Culture- and non-culture-based approaches reveal unique features of the ocular microbiome in dry eye patients.

PURPOSE: The purpose of this study was to investigate the ocular microbiome in individuals with dry eye disease and to identify features of their ocular microbiome of possible health and diagnostic significance. METHODS: Conjunctival samples were collected from both eyes in duplicate from 91 individuals (61 dry eye, 30 healthy) and used for both culture-dependent and culture-independent analyses. Samples were either analysed using next generation sequencing (V3-V4 16S rDNA) or inoculated on a wide range of agar types and grown under a broad range of conditions to maximize recovery. Isolates were identified by partial sequencing of the 16S rDNA and rpoB genes and tested for antibiotic susceptibility. We applied a L2-regularized logistic regression model on the next generation sequencing data to investigate any potential association between severe dry eye disease and the ocular microbiome. RESULTS: Culture-dependent analysis showed the highest number of colony forming units in healthy individuals. The majority of isolates recovered from the samples were Corynebacterium, Micrococcus sp., Staphylococcus epidermidis, and Cutibacterium acnes. Culture independent analysis revealed 24 phyla, of which Actinobacteria, Firmicutes and Proteobacteria were the most abundant. Over 405 genera were detected of which Corynebacterium was the most dominant, followed by Staphylococcus and Cutibacterium. The L2-regularized logistic regression model indicated that Blautia and Corynebacterium sp. may be associated with severe DED. CONCLUSIONS: Our study indicates that the ocular microbiome has characteristic features in severe DED patients. Certain Corynebacterium species and Blautia are of particular interest for future studies.

Exploring patients' adherence to antibiotics by understanding their health knowledge and relational communication in encounters with pharmacists and physicians.

Background: Antibiotics are drugs essential for the treatment of bacterial infections. Widespread and often improper use of antibiotics are driving the emergence of antimicrobial resistance (AMR) globally. A better understanding of the communicated and understood use of antibiotics as well as improved adherence to treatments are needed to meet this public health threat. Objectives: The aim of the study is to explore how knowledge of antibiotic use is collected and communicated between patients, physicians, and pharmacists, and how patients seek, understand and use available information on antibiotics in adherence to prescribed treatment. Methods: Seven focus group interviews were conducted with community pharmacists (three groups, eleven participants), physicians/general practitioners (two groups, thirteen participants), and patients (two groups, eight participants) in Norway. Four focus group interviews were conducted offline and three online. The interview data were analyzed using systematic text condensation in a four-step, descriptive and explorative thematic analysis. Results: Three main themes were developed about patients' adherence to antibiotics: 1. patients' knowledge about antibiotics and AMR; 2. sources of information about antibiotics/AMR; and 3. relational communication. Patient knowledge about both antibiotics and AMR was somewhat limited, and showed considerable variation. Patients relied on the internet, chat sites, printed information, and face-to-face meetings with health professionals for information. Relational communication between patients, physicians, and pharmacists was found to be important in reducing misunderstandings.Vulnerability, limited time, and lack of communication were barriers to receiving and understanding information during patient-physician encounters. Increased knowledge about antibiotics and AMR may result in better adherence to prescribed medications. Conclusions: Patients seek information about antibiotics and AMR in three arenas; digital platforms, printed material and face to face encounters. However, patients often misunderstand important facts relating to this issue. Relational communication between patients, physicians, and pharmacists was important to ensure adherence to treatment regimens. Pharmacists are encouraged to use open-ended questions and build upon the information obtained from the physician to provide patients with tailored advice and ensure proper adherence. Pharmacists' contribution is crucial in optimizing antibiotic use and combating AMR, as they are the final healthcare point of contact before treatment initiation.

Positioning of community pharmacists in interactions with general practitioners and patients regarding prescribing and using antibiotics.

Interprofessional collaboration between general practitioners (GPs) and community pharmacists (CPs) is important for ensuring antibiotics are used correctly and combating antibiotic resistance. The study's main objective was to investigate how CPs, GPs and patients, respectively, position CPs in their interactions with patients on antibiotic-related matters in Norwegian pharmacies. Seven focus-group interviews were performed. Data were analyzed using systematic text condensation. Positioning theory was used to identify positions assigned to CPs by themselves, by GPs and by patients. CPs position themselves as helpful, accessible drug specialists responsible for advising on antibiotic use, but also consider themselves dependent on GP-supplied information to do so. GPs position CPs as helpful, responsible businesspeople who, however, lack clinical experience and are overzealous gatekeepers. Patients position CPs as helpful people who supply information in "everyday language" and as the GP's extended arm. Patients utter they are best served when GPs and CPs collaborate. This discrepancy is a barrier to optimal service to patients in general, and to proper antibiotic use in particular.

A preliminary study of the use of MinION sequencing to specifically detect Shiga toxin-producing Escherichia coli in culture swipes containing multiple serovars of this species.

An important challenge relating to clinical diagnostics of the foodborne pathogen Shiga toxin-producing E. coli (STEC), is that PCR-detection of the shiga-toxin gene (stx) in DNA from stool samples can be accompanied by a failure to identify an STEC isolate in pure culture on agar. In this study, we have explored the use of MinION long-read sequencing of DNA from bacterial culture swipes to detect the presence of STEC, and bioinformatic tools to characterize the STEC virulence factors. The online workflow "What's in my pot" (WIMP) in the Epi2me cloud service, rapidly identified STEC also when it was present in culture swipes together with multiple other E. coli serovars, given sufficient abundance. These preliminary results provide useful information about the sensitivity of the method, which has potential to be used in clinical diagnostic of STEC, particularly in cases where a pure culture of the STEC isolate is not obtained due to the 'STEC lost Shiga toxin' phenomenon.

The effect of toll-like receptor ligands on energy metabolism and myokine expression and secretion in cultured human skeletal muscle cells.

Skeletal muscle plays an important role in glycaemic control and metabolic homeostasis, making it a tissue of interest with respect to type 2 diabetes mellitus. The aim of the present study was to determine if ligands of Toll-like receptors (TLRs) could have an impact on energy metabolism and myokine expression and secretion in cultured human skeletal muscle cells. The myotubes expressed mRNA for TLRs 1-6. TLR3, TLR4, TLR5 and TLR6 ligands (TLRLs) increased glucose metabolism. Furthermore, TLR4L and TLR5L increased oleic acid metabolism. The metabolic effects of TLRLs were not evident until after at least 24 h pre-incubation of the cells and here the metabolic effects were more evident for the metabolism of glucose than oleic acid, with a shift towards effects on oleic acid metabolism after chronic exposure (168 h). However, the stimulatory effect of TLRLs on myokine expression and secretion was detected after only 6 h, where TLR3-6L stimulated secretion of interleukin-6 (IL-6). TLR5L also increased secretion of interleukin-8 (IL-8), while TLR6L also increased secretion of granulocyte-macrophage colony stimulating factor (GM-CSF). Pre-incubation of the myotubes with IL-6 for 24 h increased oleic acid oxidation but had no effect on glucose metabolism. Thus IL-6 did not mimic all the metabolic effects of the TLRLs, implying metabolic effects beyond the actions of this myokine.

A simple and novel method for the production of polyethylene terephthalate containing agar plates for the growth and detection of bacteria able to hydrolyze this plastic.

Polyethylene terephthalate is used in the manufacture of many products. Microbes able to hydrolyze the plastic are known, and offer promise for practical waste management. Screening for hydrolysis usually involves unwieldy culturing in the presence of film. A rapid screening method based on culturing on agar plates is here described.

Norwegian Soils and Waters Contain Mesophilic, Plastic-Degrading Bacteria.

Plastic pollution has become one of the most critical environmental issues, as rapidly increasing production, compounded by persistence of plastic wastes in the environment, are outpacing efforts to keep ecosystems plastic-free. A switch to plastics more amenable to microbial attack is one of several possible responses. Against this background, the current study describes the isolation, enumeration and polyphasic characterization of plastic-degrading bacteria present in Norwegian terrestrial and aquatic habits. It shows that these bacteria are present in relatively high numbers, and that plastic-degrading capabilities are found in several taxa, most especially Streptomyces. Some isolates wereable to degrade several plastics. Notably, a Rhodococcus sp. and a Streptomyces sp. degraded, respectively, four and six of the eight plastics investigated and a number of other polymers relevant for plastic blends. The paper also has a methodological aspect, presenting various approaches for assaying plastic-degrading properties and a PCR/sequencing-based approach for the identification of potential polyethylene terephthalate-degrading genes. A candidate gene was detected in several Streptomyces isolates. The study shows that Norwegian environments are a rich source of bacteria with the ability to degrade bioplastics possibly representing a natural remediation capacity, as well as a potential source of useful enzymes.

Whole genome sequencing and antibiotic diffusion assays, provide new insight on drug resistance in the genus Pedobacter.

A total of four strains of the 'environmental superbug' Pedobacter isolated from sludge produced at Norwegian drinking water treatment plants, were characterized by whole genome sequencing and antibiotic susceptibility assays. As with previous studies on members of this genus, we found that the isolates were multi-drug resistant, and that this resistance included clinically important beta-lactams, aminoglycosides and the fluoroquinolone ciprofloxacin. Using the minION sequencing platform (Oxford Nanopore Technologies) combined with HiSeq PE150 Illumina sequencing data, the four isolates were assembled into genomes of single contigs. Analysis of the genomes revealed potential genetic factors possibly underlying some of the specific resistances observed. Metallo-beta-lactamase activity was detected in one isolate, and the same isolate contained a putative metallo-betalactamase gene resembling pedo-2. Furthermore, several genes related to multidrug efflux systems were found using the resistance database CARD. Additionally, the present study extends our knowledge on the phylogeny of this genus, adding four new genomes to the existing 50.

Dietary Fiber, Gut Microbiota, and Metabolic Regulation-Current Status in Human Randomized Trials.

New knowledge about the gut microbiota and its interaction with the host's metabolic regulation has emerged during the last few decades. Several factors may affect the composition of the gut microbiota, including dietary fiber. Dietary fiber is not hydrolyzed by human digestive enzymes, but it is acted upon by gut microbes, and metabolites like short-chain fatty acids are produced. The short-chain fatty acids may be absorbed into the circulation and affect metabolic regulation in the host or be a substrate for other microbes. Some studies have shown improved insulin sensitivity, weight regulation, and reduced inflammation with increases in gut-derived short-chain fatty acids, all of which may reduce the risk of developing metabolic diseases. To what extent a dietary intervention with fiber may affect the human gut microbiota and hence metabolic regulation, is however, currently not well described. The aim of the present review is to summarize recent research on human randomized, controlled intervention studies investigating the effect of dietary fiber on gut microbiota and metabolic regulation. Metabolic regulation is discussed with respect to markers relating to glycemic regulation and lipid metabolism. Taken together, the papers on which the current review is based, suggest that dietary fiber has the potential to change the gut microbiota and alter metabolic regulation. However, due to the heterogeneity of the studies, a firm conclusion describing the causal relationship between gut microbiota and metabolic regulation remains elusive.

A preliminary study on the potential of Nanopore MinION and Illumina MiSeq 16S rRNA gene sequencing to characterize building-dust microbiomes.

There is a growing awareness of the importance of indoor microbiomes for human health. Given their complexity, these microbiomes can only be adequately surveyed using high throughput sequencing techniques. Oxford Nanopore's MinION is the newest third generation sequencing technology on the market. With its many advantages such as portability, user friendliness, simplicity, speed of sequencing and long read length, the technology is now an actual contender to established sequencing platforms. MinION's main disadvantage is a relatively low read accuracy compared to several other platforms, although this is constantly improving. The present study, which appears to be the first of its kind, provides the results of a preliminary analysis of the microbial communities in indoor environments based on 16S rRNA gene amplicon sequencing, using both the Oxford Nanopore Technologies (ONT) MinIOn and the Illumina MiSeq DNA sequencers. At the level of family and above, there was no significant difference between the microbial compositions as revealed by the two platforms. However, at the genus, and particularly at the species level, the ONT MinION reported greater taxonomic resolution than Illumina MiSeq.

Diversion and phylogenetic relatedness of filterable bacteria from Norwegian tap and bottled waters.

Numerous articles have documented the existence of filterable bacteria. Where filtration is the chosen method of sterilization for medicinal or media components, these bacteria will by definition render products non-sterile. They may further represent a health hazard to the end user. A wide-range of bacterial genera were found in bottled and tap water filtrates from 0.2 µm filters, including genera housing opportunistic pathogens (e.g. Methylobacterium) and endospore formers (Paenibacillus). Two municipal tap water isolates were only distantly related to named species. One of these grew on agar, and could potentially provide hitherto unharvested useful biological products. The other grew only in water, and failed to produce colonies on media targeting either heterotrophs or autotrophs. The present study is one of very few looking at filterable bacteria in bottled waters intended for human consumption and the first identifying the filterable portion. It extends the range of known habitats of filterable bacteria and provides data on two new or novel species.

Detection of Aminoglycoside Resistant Bacteria in Sludge Samples From Norwegian Drinking Water Treatment Plants.

Through a culture-based approach using sludge from drinking water treatment plants, this study reports on the presence of aminoglycoside resistant bacteria at 23 different geographical locations in Norway. Sludge samples are derived from a large environmental area including drinking water sources and their surrounding catchment areas. Aminoglycoside resistant bacteria were detected at 18 of the sample sites. Only five samples did not show any growth of isolates resistant to the selected aminoglycosides, kanamycin and gentamycin. There was a statistically significant correlation between the numbers of kanamycin and gentamycin resistant bacteria isolated from the 23 samples, perhaps suggesting common determinants of resistance. Based on 16S rRNA sequencing of 223 aminoglycoside resistant isolates, three different genera of Bacteroidetes were found to dominate across samples. These were Flavobacterium, Mucilaginibacter and Pedobacter. Further phenotypic and genotypic analyses showed that efflux pumps, reduced membrane permeability and four assayed genes coding for aminoglycoside modifying enzymes AAC(6')-Ib, AAC(3')-II, APH(3')-II, APH(3')-III, could only explain the resistance of a few of the isolates selected for testing. aph(3')-II was detected in 1.6% of total isolates, aac(6')-Ib and aph(3')-III in 0.8%, while aac(3')-II was not detected in any of the isolates. The isolates, for which potential resistance mechanisms were found, represented 13 different genera suggesting that aminoglycoside resistance is widespread in bacterial genera indigenous to sludge. The present study suggests that aminoglycoside resistant bacteria are present in Norwegian environments with limited anthropogenic exposures. However, the resistance mechanisms remain largely unknown, and further analyses, including culture-independent methods, could be performed to investigate other potential resistance mechanisms. This is, to our knowledge, the first large scale nationwide investigation of aminoglycoside resistance in the Norwegian environment.

Implications of stx loss for clinical diagnostics of Shiga toxin-producing Escherichia coli.

The dynamics related to the loss of stx genes from Shiga toxin-producing Escherichia coli remain unclear. Current diagnostic procedures have shortcomings in the detection and identification of STEC. This is partly owing to the fact that stx genes may be lost during an infection or in the laboratory. The aim of the present study was to provide new insight into in vivo and in vitro stx loss in order to improve diagnostic procedures. Results from the study support the theory that loss of stx is a strain-related phenomenon and not induced by patient factors. It was observed that one strain could lose stx both in vivo and in vitro. Whole genome comparison of stx-positive and stx-negative isolates from the same patient revealed that different genomic rearrangements, such as complete or partial loss of the parent prophage, may be factors in the loss of stx. Of diagnostic interest, it was shown that patients can be co-infected with different E. coli pathotypes. Therefore, identification of eae-positive, but stx-negative isolates should not be interpreted as "Shiga toxin-lost" E. coli without further testing. Growth and recovery of STEC were supported by different selective agar media for different strains, arguing for inclusion of several media in STEC diagnostics.

Longitudinal development of the dust microbiome in a newly opened Norwegian kindergarten.

BACKGROUND: In Norway, 91% of children aged 1-5 attend kindergarten where they are exposed to indoor microbiomes which can have relevance for development and health. In order to gain a better understanding of the composition of the indoor microbiome and how it is affected by occupancy over time, floor dust samples from a newly opened kindergarten were investigated. Samples were collected during an 11-month period. Samples were analyzed for bacterial composition using 16S rRNA gene sequencing. Samples were also screened for four clinically relevant antibiotic resistance genes. In addition, Petrifilm analyses were used to evaluate surface hygiene. RESULTS: Significant changes in the microbial community composition were observed over time (PERMANOVA, P < 0.05). Particularly, changes in the abundance and the proportions of human associated bacteria were found. A decrease in the prevalence of Propionibacterium from over 16% abundance to less than 1% and an increase in Streptococcus from 10 to 16% were the most significant findings. Four classes of clinically relevant antibiotic resistance genes were tested for; three were detected in the dust, indicating the presence of resistant bacteria and a potential for resistance spread. Petrifilm analysis showed that some surfaces in the kindergarten were of consistent poor hygienic quality, and new hygienic routines are required. CONCLUSIONS: This study, which is the first of its kind performed at a newly opened kindergarten, reveals changes in the microbiome over time as well as the presence of antibiotic resistance genes and hygiene issues which are of relevance for occupant health.

Challenges in the identification of methicillin-resistant Staphylococcus argenteus by routine diagnostics.

Current clinical diagnostic procedures have shortcomings in the differentiation of Staphylococcus argenteus from Staphylococcus aureus. This article presents three cases of Staphylococcus argenteus obtained from clinical samples. The initial results from biochemical and molecular methods led to an incorrect identification of the isolates as methicillin-resistant Staphylococcus aureus. Whole genome sequencing and real-time PCR targeting the nonribosomal peptide synthetase gene led to their correct identification as methicillin-resistant Staphylococcus argenteus. The study shows that real-time PCR can be used to differentiate the two species in routine diagnostics. For purposes of identification based on whole genome sequencing, the MinION portable sequencer is a simple and affordable approach which could be used by many laboratories.

Use of a Commercially Available Microarray to Characterize Antibiotic-Resistant Clinical Isolates of Klebsiella pneumoniae.

A commercially available microarray (IDENTIBAC AMR-ve) for the detection of antibiotic resistance determinants was investigated for its potential to genotype 30 clinical isolates and two control strains of Klebsiella pneumoniae. Resistance profiles and the production of extended-spectrum ß-lactamases were determined by disc diffusion and the results were compared with the microarray profiles in order to assess its scope and limitations. Genes associated with resistance to a wide range of antibiotics, including current first line therapy options, were detected. In addition, the array also detected class 1 integrases. The array is easy to use and interpret, and is useful in providing a general description of the numbers and types of resistance determinants in K. pneumoniae. It also provides an indication of the potential for resistance gene acquisition. However, in most instances detected resistance to specific antibiotics could not unequivocally be assigned to hybridization with a specific array probe. We conclude that the microarray is a valuable and rapid means of investigating the presence of resistance gene classes of therapeutic importance. It can also provide a starting point for selecting analyses of greater resolving power, such as phylogenetic subtyping by PCR sequencing.

Proteobacteria, extremophiles and unassigned species dominate in a tape-like showerhead biofilm

Abstract The development of showerhead biofilms exposes the user to repeated contact with potentially pathogenic microbes, yet we know relatively little about the content of these aggregates. The aim of the present study was to examine the microbial content of tape-like films found protruding from a domestic showerhead. Culturing showed that the films were dominated by aerobic α- and β-proteobacteria. Three isolates made up almost the entire plate count. These were a Brevundimonas species, a metalophilic Cupriavidus species and a thermophile, Geobacillus species. Furthermore, it was shown that the Cupriavidus isolate alone had a high capacity for biofilm formation and thus might be the initiator of biofilm production. A clone library revealed the same general composition. However, half of the 70 clones analyzed could not be assigned to a particular bacterial phylum and of these 29 differed from one another by only 1–2 base pairs, indicating a single species. Thus both the culture dependent and culture independent characterizations suggest a simple yet novel composition. The work is important as the biofilm is fundamentally different in form (tape-like) and content from that of all previously reported ones, where variously Mycobacterium, Methylobacterium and Xanthomonas species have dominated, and extremophiles were not reported.

Proteobacteria, extremophiles and unassigned species dominate in a tape-like showerhead biofilm.

The development of showerhead biofilms exposes the user to repeated contact with potentially pathogenic microbes, yet we know relatively little about the content of these aggregates. The aim of the present study was to examine the microbial content of tape-like films found protruding from a domestic showerhead. Culturing showed that the films were dominated by aerobic α- and ß-proteobacteria. Three isolates made up almost the entire plate count. These were a Brevundimonas species, a metalophilic Cupriavidus species and a thermophile, Geobacillus species. Furthermore, it was shown that the Cupriavidus isolate alone had a high capacity for biofilm formation and thus might be the initiator of biofilm production. A clone library revealed the same general composition. However, half of the 70 clones analyzed could not be assigned to a particular bacterial phylum and of these 29 differed from one another by only 1-2 base pairs, indicating a single species. Thus both the culture dependent and culture independent characterizations suggest a simple yet novel composition. The work is important as the biofilm is fundamentally different in form (tape-like) and content from that of all previously reported ones, where variously Mycobacterium, Methylobacterium and Xanthomonas species have dominated, and extremophiles were not reported.

Treatment stage associated changes in cellular and molecular microbial markers during the production of drinking water at the Vansjø water works.

The production of a drinking water that meets current aesthetic, microbiological and chemical standards, generally requires a combination of mechanical purification and disinfection in a multi-component treatment chain. Treatment choices and optimisation of water processing is best informed by using markers (including microbiological parameters) which indicate how each stage contributes to the production of the potable water. The present study combines culture-based and a number of culture-independent analyses to indicate what is happening at each stage of a state-of-the-art water treatment chain at Vansjø near the city of Moss in Norway. We show that particularly clarification with flotation and post-chlorination have profound and positive effects on water quality with respect to the removal and inactivation of microbes. Post-chlorination achieved better disinfection of the water than UV-treatment and was of paramount importance, as the penultimate step filtration through granular activated shed microbes to the water. Cloning and sequencing showed that some clones present in the raw water were detected at all stages in the treatment process, perhaps providing examples of microbes breaching physically all barriers in the treatment process. Results from the study should be useful in the improvement and maintenance of the treatment process at the Vansjø plant and others.

Toxin production and antibiotic resistances in Escherichia coli isolated from bathing areas along the coastline of the Oslo fjord.

The presence of enterovirulent and/or antibiotic resistant strains of Escherichia coli in recreational bathing waters would represent a clear health issue. In total, 144 E. coli isolated from 26 beaches along the inner Oslo fjord were examined for virulence determinants and resistance to clinically important antibiotics. No isolates possessed the genetic determinants associated with enterotoxigenic strains and none showed the prototypic sorbitol negative, O157:H7 phenotype. A small number (∼1 %) produced alpha-hemolysin. Occurrences and patterns of antibiotic resistances were similar to those of E. coli isolated previously from environmental samples. In total, 6 % of the strains showed one or more clinically relevant resistances and 1.4 % were multi-drug resistant. Microarray analyses suggested that the resistance determinants were generally associated with mobile genetic elements. Resistant strains were not clonally related, and were, furthermore not concentrated at one or a few beach sites. This suggests that these strains are entering the waters at a low rate but in a widespread manner. The study demonstrates that resistant E. coli are present in coastal bathing waters where they can come into contact with bathers, and that the resistance determinants are potentially transferable. Some of the resistances registered in the study are to important antibiotics used in human medicine such as fluoroquinolones. The spread of antibiotic resistant genes, from the clinical setting to the environment, has clear implications with respect to the current management of bacterial infections and the long term value of antimicrobial therapy. The present study is the first of its kind in Norway.