Diversity of methicillin-resistant coagulase-negative Staphylococcus spp. and methicillin-resistant Mammaliicoccus spp. isolated from ruminants and New World camelids.

Information about livestock carrying methicillin-resistant coagulase-negative staphylococci and mammaliicocci (MRCoNS/MRM) is scarce. The study was designed to gain knowledge of the prevalence, the phenotypic and genotypic antimicrobial resistance and the genetic diversity of MRCoNS/MRM originating from ruminants and New World camelids. In addition, a multi-locus sequence typing scheme for the characterization of Mammaliicoccus (formerly Staphylococcus) sciuri was developed. The study was conducted from April 2014 to January 2017 at the University Clinic for Ruminants and the Institute of Microbiology at the University of Veterinary Medicine Vienna. Seven hundred twenty-three nasal swabs originating from ruminants and New World camelids with and without clinical signs were examined. After isolation, MRCoNS/MRM were identified by MALDI-TOF, rpoB sequencing and typed by DNA microarray-based analysis and PCR. Antimicrobial susceptibility testing was conducted by agar disk diffusion. From all 723 nasal swabs, 189 MRCoNS/MRM were obtained. Members of the Mammaliicoccus (M.) sciuri group were predominant (M. sciuri (n = 130), followed by M. lentus (n = 43), M. fleurettii (n = 11)). In total, 158 out of 189 isolates showed phenotypically a multi-resistance profile. A seven-loci multi-locus sequence typing scheme for M. sciuri was developed. The scheme includes the analysis of internal segments of the house-keeping genes ack, aroE, ftsZ, glpK, gmk, pta1 and tpiA. In total, 28 different sequence types (STs) were identified among 92 selected M. sciuri isolates. ST1 was the most prevalent ST (n = 35), followed by ST 2 (n = 15), ST3 and ST5 (each n = 5), ST4 (n = 3), ST6, ST7, ST8, ST9, ST10 and ST11 (each n = 2).

Straight stem and threaded cup in patients under 60 years of age: 28.8-30.2 years of follow-up.

PURPOSE: The aim of this retrospective observational study of one cohort was to evaluate the long-term outcome in patients younger than 60 years after total hip arthroplasty using a straight uncemented stem and an uncemented threaded cup. METHODS: Between 1986 and 1987, 75 hips of 75 patients (mean age, 53.35 ± 6.17 years) were consecutively implanted with an Alloclassic Zweymüller/Alloclassic SL stem and an Alloclassic CSF cup. Forty-four patients had died over the last 30 years. The remaining 31 patients (mean age, 82.9 ± 6.4 years) were reinvited for follow-up examinations. Clinical and radiographic evaluations were carried out. RESULTS: At a mean follow-up of 29.5 (28.8-30.2), 4 patients (5.3%) were lost to follow-up. For the endpoint aseptic loosening (defined as the removal of stem or the cup for 2 cases), the overall survival rate is 97.3%. For the endpoint revision for any reason (22 patients), the survival rate is 70.6%. Eleven patients needed an exchange of head and liner, caused by wear. The average time from implantation until change of head and liner was 21.44 years (SD 5.92). Other reasons for revision surgery were septic loosening (3 cases), aseptic loosening of stem and cup (1 case), aseptic loosening of stem (1 case), periprosthetic calcification (2 cases), implant fracture (1 case), periprosthetic fracture (1 case), intraoperative fissure of stem (1 case), and total wear of liner including cup (1 case). CONCLUSION: The combination of a straight stem (Alloclassic) and a screw cup (CSF) shows excellent results in young patients under the age of 60 at ultra-long-term follow-up at 30 years. Revisions due to wear of the polyethylene liner are more likely than in the older patients.

Diversity of methicillin-resistant Staphylococcus aureus (MRSA) isolated from Austrian ruminants and New World camelids.

The aim of this study was to determine the prevalence, the antimicrobial resistance patterns and the genetic diversity of methicillin-resistant Staphylococcus aureus (MRSA) from Austrian ruminants and New World camelids that were treated at the University of Veterinary Medicine, Vienna. Between April 2014 and January 2017, 723 nasal swabs originating from ruminants and New World camelids were examined. MRSA isolates were characterized by mecA/mecA1/mecC PCRs and by DNA microarray analysis. They were genotyped by spa typing, dru typing, MLST and MLVA. Glycopolymer fingerprinting by FTIR spectroscopy was also performed. Antimicrobial susceptibility testing was conducted by agar disk diffusion. Twelve MRSA isolates were mecA-positive, whereas three were mecC-positive. The MRSA isolates carried five different SCCmec elements, and belonged to three sequence types (ST45, ST130, ST398). The MRSA isolates displayed seven different resistance phenotypes. The present study describes for the first time mecC-carrying MRSA isolates originating from domesticated animals in Austria. More systematic studies are needed to unravel the role of ruminants and New World camelids as reservoirs for MRSA as a potential risk for zooanthropogenic transmission.

Active animal health surveillance in European Union Member States: gaps and opportunities.

Animal health surveillance enables the detection and control of animal diseases including zoonoses. Under the EU-FP7 project RISKSUR, a survey was conducted in 11 EU Member States and Switzerland to describe active surveillance components in 2011 managed by the public or private sector and identify gaps and opportunities. Information was collected about hazard, target population, geographical focus, legal obligation, management, surveillance design, risk-based sampling, and multi-hazard surveillance. Two countries were excluded due to incompleteness of data. Most of the 664 components targeted cattle (26·7%), pigs (17·5%) or poultry (16·0%). The most common surveillance objectives were demonstrating freedom from disease (43·8%) and case detection (26·8%). Over half of components applied risk-based sampling (57·1%), but mainly focused on a single population stratum (targeted risk-based) rather than differentiating between risk levels of different strata (stratified risk-based). About a third of components were multi-hazard (37·3%). Both risk-based sampling and multi-hazard surveillance were used more frequently in privately funded components. The study identified several gaps (e.g. lack of systematic documentation, inconsistent application of terminology) and opportunities (e.g. stratified risk-based sampling). The greater flexibility provided by the new EU Animal Health Law means that systematic evaluation of surveillance alternatives will be required to optimize cost-effectiveness.

Systematic review of surveillance systems and methods for early detection of exotic, new and re-emerging diseases in animal populations.

In this globalized world, the spread of new, exotic and re-emerging diseases has become one of the most important threats to animal production and public health. This systematic review analyses conventional and novel early detection methods applied to surveillance. In all, 125 scientific documents were considered for this study. Exotic (n = 49) and re-emerging (n = 27) diseases constituted the most frequently represented health threats. In addition, the majority of studies were related to zoonoses (n = 66). The approaches found in the review could be divided in surveillance modalities, both active (n = 23) and passive (n = 5); and tools and methodologies that support surveillance activities (n = 57). Combinations of surveillance modalities and tools (n = 40) were also found. Risk-based approaches were very common (n = 60), especially in the papers describing tools and methodologies (n = 50). The main applications, benefits and limitations of each approach were extracted from the papers. This information will be very useful for informing the development of tools to facilitate the design of cost-effective surveillance strategies. Thus, the current literature review provides key information about the advantages, disadvantages, limitations and potential application of methodologies for the early detection of new, exotic and re-emerging diseases.

Descriptive results of a prospective cohort study of avian influenza in the Mekong River Delta of Viet Nam.

A prospective cohort study of avian influenza infection in poultry flocks was carried out in the Mekong River Delta of Viet Nam between December 2008 and April 2010. Our objectives were to (i) estimate the prevalence and incidence of avian influenza virus infection and (ii) assess the efficacy of H5N1 vaccination programmes as indicated by the presence of H5 antibody in vaccinated and unvaccinated poultry. Real-time PCR and H5 multiplex assays were used to detect the antigen of avian influenza viruses from swab samples. The haemagglutination inhibition test was used to detect H5 antibody. A total of 17 968 swab and 14 878 blood samples were collected from 5476 birds over the study period. The overall incidence rate of influenza type A virus infection was 5 (95% CI 4-7) positive birds per 100 bird-months at risk. The overall incidence rate of H5 virus infection was 0.2 (95% CI 0.1-0.5) positive birds per 100 bird-months at risk. Fifty (95% CI 48-52) birds per 100 tested birds were H5 HI positive in the unvaccinated group compared with 71 (95% CI 69-73) birds per 100 in the vaccinated group. Influenza type A and H5 viruses were circulating in village poultry throughout the study period with no recorded signs of clinical disease. This implies that interventions need to be carried out continuously throughout the year rather than only focusing on the established high-risk periods. Broiler ducks had an incidence rate of influenza H5 virus infection approximately four times greater than that of layer ducks and in-contact species. We conclude that broiler ducks are likely to be the main entry route for H5 virus into poultry flocks in the MRD. Control efforts would benefit from understanding why there is a difference between villages in H5 incidence and developing strategies to provide greater protection to broiler ducks.

Bortezomib administered subcutaneously is well tolerated in bortezomib-based combination regimens used in patients with multiple myeloma.

OBJECTIVE: Bortezomib (Btz) has emerged as a standard of care in the treatment of patients with multiple myeloma (MM), but Btz-induced peripheral neuropathy (PNP) has a particularly negative impact on patients' quality of life. According to a recent study, PNP was significantly less frequent with subcutaneous administration of Btz. Here, we report our experience regarding the efficacy and tolerability of standard combination regimens in MM with subcutaneous Btz. METHODS: 14 consecutive patients with newly diagnosed MM were included in this analysis. Btz was used in different combination regimens (Btz with dexamethasone with/without thalidomide or Btz combined with melphalan and prednisone). Standard criteria were applied to evaluate response and toxicity. RESULTS: Hematological toxicities occurred only at grades 1-2 and included anemia (71%) and thrombocytopenia (21%). Nonhematologic side effects at grades 1-2 were local skin reactions at the subcutaneous injection site, which were self-limited. No notable gastrointestinal toxicity was observed with subcutaneous Btz, and therefore routine use of intravenous hydration and antiemetics was abandoned. Overall response rate for transplant-eligible patients was 86%. CONCLUSIONS: Our results confirm the improved toxicity profile of the subcutaneous administration of Btz in various standard Btz-based combination regimens. In addition, patient management with subcutaneous administration has been markedly ameliorated at our center.

A description of the management of itinerant grazing ducks in the Mekong river delta of Vietnam.

A cross-sectional survey of management practices of itinerant grazing ducks (known as field running ducks) was conducted during March 2008 in four districts of Can Tho and Bac Lieu provinces in the Mekong River Delta, Vietnam. The objective was to characterize the demographic structure of the itinerant grazing duck population and the management practices which might be related to the continuing outbreaks of H5N1 avian influenza in this region. Broiler duck flocks were owned by 55% of survey respondents, and layer flocks by 53%. Greater than 80% of ducks within 93% of villages and 99% of duck flocks were reported to have been vaccinated against H5N1 avian influenza, whereas only 19% of villages and 60% of chicken flocks had greater than 80% of chickens vaccinated. Fifty-nine percent of duck owners moved their ducks outside their home communes, whilst 37% and 28% of owners moved their ducks outside their home district and province, respectively. Larger flocks were more likely to be run outside their home district compared with smaller flocks. After adjusting for the effect of flock production type and district, the odds of an out-of-district field running duck flock movement was increased by a factor of 7.24 (95% CI 2.89-19.24) for households with flocks of more than 800 ducks, compared with flocks of less than 250. Most households sold ducks to traders (72%) or to neighbours (33%), whereas less than 20% sold their birds through markets. The findings of this study suggest that surveillance strategies for field running duck flocks should focus on layer flocks as well as larger flocks as they are more likely to be moved outside of their home district, facilitating long-distance disease spread.

Association between human cases and poultry outbreaks of highly pathogenic avian influenza in Vietnam from 2003 to 2007: a nationwide study.

This study quantifies the spatio-temporal association between outbreaks of highly pathogenic avian influenza H5N1 in domestic poultry (n = 3050) and human cases (n = 99) in Vietnam during 2003-2007, using rare events logistic regression. After adjusting for the effect of known confounders, the odds of a human case being reported to authorities increased by a factor of 6.17 [95% confidence interval (CI) 3.33-11.38] and 2.48 (95% CI 1.20 - 5.13) if poultry outbreaks were reported in the same district 1 week and 4 weeks later respectively. When jointly considering poultry outbreaks in the same and neighbouring districts, occurrence of poultry outbreaks in the same week, 1-week later, and 4 weeks later increased the odds of a human case by a factor of 2.75 (95% CI 1.43-5.30), 2.56 (95% CI 1.31-5.00) and 2.70 (95% CI 1.56-4.66) respectively. Our study found evidence of different levels of association between human cases and poultry outbreaks in the North and the South of the country. When considering the 9-week interval extending from 4 weeks before to 4 weeks after the week of reporting a human case, in the South poultry outbreaks were recorded in 58% of cases in the same district and 83% of cases in either the same or neighbouring districts, whereas in the North the equivalent results were only 23% and 42%. The strength of the association between human and poultry cases declined over the study period. We conclude that owner reporting of clinical disease in poultry needs to be enhanced by targeted agent-specific surveillance integrated with preventive and other measures, if human exposure is to be minimized.

Comparison of quality and cost-effectiveness in the evaluation of symptomatic cholelithiasis with different approaches to ultrasound availability in the ED.

Ultrasound is the imaging study of choice for the detection of gallstones, but ultrasound through medical imaging departments (MI Sono) is not readily available on an immediate basis in many emergency departments (EDs). Several studies have shown that emergency physicians can perform ultrasound themselves (ED Sono) to rule out gallstones with acceptable accuracy after relatively brief training periods, but there have been no studies to date specifically addressing the effect of ED Sono of the gallbladder on quality and cost-effectiveness in the ED. In this study, we investigated measures of quality and cost-effectiveness in evaluating patients with suspected symptomatic cholelithiasis during three different years with distinctly different approaches to ultrasound availability. The study retrospectively identified a total of 418 patients who were admitted for cholecystectomy or for a complication of cholelithiasis within 6 months of an ED visit for possible biliary colic. The percentage of patients who had gallstones documented at the first ED visit improved from 28% in 1993, when there was limited availability of ultrasound through the Medical Imaging Department (MI Sono), to 56% in 1995, when MI Sono was readily available, to 70% in 1997, when both MI Sono and ED Sono were readily available (P <.001). There were also significant differences over the 3 years in the mean number of days from the first ED visit to documentation of gallstones (19.7 in 1993, 10.7 in 1995, 7.4 in 1997, P <.001); the mean number of return visits for possible biliary colic before documentation of gallstones (1.67 in 1993, 1.24 in 1995, and 1.25 in 1997, P <.001); and the incidence of complications of cholelithiasis in the interval between the first ED visit for possible biliary colic and the date of documentation of cholelithiasis (6.8% in 1993, 5.9% in 1995, 1.5% in 1997, P =.049). The number of MI Sonos ordered by emergency physicians per case of symptomatic cholelithiasis identified increased from 1.7 in 1993 to 2.5 in 1995 and dropped back to 1.7 in 1997, when 4.2 ED Sonos per study case were also done. The cost of ED Sonos was more than offset by savings in avoiding calling in ultrasound technicians after regular Medical Imaging Department hours. The indeterminate rate for ED Sonos was 18%. Excluding indeterminates, the sensitivity of ED Sono for detection of gallstones was 88.6% (95% CI 83.1-92.8%), the specificity 98.2% (95% CI 96.0-99.3%), and the accuracy 94.8% (95% CI 92.5-96.5%). We conclude that greater availability of MI Sono in the ED was associated with improved quality in the evaluation of patients with suspected symptomatic cholelithiasis but also with increased ultrasound costs. The availability of ED Sono in addition to readily available MI Sono was associated with further improved quality and decreased costs. The indeterminate rate for ED Sono was relatively high, but excluding indeterminates, the accuracy of ED Sono was comparable with published reports of MI Sono.