Prevalence of Clostridium difficile toxin genes in the feces of veal calves and incidence of ground veal contamination.

A study was conducted in two parts to determine the prevalence of toxigenic Clostridium difficile in veal calves and retail meat. The first part of the study focused on the veal production continuum (farm to abattoir). Fifty calves from 4 veal herds (n=200) were followed for 18-22 weeks from the time of arrival on the veal farm to the time of slaughter. Fecal samples were collected from calves every 4-6 weeks. Half of the calves included in the study (n=100) were followed to the abattoir where carcass swabs were collected post slaughter. Fecal samples and carcass swabs were screened for genes encoding C. difficile toxins TcdA, TcdB, and CDT by using real-time polymerase chain reaction (PCR). Carcass swabs were also screened for toxigenic C. difficile by using traditional culture methods. In the second part of the study, ground veal products (n=50 samples) purchased from local grocery stores were examined for toxigenic C. difficile by using real-time PCR and traditional culture methods. Fecal samples from 56 of 200 (28%) calves tested positive for C. difficile toxin genes at least once over the course of the study. Calf age (p=0.011) influenced prevalence of C. difficile toxin genes in calf feces. Toxin genes of C. difficile were detected in one carcass swab by multiplex real-time PCR only. Toxigenic C. difficile was detected by PCR and culture in four (8%) and three (6%) ground veal samples, respectively. The findings of the study reveal that toxigenic C. difficile was most prevalent in veal calves (12%) just before slaughter, although viable toxigenic C. difficile was not recovered from veal carcasses. On the contrary, viable toxigenic C. difficle was recovered from 6% retail meat, thus suggesting that contamination occurs either during or after veal fabrication.

Blinded, controlled field trial of two commercially available Mycoplasma bovis bacterin vaccines in veal calves.

Mycoplasma bovis is an etiologic agent of pneumonia, arthritis, and otitis in young calves, such as those found in the special-fed veal industry. We conducted a blinded, controlled trial of two commercially available M. bovis bacterin vaccines for the prevention of respiratory disease in calves associated with M. bovis infection. Calves were randomly assigned to a subcutaneous treatment of vaccine A (n=50), adjuvant A (n=50), vaccine B (n=50), or 0.9% sterile saline solution (n=50) beginning at 27 days of age. Upper-respiratory tract colonization was not impacted by vaccination status. Vaccine A significantly reduced the presence of lung lesions (p=0.0325), however there was no significant reduction of M. bovis in lung lesions. Vaccine B did not significantly reduce total lung lesions or M. bovis-specific lung lesions. The relative risk was determined to be 0.56, 1.0, and 1.36 for vaccine A, adjuvant A, and vaccine B, respectively. There was no association between the total specific antibody isotype (IgM, IgG1, IgG2, IgA) concentrations or M. bovis antibodies and the M. bovis-associated morbidity in the veal calves. Under the field conditions of this study, observed vaccine efficacy for vaccine A and vaccine B was 44% and less than 1%, respectively.

Meta-analysis of fall-risk tools in hospitalized adults.

OBJECTIVE: The aim of the study was to identify which fall-risk tool is most accurate for assessing adults in the hospital setting. BACKGROUND: Falls can have physical, emotional, social, and financial consequences. Risk assessment affords the first opportunity in prevention. METHODS: To standardize the use of a fall-risk tool across the Baylor Health Care System, nurse executives undertook a meta-analysis of published research on fall-risk assessment tools used with adult inpatients. RESULTS: Both random-effects and fixed-effects models showed that Morse Fall Scale had significantly higher sensitivity than St Thomas's Risk Assessment Tool (STRATIFY). Specificity of Morse Fall Scale was significantly lower than that of STRATIFY with the fixed-effects model, but the random-effects model showed the opposite. Morse Fall Scale had a significantly higher Youden index than STRATIFY with the fixed-effects model (P = .001), but the result from random-effects model indicated no significant difference (P = .117). The sensitivity, specificity, and Youden index fell within the 95% confidence intervals. CONCLUSIONS: Meta-analysis is a useful methodology for evaluating current evidence when variation exists in the literature.

Real-time multiplex polymerase chain reaction assay for rapid detection of Clostridium difficile toxin-encoding strains.

Clostridium difficile is considered an important emerging pathogen capable of causing disease in humans and animal species. In our study, we developed and evaluated a multiplex real-time polymerase chain reaction (PCR) assay for the detection of C. difficile genes encoding toxin A (tcdA), toxin B (tcdB), and binary toxin (cdtA and cdtB). The standardized real-time PCR assay for toxin genes of C. difficile was used to screen for toxigenic C. difficile in fecal samples from 71 preweaned calves, 53 retail ground meat samples, and 27 pasteurized milk samples. All samples were also examined for C. difficile using traditional culture techniques to validate the PCR assay. A total of 24 fecal samples (33.80%) were positive for toxigenic C. difficile using either multiplex real-time PCR or culture. Toxin-encoding C. difficile was detected in 23 enriched fecal samples using the multiplex real-time PCR assay and only 15 samples using culture techniques. C. difficile was not detected in ground meat or pasteurized milk by traditional culture or real-time PCR assay. Eleven fecal samples were positive for all 4 toxin genes, suggesting that preweaned calves may be a likely source for toxigenic C. difficile. On the basis of findings of our study, it can be concluded that multiplex real-time PCR carried out on samples enriched for C. difficile is a reliable, sensitive, and specific diagnostic tool for rapid screening and identification of samples contaminated with C. difficile.

Salmonella infections in the common raccoon (Procyon lotor) in western Pennsylvania.

Ten Salmonella enterica serotypes were isolated from fecal samples collected from anesthetized raccoons (n = 738) trapped in six Pennsylvania counties from 2003 to 2005. Comparison of raccoon pulsed-field gel electrophoresis (PFGE) pulse type data with the Pennsylvania Department of Health PFGE database revealed that the patterns of seven Salmonella serotypes matched those isolated from humans with salmonellosis.

Assessment of phenotypic and genotypic diversity of Escherichia coli shed by healthy lactating dairy cattle.

A study was conducted to assess the diversity among fecal Escherichia coli from healthy lactating cattle. E. coli (n = 100) isolates from 10 healthy lactating dairy cows of a Pennsylvania dairy herd were examined for phenotypic and genotypic characteristics. Results revealed 26, 58, 10, and 6 E. coli isolates belonged to phylogenetic groups A, B1, B2, and D respectively. Overall, 63 serotypes, nine antibiotic resistance profiles, and 65 pulsed-field gel electrophoresis (PFGE) profiles were observed among the 100 isolates. Based on the combination of phenotypic and genotypic characteristics, the 100 E. coli isolates were classified into 76 clonal types. The numbers of different phenotypic and genotypic characteristics of E. coli were observed for each cow at ranges of 2-10, 1- 4, 2-10, and 4-10 for serotypes, antibiograms, PFGE profiles, and clonal types, respectively. The Chao1 estimator was used to estimate diversity among fecal E. coli. It was estimated that a range of 3-55, 1- 4, 2-55, and 8-55 fecal isolates from one cow would be required to include all possible types of E. coli based on serotype, antibiotic resistance profile, PFGE profile, and clonal type respectively. Based on the findings of the study it can be inferred that 1) dairy cattle should be considered as a significant reservoir of genotypically and phenotypically diverse E. coli, and 2) epidemiological investigations that focus on commensal bacteria should take into consideration the diversity within the species being investigated; if not addressed adequately, inappropriate sample size could lead to inaccurate study findings.

The power of collaboration: Arizona's best kept secret.

The current healthcare challenges have generated significant interest in the Magnet Nursing Services solution. The distribution of the Magnet organizations across the United States reflects an interesting set of circumstances that have potentially influenced the success or failure of Magnet designation. Arizona nursing leadership decided to address the problems directly through the power of collaboration to create a "magnet state." The purpose of this article is to explore Magnet designation as a solution to today's healthcare crisis, the power of state leadership collaboration to address work environment issues, and the notion of developing a state plan to reverse the daunting statistics that negatively impact quality of care. This success story is Arizona's best kept secret that begs to be shared with other nurses leaders who are seeking out-of-the box solutions.