A quality assessment of inflammatory bowel disease nursing care in Finland: a nationwide cross-sectional descriptive study

OBJECTIVES OF THE ARTICLE

Inflammatory bowel disease (IBD) nursing has been identified as a crucial component in the IBD service delivery. This article aims to provide a comprehensive overview of the state of IBD nursing care in Finland, and to identify areas that would benefit from further research.

MATERIALS AND METHODS

Tertiary IBD outpatient clinics nationwide were invited to participate in a cross-sectional descriptive study conducted using an electronic survey. The quality of IBD nursing services was assessed using the Nursing Care Quality in IBD (NCQ-IBD) evaluation tool.

RESULTS

Of the 34 identified clinics, 27 participated (79.4%) in the study. The NCQ-IBD tool classifies the clinics in four categories, where A indicates the highest level of quality, and D the lowest. In this study, 26 clinics (96.3%) were classified at level C, and one clinic (3.7%) at level D. Nursing responsibilities in IBD management and informing the patients were at a high level of quality, whereas nursing research in IBD was at a low level. An IBD database (i.e. clinical IBD registry) was in use only in 10 clinics. Although training in the clinical aspects of IBD was readily available, there was a lack of training plans for IBD, and clinics seldom held an annual review of the IBD nursing activities and outcomes. There were very few clinics using structured indices and questionnaires, and only 16 clinics (59.3%) applied a written IBD protocol.

CONCLUSION

In the Finnish IBD nursing service, as measured with the NCQ-IBD tool, several areas for future improvement were identified.

Aerosol precautions and airway complications: a national prospective multicentre cohort study

The perceived risk of transmission of aerosolised viral particles from patients to airway practitioners during the COVID-19 pandemic led to the widespread use of aerosol precautions, including personal protective equipment and modifications to anaesthetic technique. The risk of these aerosol precautions on peri-operative airway complications has not been assessed outside of simulation studies. This prospective, national, multicentre cohort study aimed to quantify this risk. Adult patients undergoing general anaesthesia for elective or emergency procedures over a 96-hour period were included. Data collected included use of aerosol precautions by the airway practitioner, airway complications and potential confounding variables. Mixed-effects logistic regression was used to assess the risk of individual aerosol precautions on overall and specific airway complications. Data from 5905 patients from 70 hospital sites were included. The rate of airway complications was 10.0% (95%CI 9.2-10.8%). Use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications (odds ratio 1.38, 95%CI 1.04-1.83), predominantly due to an association with difficult facemask ventilation (odds ratio 1.68, 95%CI 1.09-2.61) and desaturation on pulse oximetry (odds ratio 2.39, 95%CI 1.26-4.54). Use of goggles, powered air-purifying respirators, long-sleeved gowns, double gloves and videolaryngoscopy were not associated with any alteration in the risk of airway complications. Overall, the use of filtering facepiece class 2 or class 3 respirators was associated with an increased risk of airway complications, but most aerosol precautions used during the COVID-19 pandemic were not.

Intraosseous access in neonates and infants: risk of severe complications - a case report

Gaining vascular access in a neonate during cardiopulmonary resuscitation is crucial and challenging. Intraosseous (IO) access can offer a fast and reliable method for achieving emergency access for fluids and drugs when venous access fails in a critically ill child. IO access can however result in rare, but serious adverse events including compartment syndrome and amputation. We describe a case resulting in leg amputation due to IO infusion in a neonate after resuscitation and therapeutic hypothermia. We compared 10 tibia X-rays in three age groups. The mean medullary diameter of the proximal tibia at the recommended site for IO access was 7 mm in neonate, 10 mm in 1- to 12-month-old infants, and 12 mm in 3- to 4-year-old children. This provides a narrow margin of safety for the correct positioning and the avoidance of dislodgement of the IO needle. The correct position of the IO needle should be confirmed by bone marrow aspiration and fluid bolus. Unnecessary touching of the IO needle after fixing it in place should be avoided by inserting a luer-lock catheter with a three-way stop-cock for IO drug and fluid administration. Regular observation of the circulation and possible swelling of the leg should be performed. The IO administration of inotropic infusions should also be avoided after the initial resuscitation phase. When treating with therapeutic hypothermia, it may be wise to remove the IO needle much earlier than the currently recommended 24 h because of the problems in peripheral circulation and its monitoring.

The burden of inflammatory bowel disease on health care utilization and quality of life

OBJECTIVE

The aim of this study was to explore the utilization of health services by Finnish adults with inflammatory bowel disease (IBD) and to assess the associated demographic and health-related quality of life (HRQoL) factors.

MATERIAL AND METHODS

556 Finnish IBD patients eligible for reimbursement for IBD medication according to the Social Insurance Institution in Finland answered our postal cross-sectional survey. The study questionnaire included questions about demographic characteristics of the patients, health care resource use, and HRQoL. The number of doctor visits was compared with those of irritable bowel syndrome patients.

RESULTS

During the previous year, more than three quarters of the respondents reported disturbing IBD symptoms. The majority (64%) had seen a doctor due to their IBD, women more often than men (p < 0.001). The use of health services did not differ between diagnostic (Crohn's disease or ulcerative colitis) or age groups, marital status, education, or time elapsed since diagnosis. Women were absent from work more frequently than men (p = 0.01). The amount of physician visits, work absenteeism, and a higher amount of undergone procedures were related to impaired HRQoL (p < 0.001 on all accounts).

CONCLUSIONS

Despite comprehensive public health services and specialized care for IBD patients in Finland, a majority expressed disturbing IBD symptoms. Since the amount of physician visits, work absenteeism and a higher amount of procedures were related to a diminished HRQoL, the patients who are most often met by professional caregivers are often those whose HRQoL needs to be more adequately addressed.

Personality traits and brain dopaminergic function in Parkinson's disease

A distinctive personality type, characterized by introversion, inflexibility, and low novelty seeking, has been suggested to be associated with Parkinson's disease. To test the hypothesis that Parkinson's disease is associated with a specific dopamine-related personality type, the personality structures of 61 unmedicated Parkinson's disease patients and 45 healthy controls were examined. Additionally, in 47 Parkinson's disease patients, the dopaminergic function in the brain was directly measured with 6-[(18)F]fluoro-l-dopa ((18)F-dopa) positron emission tomography (PET) with MRI coregistration. The novelty-seeking personality score, supposedly associated with the parkinsonian personality, was slightly lower in the Parkinson's disease group compared with controls, but it did not have a significant relationship with (18)F-dopa uptake in any of the brain regions studied (r = -0.12 to 0.11, P > 0.15). The harm-avoidance personality score, associated with anxiety and depression, was clearly increased in patients with Parkinson's disease and it had a paradoxical, highly significant positive correlation with the (18)F-dopa uptake in the right caudate nucleus (r = 0.53, P = 0.04, Bonferroni corrected for 220 comparisons). Although the results of this study are not in disagreement with the concept of low-novelty-seeking personality type in Parkinson's disease, the personality type does not seem to be dopamine dependent. The correlation between the personality trait of harm avoidance and (18)F-dopa may reflect a specific feedback circuitry of neurotransmitters that is associated with negative emotionality in Parkinson's disease.

Increased frontal [(18)F]fluorodopa uptake in early Parkinson's disease: sex differences in the prefrontal cortex

Previous imaging studies in Parkinson's disease have focused mainly on the striatum, a region with very high dopaminergic activity. Using modern high-sensitivity 3D [(18)F]fluorodopa (Fdopa)-PET, mesocortical monoamine projections can be studied. To study the frontal monoaminergic system in unmedicated early Parkinson's disease in vivo, we examined 20 early Parkinson's disease patients (10 women, 10 men) and 16 healthy subjects (nine women, seven men) with 3D Fdopa-PET, using standard region-of-interest-based analysis with MRI co-registration. Women with Parkinson's disease had 87% higher Fdopa uptake in the right dorsolateral prefrontal cortex (area 46) compared with men with Parkinson's disease, whereas there was no sex difference in the control group (sex x disease interaction, P = 0.03). The uptake in the right dorsolateral prefrontal cortex was 82% higher in men with Parkinson's disease and 219% higher in women with Parkinson's disease compared with control groups (effect of disease, P < 0.0001). Also in the left dorsolateral prefrontal cortex and in the medial frontal cortex, early Parkinson's disease patients had significantly (18-94%) higher Fdopa uptake compared with healthy controls. In the putamen, both men and women with Parkinson's disease had a significantly lower (27-46%) uptake compared with healthy controls. These results indicate that frontal monoaminergic activity is increased and that there is a sex difference in the prefrontal monoaminergic system in early Parkinson's disease. The reported sex difference may be linked to clinical sex differences in the symptoms and treatment response in Parkinson's disease.

Rate of progression in Parkinson's disease: a 6-[18F]fluoro-L-dopa PET study

The aim of this study was to investigate the rate of progression in Parkinson's disease (PD) with 6-[(18)F]fluoro-L-dopa (FDOPA) positron emission tomography (PET). We investigated 21 patients with PD and eight healthy controls. Ten of the patients were de novo at the time of the first PET scan and antiparkinsonian medication was started thereafter, with a favourable response. A FDOPA PET scan was carried out twice at an approximately 5-year interval. The regions of interest were drawn on individual magnetic resonance imaging (MRI) images, matched with the PET images. At the first PET scan, in PD patients the mean k(i)(occ) (x 10(-3) min(-1)) in the anterior putamen was 5.6 +/- 2.7 (mean +/- S.D.; 55% of the control mean) and in the posterior putamen 4.5 +/- 2.4 (45% of the control mean). The k(i)(occ) value for the caudate nucleus was 7.5 +/- 2.1 (x 10(-3) min(-1); 76% of the control mean). The FDOPA uptake declined by the time of the second PET scan and the annual rate of decline was 8.3 +/- 6.3% (P < 0.001) of the baseline mean in the anterior putamen and 10.3 +/- 4.8% (P < 0.001) in the posterior putamen. In the caudate nucleus, FDOPA uptake decreased by 5.9 +/- 5.1% (P < 0.001) of the baseline mean per year. The estimated preclinical period was longest for the posterior putamen being 6.5 years. For the anterior putamen the preclinical period was 4.6 years. In the caudate nucleus, the estimated FDOPA uptake was at normal level at disease onset. In healthy controls, there was no significant decline in FDOPA uptake in any striatal subregion. Our results suggest that the disease process in PD first affects posterior putamen, followed by the anterior putamen and the caudate nucleus, but once started, the absolute rate of decline is the same. In healthy controls, no significant decline in FDOPA was detected.

[(18)F]FDOPA and [(18)F]CFT are both sensitive PET markers to detect presynaptic dopaminergic hypofunction in early Parkinson's disease

The aim of this study was to compare two PET ligands, 6-[(18)F]fluoro-L-dopa ([(18)F]FDOPA) and (18)F-labeled CFT, 2beta-carbomethoxy-3beta-(4-[(18)F]-fluorophenyl)tropane ([(18)F]CFT), in detecting presynaptic dopaminergic hypofunction in early Parkinson's disease (PD). These ligands reflect different aspects of presynaptic dopaminergic function, since [(18)F]FDOPA mainly reflects 6-[(18)F]fluorodopamine (fluorodopamine) synthesis and storage whereas [(18)F]CFT uptake is related to dopamine transporter function. Eight de novo patients with PD who had never been on antiparkinsonian medication were investigated with [(18)F]FDOPA and [(18)F]CFT PET. Five healthy volunteers were studied as controls. In PD patients, both [(18)F]FDOPA and [(18)F]CFT uptakes were significantly reduced both in the contralateral and ipsilateral anterior and posterior putamen. The reduction was greatest in the contralateral posterior putamen (to 28% of control mean for [(18)F]FDOPA, P < 0.0001 and to 16% for [(18)F]CFT, P < 0.0001). Individually, all patients' [(18)F]FDOPA and [(18)F]CFT uptake values in the contralateral anterior and posterior putamen were below 3 SD of the control mean. In the caudate nucleus, the mean uptake of both tracers was significantly reduced both ipsilaterally and contralaterally, but less severely than in the putamen (to 69% of the control mean for [(18)F]FDOPA, P = 0.003 and to 60% for [(18)F]CFT, P = 0.001 contralaterally). Our results show that both [(18)F]FDOPA as well as [(18)F]CFT sensitively detect presynaptic dopaminergic hypofunction in early PD. They demonstrate a considerable reduction of tracer uptake that is greatest in the posterior putamen, followed by the anterior putamen and the caudate nucleus.

Reproducibility and effect of levodopa on dopamine transporter function measurements: a [18F]CFT PET study

The objective of this article was to study the reproducibility and effect of levodopa on dopamine transporter function measurements using 2beta-carbomethoxy-3beta-(4-[18F]fluorophenyl)tropane ([18F]CFT) positron emission tomography (PET). Seven de novo patients with Parkinson's disease (PD) were studied twice, before and after three months of levodopa medication. Eight healthy volunteer subjects participated in the reproducibility study. The [18F]CFT PET scan was done twice with an interval of approximately 2.5 months. The regions of interest (anterior and posterior putamen, caudate nucleus, and cerebellum) were drawn on individual magnetic resonance imaging (MRI) images, matched with the PET images, and copied onto the PET images. The [18F]CFT uptake was calculated as the region-cerebellum:cerebellum ratio at 180 to 210 minutes. Three-month levodopa treatment in PD patients had no significant effect on [18F]CFT uptake in any striatal subregion between the two PET scans. In PD patients, the percent change from baseline was 4.1% in the anterior putamen, 1.9% in the posterior putamen, and 4.0% in the caudate nucleus. No significant differences in [18F]CFT uptake between the first and second PET scan in any striatal subregion occurred in healthy controls. The intraclass correlation, indicating the reproducibility of the PET scan within subjects, was 0.94 for the anterior putamen, 0.86 for the posterior putamen, and 0.91 for the caudate nucleus. The percent change from baseline was 4.0% in the anterior putamen, 1.1% in the posterior putamen, and 2.8% in the caudate nucleus. Long-term levodopa treatment in PD patients had no effect on the [18F]CFT uptake in the striatum and the test-retest reproducibility was very high. These findings confirm [18F]CFT as a suitable ligand to monitor progression of PD.

Progression in Parkinson's disease: a positron emission tomography study with a dopamine transporter ligand [18F]CFT

We studied the rate of progression of striatal dopamine transporter function in Parkinson's disease (PD). Eight patients with early PD without antiparkinsonian medication and 7 healthy volunteers were investigated with [18F]CFT positron emission tomography (PET). The PET scan was carried out twice at an approximate 2-year interval. The uptake of [18F]CFT was calculated as a region-cerebellum:cerebellum ratio at 180 to 210 minutes after injection. At the first PET scan, the [18F]CFT uptake in PD patients in the putamen was 1.45 +/- 0.45 (mean +/- SD) (42% of the control mean) and 2.43 +/- 0.59 in the caudate nucleus (76% of the control mean). The ratios declined by the time of the second PET scan, and the rate of annual decline of the baseline mean in PD patients was 13.1% in the putamen and 12.5% in the caudate nucleus. In controls, the corresponding figures were 2.1% for the putamen and 2.9% for the caudate nucleus. The decline in [18F]CFT uptake was significantly higher in PD patients than in controls. Thus, dopamine transporter ligands such as [18F]CFT seem to be sensitive markers for the rate of progression in PD.

Cognitive impairment and the brain dopaminergic system in Parkinson disease: [18F]fluorodopa positron emission tomographic study

OBJECTIVE

To investigate the role of the brain dopaminergic system in cognitive impairment in patients with Parkinson disease (PD).

DESIGN

We studied 28 patients with PD and 16 age-matched healthy control subjects using [18F] fluorodopa (fluorodopa F 18) positron emission tomography. Patients with PD showed a variable degree of cognitive impairment, which was assessed using the Mini-Mental State Examination and detailed neuropsychologic assessment, including tests sensitive for frontal lobe function.

RESULTS

[18F] Fluorodopa uptake was reduced in the putamen (to 36% of the control mean; P<.001), the caudate nucleus (to 61% of the control mean; P<.001), and the frontal cortex (to 45% of the control mean; P<.001) in patients with PD compared with controls. There was no significant association between the degree of overall cognitive impairment of patients and [18F] fluorodopa uptake values. The influx constant (Ki(occ)) in the caudate nucleus had a negative association with performance in the attention-demanding Stroop interference task, especially with the interference time. The Ki(occ) in the frontal cortex had a positive correlation with performance in the digit span (backwards), verbal fluency, and verbal immediate recall tests. Thus, the better the patient performed in tasks demanding immediate and working memory and executive strategies, the better the [18F] fluorodopa uptake in the frontal cortex. In the putamen, no significant correlation was seen between the Ki(occ) value and any of the cognitive tests. The severity of the motor symptoms of PD and [18F]fluorodopa uptake showed a negative correlation in the putamen (r = -0.38; P = .04), and in the caudate nucleus a similar trend was seen (r = -0.36; P = .06).

CONCLUSIONS

Reduced [18F]fluorodopa uptake in PD in the caudate nucleus (and frontal cortex) is related to impairment in neuropsychologic tests measuring verbal fluency, working memory, and attentional functioning reflecting frontal lobe function. This indicates that dysfunction of the dopamine system has an impact on the cognitive impairment of patients with PD. However, our results do not exclude the possibility of more generalized cognitive impairment in PD, the pathophysiology of which is probably different and more generalized.

Effects of growth-promoting antimicrobials on inhibition of Yersinia enterocolitica O:3 by porcine ileal microflora

The survival of Yersinia enterocolitica serotype O:3 was examined in an in vitro model of the porcine ileum in the presence of normal ileal microflora using a medium supplemented with the growth-promoting antimicrobials avoparcin, spiramycin, tylosin, carbadox and olaquindox, or without any antimicrobials, at 39 degrees C for 5 d. Growth of Y. enterocolitica was inhibited in all trials in the following order: avoparcin < carbadox < spiramycin < no feed additives < tylosin < olaquindox. The media supplemented with avoparcin, carbadox and spiramycin supported the survival of Y. enterocolitica up to 5 d. When incubated with the normal ileal microflora without any growth-promoting antimicrobials, Y. enterocolitica could not be isolated after 4 d. With olaquindox and tylosin, Y. enterocolitica was not detected after 3 d.

Note: inhibition of the growth of Yersinia enterocolitica O:3 by the microflora of porcine caecum and ileum in an in vitro model

The growth of Yersinia enterocolitica O:3 was tested in an in vitro model of the porcine intestine at the physiological temperature of 39 degrees C of growing pigs. The model supported a stable population of Y. enterocolitica at a level 10(8)-10(9) cells ml-1. Plasmid profile analysis and the Ca(2+)-dependent proportion of the population suggested that the great majority of the Y. enterocolitica population retained the 70 kb virulence plasmid, pYV, throughout the experimental period of 5 d. The growth of Y. enterocolitica was substantially inhibited by the ileal and the caecal flora compared to the growth of the bacterium alone. Yersinia enterocolitica was not isolated after 3 d of cultivation.

Association af changes in the bacterial ecology of bovine mastitis with changes in the use of milking machines and antibacterial drugs

The results of mastitis bacteriology made by the National Veterinary and Food Research Institute in Finland during the past 50 years (1.15 million samples) are viewed in relation to simultaneous changes in dairy cow management. Although intensive preventive measures have been applied for decades, the prevalence of bovine mastitis has not decreased. Instead, pathogenic bacteria are becoming progressively less susceptible to the available therapy. In part this must be due to the emergence of antibiotic resistant strains of bacteria, but it seems that the bacterial spectrum has also changed. The incidence of Streptococcus agalactiae (group B streptococci) has decreased, while in contrast, the incidence of staphylococci, initially Staphylococcus aureus and later coagulase-negative staphylococci, has increased. Results suggest that external pressure, like changes in animal husbandry, including antimicrobial treatments and introduction of modern milking machines, act as selective forces on the bacterial species which cause bovine mastitis.

Selective solid-phase extraction of urinary 2,3-dinor-6-ketoprostaglandin F1 alpha for determination with radioimmunoassay

This paper describes a method for selective two-step solid-phase extraction of urinary 2,3-dinor-6-ketoprostaglandin F1 alpha for reliable determination with radioimmunoassay. In the immunoreactivity profile of non-selectively extracted urine after HPLC separation, over 90% of the total 2,3-dinor-6-ketoprostaglandin F1 alpha immunoreactivity consisted of interfering material coeluting with 6-ketoprostaglandin F1 alpha and 2,3-dinor-6-ketoprostaglandin F1 alpha. Among the alkyl silica sorbents studied (methyl, butyl, octyl, and octadecyl), an efficient separation of 2,3-dinor-6-ketoprostaglandin F1 alpha from 6-ketoprostaglandin F1 alpha and the lowest immunoreactive concentration of analyte were achieved in extraction on the methyl silica sorbent by elution of 2,3-dinor-6-ketoprostaglandin F1 alpha with chloroform: hexane (85:15, v/v) from the cartridge. The proportion of specific immunoreactivity could be further increased by two-step extraction of sample on methyl silica cartridges, first at pH 3 and then at pH 10 using diethyl ether:hexane (85:15, v/v) and chloroform as eluent, respectively. After this, a high correlation was found with concentrations of samples determined by radioimmunoassay using three different antisera. A significant correlation of values was also observed between samples measured by radioimmunoassay and those measured by GC-MS. The values of 12-h excretion of 2,3-dinor-6-ketoprostaglandin F1 alpha in eight volunteers (268 +/- 204 ng/g creatinine, mean +/- SD) as well as the inhibitory effect of acetylsalicylic acid (74 +/- 12%) are in accordance with those reported in the literature. This selective extraction procedure provides a high validity in radioimmunoassay without requiring subsequent TLC or HPLC purification.

Association af changes in the bacterial ecology of bovine mastitis with changes in the use of milking machines and antibacterial drugs

The results of mastitis bacteriology made by the National Veterinary and Food Research Institute in Finland during the past 50 years (1.15 million samples) are viewed in relation to simultaneous changes in dairy cow management. Although intensive preventive measures have been applied for decades, the prevalence of bovine mastitis has not decreased. Instead, pathogenic bacteria are becoming progressively less susceptible to the available therapy. In part this must be due to the emergence of antibiotic resistant strains of bacteria, but it seems that the bacterial spectrum has also changed. The incidence of Streptococcus agalactiae (group B streptococci) has decreased, while in contrast, the incidence of staphylococci, initially Staphylococcus aureus and later coagulase-negative staphylococci, has increased. Results suggest that external pressure, like changes in animal husbandry, including antimicrobial treatments and introduction of modern milking machines, act as selective forces on the bacterial species which cause bovine mastitis.

Use of competitive exclusion to protect newly-hatched chicks against intestinal colonisation and invasion by Salmonella enteritidis PT4

1. The recommended dose of a commercial competitive exclusion (CE) product (BROILACT) was given orally to newly-hatched broiler chicks to protect them against oral challenge by Salmonella enteritidis PT4. 2. In 5 replicate trials, half of the birds thus treated and half from untreated control groups were examined for salmonellas at 5 d and the other half at 12 d after challenge. 3. Caecal contents were examined quantitatively while heart, liver and spleen samples were examined qualitatively by enrichment. 4. The treatment effectively prevented both colonisation of the caeca and invasion of the other organs by S. enteritidis PT4; the average number of salmonellas was less than 10 colony forming units (cfu)/g of caecal contents in the treated birds and more than 10 million cfu/g in the untreated birds. 5. Infection of organs other than the caeca was completely prevented by protective treatment, whereas 38% of the untreated birds were still infected at the end of the trial.

Long-term experience with competitive exclusion and salmonellas in Finland

Poultry production is under strict official control in Finland. Fifteen years after the introduction of 'competitive exclusion' treatment the majority of growers (over 70%) use it routinely. The number of Salmonella-positive flocks is less than 5% and the incidence of Salmonella-contaminated broiler carcasses has been 5-11% in the last two years. The average number of Salmonella cells on contaminated carcasses is very low, generally less than 5 per carcass. Between 70 and 80% of human Salmonella infections are contracted abroad, mainly outside the Nordic countries. It is estimated that only 15-20% of some 1200 cases of domestic origin are caused by contaminated poultry.

Competitive exclusion in the young bird: challenge models, administration and reciprocal protection

The competitive exclusion (CE) concept has been tested against both non-invasive and invasive salmonella serotypes. Studies with different challenge models indicate that CE treatment is likely to protect the young bird against all serotypes that are capable of intestinal colonization. Spray or 'droplet' application of the CE-treatment material was compared with administration in the first drinking water. Both methods gave a similar degree of protection against Salmonella infantis. A study was made to compare protection of newly hatched chicks and turkey poults by the one commercial CE product Broilact, and two similar preparations involving intestinal microorganisms from an adult turkey. Each preparation protected both avian species when administered orally prior to challenge, but the degree of protection obtained varied with the type of preparation and its host origin.

The competitive exclusion concept: development and future

The origin of the competitive exclusion (CE) concept in controlling a Salmonella infantis outbreak in poultry in 1971 and the subsequent development of a commercial treatment product are described. The possible role of CE in salmonella control, current status of the concept and theories relating to the bacteria involved and mechanisms of protection are reviewed. Some observations are made on the need for methodological development and possibilities for extending the scope of CE to other pathogens and types of domestic animal.

Competitive exclusion of campylobacters from poultry with K-bacteria and Broilact

The competitive exclusion (CE) product (Broilact) which is effective against Salmonellas, was found to be inactive against campylobacters. Microecological concepts were applied in the search of a new competitive flora and two novel strains ('K-bacteria') were isolated. These strains resembled campylobacters but differed from them in morphology, enzyme profiles (API), cellular fatty acid profiles and when tested with a ribosomal RNA hybridization probe (Gene-Trak). Two-week laboratory trials on broiler chickens showed that CE treatment may protect the birds against campylobacters but revealed the need for facultatively anaerobic bacteria in establishing a protective flora. A 5-week pilot scale trial was carried out. The trial involved 1800 newly hatched chicks in 30 groups. K-bacteria and Broilact, which provided the necessary facultatively anaerobic bacteria, were administered to some of the birds in the first drinking water. A seeder bird technique was used to challenge experimental and control birds with Campylobacter jejuni biotype 2 (broiler origin). Three seeder birds were placed in each group of 60 birds. Groups were sampled weekly for campylobacters and finally at the slaughterhouse. From each group, the caecal contents of two birds were examined quantitatively for campylobacters. The performance of the birds was also monitored during the trial. The results showed a 1.5 week delay in the onset of campylobacter infection in treated chicks and a consistently lower level of colonization in comparison with control birds. At slaughter, levels of carriage in caecal contents of treated birds were 1.5-2.0 log10 units lower than those of controls, despite apparent stress from harvesting and transportation. The treatment had no economically important effects on the performance of the birds during rearing.

Pilot-scale testing of the competitive exclusion method in chickens

1. The efficacy of a commercial competitive exclusion (CE) product, BROILACT, was tested in pilot-scale trials involving groups of 100 broiler chicks. 2. Each group was challenged with Salmonella infantis through contact with infected seeder birds and numbers of salmonellae in the caecal contents were determined weekly. 3. The performance of the birds was also monitored over a 5-week period. 4. The results showed a gradual decline of the infection, even in the untreated groups, and a dose-dependent response to treatment. 5. The treatment had no significant effect on the performance of the birds.

The growth of salmonellae in tomatoes

The growth of Salmonella enteritidis, S. infantis and S. typhimurium in tomatoes was studied at 7,22 and 30 degrees C. The pH values of tomatoes varied from 3.99 to 4.37 before incubation and from 3.90 to 4.36 after incubation at different temperatures. No growth was observed at 7 degrees C. S. enteritidis, S. infantis and S. typhimurium grew from cell densities of 1.2 x 10(1), 0.7 x 10(1) per g to 2.0 x 10(6), 2.3 x 10(6) and 7.1 x 10(6) per g, respectively, at 22 degrees C in 24 h. At 30 degrees C, the number of bacteria was about one logarithmic unit higher than at 22 degrees C after the same incubation time. The results of this study demonstrated a possible risk of tomatoes as vehicles of Salmonella spp.

Fate of Listeria monocytogenes in orally dosed chicks

The fate of Listeria monocytogenes in chicks perorally dosed with these bacteria at 2 days of age was determined by bacterial enumeration, immunoperoxidase staining and histological examination of the liver, muscle and gastrointestinal tract. Results revealed listerial egress from the digestive tract and elimination of the organism from the body in most of the chicks within 9 days post-inoculation. L. monocytogenes was isolated from the caecum of only one of 10 chicks examined at 4 weeks post-inoculation. Results indicate that chickens are not likely to be common reservoirs of L. monocytogenes. Intestinal carriage of L. monocytogenes by poultry may frequently be transient, resulting from ingestion of Listeria-contaminated feed and soil.

The inhibition of the growth of Bacillus cereus in liver sausage

The growth of Bacillus cereus is a problem in liver sausage especially when the sausages are stored at high temperatures. Even concentrations of greater than 10(6)/g have been detected. In this study we found that when combining glucono-delta-lactone, sodium erythorbate and citric acid with sodium nitrite and salt the growth of B. cereus could be delayed or totally inhibited.

Epidemiological evaluation of the salmonella-controlling effect of a nationwide use of a competitive exclusion culture in poultry

The purpose of the study was to evaluate the salmonella contamination-controlling effect of a nationwide use of a competitive exclusion culture in poultry. During a 5-yr period, a bacterial flora from caecum of adult birds was given to broiler chickens in order to control salmonella infection. The culture was given on 144 occasions to a total of 2.86 million chickens. The base for the evaluation was the compulsory and regular control for salmonella contamination conducted according to the salmonella control program applied to Sweden. Epidemiological evaluation, especially in relation to the use of the culture during a period when salmonella was spread from a feed factory, strongly supports the conclusion that the culture has a salmonella contamination-preventing effect under field conditions, as earlier had been found in laboratory studies. Questionnaires answered by producers did not indicate significant adverse effects of the treatment.

Combined therapy of Salmonella infection in chickens by antimicrobial agents followed by cultured cecal bacteria

Week-old chickens infected with Salmonella infantis when one day old were treated with antimicrobial drugs either given alone or followed by peroral inoculation of bacterial culture. The bacteria were derived from the cecal contents of adult chickens. The antimicrobial drugs used were: neomycin, neomycin plus oxytetracycline, neomycin plus polymyxin, and sulfadiazine plus trimethoprim. The combined therapy with oxytetracycline plus neomycin and bacterial culture seemed to be the most effective, although the efficacy varied between the parallel trials. Sulfadiazine plus trimethoprim followed by treatment with the bacterial culture decreased the infection rate. The bacterial culture alone also had a slight anti-salmonella effect. When only antimicrobials were given, salmonellae rapidly reappeared in the intestines when the therapy was stopped.

Therapeutical trials with antimicrobial agents and cultured cecal microflora in Salmonella infantis infections in chickens

The efficacy of short antimicrobial therapy was examined in chicks infected with S. infantis on the day of hatching. An attempt was made to prevent the reappearance of salmonellae by treating the chicks with a culture of cecal microflora to re-establish the normal intestinal flora. The following drugs were used: neomycin/polymyxin, oxytetracyline/neomycin, dihydrostreptomycin, furazolidone, and trimethoprim/sulphadiazine. The oxytetracycline/neomycin therapy was most effective, but reappearance of the infection was not avoided. Combined therapy with other antimicrobials and the culture reduced the number of infected chicks compared with the respective control groups. A slight reduction was also found when the culture was used alone without any preceding antimicrobial treatment.

An epizootic of Salmonella typhimurium var. copenhagen in broilers and the use of cultured chicken interestinal flora for its control

1. An epizootic caused by Salmonella typhimurium var. copenhagen and occurring on the farms of one company was examined with the following factors in mind: the spread of the epizootic, the infection rate of the flocks and the role of the food, hatchery and parent stock. 2. A microbiological technique was used the aim of preventing infection on the farms. 3. The method of control was not as effective the field as in the laboratory; the possible reasons for this are discussed.

An epidemic of Salmonella infantis infection in Finnish broiler chickens in 1975--76

A large S. infantis infection epidemic in broiler chickens was studied during a period of one year. The outbreak affected three broiler producing companies in Finland. The infection spread to breeding farms according to available data during the summer of 1975. The epidemic still prevailed at the end of the studies on the farms of certain companies.

The origin of the infection and the means of its spreading could not be ascertained. Some epidemiological evidence suggesting that a hatchery might have spread the infection was found. Contaminated feed may also have been involved, although the findings do not support feed as the principal vehicle in the epidemic. A complex pattern of transmission is most probable.

A microbiological preventive method based on the feeding of a culture of intestinal flora of adult chickens to newly hatched broiler chickens was used on many farms in the study. The feeding of the culture lowered the proportion of infected flocks on the farms and significantly lowered the number of infected birds in those flocks, where the prevention was not complete. kw|Keywords|k]Salmonella infantis; k]infection; k]epidemic; k]broiler chicken

The occurrence of Clostridium botulinum type E in Finnish trout farms and the prevention of toxin formation in fresh-salted vacuum-packed trout fillets

The occurrence of C. botulinum on two Finnish rainbow trout farms were studied. C. botulinum type E toxin was detected from samples of fish intestines in 10% and 4% of the samples and in 0% and 100% of dam bottom sediments, respectively. The toxin formation of inoculated C. botulinum type E in three different brands of commercial fresh-salted vacuum-packed trout fillets was also investigated. In the brand with a salt concentration of 2.7% (a w = 0.96) and no nitrate, the toxin was formed in two weeks at 10 and 20 degrees C. If the pH of the product was lowed to 4.90 and NaCl concentration increased to 5.67% (a w = 0.94%) no toxin was formed even without the use of nitrate. By adding 0.1% of sodium nitrate to the curing solution (0.046% nitrate in the product) the toxin formation was brought to an end. According to the results of the study C. botulinum type E presents a potential health risk for man as well as for fish also in Finland. Trout products must be manufactured and stored in such a way that the possibility of toxin formation is eliminated.

Effect of starter culture on staphylococcal enterotoxin and thermonuclease production in dry sausage

Different amounts of enterotoxin A-, B-, and C1-producing staphylococci were added to dry sausage prepared by normal processes, either alone or in conjunction with a starter culture (micrococci and lactobacilli). The sausage was examined after 0, 3, 7, 14, and 30 days for staphylococci, micrococci, and lactobacilli, and measurements were made of water activity, pH, enterotoxin, and thermostable nuclease. The results showed that in the absence of starter culture measurable amounts of enterotoxin A were formed in a 200-g sample of dry sausage in 3 days, the level of Staphylococcus aureus infection being over 10(6) cells/g. Enterotoxin B was not found, although the total number of staphylococci was over 10(8) cells/g. Enterotoxin C1 was observed when the Staphylococcus count was about 8 X 10(7) cells/g, but was no longer detectable after 7 days. The starter culture prevented the production of enterotoxin A in all cases investigated. By contrast, a very high-level inoculation of an enterotoxin C1-producing strain gave a positive result after 3 days of incubation even in the presence of a starter culture. Heat-stable nuclease was observed in all sausages to which enterotoxin-producing staphylococci were added. The cell count determined in a sample of sausage had no definite correlation with the thermonuclease activity of the sample.

Hazards involved in the use of furazolidone for the prevention of salmonellosis in broiler chickens

The purpose of this work was to study the effects of interrupted, continuous and post-salmonella inoculation treatment with furazolidone in the feed on the colonization of Salmonella infantis in the intestines of chickens, as well as the influence of furazolidone in vitro on the effect of a mixed culture used for the prevention of salmonellosis in chickens.It was shown that chickens given interrupted treatment with 0.01% furazolidone had significantly more salmonellas in the caeca than either chickens fed continuously with this drug or chickens without any treatment. The use of 0.01% furazolidone after inoculation with Salmonella infantis had no effect on Salmonella infantis in the caeca of chickens.The mixed bacterial culture from the normal intestinal flora lost its preventive effect on salmonellosis when cultured with 0.01% furazolidone.