Characterization and antimicrobial resistance of Campylobacter jejuni and Campylobacter coli isolated from chicken and pork.

The prevalence and antimicrobial resistance (AMR) profile were investigated in Campylobacter jejuni and Campylobacter coli in chicken and pork in Fukuoka, Japan in 2019. Their AMR profiles were compared with those of C. jejuni and C. coli strains isolated in 2013. A total of 53 chicken and 14 pork samples were collected from different supermarkets in Fukuoka in 2019. Campylobacter spp. were isolated by conventional method and characterized by PCR and MALDI-TOF MS. Among 53 chicken samples tested in 2019, 24.5% and 5.7% were positive for C. jejuni and C. coli, respectively, and three (21.4%) of 14 pork samples were positive for C. coli, but not C. jejuni. From the positive samples, 13 and six strains of C. jejuni and C. coli were isolated, respectively. Antimicrobial susceptibility test against 12 different antimicrobials were performed on 48 isolates (43 C. jejuni and five C. coli) from chicken in 2013 and 19 isolates (13 C. jejuni from chicken, three C. coli from chicken and three C. coli from pork) in 2019 using the disk diffusion method. All the C. jejuni and C. coli isolated in 2013 and 2019 were highly resistant to cefazolin and sulfamethoxazole/trimethoprim. Among the C. jejuni isolates from chickens, 25.6% of 2013 isolates were resistant to nalidixic acid, ciprofloxacin, and levofloxacin, and 7% to ampicillin and minocycline, while 30.8% of the isolates were resistant to minocycline, 23.1% to nalidixic acid, ciprofloxacin, and levofloxacin, and 15.4% to ampicillin in 2019. Among the C. coli isolates, 80% of isolates from chickens in 2013, and 33.3% from chicken and 100% from pork in 2019 were resistant to nalidixic acid, ciprofloxacin, and levofloxacin. The frequency of multi-drug resistant (MDR) C. jejuni and C. coli strains from chickens in 2019 were 30.8% and 33.3%, respectively, which were lower than those isolated in 2013 (37.2% and 100%, respectively). One C. jejuni and two C. coli isolates from 2013 were resistant to six antibiotics. However, two C. jejuni and one C. coli isolate from chickens in 2019 were resistant to seven and five antibiotics, respectively. All the C. coli isolates from pork in 2019 were resistant to five antibiotics. The high frequency of AMR strains in C. coli isolates from pork suggests that appropriate use of antimicrobials is required in swine husbandry.

Molecular epidemiology of resistance to antimalarial drugs in the Greater Mekong subregion: an observational study.

BACKGROUND: The Greater Mekong subregion is a recurrent source of antimalarial drug resistance in Plasmodium falciparum malaria. This study aimed to characterise the extent and spread of resistance across this entire region between 2007 and 2018. METHODS: P falciparum isolates from Myanmar, Thailand, Laos, and Cambodia were obtained from clinical trials and epidemiological studies done between Jan 1, 2007, and Dec 31, 2018, and were genotyped for molecular markers (pfkelch, pfcrt, pfplasmepsin2, and pfmdr1) of antimalarial drug resistance. Genetic relatedness was assessed using microsatellite and single nucleotide polymorphism typing of flanking sequences around target genes. FINDINGS: 10 632 isolates were genotyped. A single long pfkelch Cys580Tyr haplotype (from -50 kb to +31·5 kb) conferring artemisinin resistance (PfPailin) now dominates across the eastern Greater Mekong subregion. Piperaquine resistance associated with pfplasmepsin2 gene amplification and mutations in pfcrt downstream of the Lys76Thr chloroquine resistance locus has also developed. On the Thailand-Myanmar border a different pfkelch Cys580Tyr lineage rose to high frequencies before it was eliminated. Elsewhere in Myanmar the Cys580Tyr allele remains widespread at low allele frequencies. Meanwhile a single artemisinin-resistant pfkelch Phe446Ile haplotype has spread across Myanmar. Despite intense use of dihydroartemisinin-piperaquine in Kayin state, eastern Myanmar, both in treatment and mass drug administrations, no selection of piperaquine resistance markers was observed. pfmdr1 amplification, a marker of resistance to mefloquine, remains at low prevalence across the entire region. INTERPRETATION: Artemisinin resistance in P falciparum is now prevalent across the Greater Mekong subregion. In the eastern Greater Mekong subregion a multidrug resistant P falciparum lineage (PfPailin) dominates. In Myanmar a long pfkelch Phe446Ile haplotype has spread widely but, by contrast with the eastern Greater Mekong subregion, there is no indication of artemisinin combination therapy (ACT) partner drug resistance from genotyping known markers, and no evidence of spread of ACT resistant P falciparum from the east to the west. There is still a window of opportunity to prevent global spread of ACT resistance. FUNDING: Thailand Science Research and Innovation, Initiative 5%, Expertise France, Wellcome Trust.

Reflections on mental capacity assessments in general hospitals.

Research suggests that a significant proportion of inpatients in general medical wards may lack capacity to make treatment decisions, a situation that often goes unrecognised by clinicians. We would like to briefly discuss two cases from a non-psychiatric setting, where a mental disorder served to inhibit the individual's ability to weigh-up associated risks when deciding to refuse potentially life-sustaining healthcare interventions. In both cases the history of mental disorder was well established yet, for markedly different reasons, the respective presentation was such that the influence of the disorder on decision-making was not evident to the treating teams.