Author Correction: Rapid susceptibility profiling of carbapenem-resistant Klebsiella pneumoniae.

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Rapid susceptibility profiling of carbapenem-resistant Klebsiella pneumoniae.

The expanding global distribution of multi-resistant Klebsiella pneumoniae demands faster antimicrobial susceptibility testing (AST) to guide antibiotic treatment. Current ASTs rely on time-consuming differentiation of resistance and susceptibility after initial isolation of bacteria from a clinical specimen. Here we describe a flow cytometry workflow to determine carbapenem susceptibility from bacterial cell characteristics in an international K. pneumoniae isolate collection (n = 48), with a range of carbapenemases. Our flow cytometry-assisted susceptibility test (FAST) method combines rapid qualitative susceptible/non-susceptible classification and quantitative MIC measurement in a single process completed shortly after receipt of a primary isolate (54 and 158 minutes respectively). The qualitative FAST results and FAST-derived MIC (MICFAST) correspond closely with broth microdilution MIC (MICBMD, Matthew's correlation coefficient 0.887), align with the international AST standard (ISO 200776-1; 2006) and could be used for rapid determination of antimicrobial susceptibility in a wider range of Gram negative and Gram positive bacteria.

High prevalence of tuberculosis in newly enrolled HIV patients in Zambia: need for enhanced screening approach.

SETTING: Tuberculosis (TB) remains a leading cause of morbidity and mortality in sub-Saharan Africa. In Zambia, smear microscopy and chest radiography (CXR) are the primary TB diagnostic tools, and most cases are not bacteriologically confirmed. OBJECTIVE: We implemented enhanced screening to determine the TB burden among new human immunodeficiency virus (HIV) clinic enrollees. DESIGN: Consecutive adult HIV clinic enrollees were screened, regardless of symptoms. All underwent microscopy (Ziehl-Neelsen/fluorescence microscopy) on three sputum specimens, physical examination, and digital CXR. Sputum, blood and urine specimens were cultured. Xpert(®) MTB/RIF testing was performed retrospectively. RESULTS: From July 2011 to April 2012, 399 patients were enrolled. The median age was 34.4 years; body mass index was 20.8 kg/m(2), CD4 count was 202 cells/µl and 86% were symptomatic. Culture-confirmed TB was diagnosed in 72/399 (18%) patients; an additional 31/399 (8%) were culture-negative but diagnosed clinically. Symptom screening for any cough, fever, weight loss or night sweats had high sensitivity (95%) but low specificity (14%) for detecting culture-confirmed cases. Among culture-confirmed cases, 35/72 (49%) were missed clinically and detected only by culture. Xpert was 64% sensitive and 98% specific. CONCLUSIONS: High TB prevalence was found in Zambians newly enrolled into HIV care. Screening with sensitive diagnostics should be considered with culture when feasible in this population.

The effect of intra-uterine devices on the reproductive physiology and behaviour of pony mares.

Spherical (35 mm diameter) glass intra-uterine devices (IUDs) are commonly understood to modify sexual behaviour in performance mares. The effect of IUDs on the endocrinology (luteinising hormone, oestradiol, progesterone, testosterone), ovarian and uterine function, sexual and social behaviours associated with the ovarian cycle were evaluated during the natural breeding season in nine, nuliparous pony mares (4.6±0.5 years old, 230±12 kg bodyweight). Age and weight-matched groups were allocated to sham-treatment (n=5) or IUD-implantation (n=4) groups. Fifty complete ovarian cycles were evaluated, with 26 ovarian cycles monitored for the nine mares prior to treatment and a further 12 cycles were evaluated for mares in each of the groups post-treatment. Detailed characterisation of cyclic reproductive changes in the pony may be of value for controlled breeding programmes. The presence of an IUD was well-tolerated, but failed to modify any recorded aspect of reproductive physiology or behaviour.

Immunobiology of dendritic cells in the rat.

Dendritic cells (DC) are crucial orchestrators of the adaptive immune response. They are highly effective antigen samplers and have a unique ability amongst antigen presenting cells to activate naïve T lymphocytes and subsequently direct the quality of the immune response. Understanding how DC initiate and regulate immune responses requires in-depth knowledge of DC function at cellular and molecular levels. Research on the biology of DC has predominantly used in vitro-generated and ex vivo-isolated DC from mice and humans. It is, however, often difficult to relate such DC to those that actually exist in vivo. The model we have developed in the rat permits analysis of DC in a near-physiological setting, and provides a description of DC biology that other systems must take into account. In this review we focus on our own research on DC in the gastro-intestinal tract, covering a variety of concepts in DC biology, and relate our findings to the work of others, to provide an overall picture of what is known regarding the nature of this complex cell type in the rat.

The Isolation and Partial Characterization of the Lipopolysaccharides from Several Rhizobium trifolii Mutants Affected in Root Hair Infection.

The lipopolysaccharides (LPSs) from Rhizobium trifolii ANU843 and several transposon (Tn5) symbiotic mutants derived from ANU843 were isolated and partially characterized. The mutant strains are unable to induce normal root hair curling (Hac- phenotype) or nodulation (Nod-phenotype) in clover plants. The LPSs from the parent and mutants are very similar in composition. Analysis by PAGE shows that the LPSs consist of higher and lower molecular weight forms. The higher molecular weight form of the LPSs exists in several aggregation states when PAGE is done in 0.1% SDS but collapses into a single band when PAGE is done in 0.5% SDS. Mild acid hydrolysis of all the LPSs releases two polysaccharides, PS1 and PS2. Immunoblots of the PAGE gels and enzyme linked immunosorbant assay inhibition assays show that the PS1 fractions contain the immunodominant sites of the LPSs and that these sites are present in the higher molecular weight form of the LPSs. All the PS1 fractions contain methylated sugars, 2-amino-2,6-dideoxyhexose, heptose, glucuronic acid, and 2-keto-3-deoxyoctonic acid (KDO). All the PS2 fractions contain galacturonic acid, mannose, galactose, and KDO. The PS2 fractions have a molecular weight of about 700. The KDO is present at the reducing end of both the PS1 and the PS2 fractions. The PS1 and PS2 fractions from the mutants contain more glucose than these fractions from the parent. The LPS from a deletion mutant contains less acyl groups than the other LPSs. Immunoblots of the LPSs show that the parent and nod A mutant LPSs contain an additional antigenic band which is not observed in the other LPSs.

Continuity of care through improved documentation.

An 18-month, nursing service-education project studied means to improve the quality of maternity services in satellite clinic settings. Tools, inservice education meetings, and questionnaires were used to guide nurses, other team members, and students in patient education services. Progress in written and verbal communications was made. Ongoing collaboration between the nurse practitioner and nurse educator produced mutual benefits and unanticipated outcomes.

Effect of basic preventive health practices and mass media on the practice of breast self-examination.

To assess factors that affected utilization of breast self-examination in 160 women enrolled in masters degree programs--in nursing and in programs outside of health disciplines--a questionnaire sought information about 1) the relationship between practice of six basic preventive health measures and practice of breast self-examination, and 2) changes which occurred in women's practices of breast self-examination subsequent to the October 1974 mass media coverage of Mrs. Betty Ford's mastectomy. Descriptive data about other factors that influenced women's practice of breast self-examination were obtained. Findings indicated a relationship between positive practice of breast self-examination and positive practices of other preventive health measures in women of health and nonhealth orientation up to 35 years of age and under, but not in those over 35 years of age. Significantly increased breast self-examination practices in women of all ages were reported following Mrs. Ford's mastectomy. Implications favorable to the early detection of breast disease are suggested.