technical notes]. / L'ernia inguinale oggi. Note di tecnica.

Following a short introduction on Bassini's operation, alternative surgical techniques are discussed: Postempski, Halsted, Mugnai-Ferrari, Anson-McVay, Marcy, Ferguson, Shouldice with their indications, advantages and disadvantages. Personal experience in the surgical treatment of 516 patients suffering from inguinal hernia is then reported and stress is laid on the need for precise anatomic knowledge of the inguinal region and skill in one technique in particular to limit the risk of recurrences.

[Role of post-embolectomy anticoagulant therapy in the prevention of recurrences]. / Ruolo della terapia anticoagulante post-embolectomia nella prevenzione delle recidive.

The authors review two homogenous groups of patients subjected to surgical embolectomy, one group receiving standard anticoagulant therapy before and after surgery, and the other not receiving that treatment regularly or at all. The results obtained in the two groups indicate that anticoagulant therapy plays a role of no mean order in the prevention of postoperative relapses.