Time to Detection with BacT/Alert FA Plus Compared to BacT/Alert FA Blood Culture Media.

Rapid identification of the causative pathogen in patients with bacteremia allows adjustment of antibiotic therapy and improves patient outcomes. We compared in vitro and real-life time to detection (TTD) of two blood culture media, BacT/Alert FA (FA) and BacT/Alert FA Plus (FA Plus), for the nine most common species of bacterial pathogens recovered from blood samples. Experimental data from simulated cultures was compared with microbiology records of TTD for both culture media with growth of the species of interest in clinical blood cultures. In the experimental conditions, median TTD was 3.8 hours (23.9 %) shorter using FA Plus media. The magnitude of reduction differed between species. Similarly, in real life data, FA Plus had shorter TTD than FA media; however, the difference between culture media was smaller, and median TTD was only 1 hour (8.5 %) less. We found shorter TTD with BacT/Alert FA Plus culture media, both experimentally and in real-life conditions and unrelated to antibiotic neutralization, highlighting the importance of appropriate blood culture media selection.

Population pharmacokinetics of colistin and the relation to survival in critically ill patients infected with colistin susceptible and carbapenem-resistant bacteria.

OBJECTIVES: The aim was to analyse the population pharmacokinetics of colistin and to explore the relationship between colistin exposure and time to death. METHODS: Patients included in the AIDA randomized controlled trial were treated with colistin for severe infections caused by carbapenem-resistant Gram-negative bacteria. All subjects received a 9 million units (MU) loading dose, followed by a 4.5 MU twice daily maintenance dose, with dose reduction if creatinine clearance (CrCL) < 50 mL/min. Individual colistin exposures were estimated from the developed population pharmacokinetic model and an optimized two-sample per patient sampling design. Time to death was evaluated in a parametric survival analysis. RESULTS: Out of 406 randomized patients, 349 contributed pharmacokinetic data. The median (90% range) colistin plasma concentration was 0.44 (0.14-1.59) mg/L at 15 minutes after the end of first infusion. In samples drawn 10 hr after a maintenance dose, concentrations were >2 mg/L in 94% (195/208) and 44% (38/87) of patients with CrCL ≤120 mL/min, and >120 mL/min, respectively. Colistin methanesulfonate sodium (CMS) and colistin clearances were strongly dependent on CrCL. High colistin exposure to MIC ratio was associated with increased hazard of death in the multivariate analysis (adjusted hazard ratio (95% CI): 1.07 (1.03-1.12)). Other significant predictors included SOFA score at baseline (HR 1.24 (1.19-1.30) per score increase), age and Acinetobacter or Pseudomonas as index pathogen. DISCUSSION: The population pharmacokinetic model predicted that >90% of the patients had colistin concentrations >2 mg/L at steady state, but only 66% at 4 hr after start of treatment. High colistin exposure was associated with poor kidney function, and was not related to a prolonged survival.

How to: molecular investigation of a hospital outbreak.

BACKGROUND: Studying hospital outbreaks by using molecular tools, i.e. synthesizing the molecular epidemiology data to its appropriate clinical-epidemiologic context, is crucial in order to identify infection source, infer transmission dynamics, appropriately allocate prevention resources and implement control measures. Whole-genome sequencing (WGS) of pathogens has become the reference standard, as it is becoming more accessible and affordable. Consequently, sequencing of the full pathogen genome via WGS and major progress in fit-for-purpose genomic data analysis tools and interpretation is revolutionizing the field of outbreak investigations in hospitals. Metagenomics is an additional evolving field that might become commonly used in the future for outbreak investigations. Nevertheless, practitioners are frequently limited in terms of WGS or metagenomics, especially for local outbreak analyses, as a result of costs or logistical considerations, reduced or lack of locally available resources and/or expertise. As a result, traditional approaches, including pulsed-field gel electrophoresis, repetitive-element palindromic PCR and multilocus sequence typing, along with other typing methods, are still widely used. AIMS: To provide practitioners with evidenced-based action plans for usage of the various typing techniques in order to investigate the molecular epidemiology of nosocomial outbreaks, of clinically significant pathogens in acute-care hospitals. SOURCES: PubMed search with relevant keywords along with personal collection of relevant publications. CONTENT: Representative case scenarios and critical review of the relevant scientific literature. IMPLICATIONS: The review provides practical action plans to manage molecular epidemiologic investigations of outbreaks caused by clinically significant nosocomial pathogens, while prioritizing the use and timely integration of the various methodologies.

Evaluation of carriage and environmental contamination by carbapenem-resistant Acinetobacter baumannii.

We evaluated the sensitivity of surveillance cultures for carbapenem-resistant Acinetobacter baumannii (CRAB) in patients and in their environment. Patients with a CRAB-positive clinical culture were sampled within 7 days; the buccal mucosa and rectum were sampled using swabs, and skin was sampled using pre-moistened sterile sponges. Sponges were also used to sample the surrounding environment. Specimens were inoculated onto CHROMagar MDR Acinetobacter plates both directly and after overnight enrichment. CRAB load was scored semi-quantitatively and composite scores for patient colonization and environmental contamination were calculated. Thirty-four patients were included. Screening sensitivity was 28/34 (82%) for buccal mucosa, 30/34 (88%) for skin, and 25/34 (74%) for rectum. Combined sensitivity was 32/34 (94%). Among patients with CRAB-positive respiratory cultures, sensitivity for buccal mucosa was 20/20 (100%). Direct inoculation had excellent sensitivity: 25/28 (89%) for all three sites combined. In the subgroup of patients who did not have a respiratory source for CRAB, direct inoculation sensitivity was lower than among patients with CRAB-positive respiratory cultures: 5/8 (63%) versus 20/20 (100%). The environment of all patients was contaminated with CRAB. There was a positive correlation between the patient colonization score and the environmental contamination score (r = 0.63, p <0.001; r = 0.4, p 0.04 for buccal mucosa, r = 0.7, p <0.001 for skin, and r = 0.46, p 0.14 for rectum). In conclusion, screening for CRAB carriers can be performed by direct plating of skin and buccal mucosa samples. Environmental contamination is common and can be monitored. Implementing screening may facilitate infection control efforts to limit the spread of CRAB.

The use of a neural network for studying the relationship between air pollution and asthma-related emergency room visits.

To establish the relationship between air pollution levels and bronchial asthma-associated emergency room (ER) visits, we adapted artificial network technology to conduct this study which focused on three different pollutants, sulphur dioxide, nitrogen oxide and ozone. The study population was comprised of adults presenting to the emergency room of a large metropolitan hospital in Israel during a 3-month period with acute exacerbation of bronchial asthma and who had a past history of intermittent airway disease compatible with bronchial asthma. The range of mean daily pollutants levels for the whole period were: O3 = 15-26 micrograms m-3, NOx = 36-108 micrograms m-3, NO = 16-70 micrograms m-3, and SO2 = 11-32 micrograms m-3. The data sets were composed of input air pollution levels and output ER visits. The first 126 data sets used for the training phase showed that maximal ER visits were mainly associated with the highest cumulative values of air pollution and mostly with nitrogen oxide. In phase two, an attempt was made to predict ER visits based on air pollution level in 49 data sets. The study findings demonstrated that ordinary network technology can be used for learning the effect of air pollution ER visits and, although limited in accuracy, to also predict future ER visits.

A case-control study to identify predictors of 14-day mortality following carbapenem-resistant Acinetobacter baumannii bacteraemia.

Carbapenem-resistant Acinetobacter baumannii (CRAB) is an increasingly common nosocomial pathogen. We sought to identify clinical and microbiological predictors of 14-day mortality among patients with CRAB bacteraemia. This case-control study included all adult patients in one Israeli hospital with CRAB on blood culture between July 2008 and June 2011. Cases were defined as patients who died within 14 days of bacteraemia onset and controls as patients who survived over 14 days. Sequence-typing of the blaOXA-51-like gene and REP-PCR identified CRAB clone groups. Logistic regression was performed to analyze predictors of 14-day all-cause mortality. To correct for differences in treatment onset, Cox regression was used to examine the effect of receiving an active antibiotic. Eighty-three cases and 89 controls were included. Six major CRAB clone groups were identified, with 14-day mortality ranging from 17 to 66%. Independent predictors of 14-day mortality were severity of illness (OR = 1.38 for each 1-point increase in Sequential Organ Failure Assessment (SOFA) score; 95% CI, 1.21, 1.56), independence in activities of daily living (ADL) on admission (OR = 3.40; 95% CI, 1.20, 9.67, for fully dependent vs. independent), surgery before bacteraemia (OR = 0.25; 95% CI, 0.11, 0.59) and clone group (OR = 7.76; 95% CI, 2.52, 23.85, for the most virulent group vs. the reference group). In the multivariate Cox model using a propensity score to adjust for SOFA, clone, ADL and surgery, active antibiotic treatment was protective (HR = 0.30; 95% CI, 0.15, 0.60). Differences in virulence between CRAB clones may partly explain heterogeneous results in previous studies of mortality following CRAB infection.

Non-rotated midgut in a dog.

Macroscopic observations of the partly-dissected abdomen of the preserved cadaver of a Labrador bitch were recorded and photographs taken. Neither the duodenum nor the colon looped around the root of the great (jejuno-ileal) mesentery, but both were long enough to have done so. The abdominal organs appeared to be otherwise normal, as did the other parts of the body. The condition appeared to have resulted from non-rotation of the midgut during embryonic development and to have no adverse effect on the animal.

A comparison of the effectiveness of three neck-hold killing traps in occluding carotid arteries in the neck of the brushtail possum.

AIMS: To compare the potential humaneness of three types of neck-hold killing traps in terms of the blood vessels that are occluded, and to examine the anatomy of the blood vessels that supply blood to the possum's brain. METHOD: The prevalence of occlusion of the common carotid arteries and the trachea was examined in 33 possums which were caught with Timms, LDL and Conibear 160 traps. The anatomy of the blood supply to the brain was examined in six possums using a resin casting technique. RESULTS: The prevalence of complete bilateral common carotid artery occlusion was 77% for the Timms trap, 45% for the LDL trap and 22% for the Conibear 160 trap. The major route for blood supply to the brain was via the common carotid arteries. CONCLUSION: Where the aim is to kill possums quickly by ischaemia of the brain, the Timms trap is to be preferred over the LDL and Conibear 160 traps.

Recognition of > or = 3850 Ma water-lain sediments in West Greenland and their significance for the early Archaean Earth.

A layered body of amphibolite, banded iron formation (BIF), and ultramafic rocks from the island of Akilia, southern West Greenland, is cut by a quartz-dioritic sheet from which SHRIMP zircon 206Pb/207Pb weighted mean ages of 3865 +/- 11 Ma and 3840 +/- 8 Ma (2 sigma) can be calculated by different approaches. Three other methods of assessing the zircon data yield ages of >3830 Ma. The BIFs are interpreted as water-lain sediments, which with a minimum age of approximately 3850 Ma, are the oldest sediments yet documented. These rocks provide proof that by approximately 3850 Ma (1) there was a hydrosphere, supporting the chemical sedimentation of BIF, and that not all water was stored in hydrous minerals, and (2) that conditions satisfying the stability of liquid water imply surface temperatures were similar to present. Carbon isotope data of graphitic microdomains in apatite from the Akilia island BIF are consistent with a bio-organic origin (Mojzsis et al. 1996), extending the record of life on Earth to >3850 Ma. Life and surface water by approximately 3850 Ma provide constraints on either the energetics or termination of the late meteoritic bombardment event (suggested from the lunar cratering record) on Earth.

Evidence for life on Earth before 3,800 million years ago.

It is unknown when life first appeared on Earth. The earliest known microfossils (approximately 3,500 Myr before present) are structurally complex, and if it is assumed that the associated organisms required a long time to develop this degree of complexity, then the existence of life much earlier than this can be argued. But the known examples of crustal rocks older than 3,500 Myr have experienced intense metamorphism, which would have obliterated any fragile microfossils contained therein. It is therefore necessary to search for geochemical evidence of past biotic activity that has been preserved within minerals that are resistant to metamorphism. Here we report ion-microprobe measurements of the carbon-isotope composition of carbonaceous inclusions within grains of apatite (basic calcium phosphate) from the oldest known sediment sequences--a approximately 3,800-Myr-old banded iron formation from the Isua supracrustal belt, West Greenland, and a similar formation from the nearby Akilia island that is possibly older than 3,850 Myr. The carbon in the carbonaceous inclusions is isotopically light, indicative of biological activity; no known abiotic process can explain the data. Unless some unknown abiotic process exists which is able both to create such isotopically light carbon and then selectively incorporate it into apatite grains, our results provide evidence for the emergence of life on Earth by at least 3,800 Myr before present.

The use of a shotgun for the emergency slaughter or euthanasia of large mature pigs.

The isolated heads of a Friesian bull and three large, Large White pigs were shot from various aspects with a 12-gauge shotgun using both a single 28 g solid lead projectile and buckshot, the latter consisting of nine individual lead pellets with a combined mass of 28 g. The sites of impact to the skull included the conventional frontal region, an occipital site and immediately behind the ear. A live mature Large White sow was shot with buckshot in the depression just caudal to the right ear, resulting in immediate insensibility and death. The damage caused to the isolated heads indicated that similar effects could be expected if the heads had been part of intact living animals. It is suggested that buckshot (nine lead pellets with a combined mass of 28 g) fired from a 12-gauge shotgun may be suitable for the emergency slaughter or euthanasia of a wide variety of domestic livestock and other species of animal.

The use of a shotgun for euthanasia of stranded cetaceans.

A 12-gauge shotgun, loaded with either a solid 28 g lead slug or buckshot consisting of nine individual lead pellets with a total mass of 28 g, was used to shoot the heads of one dead common dolphin (Delphinus delphis) and five dead long-finned pilot whales (Globicephala melaena) varying in length from 2.5 m to 5 m. The dolphin and the smallest pilot whale were shot with both projectiles from the dorsal surface of the head. The projectiles penetrated the head and dorsal surface of the skull, but not the base of the cranium. This site using buckshot was not effective in the larger animals. Two whales between 3 and 4 m in length were shot with buckshot through the lateral side of the head caudal to and above the eye, without penetration of the contralateral side of the head. It is concluded that shooting smaller cetaceans with a shotgun can be effective and safe. Further work is required to develop more suitable projectiles for cetaceans up to the size of mature pilot whales.