Antimicrobial susceptibility among respiratory tract pathogens isolated from diseased cattle and pigs from different parts of Europe.

AIMS: To survey antibiotic susceptibility of bacteria causing cattle and pig respiratory infections in 10 European countries. METHODS AND RESULTS: Non-replicate nasopharyngeal/nasal or lung swabs were collected from animals with acute respiratory signs during 2015-2016. Pasteurella multocida, Mannheimia haemolytica, Histophilus somni from cattle (n = 281), and P. multocida, Actinobacillus pleuropneumoniae, Glaesserella parasuis, Bordetella bronchiseptica, and Streptococcus suis from pigs (n = 593) were isolated. MICs were assessed following CLSI standards and interpreted using veterinary breakpoints where available. Histophilus somni isolates were fully antibiotic susceptible. Bovine P. multocida and M. haemolytica were susceptible to all antibiotics, except tetracycline (11.6%-17.6% resistance). Low macrolide and spectinomycin resistance was observed for P. multocida and M. haemolytica (1.3%-8.8%). Similar susceptibility was observed in pigs, where breakpoints are available. Resistance in P. multocida, A. pleuropneumoniae, and S. suis to ceftiofur, enrofloxacin, and florfenicol was absent or <5%. Tetracycline resistance varied from 10.6% to 21.3%, but was 82.4% in S. suis. Overall multidrug-resistance was low. Antibiotic resistance in 2015-2016 remained similar as in 2009-2012. CONCLUSIONS: Low antibiotic resistance was observed among respiratory tract pathogens, except for tetracycline.

Minimal inhibitory concentration of seven antimicrobials to Mycoplasma gallisepticum and Mycoplasma synoviae isolates from six European countries.

Mycoplasma gallisepticum and Mycoplasma synoviae are bacterial pathogens that cause disease in poultry, adversely affecting their health and welfare, and are a financial burden on producers. This manuscript describes the results of the MycoPath project that is the first international antimicrobial susceptibility programme for mycoplasma pathogens isolated from poultry. Improved comparative analysis of minimal inhibitory concentration (MIC) results from participating countries was facilitated by using one laboratory determining all MICs. Chicken and turkey isolates were obtained from France, Germany, Great Britain, Hungary, Italy and Spain during 2014-2016. One isolate per farm was retained. The MIC of seven antimicrobial agents was determined using a broth microdilution method, with Friis Medium (M. gallisepticum) or Modified Chanock's Medium (M. synoviae). Of the 222 isolates recovered, 82 were M. gallisepticum and 130 were M. synoviae. M. gallisepticum MIC50/90 values were 0.12/0.5, 2/8, 0.5/4, 0.12/>64, 0.008/0.062, 0.008/32, 0.062/4 mg/l for doxycycline, enrofloxacin, oxytetracycline, spiramycin, tiamulin, tilmicosin and tylosin, respectively. For M. synoviae, the values were 0.5/1, 8/16, 0.5/1, 0.5/8, 0.25/0.5, 0.062/2 and 0.062/16 mg/l respectively. A bimodal MIC distribution for the fluoroquinolone (enrofloxacin) and the macrolides (spiramycin, tilmicosin and tylosin) indicate that both species have sub-populations that are less susceptible in vitro to those antimicrobials. Some differences in susceptibilities were observed according to host species, Mycoplasma species, and country of origin. This study provides a baseline of novel data for future monitoring of antimicrobial resistance in poultry Mycoplasma species. Additionally, this information will facilitate the selection of the antimicrobial agents most likely to be effective, thus ensuring their minimal use with targeted and correct therapeutic treatments.Highlights First large-scale pan-European collection of representative Mg and Ms isolates.MIC values assessed in central laboratory for Mg and Ms from chickens and turkeys.Range of MIC values for 82 Mg and 130 Ms isolates to seven licenced antibiotics shown.Data can be used to help determine Mg and Ms veterinary-specific breakpoints.

Making it stick: use of active learning strategies in continuing medical education.

BACKGROUND: Despite the known benefits of active learning (AL), the predominate educational format in higher education is the lecture. The reasons for slow adaptation of AL in medical education are not well understood. The purpose of this survey was to determine knowledge, usage, attitudes, and barriers to AL use in academic Continuing Medical Education (CME). METHOD: A 20-item questionnaire was developed and sent with a link to an online questionnaire to the Society of Academic Continuing Medical Education (SACME) listserv of ~ 350 professionals representing academic medical centers, teaching hospitals, and medical specialty societies in the United States (U.S.) and Canada. Responses were collected with SurveyMonkey® from October-November, 2019. Data were analyzed using SPSS®. RESULTS: Responses from 146 SACME members in 91 CME units yielded a ~ 42% survey response rate. Many respondents reported their self-perceived knowledge of AL as high. Advanced training (e.g., certificate, Master of Education degree) was positively correlated with AL knowledge. AL methods were reportedly used in half of the CME activities in the majority (80%) of institutions. Higher levels of self-perceived knowledge were correlated with an increased percentage of AL-related CME activities. Commonly perceived barriers to use of AL were presenters' lack of familiarity and a need for more time-consuming preparation. CONCLUSIONS: More efforts are needed to increase innovation and incorporate evidence-based AL strategies in medical education, especially to foster learner engagement, critical thinking, and problem-solving ability.

[Acceptance of Binding Preventive Examinations: A Survey of Parents in Hessen]. / Akzeptanz verbindlicher Vorsorgeuntersuchungen ­ Ergebnisse einer Elternbefragung in Hessen.

OBJECTIVE: In 2008, the Child Health Protection Act (Kindergesundheitsschutz-Gesetz) became effective in Hesse. Since then, participation in the early screening examinations U1 to U9 in Hesse is obligatory. The implementation of the law is part of the responsibility of the Hessian Children's Preventive Healthcare Centre (Hessisches Kindervorsorgezentrum (HKVZ)), which invites parents and legal guardians to each examination from U4 up to and including U9. To obtain information on the acceptance of the law, the HKVZ carried out for the first time a survey of parents and legal guardians as part of their quality management. The following questions were raised: How well accepted are obligatory check-ups by Hessian parents? What is the degree of popularity and the limitation of such a law? METHOD: Along with the letter of invitation to participate in U7a, all parents and legal guardians received an anonymous survey questionnaire to be filled out and returned to the HKVZ. The evaluation took place in the HKVZ. RESULTS: Especially noteworthy are 3 results of the survey: When asked if health problems were detected during the check-ups, 8.94% of the parents and legal guardians answered the question with a "yes". Almost every ninth child examined was found to have health problems during the check-up. The reasons for a missed check-up were comparatively trivial. 96.53% of the respondents had not missed a check-up, only 2.88% answered this question with a "yes" and 0.59% did not give any information here. The most frequent reason for a missed examination with 1.59% was that it was simply "forgotten". In the category "other", 1.12% mentioned a disease of the child or a stay abroad as the most frequent reason for a missed check-up. Difficulty in making an appointment with the pediatrician (0.35% was another reason. The high level of awareness of the Hessian Child Health Protection Act (94.12% of respondents) and the positive ratings of the letters sent by the HKVZ (84.06% good to very good) reflect its acceptance. Further research is needed to confirm the effectiveness of such preventive health care examinations.

Isolation and in vitro antimicrobial susceptibility of porcine Lawsonia intracellularis from Brazil and Thailand.

BACKGROUND: Lawsonia intracellularis is an obligate intracellular bacterium which cannot be cultured by conventional bacteriological methods. Furthermore, L. intracellularis needs enriched medium and a unique atmosphere for isolation, cultivation and propagation. Because of this,there are only a few isolates of L. intracellularis available and few studies in vitro demonstrating the susceptibility of this bacterium to antimicrobial agents. The objectives of this study were to isolate South American and Southeast Asia strains of L.intracellularis and to determine the in vitro antimicrobial activity against these isolates. Tested antimicrobials included: chlortetracycline, lincomycin, tiamulin, tylosin and valnemulin(against both Brazilian and Thailand strains) and additionally, amoxicillin, zinc-bacitracin, carbadox, enrofloxacin, gentamicin, sulfamethazine, trimethoprim, spectinomycin and a combination (1:1) of spectinomycin and lincomycin were also tested against the Thai isolates. The minimum inhibitory concentration (MIC) was determined by the antimicrobial activity that inhibited 99% of L. intracellularis growth in a cell culture as compared to the control (antimicrobial-free). RESULTS: Two strains from Brazil and three strains from Thailand were successfully isolated and established in cell culture. Each antimicrobial was evaluated for intracellular and extracellular activity. Pleuromutilin group (valnemulin and tiamulin) and carbadox were the most active against L. intracellularis strains tested. Tylosin showed intermediate activity, chlortetracycline had variable results between low and intermediate activity, as well as spectinomycin, spectinomycin and lincomycin, amoxicillin, sulfamethazine and enrofloxacin. L. intracellularis was resistant to lincomycin, gentamicin, trimethoprim, colistin and bacitracin in in vitro conditions. CONCLUSIONS: This is the first report of isolation of L. intracellularis strains from South America and Southeast Asia and characterization of the antimicrobial susceptibility patterns of these new strains.

Autism spectrum disorders: an update on oral health management.

UNLABELLED: Dental professionals caring for patients with a diagnosis of autism spectrum disorder (ASD) will need to provide oral health care based on a family-centered approach that involves a comprehensive understanding of parental concerns and preferences, as well as the unique medical management, behaviors, and needs of the individual patient. BACKGROUND: With the rising prevalence of autism spectrum disorders (ASD), oral health providers will find themselves increasingly likely to care for these patients in their daily practice. The purpose of this article is to provide a comprehensive update on the medical and oral health management of patients with autism spectrum disorders. METHODS: The authors conducted a literature review by searching for relevant articles written in English in the PubMed database pertaining to the medical and oral health management of autism, including caries status, preventive, behavioral, trauma, and restorative considerations. CONCLUSIONS: A detailed family centered approach based on parental preferences and concerns, the patient's challenging behaviors, and related comorbidities can serve to improve the treatment planning and oral health management of dental patients with ASD.

Pan-European monitoring of susceptibility to human-use antimicrobial agents in enteric bacteria isolated from healthy food-producing animals.

OBJECTIVES: To determine the antimicrobial susceptibility of Escherichia coli, Salmonella, Campylobacter and Enterococcus from cattle, pigs and chickens across the European Union (EU) using uniform methodology. METHODS: Intestinal samples (1624) were taken at slaughter across five EU countries. Bacteria were isolated in national laboratories, whilst MICs were determined in a central laboratory for key antimicrobials used in human medicine. Clinical resistance was based on CLSI breakpoints and decreased susceptibility based on European Food Safety Authority (EFSA)/EUCAST epidemiological cut-off values. RESULTS: Isolation rates were high for E. coli (n=1540), low for Salmonella (n=201) and intermediate for Campylobacter (n=940) and Enterococcus (n=786). For E. coli and Salmonella, clinical resistance to newer compounds (cefepime, cefotaxime and ciprofloxacin) was absent or low, but decreased susceptibility was apparent, particularly in chicken strains. Resistance to older compounds (except gentamicin) was variable and higher. Colistin resistance was absent for E. coli, but apparent for Salmonella. For Campylobacter jejuni, ciprofloxacin resistance was markedly prevalent for chickens, whereas clinical resistance and decreased susceptibility to erythromycin was absent or very low. For Campylobacter coli, resistance was notably higher. None of the Enterococcus faecium strains was resistant to linezolid, but some were resistant to ampicillin or vancomycin. Resistance to quinupristin/dalfopristin was frequent. CONCLUSIONS: Resistance patterns varied widely depending on bacterial species, antibiotics, hosts and region. Resistance varied among countries, particularly for older antimicrobials, but clinical resistance to newer antibiotics used to treat foodborne disease in humans was generally very low. In the absence of resistance to newer compounds in E. coli and Salmonella, the apparent decreased susceptibility should be monitored.

Antimicrobial susceptibility profiles of Mycoplasma hyorhinis strains isolated from five European countries between 2019 and 2021.

Mycoplasma hyorhinis is an emerging swine pathogen bacterium causing polyserositis and polyarthritis in weaners and finishers. The pathogen is distributed world-wide, generating significant economic losses. No commercially available vaccine is available in Europe. Therefore, besides improving the housing conditions for prevention, antimicrobial therapy of the diseased animals is the only option to control the infection. Our aim was to determine the minimal inhibitory concentrations (MIC) of ten antimicrobials potentially used against M. hyorhinis infection. The antibiotic susceptibility of 76 M. hyorhinis isolates from Belgium, Germany, Hungary, Italy and Poland collected between 2019 and 2021 was determined by broth micro-dilution method and mismatch amplification mutation assay (MAMA). Low concentrations of tiamulin (MIC90 0.312 µg/ml), doxycycline (MIC90 0.078 µg/ml), oxytetracycline (MIC90 0.25 µg/ml), florfenicol (MIC90 2 µg/ml) and moderate concentrations of enrofloxacin (MIC90 1.25 µg/ml) inhibited the growth of the isolates. For the tested macrolides and lincomycin, a bimodal MIC pattern was observed (MIC90 >64 µg/ml for lincomycin, tulathromycin, tylosin and tilmicosin and 5 µg/ml for tylvalosin). The results of the MAMA assay were in line with the conventional method with three exceptions. Based on our statistical analyses, significant differences in MIC values of tiamulin and doxycycline were observed between certain countries. Our results show various levels of antimicrobial susceptibility among M. hyorhinis isolates to the tested antibiotics. The data underline the importance of susceptibility monitoring on pan-European level and provides essential information for proper antibiotic choice in therapy.

Little boy black and blue.

Tooth decay is common in US children, especially for children in low-income families. More than half of second-grade children have cavities. Therefore, root canal procedures are becoming more common in children. We report a case of a 2-year-old boy with a rare complication of a root canal procedure secondary to sodium hypochlorite toxicity. Sodium hypochlorite, a commonly used root canal irrigant, and its toxicity are reviewed.

Assessment of noise exposures in a pediatric dentistry residency clinic.

PURPOSE: In addition to sounds from dental equipment, pediatric dentists are exposed to noise produced by precooperative and/or noncooperative children. The purpose of this study was to evaluate the daily personal noise exposure of a pediatric dentistry resident while treating children in a teaching clinic to determine both comprehensive noise doses and peak noise occurrences as well as to assess the risk for noise-induced hearing loss. METHODS: A noise dosimeter (Noise-Pro DLX) was used to measure the total personal noise exposure dose using the Occupational Safety and Health Administration (OSHA) Hearing Conservation Amendment criteria and the US National Institute for Occupational Safety and Health (NIOSH) occupational noise exposure revised criteria. Comprehensive noise doses for 31 days were obtained for a single resident. RESULTS: OSHA and NIOSH-allowable limits were not exceeded during any one day in the study period. Noise levels during crying episodes, however, were higher than the reported noise levels of dental instruments and reached maximum levels of 112.9 dBA. CONCLUSIONS: Noise levels to which the pediatric dental resident was exposed fell below the Occupational Safety and Health Administration's and National Institute for Occupational Safety and Health's damage-risk thresholds for noise-induced hearing loss.

End-expired nitrous oxide concentrations compared to flowmeter settings during operative dental treatment in children.

PURPOSE: The purpose of this study was to analyze inspired and end-expired alveolar nitrous oxide (N(2)O) concentrations during operative dental treatment in 6- to 9- year-old children and compare them to the concentrations dispensed by the dental N(2)O delivery system's flowmeter. METHODS: Twenty-three healthy 6- to 9-year-olds who received restorative dental care underwent placement of a sampling probe in the posterior nasopharynx. Via nasal mask, 100% oxygen was administered at a rate of 3L/minute for 2 minutes. N(2)O was then introduced at a flowmeter reading of 50% for 5 minutes and thereafter reduced to 30% for the duration of treatment, followed by 100% oxygen for 5 minutes postoperatively. Respiratory rate, inspired and end-expired nitrous oxide and oxygen concentrations, and pressure of end-tidal carbon dioxide values were measured and recorded from the nasopharyngeal probe with an anesthesia gas monitor. RESULTS: End-expired alveolar N(2)O concentrations were, on average, 63% below flowmeter settings. After rapid induction with 50% N(2)O, an end-expired N(2)O saturation maximum of 11% was attained, on average, after 90 seconds. The time to flush out remaining N(2)O after delivery of 100% oxygen varied between 30 and 195 seconds. CONCLUSIONS: End-expired alveolar nitrous oxide and oxygen concentrations and pressure of end-tidal carbon dioxide values were successfully recorded during operative dental treatment of 6- to 9-year-old awake and non-intubated children in the traditional dental setting.

Antimicrobial susceptibility monitoring of Mycoplasma hyopneumoniae isolated from seven European countries during 2015-2016.

Mycoplasma hyopneumoniae is the causative agent of porcine enzootic pneumonia, a chronic respiratory disease, causing significant economic losses. Results from the 2015-2016 MycoPath pan-European antimicrobial susceptibility monitoring survey of M. hyopneumoniae are presented. In total, 147 M. hyopneumoniae porcine isolates from Belgium, France, Germany, Great Britain, Hungary, Italy, and Spain were tested. One isolate per farm was retained from pigs that had not been recently treated with antimicrobial agents. The minimal inhibitory concentration (MIC) of 13 antimicrobial agents was determined in a central laboratory using a broth microdilution method, with Friis Medium, incubated at 35 ± 1 °C for 5-12 days. M. hyopneumoniae NCTC 10110 was used as Quality Control. MIC50/MIC90 (mg/L) values were: enrofloxacin 0.06/1; marbofloxacin 0.06/2; spiramycin 0.06/0.25; tulathromycin ≤0.001/0.004; gamithromycin 0.06/0.5; tylosin 0.016/0.06; tilmicosin 0.06/0.5; florfenicol 0.5/1; doxycycline 0.25/1; oxytetracycline 0.25/2; lincomycin 0.06/0.25; tiamulin 0.016/0.06 and valnemulin ≤0.001/0.004. Compared with the data from 2010 to 2012 MycoPath study (50 isolates), MIC50/90 results were similar and the majority were within ± two dilution steps, except for the MIC50 of oxytetracycline which is more than two dilution steps higher in the present study. Between-country comparisons show some differences in the MIC values for the fluoroquinolones, tulathromycin and tylosin, but the limited sample size per country precludes performing meaningful country comparisons for several countries. Standardized laboratory methods and interpretive criteria for MIC testing of veterinary mycoplasmas are clearly needed; there are currently no clinical breakpoints available to facilitate data interpretation and correlation of MICs with in vivo efficacy.

A pan-European survey of antimicrobial susceptibility towards human-use antimicrobial drugs among zoonotic and commensal enteric bacteria isolated from healthy food-producing animals.

OBJECTIVES: The aim of the study was to study antimicrobial susceptibility in Escherichia coli, Salmonella, Campylobacter and Enterococcus recovered from chickens, pigs and cattle using uniform methodology. METHODS: Intestinal samples were taken at slaughter in five EU countries per host and bacteria isolated in national laboratories. MICs were determined in a central laboratory of key antimicrobials used in human medicine. Clinical resistance was based on CLSI breakpoints and decreased susceptibility on EFSA epidemiological cut-off values. RESULTS: Isolation rates from a total of 1500 samples were high for E. coli (n=1465), low for Salmonella (n=205) and intermediate for Campylobacter (n=785) and Enterococcus (n=718). Resistance prevalence varied among antibiotics, bacteria, hosts and countries. For E. coli and Salmonella, clinical resistance to newer compounds (cefepime, cefotaxime, ciprofloxacin) was absent or low, but a decreased susceptibility was apparent, particularly in chickens. Clinical resistance to older compounds (except colistin and gentamicin) was variable and higher. For Campylobacter jejuni from chickens, ciprofloxacin resistance was markedly higher than in isolates from cattle. Clinical resistance to erythromycin was absent for both hosts; decreased susceptibility very low. Similar trends were determined for Campylobacter coli, but C. jejuni was less resistant. None of the enterococcal strains was resistant to linezolid, but a few displayed resistance to ampicillin or vancomycin. Resistance prevalence to quinupristin/dalfopristin was clearly higher. CONCLUSIONS: Antimicrobial resistance among enteric organisms in food animals varied among countries, particularly for older antimicrobials, but clinical resistance to essential compounds used to treat disease in humans was generally zero or low. In the absence of clinical resistance to newer compounds in E. coli and Salmonella, the apparent decreased susceptibility should be monitored carefully.

New antimicrobial susceptibility data from monitoring of Mycoplasma bovis isolated in Europe.

Mycoplasma bovis is an important respiratory pathogen of cattle across Europe and is included in the MycoPath pan-European antimicrobial susceptibility monitoring programme. M. bovis strains (232) were isolated from cattle, not recently treated with antimicrobials, at diverse geographical locations in France, Great Britain, Hungary, Italy and Spain during 2014 to 2016. Only one isolate per farm and per outbreak was retained. For each isolate, the MICs of ten antimicrobials were determined in a central laboratory using a broth microdilution method with modified Eaton's medium and incubation at 35 °C ± 1 °C for 24 ± 6 h. MIC50/MIC90 (mg/L) values for the 232 strains were: danofloxacin 0.25/1; enrofloxacin 0.5/8; marbofloxacin 1/4; gamithromycin >64/>64; spiramycin 8/16; tilmicosin >64/>64; tulathromycin >64/>64; tylosin 64/>64; florfenicol 4/8; oxytetracycline 8/32. Minor between-country differences in the MIC90 values were observed for the fluoroquinolones, spiramycin and oxytetracycline, whilst the MIC values for the other compounds were similar. Spain and Italy had the higher MIC90 values for the fluoroquinolones. Compared with the 2010-2012 study (156 isolates) results are similar, with an overall MIC50 increase of at most one doubling dilution for enrofloxacin, spiramycin, tylosin, florfenicol and oxytetracycline. In contrast, the MIC90 value for oxytetracycline decreased from >64 to 32 mg/L. Standardized laboratory methods and interpretive criteria for MIC testing of veterinary mycoplasmas are clearly needed; there are currently no clinical breakpoints available to facilitate data interpretation and correlation of MICs with in vivo efficacy.

Stevens-Johnson Syndrome: A Review and Report of Two Cases.

Stevens-Johnson syndrome (SJS) is a rare condition, characterized by its dramatic involvement of the skin and various mucosal surfaces including the oral mucosae, that severely impairs the affected patient's ability to speak, chew, or swallow. The purpose of this report was to present two cases with significant variations in the clinical presentation of Stevens-Johnson syndrome. In both situations, the patients' conditions were not immediately recognized. Pediatric dentists should be aware of these variations in the clinical manifestations of SJS, as the signs and symptoms can initially mimic common viral conditions. Appropriate diagnosis can result in timely referral to a hospital environment, optimizing patient management and recovery.

Pyramidal and Taurodont Molars and Their Association With Other Tooth Anomalies.

PURPOSE: Determine the prevalence of pyramidal molars (PMs), associated tooth anomalies, and medical conditions (MC). METHODS: Pantomograms from 10,168 subjects were searched for PMs. RESULTS: A total of 148 individuals (75.7 percent females), aged 9.7 to 18.9 years old, had PMs. Subjects with MCs (53.4 percent) had on average 17 percent more PMs (P=.0476) and 2.8 times greater odds of palatally displaced canines (P=.0309). The mean number of pyramidal and taurodont molars per subject was 2.9±1.4 (SD) and 3.1±1.7 (SD), respectively. In both sexes, 63.5 percent of all observed PMs were located in the maxilla and 78.5 percent of all PMs were second molars. Taurodont molars increased by 9.4 percent as other tooth anomalies increased by one, but decreased by 8.2 percent for each additional PM. Tooth anomalies associated with PMs were palatally displaced canines (17.6 percent) and short root anomaly of maxillary central incisors (6.1 percent). Delayed eruption was noted in 9.5 percent, tooth agenesis in 6.1 percent, and supernumerary teeth in 3.4 percent. CONCLUSIONS: The prevalence of pyramidal molars was 1.4 percent, and the female-to-male ratio was 3.1 to one. Pyramidal molars are often associated with medical conditions and other tooth anomalies.

Antimicrobial Susceptibility Monitoring of Bacterial Pathogens Isolated from Urinary Tract Infections in Dogs and Cats Across Europe: ComPath Results.

ComPath is a pan-European antimicrobial surveillance program collecting bacterial pathogens from dogs and cats not recently exposed to antimicrobials. We present minimum inhibitory concentration data obtained using Clinical and Laboratory Standards Institute methodology for 616 urinary tract infection (UTI) isolates collected between 2008 and 2010. In both dogs and cats, the most common pathogen was Escherichia coli (59.8% and 46.7%, respectively). Antimicrobial activity against E. coli in dogs and cats was similar with fluoroquinolone and trimethoprim/sulfamethoxazole susceptibility >90%. Ampicillin susceptibility was ∼80%. Staphylococcus intermedius Group isolates from dogs (67/437, 15.3%) had high antimicrobial susceptibility (>90%) toward beta-lactams, fluoroquinolones, and trimethoprim/sulfamethoxazole. Four canine isolates (6%) were oxacillin resistant, and harbored mecA. Proteus mirabilis from dogs (48/437, 11.0%) had high antimicrobial susceptibility (∼90%) to amoxicillin/clavulanic acid, enrofloxacin, and marbofloxacin and slightly lower susceptibility (∼80-85%) to ampicillin and orbifloxacin. Streptococcus canis isolates (35/437, 8.0%) from dogs were all susceptible to ampicillin and amoxicillin/clavulanic acid and >90% susceptible to marbofloxacin. Although resistance was not observed, high intermediate susceptibility was seen for both enrofloxacin (28.6%) and orbifloxacin (85.7%). Overall, antimicrobial in vitro activity appears to be high in UTI pathogens from dogs and cats with low multidrug resistance, although a lack of specific dog and cat breakpoints for important antimicrobials such as cefovecin, cephalexin, and ibafloxacin prevents analysis of susceptibility for these agents.

Antimicrobial susceptibility monitoring of Mycoplasma hyopneumoniae and Mycoplasma bovis isolated in Europe.

Mycoplasma hyopneumoniae in pigs and Mycoplasma bovis in cattle are major pathogens affecting livestock across Europe and are the focus of the MycoPath pan-European antimicrobial susceptibility monitoring programme. Fifty M. hyopneumoniae isolates from Belgium, Spain and the United Kingdom (UK), and 156 M. bovis isolates from France, Hungary, Spain and the UK that met specific criteria were tested for antimicrobial susceptibility in a central laboratory by using a microbroth dilution method. Specific isolate criteria included recovery from animals not recently treated with antimicrobials, isolates from different locations within each country and retaining only one isolate per farm. MIC50/MIC90 values were 0.031/0.5, 0.031/0.5, 0.062/0.25, ≤0.001/0.004, 0.031/0.125, 0.25/0.5 and 0.062/0.25mg/L for enrofloxacin, marbofloxacin, spiramycin, tulathromycin, tylosin, florfenicol and oxytetracycline respectively against M. hyopneumoniae and 0.25/4, 1/4, 4/16, >64/ >64, 32/ >64, 2/4 and 4/64mg/L, respectively against M. bovis. MIC50/MIC90 values for tiamulin and valnemulin against M. hyopneumoniae were 0.016/0.062 and ≤0.001/ ≤0.001mg/L respectively. The MIC50/MIC90 values of danofloxacin and gamithromycin for M. bovis were 0.25/1 and >64/ >64mg/L respectively. The highest MIC90 values for M. hyopneumoniae were found in the UK at 1.0mg/L for enrofloxacin, marbofloxacin and florfenicol. In contrast, for M. bovis the lowest MIC90 value was 1.0mg/L, but ranged to >64mg/L. Specific laboratory standards and clinical breakpoints for veterinary Mycoplasma species are required as no independently validated clinical breakpoints are specified for veterinary Mycoplasma species, which makes data interpretation and correlation to in vivo efficacy difficult.

Maxillary Nine-year Molars: Prevalence and Associated Dental and Medical Conditions.

PURPOSE: The purpose of this study was to determine, from a large number of panoramic images taken in the clinic of a pediatric dentistry residency program, the prevalence of maxillary nine-year molars (9YM), associated medical conditions (MCs), and the presence of coexisting tooth anomalies (TAs). METHODS: Pantomograms from 13,140 patients were searched for 9YM. Radiographs from identified subjects were examined for coexisting TAs, and charted MCs were noted. For identified 9YM, Nolla's stage of tooth formation was determined and the subjects' dental ages were calculated. RESULTS: Among 53 subjects (68 percent females), 21 unilateral and 32 bilateral cases of 9YM occurred. Females and males were of similar age (7.98 versus 7.91 years old). Overall dental and chronological ages were significantly different: dental development in bilateral cases was delayed by 4.1 months in females and 2.9 months in both sexes (P=.003). In unilateral cases, it was accelerated by 3.6 months in females and 3.5 months in males. The specific tooth age for all 9YM was 4.95 years for females and 5.56 years for males (P=.018). The average count of associated findings (e.g., missing teeth, peg laterals, other TAs, and other eruption delays) was 0.62 in unilateral and 1.44 in bilateral cases (P=.02). Commonly associated MCs included clefting (N equals five), and Down syndrome (n equals three). CONCLUSIONS: The prevalence of nine-year molars was one in 248 (0.4 percent), and the average delay in dental development was 2.7 years.

Monitoring of antimicrobial susceptibility of respiratory tract pathogens isolated from diseased cattle and pigs across Europe, 2009-2012: VetPath results.

VetPath is an ongoing pan-European antibiotic susceptibility monitoring programme that collects pathogens from diseased cattle, pigs and poultry. In the current study, 996 isolates from cattle and pig respiratory tract infections were tested for their antimicrobial susceptibilities. Non-replicate lung samples or nasopharyngeal/nasal swabs were collected from animals with acute clinical signs in 10 countries during 2009-2012. Pasteurella multocida, Mannheimia haemolytica and Histophilus somni from cattle and P. multocida, Actinobacillus pleuropneumoniae, Haemophilus parasuis, Bordetella bronchiseptica and Streptococcus suis from pigs were isolated by standard methods. S. suis was also isolated from meningitis cases. MIC values of 16 or 17 antibiotics were assessed centrally by broth microdilution following CLSI standards. Results were interpreted using CLSI breakpoints where available. Cattle isolates were generally highly susceptible to most antibiotics, except to tetracycline (3.0-12.0% resistance). Low levels of resistance (0-4.0%) were observed for the macrolide antibiotics. Resistance to spectinomycin varied from 0 to 6.0%. In pig isolates similar observations were made. Resistance to amoxicillin/clavulanic acid, ceftiofur, enrofloxacin, florfenicol, tulathromycin, tiamulin and tilmicosin was absent or <2%. Trimethoprim/sulfamethoxazole resistance varied from 1.9 to 5.3%, but tetracycline resistance varied from 20.4% in P. multocida to 88.1% in S. suis. For most antibiotics and pathogens the percentage resistance remained unchanged or only increased numerically as compared to that of the period 2002-2006. In conclusion, absence or low resistance to antibiotics with defined clinical breakpoints, except for tetracycline, was observed among the major respiratory tract pathogens recovered from livestock. Comparison of all antibiotics and organisms was hampered since for almost half of the antibiotics no CLSI-defined breakpoints were available.