Evaluation of the MicroScan Colistin Well and Gradient Diffusion Strips for Colistin Susceptibility Testing in Enterobacteriaceae.

Many laboratories are unable to perform colistin susceptibility testing. Diffusion-based antimicrobial susceptibility testing methods are not recommended, and not all laboratories have the capacity to perform broth microdilution (BMD). Using a multistep tiered approach, we investigated whether the adapted use of the MicroScan colistin well (4 µg/ml) could enhance laboratory capacity for the detection and subsequent molecular characterization of colistin-resistant Enterobacteriaceae For the MicroScan colistin well, categorical agreement with BMD was 92.7%, and the very major error rate was 10.7%. For gradient diffusion strips, the categorical agreement was 86.4%, and the very major error rate was 53.6%. The MicroScan colistin well detected all isolates carrying mcr-1 or mcr-2 genes (n = 16), but gradient diffusion strips identified an MIC of ≥4 for colistin for only 62.5% of these isolates. A 6-month prospective phenotypic and genotypic study performed at a single clinical microbiology laboratory assessed isolates growing in the MicroScan colistin well for concordance. While 37 of 39 isolates growing in the MicroScan colistin well displayed a colistin MIC of ≥4 by BMD, all were determined to be negative for the mcr-1 and mcr-2 genes by PCR. A retrospective review of all Escherichia coli, Klebsiella spp., and Enterobacter spp. tested by MicroScan at this laboratory in 2016 identified 260 of 7,894 (3.3%) isolates that grew in the MicroScan colistin well. Based on the data presented, clinical and public health laboratories could use the MicroScan colistin well as a first screen for the detection of isolates displaying elevated colistin MICs, which could then undergo further characterization.

Strangulation in sexual homicide: Is it opportunity, victim's vulnerability or sadism?

Although most homicides involve the use of a weapon, some offenders still prefer killing with their own hands, using strangulation. In fact, when disaggregating the various types of homicides, sexual homicide offenders appear as having a preference for "personal weapon" to kill the victim. Personal weapons, such as strangulation, asphyxiation, and beating, are the most commonly used killing methods in sexual homicide. Using a sample of 451 cases of sexual homicide of adult female, the current study examines three hypotheses as to why strangulation is the method of choice to kill in sexual homicide: 1) weapon of opportunity, 2) victim's vulnerability, and 3) sexual sadism. Results from logistic regressions and artificial neural network analysis show that all three hypotheses are supported, sexual homicide offenders using strangulation being less likely to target a victim with a strong build, to bring and use a weapon. However, strangulation is more likely to be used to kill the victim when the offender is characterized with sadism. Implications of the findings are discussed in light of our understanding of the crime-commission process involved in sexual homicide.