In vitro efficacy of antibiotic loaded calcium sulfate beads (Stimulan Rapid Cure) against polymicrobial communities and individual bacterial strains derived from diabetic foot infections.

Introduction. Diabetic foot infection (DFI) is the main reason for diabetes-related hospitalisation and is a major cause of diabetes-related amputation. DFIs are often complicated by ischaemia in the affected limb, the presence of polymicrobial biofilms and increasingly the occurrence of antibiotic resistant bacteria.Hypothesis/Gap statement. Antibiotic loaded beads could inhibit the growth of polymicrobial DFI communities with differing compositions in vitro.Aim. This study investigates the in vitro efficacy of antibiotic loaded calcium sulfate beads (Stimulan Rapid Cure, Biocomposites Ltd., UK) against polymicrobial DFI communities and individual bacterial strains derived from DFIs.Methodology. Debrided tissue obtained from the base of infected diabetic foot ulcers was homogenised and spread over the surface of Columbia blood agar (CBA) and fastidious anaerobe agar (FAA) plates. Calcium sulfate beads containing a combination of vancomycin and gentamicin were then placed on the surface of the agar and following incubation, zones of inhibition (ZOI) were measured. For individual bacterial strains isolated from the infected tissue, calcium sulfate beads containing vancomycin, gentamicin, flucloxacillin or rifampicin and beads containing a combination of vancomycin and gentamicin or flucloxacillin and rifampicin were tested for their ability to inhibit growth.Results. Calcium sulfate beads loaded with a combination of vancomycin and gentamicin were able to inhibit bacterial growth from all polymicrobial tissue homogenates tested, with ZOI diameters ranging from 15 to 40 mm. In the case of individual bacterial strains, beads containing combinations of vancomycin and gentamicin or flucloxacillin and rifampicin were able to produce ZOI with Gram-positive facultatitive anaerobic strains such as Staphylococcus aureus and Enterococcus faecalis, Gram-negative facultative anaerobic strains such as Pseudomonas aeruginosa and obligate anaerobic strains such as Finegoldia magna even where acquired resistance to one of the antibiotics in the combination was evidenced.Conclusion. The local use of calcium sulfate beads containing a combination of two antibiotics demonstrated high efficacy against polymicrobial DFI communities and individual DFI bacterial strains in in vitro zone of inhibition tests. These results show promise for clinical application, but further research and clinical studies are required.

Increasing Prevalence and Stable Incidence Rates of Inflammatory Bowel Disease Among First Nations: Population-Based Evidence From a Western Canadian Province.

BACKGROUND: There is limited to no evidence of the prevalence and incidence rates of inflammatory bowel disease (IBD) among Indigenous peoples. In partnership with Indigenous patients and family advocates, we aimed to estimate the prevalence, incidence, and trends over time of IBD among First Nations (FNs) since 1999 in the Western Canadian province of Saskatchewan. METHODS: We conducted a retrospective population-based study linking provincial administrative health data from the 1999-2000 to 2016-2017 fiscal years. An IBD case definition requiring multiple health care contacts was used. The prevalence and incidence data were modeled using generalized linear models and a negative binomial distribution. Models considered the effect of age groups, sex, diagnosis type (ulcerative colitis [UC], Crohn disease [CD]), and fiscal years to estimate prevalence and incidence rates and trends over time. RESULTS: The prevalence of IBD among FNs increased from 64/100,000 (95% confidence interval [CI], 62-66) in 1999-2000 to 142/100,000 (95% CI, 140-144) people in 2016-2017, with an annual average increase of 4.2% (95% CI, 3.2%-5.2%). Similarly, the prevalence of UC and CD, respectively, increased by 3.4% (95% CI, 2.3%-4.6%) and 4.1% (95% CI, 3.3%-4.9%) per year. In contrast, the incidence rates of IBD, UC, and CD among FNs depicted stable trends over time; no statistically significant changes were observed in the annual change trend tests. The ratio of UC to CD was 1.71. CONCLUSIONS: We provided population-based evidence of the increasing prevalence and stable incidence rates of IBD among FNs. Further studies are needed in other regions to continue understanding the patterns of IBD among Indigenous peoples.

Clostridial dermatitis and cellulitis: an emerging disease of turkeys.

Clostridial dermatitis of turkeys (CDT) has emerged as a major issue across most geographic regions of the United States. The prevalence and severity of dermatitis has increased over the last several years, since the time it was first reported in 1993. Cellulitis in poultry can be associated with Staphylococcus aureus or Escherichia coli, but the more recent field situation in turkeys is specifically associated with Clostridium spp. The prevalence of cellulitis is relatively low; however, the disease can be devastating in the individual flocks affected. Clostridium septicum, Clostridium perfringens, Clostridium sordelli, and S. aureus can cause cellulitis. Escherichia coli, Streptococcus spp., and other bacteria have occasionally been isolated from birds diagnosed with cellulitis. CDT appears as excessive mortality in older birds around 16-18 weeks of age. It has been reported from field experience as early as 7 wk of age. Clinical signs of CDT can range from sudden death to inappetence, depression, leg weakness, recumbency, and ataxia. The disease is characterized by reddish to dark or greenish discoloration of the skin around the thighs, abdomen, keel, tail region, back, and wings. The lesions can extend into the underlying muscles, and there can be gas bubbles under the skin which result in crepitation. Some cases present with dead birds having "bubbly tail," fluid-filled blisters associated with broken feather follicles around the base of the tail. Bubbly tail in breeder toms might not cause excessive mortality, but the lesions are so severe that the birds cannot be used for semen collection. Incidence of mortality from this condition can be severe and acute (i.e., rapid onset of high mortality). The dead birds decompose very quickly. Microscopically, there is necrosis, with or without inflammation of the skin, especially in the dermis and occasionally in the skeletal muscles, associated with large numbers of rod-shaped bacteria. Overcrowding, aggressive birds, poor-wet litter, decreased down time, a contaminated environment including feed and water, poor hygienic conditions, and contaminated vaccines and vaccine equipment, etc., can predispose birds for CDT. Preventative measures and treatment are discussed extensively in this review.