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Talbot S, Zordan R, Bennett K, Sasanelli F, Griffith A, Woodford N, Walter WL. Quadriceps tendon malalignment is an independent anatomical deformity which is the primary abnormality associated with lateral facet patellofemoral joint osteoarthritis. Knee Surg Sports Traumatol Arthrosc 2023; 31:5950-5961. [PMID: 37989778 DOI: 10.1007/s00167-023-07661-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2023] [Accepted: 11/02/2023] [Indexed: 11/23/2023]
Abstract
PURPOSE The purposes of this study are to, firstly, develop techniques to accurately identify extensor mechanism malalignment by measuring the alignment of the quadriceps tendon (QTA) with computerized tomography (CT) scans. Secondly, to investigate correlations between QTA and lower limb bony anatomical variations within a representative normal population. Lastly, to evaluate the clinical significance of QTA by establishing its potential connection with lateral facet patellofemoral joint osteoarthritis (LFPFJOA). METHOD CT scans were orientated to a mechanical axis reference frame and three techniques developed to measure the alignment of the quadriceps tendon. Multiple measurement of bony alignment from the hip to the ankle were performed on each scan. A series of 110 cadaveric CT scans were measured to determine normal values, reproducibility, and correlations with bony anatomy. Secondly, a comparison between 2 groups of 25 patients, 1 group with LFPFJOA and 1 group with isolated medial OA and no LFPFJOA. RESULTS From the cadaveric study, it was determined that the alignment of the quadriceps tendon is on average 4.3° (SD 3.9) varus and the apex of the tendon is 9.1 mm (SD 7.7 mm) lateral to the trochlear groove and externally rotated 1.9° (SD 12.4°) from the centre of the femoral shaft. There was no association between the quadriceps tendon alignment and any other bony measurements including tibial tubercle trochlear groove distance (TTTG), coronal alignment, trochlear groove alignment and femoral neck anteversion. A lateralized QTA was significantly associated with LFPFJOA. QTA in the LFPFJOA group was 9.6° varus (SD 2.8°), 21.3 mm (SD 6.6) lateralised and 17.3° ER (SD 11°) compared to 5.5° (SD 2.3°), 10.7 mm (SD 4.9) and 3.3° (SD 7.2°), respectively, in the control group (p < 0.001). A significant association with LFPFJOA was also found for TTTG (17.2 mm (SD 5.7) vs 12.1 mm (SD 4.3), p < 0.01). Logistic regression analysis confirmed the QTA as having the stronger association with LFPFJOA than TTTG (AUC 0.87 to 0.92 for QTA vs 0.79 for TTTG). CONCLUSION These studies have confirmed the ability to accurately determine QTA on CT scans. The normal values indicate that the QTA is highly variable and unrelated to bony anatomy. The comparative study has determined that QTA is clinically relevant and a lateralised QTA is the dominant predictor of severe LFPFJOA. This deformity should be considered when assessing patella maltracking associated with patella osteoarthritis, patella instability and arthroplasty. LEVEL OF EVIDENCE III (retrospective cohort study).
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Affiliation(s)
- Simon Talbot
- Department of Orthopaedic Surgery, Western Health, 160 Gordon Street, Footscray, 3011, Australia.
- , 1/210 Burgundy St, Heidelberg, 3084, Australia.
| | - Rachel Zordan
- Medicine, Dentistry and Health Sciences, University of Melbourne, Grattan Street, Parkville, VIC, 3010, Australia
- St Vincent's Hospital, Melbourne, Education and Learning, Victoria Parade, Fitzroy, VIC, 3065, Australia
| | - Kyle Bennett
- Department of Orthopaedic Surgery, Western Health, 160 Gordon Street, Footscray, 3011, Australia
| | - Francesca Sasanelli
- Department of Orthopaedic Surgery, Western Health, 160 Gordon Street, Footscray, 3011, Australia
| | - Andrew Griffith
- Department of Orthopaedic Surgery, Western Health, 160 Gordon Street, Footscray, 3011, Australia
| | - Noel Woodford
- Victorian Institute of Forensic Medicine, 65 Kavanagh St, Southbank, 3006, Australia
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - William L Walter
- Department of Orthopaedics and Traumatic Surgery, The University of Sydney, Sydney, Australia
- Northern Local Area Health District (Royal North Shore Hospital), Sydney, Australia
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Thorne H, Devereux L, Li J, Alsop K, Christie L, van Geelen CT, Burdett N, Pishas KI, Woodford N, Leditschke J, Izzath MHMA, Strachan K, Young G, Jaravaza RD, Madadin MS, Archer M, Glengarry J, Iles L, Rathnaweera A, Hampson C, Almazrooei K, Burke M, Bandara P, Ranson D, Saeedi E, McNally O, Mileshkin L, Hamilton A, Ananda S, Au-Yeung G, Antill Y, Sandhu S, Savas P, Francis PA, Luen S, Loi S, Jennens R, Scott C, Moodie K, Cummings M, Reid A, McCart Reed A, Bowtell D, Lakhani SR, Fox S. BRCA1 and BRCA2 carriers with breast, ovarian and prostate cancer demonstrate a different pattern of metastatic disease compared with non-carriers: results from a rapid autopsy programme. Histopathology 2023; 83:91-103. [PMID: 36999648 DOI: 10.1111/his.14906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/31/2023] [Accepted: 02/26/2023] [Indexed: 04/01/2023]
Abstract
AIM To catalogue and compare the pattern of metastatic disease in germline BRCA1/2 pathogenic mutation carriers and non-carriers with breast, ovarian and prostate cancer from a rapid autopsy programme. METHODS AND RESULTS The number of metastases in the major body systems and the proportion of participants with metastases were documented in 50 participants (19 germline mutation carriers). Analysis was conducted on the participants' pattern of disease for the different cancers and mutation subgroups. The four commonly affected organ systems were the digestive (liver only) (82%), respiratory (76%), gastrointestinal (65%) and reticuloendothelial (42%). There were significant differences in the pattern of metastatic breast cancer in BRCA1/2 germline carriers compared with non-carriers. Breast cancer carriers had significantly fewer organ systems involved (median n = 3, range = 1-3) compared with non-carriers (median n = 9, range = 1-7) (P = 0.03). BRCA1/2 carriers with ovarian carcinomas had significantly more organ systems with metastatic carcinoma (median n = 10, range = 3-8) than non-carriers (median n = 5, range = 3-5) (P < 0.001). There were no significant differences in the number of involved systems in BRCA2 carriers compared with non-carriers with prostate cancer (P = 1.0). There was an absence of locoregional disease (6.5%) compared with distant disease (93.5%) among the three cancer subtypes (P < 0.001). The majority of metastatic deposits (97%) collected during the autopsy were identified by recent diagnostic imaging. CONCLUSION Even though a major limitation of this study is that our numbers are small, especially in the breast cancer carrier group, the metastatic patterns of breast and ovarian cancers may be impacted by BRCA1/2 carrier status, suggesting that tumours derived from patients with these mutations use different mechanisms of dissemination. The findings may focus clinical diagnostic imaging for monitoring metastases where whole-body imaging resources are scant.
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Affiliation(s)
- Heather Thorne
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Lisa Devereux
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Jason Li
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kathryn Alsop
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Liz Christie
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Courtney T van Geelen
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nikki Burdett
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Kathleen I Pishas
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Noel Woodford
- The Victorian Institute of Forensic Medicine, Southbank, Australia
- Department of Forensic Medicine, Monash University, Clayton, Australia
| | - Jodie Leditschke
- The Victorian Institute of Forensic Medicine, Southbank, Australia
| | | | - Kate Strachan
- The Victorian Institute of Forensic Medicine, Southbank, Australia
| | - Gregory Young
- The Victorian Institute of Forensic Medicine, Southbank, Australia
| | - Rufaro D Jaravaza
- The Victorian Institute of Forensic Medicine, Southbank, Australia
- National Health Laboratory Service, Tygerberg Hospital, Cape Town, South Africa
- Division of Anatomical Pathology, Stellenbosch University, Stellenbosch, South Africa
| | - Mohammed S Madadin
- The Victorian Institute of Forensic Medicine, Southbank, Australia
- Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Melanie Archer
- The Victorian Institute of Forensic Medicine, Southbank, Australia
| | - Joanna Glengarry
- The Victorian Institute of Forensic Medicine, Southbank, Australia
| | - Linda Iles
- The Victorian Institute of Forensic Medicine, Southbank, Australia
| | | | - Clare Hampson
- The Victorian Institute of Forensic Medicine, Southbank, Australia
| | | | - Michael Burke
- The Victorian Institute of Forensic Medicine, Southbank, Australia
| | - Pradeep Bandara
- The Victorian Institute of Forensic Medicine, Southbank, Australia
- Base Hospital Dambulla, Dambulla, Sri Lanka
- Base Hospital Puttlam, Puttlam, Sri Lanka
| | - David Ranson
- The Victorian Institute of Forensic Medicine, Southbank, Australia
| | - Essa Saeedi
- The Victorian Institute of Forensic Medicine, Southbank, Australia
- Abu Dhabi Police, Abu Dhabi, United Arab Emirates
| | - Orla McNally
- The Royal Women's Hospital, Parkville, Australia
- The University of Melbourne, Parkville, Australia
| | - Linda Mileshkin
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Anne Hamilton
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sumitra Ananda
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - George Au-Yeung
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Yoland Antill
- Department of Medical Oncology, Cabrini Health, Malvern, Australia
- Department of Medical Oncology, Peninsula Health, Melbourne, Australia
- Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Australia
| | - Shahneen Sandhu
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Peter Savas
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Prudence A Francis
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Stephen Luen
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sherene Loi
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Ross Jennens
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Department of Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Clare Scott
- The University of Melbourne, Parkville, Australia
- The Walter and Eliza Hall Institute, Parkville, Australia
| | - Kate Moodie
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Cancer Imaging Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Margaret Cummings
- Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
| | - Andrew Reid
- Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
- State-Wide Forensic Medical Services, Hobart, Tasmania, Australia
- School of Medicine, University of Tasmania, Hobart, Tasmania, Australia
- University of Queensland, Brisbane, Australia
| | - Amy McCart Reed
- Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - David Bowtell
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Sunil R Lakhani
- Pathology Queensland, Royal Brisbane and Women's Hospital, Brisbane, Australia
- Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Stephen Fox
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Australia
- Research Department, Peter MacCallum Cancer Centre, Melbourne, Australia
- Pathology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
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Gunawardena SA, Cordeiro C, Di Vella G, Fernando D, Rajapaksha S, Samaranayake R, Sapino A, Tennakoon A, Waduge S, Woodford N, Wijeratne S, Zoja R. Survey on postmortem screening and management of COVID-19 related deaths. Pathologica 2022; 113:413-420. [PMID: 34974546 PMCID: PMC8720393 DOI: 10.32074/1591-951x-254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Accepted: 04/13/2021] [Indexed: 12/21/2022] Open
Abstract
The COVID-19 pandemic is associated with a high case fatality rate in some countries even thought the majority of cases are asymptomatic. Scientific studies on this novel virus is limited and there is uncertainty regarding the best practices for death investigations both in terms of detection of the disease as well as autopsy safety. An online survey was conducted to identify how different institutions responded to the screening and management of dead bodies during the early phase of the pandemic from January to May. A questionnaire was developed using Google Forms and data was collected from 14 different forensic and pathological institutions in 9 countries. None of the institutions had performed any screening prior to March. Four institutions stated that screening was done routinely. In total, 322 cases had been screened using RT-PCR, out of which 40 positive cases were detected among four institutions. The commonest types of samples obtained were nasopharyngeal and oropharyngeal swabs which also had the highest rates of positivity followed by tracheal swab. Blood, swabs from cut surfaces of lung and lung tissue also gave positive results in some cases. Majority of the positive cases were > 65 years with a history suggestive of respiratory infection and were clinically suspected to have COVID-19 before death. Except for one institution which performed limited dissections, standard autopsies were conducted on all positive cases. Disposal of bodies involved the use of sealed body bags and labelling as COVID positive. Funeral rites were restricted and none of the institutions advocated cremation. There were no reports of disease transmission to those who handled COVID positive bodies.
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Affiliation(s)
- Sameera A Gunawardena
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Cristina Cordeiro
- Instituto Nacional de Medicina Legal e Ciências Forenses, Coimbra, Portugal
| | | | - Dinesh Fernando
- Department of Forensic Medicine, University of Peradeniya, Sri Lanka
| | | | - Ravindra Samaranayake
- Department of Forensic Medicine and Toxicology, Faculty of Medicine, University of Colombo, Sri Lanka
| | - Anna Sapino
- Department of Medical Sciences, University of Turin, Italy on behalf of SIAPEC-IAP
| | - Ajith Tennakoon
- Institute of Forensic Medicine and Toxicology, Colombo, Sri Lanka
| | | | - Noel Woodford
- Department of Forensic Medicine, Monash University & Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | | | - Riccardo Zoja
- Institute of Legal and Forensic Medicine, University of Milan, Italy
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Thompson T, Morgan N, Connell V, Zentner D, Woodford N, Davis A, Pflaumer A, Parsons S, James P. A Model for Collaboration: Sudden Death Pathway. Heart Lung Circ 2022. [DOI: 10.1016/j.hlc.2022.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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5
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O'Donnell C, Iles L, Woodford N. Post-mortem CT lung findings at a medicolegal institute in SARS-CoV-2 RT-PCR positive cases with autopsy correlation. Forensic Sci Med Pathol 2021; 17:611-620. [PMID: 34160740 PMCID: PMC8220885 DOI: 10.1007/s12024-021-00389-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2021] [Indexed: 12/23/2022]
Abstract
CoVID-19 is a novel viral infection with now well-established clinical radiological findings. There is limited data on post-mortem imaging. We explore the proposition that PMCT could be used as screening test. In an 11-week period, 39 deceased persons were referred for medicolegal investigation with pre-existing or subsequent nasopharyngeal swabs showing positivity on SARS-CoV-2 RT-PCR testing. All 39 had routine whole-body CT scans on admission and 12 underwent medicolegal autopsy. These cases were contrasted with 4 others which were negative on nasopharyngeal swabs despite PMCT findings suggestive of CoVID-19 pneumonia (designated false positive). Nine of the 12 autopsies showed lung histology consistent with those reported in CoVID-19 pneumonia. Typical clinical CoVID-19 lung findings on PMCT were only detected in 5 (42%). In 3 of the 4 false positive cases, lung findings showed non-COVID-19 histology but in 1, findings were identical. PMCT CoVID-19 findings in the lungs are therefore not specific and may not be detected in all cases due to obscuration by expected agonal CT findings or other pathologies that pre-dated SARS-CoV-2 infection. PMCT findings may otherwise be subtle. Although PMCT may hint at CoVID-19, we believe that nasopharyngeal swabs are still required for definitive diagnosis. Even with positive swabs, clinical CoVID-19 lung findings on PMCT are often not detected. PMCT findings can be subtle, extreme or obscured by agonal changes. Given this range of PMCT changes, the challenge for pathologists is to determine whether death has been caused by, or merely associated with, SARS-CoV-2 infection.
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Affiliation(s)
- Chris O'Donnell
- Department of Forensic Pathology, Victorian Institute of Forensic Medicine, Southbank, Australia. .,Department of Forensic Medicine, Monash University, Clayton, Australia.
| | - Linda Iles
- Department of Forensic Pathology, Victorian Institute of Forensic Medicine, Southbank, Australia.,Department of Forensic Medicine, Monash University, Clayton, Australia
| | - Noel Woodford
- Department of Forensic Pathology, Victorian Institute of Forensic Medicine, Southbank, Australia.,Department of Forensic Medicine, Monash University, Clayton, Australia
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Harris HC, Buckley AM, Spittal W, Ewin D, Clark E, Altringham J, Bentley K, Moura IB, Wilcox MH, Woodford N, Davies K, Chilton CH. The effect of intestinal microbiota dysbiosis on growth and detection of carbapenemase-producing Enterobacterales within an in vitro gut model. J Hosp Infect 2021; 113:1-9. [PMID: 33932556 DOI: 10.1016/j.jhin.2021.04.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/18/2021] [Accepted: 04/14/2021] [Indexed: 01/07/2023]
Abstract
BACKGROUND Carbapenemase-producing Enterobacterales (CPE) can colonize the gut and are of major clinical concern. Identification of CPE colonization is problematic; there is no gold-standard detection method, and the effects of antibiotic exposure and microbiota dysbiosis on detection are unknown. AIM Based on a national survey we selected four CPE screening assays in common use. We used a clinically reflective in vitro model of human gut microbiota to investigate the performance of each test to detect three different CPE strains under different, clinically relevant antibiotic exposures. METHODS Twelve gut models were seeded with a pooled faecal slurry and exposed to CPE either before, after, concomitant with, or in the absence of piperacillin-tazobactam (358 mg/L, 3 × daily, seven days). Total Enterobacterales and CPE populations were enumerated daily. Regular screening for CPE was performed using Cepheid Xpert® Carba-R molecular test, and with Brilliance™ CRE, Colorex™ mSuperCARBA and CHROMID® CARBA SMART agars. FINDINGS Detection of CPE when the microbiota are intact is problematic. Antibiotic exposure disrupts microbiota populations and allows CPE proliferation, increasing detection. The performances of assays varied, particularly with respect to different CPE strains. The Cepheid assay performed better than the three agar methods for detecting a low level of CPE within an intact microbiota, although performance of all screening methods was comparable when CPE populations increased in a disrupted microbiota. CONCLUSION CPE strains differed in their dynamics of colonization in an in vitro gut model and in their subsequent response to antibiotic exposure. This affected detection by molecular and screening methods, which has implications for the sensitivity of CPE screening in healthcare settings.
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Affiliation(s)
- H C Harris
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - A M Buckley
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - W Spittal
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - D Ewin
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - E Clark
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - J Altringham
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - K Bentley
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - I B Moura
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - M H Wilcox
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, The General Infirmary, Leeds, UK
| | - N Woodford
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI), Reference Unit, Microbiology Services - Colindale, Public Health England, UK
| | - K Davies
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK; Department of Microbiology, Leeds Teaching Hospitals NHS Trust, The General Infirmary, Leeds, UK
| | - C H Chilton
- Heath Care Associated Infection Research Group, Leeds Institute of Medical Research, Faculty of Medicine and Health, University of Leeds, Leeds, UK.
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Vergara IA, Mintoff CP, Sandhu S, McIntosh L, Young RJ, Wong SQ, Colebatch A, Cameron DL, Kwon JL, Wolfe R, Peng A, Ellul J, Dou X, Fedele C, Boyle S, Arnau GM, Raleigh J, Hatzimihalis A, Szeto P, Mooi J, Widmer DS, Cheng PF, Amann V, Dummer R, Hayward N, Wilmott J, Scolyer RA, Cho RJ, Bowtell D, Thorne H, Alsop K, Cordner S, Woodford N, Leditschke J, O'Brien P, Dawson SJ, McArthur GA, Mann GJ, Levesque MP, Papenfuss AT, Shackleton M. Evolution of late-stage metastatic melanoma is dominated by aneuploidy and whole genome doubling. Nat Commun 2021; 12:1434. [PMID: 33664264 PMCID: PMC7933255 DOI: 10.1038/s41467-021-21576-8] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Accepted: 01/26/2021] [Indexed: 12/24/2022] Open
Abstract
Although melanoma is initiated by acquisition of point mutations and limited focal copy number alterations in melanocytes-of-origin, the nature of genetic changes that characterise lethal metastatic disease is poorly understood. Here, we analyze the evolution of human melanoma progressing from early to late disease in 13 patients by sampling their tumours at multiple sites and times. Whole exome and genome sequencing data from 88 tumour samples reveals only limited gain of point mutations generally, with net mutational loss in some metastases. In contrast, melanoma evolution is dominated by whole genome doubling and large-scale aneuploidy, in which widespread loss of heterozygosity sculpts the burden of point mutations, neoantigens and structural variants even in treatment-naïve and primary cutaneous melanomas in some patients. These results imply that dysregulation of genomic integrity is a key driver of selective clonal advantage during melanoma progression.
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Affiliation(s)
- Ismael A Vergara
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Melanoma Institute of Australia, Sydney, Australia
| | | | | | - Lachlan McIntosh
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Mathematics and Statistics, The University of Melbourne, Parkville, VIC, Australia
| | | | - Stephen Q Wong
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | - Daniel L Cameron
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia
| | - Julia Lai Kwon
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Rory Wolfe
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Angela Peng
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jason Ellul
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Xuelin Dou
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Clare Fedele
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Samantha Boyle
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | | | | | | | - Pacman Szeto
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jennifer Mooi
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Daniel S Widmer
- Department of Dermatology, University of Zürich Hospital, Zürich, Switzerland
| | - Phil F Cheng
- Department of Dermatology, University of Zürich Hospital, Zürich, Switzerland
| | - Valerie Amann
- Department of Dermatology, University of Zürich Hospital, Zürich, Switzerland
| | - Reinhard Dummer
- Department of Dermatology, University of Zürich Hospital, Zürich, Switzerland
| | - Nicholas Hayward
- Melanoma Institute of Australia, Sydney, Australia
- QIMR Berghofer Medical Research Institute, Brisbane, Australia
| | | | - Richard A Scolyer
- Melanoma Institute of Australia, Sydney, Australia
- Tissue Pathology and Diagnostic Oncology, Royal Prince Alfred Hospital, Sydney, Australia
- Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Raymond J Cho
- Department of Dermatology, University of California, San Francisco, CA, USA
| | - David Bowtell
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Heather Thorne
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Kathryn Alsop
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Stephen Cordner
- The Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - Noel Woodford
- The Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - Jodie Leditschke
- The Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - Patricia O'Brien
- The Victorian Institute of Forensic Medicine, Melbourne, Australia
| | - Sarah-Jane Dawson
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Centre of Cancer Research, The University of Melbourne, Parkville, VIC, Australia
| | - Grant A McArthur
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia
| | - Graham J Mann
- Melanoma Institute of Australia, Sydney, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, University of Sydney, Sydney, Australia
| | - Mitchell P Levesque
- Department of Dermatology, University of Zürich Hospital, Zürich, Switzerland
| | - Anthony T Papenfuss
- Bioinformatics Division, Walter and Eliza Hall Institute of Medical Research, Melbourne, Australia.
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Department of Mathematics and Statistics, The University of Melbourne, Parkville, VIC, Australia.
- Department of Medical Biology, The University of Melbourne, Parkville, VIC, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.
| | - Mark Shackleton
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia.
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
- Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, VIC, Australia.
- Department of Oncology, Alfred Health, Melbourne, Australia.
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Cordner S, Bruenisholz E, Catoggio D, Chadwick P, Champion J, Davey A, Kogios R, Williams M, Woodford N. The uniform evidence act and Australian judges ability to assess properly the validity and reliability of expert evidence. AUST J FORENSIC SCI 2020. [DOI: 10.1080/00450618.2020.1741762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Stephen Cordner
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | | | - Dean Catoggio
- National Institute of Forensic Science, Melbourne, Australia
| | | | | | - Anna Davey
- Forensic Foundations, Melbourne, Australia
| | - Rebecca Kogios
- Forensic Services Department, Victoria Police, Docklands, Australia
| | | | - Noel Woodford
- Victorian Institute of Forensic Medicine, Southbank, Australia
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9
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Cordner S, Woodford N. In Australia the jury decides:the reliability and validity of expert evidence: a perspective from forensic pathology. AUST J FORENSIC SCI 2020. [DOI: 10.1080/00450618.2020.1729414] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Stephen Cordner
- Victorian Institute of Forensic Medicine, Melbourne, Australia
- Department of Forensic Medicine, Monash University, Melbourne, Australia
| | - Noel Woodford
- Victorian Institute of Forensic Medicine, Melbourne, Australia
- Department of Forensic Medicine, Monash University, Melbourne, Australia
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Pham T, Young C, Woodford N, Ranson D, Young CMF, Ibrahim JE. Difference in the characteristics of mortality reports during a heatwave period: retrospective analysis comparing deaths during a heatwave in January 2014 with the same period a year earlier. BMJ Open 2019; 9:e026118. [PMID: 31110093 PMCID: PMC6530441 DOI: 10.1136/bmjopen-2018-026118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVES To describe the characteristics of deaths reported to the Coroners Court of Victoria (CCOV) during Victoria's last heatwave (14-17 January 2014) and subsequent 4 days (18-21 January) using medicolegal data obtained from both the police investigation report and the pathologist's report. DESIGN, SETTING AND PARTICIPANTS A single-jurisdiction population-based retrospective analysis of consecutive heat-related deaths (HRDs) reported to the CCOV between 14 and 21 January 2014 with a historical comparison group. MAIN OUTCOME MEASURES Descriptive statistics were used to summarise case demographics, causes of death and the types of investigations performed. The cases from 2014 were subgrouped into HRD and non-HRD. RESULTS Of the 222 cases during the study period in 2014, 94 (42.3%) were HRDs and 128 (57.7%) were non-HRDs. HRDs were significantly older than non-HRDs (70.5 years: SD=13.8 vs 61.0 years: SD=22.4, t(220)=3.60, p<0.001, 95% CI 4.3 to 14.6). The most common primary cause of death in HRDs was circulatory system disease (n=57, 60.6%), which was significantly higher when compared with non-HRDs (n=39, 30.5%; χ2=20.1, p<0.001, OR 3.5, 95% CI 2.0 to 6.2). HRDs required significantly greater toxicology investigation (89.4% (n=84) vs 71.9% (n=92); χ2=10.9, p<0.001, OR 3.3, 95% CI 1.54 to 7.03) and greater vitreous biochemistry testing (40.4% (n=38) vs 16.4% (n=21); χ2=16.0, p<0.001, OR 3.5, 95% CI 1.9 to 6.5). CONCLUSIONS A heatwave places a significant burden on death investigation services. The inclusion of additional laboratory tests and more detailed circumstantial information are essential if the factors that contribute to HRDs are to be identified.
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Affiliation(s)
- Tony Pham
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Caitlin Young
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Noel Woodford
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - David Ranson
- Victorian Institute of Forensic Medicine, Southbank, Victoria, Australia
| | - Carmel M F Young
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
| | - Joseph E Ibrahim
- Department of Forensic Medicine, Monash University, Southbank, Victoria, Australia
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11
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Barantsevich NE, Orlova OE, Shlyakhto EV, Johnson EM, Woodford N, Lass-Floerl C, Churkina IV, Mitrokhin SD, Shkoda AS, Barantsevich EP. Emergence of Candida auris in Russia. J Hosp Infect 2019; 102:445-448. [PMID: 30851375 DOI: 10.1016/j.jhin.2019.02.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2018] [Accepted: 02/28/2019] [Indexed: 11/27/2022]
Abstract
This paper reports the emergence of Candida auris infections in an intensive care unit at a hospital in Moscow. Forty-nine cases were diagnosed in 2016-2017, and the risk factors and antifungal susceptibilities are described. The 30-day all-cause mortality for 19 bloodstream infections in patients who did not receive appropriate antifungal therapy was 42.1%. Phylogenetic analysis of the internal transcribed spacer and D1-D2 regions and K143R substitution in the ERG11 gene indicated that the studied C. auris strains were of South Asian origin. This first reported series of C. auris infections in Russia demonstrates the rapid dissemination of this species, and the need for international surveillance and control measures.
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Affiliation(s)
- N E Barantsevich
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - O E Orlova
- L.A. Vorohobov State Clinical Hospital, Moscow, Russia
| | - E V Shlyakhto
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - E M Johnson
- Public Health England, National Infection Service, Bristol, UK
| | - N Woodford
- Public Health England, National Infection Service, London, UK
| | - C Lass-Floerl
- Medical University of Innsbruck, Division of Hygiene and Medical Microbiology, Innsbruck, Austria
| | - I V Churkina
- Almazov National Medical Research Centre, Saint-Petersburg, Russia
| | - S D Mitrokhin
- L.A. Vorohobov State Clinical Hospital, Moscow, Russia
| | - A S Shkoda
- L.A. Vorohobov State Clinical Hospital, Moscow, Russia
| | - E P Barantsevich
- Almazov National Medical Research Centre, Saint-Petersburg, Russia.
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12
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Blandy O, Honeyford K, Gharbi M, Thomas A, Ramzan F, Ellington M, Hope R, Holmes A, Johnson A, Aylin P, Woodford N, Sriskandan S. Factors that impact on the burden of Escherichia coli bacteraemia: multivariable regression analysis of 2011–2015 data from West London. J Hosp Infect 2019; 101:120-128. [DOI: 10.1016/j.jhin.2018.10.024] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2018] [Accepted: 10/30/2018] [Indexed: 11/24/2022]
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13
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Jermacane D, Coope CM, Ironmonger D, Cleary P, Muller-Pebody B, Hope R, Hopkins S, Puleston R, Freeman R, Hopkins KL, Johnson AP, Woodford N, Oliver I. An evaluation of the electronic reporting system for the enhanced surveillance of carbapenemase-producing Gram-negative bacteria in England. J Hosp Infect 2019; 102:17-24. [PMID: 30641097 DOI: 10.1016/j.jhin.2019.01.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2018] [Accepted: 01/03/2019] [Indexed: 01/04/2023]
Abstract
BACKGROUND An electronic reporting system (ERS) for the enhanced surveillance of carbapenemase-producing Gram-negative bacteria (CPGNB) was launched by Public Health England in May 2015. AIM This evaluation aimed to assess uptake, timeliness and completeness of data provided and explore potential barriers and facilitators to adopting the system. METHODS The evaluation comprised a retrospective analysis of surveillance data and semi-structured interviews with ERS users. FINDINGS The proportion of organisms referred for investigation of carbapenem resistance via ERS increased over the first 12 months post-implementation from 35% to 73%; uptake varied widely across regions of England. Completeness of enhanced data fields was poor in 78% of submitted isolates. The median number of days to report confirmatory test results via ERS was 1 day for the regional service and nine days for the national reference laboratory, which additionally conducts phenotypic testing to confirm carbapenemase negativity. Hindrances to ERS utility included: a lack of designated, ongoing resource for system maintenance, technical support and development; uncertainty about how and when to use ERS and workload. Incomplete data prevented gaining a better understanding of important risk factors and transmission routes of CPGNB in England. CONCLUSION The ERS is the only surveillance system in England with the potential to gather intelligence on important risk factors for CPGNB to inform public health measures to control their spread. Although the ERS captures more information on CPGNB than other surveillance systems, timeliness and completeness of the enhanced data require substantial improvements in order to deliver the desired health benefits.
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Affiliation(s)
- D Jermacane
- Field Service, National Infection Service, Public Health England, UK
| | - C M Coope
- Field Service, National Infection Service, Public Health England, UK; NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK.
| | - D Ironmonger
- Field Service, National Infection Service, Public Health England, UK
| | - P Cleary
- Field Service, National Infection Service, Public Health England, UK
| | - B Muller-Pebody
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - R Hope
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - S Hopkins
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - R Puleston
- Field Service, National Infection Service, Public Health England, UK
| | - R Freeman
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - K L Hopkins
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - A P Johnson
- Division of Healthcare-Associated Infection and Antimicrobial Resistance, National Infection Service, Public Health England, London, UK
| | - N Woodford
- National Infection Service Laboratories, Public Health England, London, UK
| | - I Oliver
- Field Service, National Infection Service, Public Health England, UK; NIHR Health Protection Research Unit in Evaluation of Interventions, University of Bristol, Bristol, UK
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14
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Rutty GN, Alminyah A, Apostol M, Boel LWT, Brough A, Bouwer H, O'Donnell C, Fujimoto H, Iino M, Kroll J, Lee CT, Levey DS, Makino Y, Oesterhelweg L, Ong B, Ranson D, Robinson C, Singh MKC, Villa C, Viner M, Woodford N, Watkins T, Wozniak K. Positional Statement: Radiology Disaster Victim Identification Reporting Forms. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.jofri.2018.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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15
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Berry C, Davies K, Woodford N, Wilcox M, Chilton C. Survey of screening methods, rates and policies for the detection of carbapenemase-producing Enterobacteriaceae in English hospitals. J Hosp Infect 2018; 101:158-162. [PMID: 30092291 DOI: 10.1016/j.jhin.2018.08.005] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 08/01/2018] [Indexed: 11/28/2022]
Abstract
Multi-drug-resistant Gram-negative bacteria are of major clinical concern. The increasing prevalence of carbapenemase-producing Enterobacteriaceae (CPE), resistant to all beta-lactams including carbapenems and able to colonize the large intestine, represents a key threat. Rapid, accurate detection of intestinal CPE colonization is critical to minimize transmission, and hence reduce costly, difficult-to-treat CPE infections. There is currently no 'gold standard' CPE detection method. A survey of diagnostic laboratories in England found considerable heterogeneity in diagnostic CPE testing methods and procedures.
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Affiliation(s)
- C Berry
- Healthcare Associated Infection Research Group, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK.
| | - K Davies
- Healthcare Associated Infection Research Group, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - N Woodford
- NIS Laboratories, National Infection Service, Public Health England, Colindale, London, UK
| | - M Wilcox
- Healthcare Associated Infection Research Group, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
| | - C Chilton
- Healthcare Associated Infection Research Group, Leeds Institute for Biomedical and Clinical Sciences, University of Leeds and Leeds Teaching Hospitals NHS Trust, Leeds General Infirmary, Leeds, UK
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16
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Mushtaq S, Vickers A, Payne Z, Kenna D, Turton J, Woodford N, Livermore D. P045 Strain and antibiogram changes, over time, in paediatric cystic fibrosis patients colonised with Pseudomonas aeruginosa. J Cyst Fibros 2018. [DOI: 10.1016/s1569-1993(18)30342-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Mulroney KT, Hall JM, Huang X, Turnbull E, Bzdyl NM, Chakera A, Naseer U, Corea EM, Ellington MJ, Hopkins KL, Wester AL, Ekelund O, Woodford N, Inglis TJJ. Author Correction: Rapid susceptibility profiling of carbapenem-resistant Klebsiella pneumoniae. Sci Rep 2018; 8:6697. [PMID: 29686361 PMCID: PMC5913273 DOI: 10.1038/s41598-018-25216-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- K T Mulroney
- Harry Perkins Institute of Medical Research, School of Medicine, Faculty of Health and Medical Sciences, the University of Western Australia, Nedlands, Western Australia, Australia
| | - J M Hall
- Marshall Centre, School of Biomedical Sciences, Faculty of Health and Medical Sciences, the University of Western Australia, Nedlands, Western Australia, Australia
| | - X Huang
- Marshall Centre, School of Biomedical Sciences, Faculty of Health and Medical Sciences, the University of Western Australia, Nedlands, Western Australia, Australia.,Department of Microbiology, PathWest Laboratory Medicine, WA, Nedlands, Australia
| | - E Turnbull
- Marshall Centre, School of Biomedical Sciences, Faculty of Health and Medical Sciences, the University of Western Australia, Nedlands, Western Australia, Australia
| | - N M Bzdyl
- Marshall Centre, School of Biomedical Sciences, Faculty of Health and Medical Sciences, the University of Western Australia, Nedlands, Western Australia, Australia
| | - A Chakera
- Harry Perkins Institute of Medical Research, School of Medicine, Faculty of Health and Medical Sciences, the University of Western Australia, Nedlands, Western Australia, Australia
| | - U Naseer
- Norwegian Institute of Public Health, Oslo, Norway
| | - E M Corea
- Department of Microbiology, University of Colombo, Kynsey Road, Colombo, Sri Lanka
| | - M J Ellington
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - K L Hopkins
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - A L Wester
- Norwegian Institute of Public Health, Oslo, Norway
| | - O Ekelund
- Department of Clinical Microbiology and EUCAST Development Laboratory, Region Kronoberg, Växjö, Sweden
| | - N Woodford
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London, NW9 5EQ, UK
| | - T J J Inglis
- Marshall Centre, School of Biomedical Sciences, Faculty of Health and Medical Sciences, the University of Western Australia, Nedlands, Western Australia, Australia. .,Department of Microbiology, PathWest Laboratory Medicine, WA, Nedlands, Australia. .,Division of Pathology and Laboratory Medicine, School of Medicine, Faculty of Health and Medical Sciences, the University of Western Australia, Nedlands, Western Australia, Australia.
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18
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O'Donnell C, Lynch M, Woodford N. Can post-mortem CT and angiography provide all the answers? Lancet 2017; 390:646-647. [PMID: 28816131 DOI: 10.1016/s0140-6736(17)31828-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2017] [Accepted: 06/23/2017] [Indexed: 10/19/2022]
Affiliation(s)
- Chris O'Donnell
- Department of Forensic Medicine, Monash University, Melbourne, 3006 VIC, Australia.
| | - Matthew Lynch
- Department of Forensic Medicine, Monash University, Melbourne, 3006 VIC, Australia
| | - Noel Woodford
- Department of Forensic Medicine, Monash University, Melbourne, 3006 VIC, Australia
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19
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Inkster T, Coia J, Meunier D, Doumith M, Martin K, Pike R, Imrie L, Kane H, Hay M, Wiuff C, Wilson J, Deighan C, Hopkins KL, Woodford N, Hill R. First outbreak of colonization by linezolid- and glycopeptide-resistant Enterococcus faecium harbouring the cfr gene in a UK nephrology unit. J Hosp Infect 2017; 97:397-402. [PMID: 28698020 DOI: 10.1016/j.jhin.2017.07.003] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2017] [Accepted: 07/04/2017] [Indexed: 01/06/2023]
Abstract
AIM To describe an outbreak of colonization by linezolid- and glycopeptide-resistant Enterococcus faecium harbouring the cfr gene in a UK nephrology unit. METHODS Isolates of linezolid-resistant E. faecium were typed by pulsed-field gel electrophoresis (PFGE), and examined by polymerase chain reaction (PCR) and sequencing for the transmissible cfr gene that confers resistance to linezolid. Enhanced environmental cleaning, initial and weekly screening of all patients, and monitoring of adherence to standard infection control precautions were implemented. FINDINGS Five patients with pre-existing renal disease were found to have rectal colonization with linezolid-resistant E. faecium over a two-week period. The index case was a 57-year-old male from India who had travelled to the UK. One patient also had a linezolid-resistant E. faecium of a different PFGE profile isolated from a heel wound. All isolates were confirmed to harbour the cfr gene by PCR and Sanger sequencing, and all were resistant to glycopeptides (VanA phenotype). CONCLUSIONS This article describes the first UK outbreak with a single strain of linezolid- and glycopeptide-resistant E. faecium harbouring the cfr gene, affecting five patients in a nephrology unit. Following the implementation of aggressive infection control measures, no further cases were detected beyond a two-week period.
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Affiliation(s)
- T Inkster
- Queen Elizabeth University Hospital, Glasgow, UK.
| | - J Coia
- Glasgow Royal Infirmary, Glasgow, UK
| | - D Meunier
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, UK
| | - M Doumith
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, UK
| | - K Martin
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, UK
| | - R Pike
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, UK
| | - L Imrie
- Health Protection Scotland, Glasgow, UK
| | - H Kane
- Health Protection Scotland, Glasgow, UK
| | - M Hay
- Glasgow Royal Infirmary, Glasgow, UK
| | - C Wiuff
- Health Protection Scotland, Glasgow, UK
| | - J Wilson
- Health Protection Scotland, Glasgow, UK
| | - C Deighan
- Glasgow Royal Infirmary, Glasgow, UK
| | - K L Hopkins
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, UK
| | - N Woodford
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, UK
| | - R Hill
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, National Infection Service, Public Health England, London, UK
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20
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Kenna D, Fuller A, Martin K, Pike R, Perry C, Shah J, Lilley D, Hill R, Woodford N, Logan J, Turton J. 138 Use of rpoB sequence clustering for species-level identification of the Elizabethkingia genus from UK CF patients, and an investigation of associated antimicrobial susceptibility. J Cyst Fibros 2017. [DOI: 10.1016/s1569-1993(17)30502-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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21
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Wilmore SMS, Kranzer K, Williams A, Makamure B, Nhidza AF, Mayini J, Bandason T, Metcalfe J, Nicol MP, Balakrishnan I, Ellington MJ, Woodford N, Hopkins S, McHugh TD, Ferrand RA. Carriage of extended-spectrum beta-lactamase-producing Enterobacteriaceae in HIV-infected children in Zimbabwe. J Med Microbiol 2017; 66:609-615. [PMID: 28513417 PMCID: PMC5817228 DOI: 10.1099/jmm.0.000474] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Background Antimicrobial resistance is an emerging global health issue. Data on the epidemiology of multidrug-resistant organisms are scarce for Africa, especially in HIV-infected individuals who often have frequent contact with healthcare. We investigated the prevalence of extended-spectrum beta-lactamase-producing Enterobacteriaceae (ESBL-E) carriage in stool among HIV-infected children attending an HIV outpatient department in Harare, Zimbabwe. Methods We recruited children who were stable on antiretroviral therapy (ART) attending a HIV clinic from August 2014 to June 2015. Information was collected on antibiotic use and hospitalization. Stool was tested for ESBL-E through combination disc diffusion. API20E identification and antimicrobial susceptibility was performed on the positive samples followed by whole genome sequencing. Results Stool was collected from 175/202 (86.6 %) children. Median age was 11 [inter-quartile range (IQR) 9–12] years. Median time on ART was 4.6 years (IQR 2.4–6.4). ESBL-Es were found in 24/175 samples (13.7 %); 50 % of all ESBL-Es were resistant to amoxicillin-clavulanate, 100 % to co-trimoxazole, 45.8 % to chloramphenicol, 91.6 % to ceftriaxone, 20.8 % to gentamicin and 62.5 % to ciprofloxacin. ESBL-Es variously encoded CTX-M, OXA, TEM and SHV enzymes. The odds of ESBL-E carriage were 8.5 times (95 % CI 2.2–32.3) higher in those on ART for less than one year (versus longer) and 8.5 times (95 % CI 1.1–32.3) higher in those recently hospitalized for a chest infection. Conclusion We found a 13.7 % prevalence of ESBL-E carriage in a population where ESBL-E carriage has not been described previously. Antimicrobial resistance (AMR) in Africa merits further study, particularly given the high HIV prevalence and limited diagnostic and therapeutic options available.
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Affiliation(s)
- S M S Wilmore
- Royal Free Hospital NHS Trust, London, UK.,London School of Hygiene and Tropical Medicine, London, UK.,UCL Centre for Clinical Microbiology, University College London, London, UK
| | - K Kranzer
- London School of Hygiene and Tropical Medicine, London, UK.,National German Mycobacterium Reference, Borstel, Germany
| | - A Williams
- Royal Free Hospital NHS Trust, London, UK
| | - B Makamure
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - A F Nhidza
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - J Mayini
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - T Bandason
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - J Metcalfe
- University of California, San Francisco, USA
| | - M P Nicol
- University of Cape Town, National Health Laboratory Service, Cape Town, South Africa
| | | | | | | | - S Hopkins
- Royal Free Hospital NHS Trust, London, UK.,Public Health England, London, UK
| | - T D McHugh
- UCL Centre for Clinical Microbiology, University College London, London, UK
| | - R A Ferrand
- London School of Hygiene and Tropical Medicine, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
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22
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Doumith M, Findlay J, Hirani H, Hopkins KL, Livermore DM, Dodgson A, Woodford N. Major role of pKpQIL-like plasmids in the early dissemination of KPC-type carbapenemases in the UK. J Antimicrob Chemother 2017; 72:2241-2248. [DOI: 10.1093/jac/dkx141] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Accepted: 04/19/2017] [Indexed: 11/15/2022] Open
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Ellington MJ, Ekelund O, Aarestrup FM, Canton R, Doumith M, Giske C, Grundman H, Hasman H, Holden MTG, Hopkins KL, Iredell J, Kahlmeter G, Köser CU, MacGowan A, Mevius D, Mulvey M, Naas T, Peto T, Rolain JM, Samuelsen Ø, Woodford N. The role of whole genome sequencing in antimicrobial susceptibility testing of bacteria: report from the EUCAST Subcommittee. Clin Microbiol Infect 2016; 23:2-22. [PMID: 27890457 DOI: 10.1016/j.cmi.2016.11.012] [Citation(s) in RCA: 308] [Impact Index Per Article: 38.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 11/18/2016] [Indexed: 12/11/2022]
Abstract
Whole genome sequencing (WGS) offers the potential to predict antimicrobial susceptibility from a single assay. The European Committee on Antimicrobial Susceptibility Testing established a subcommittee to review the current development status of WGS for bacterial antimicrobial susceptibility testing (AST). The published evidence for using WGS as a tool to infer antimicrobial susceptibility accurately is currently either poor or non-existent and the evidence / knowledge base requires significant expansion. The primary comparators for assessing genotypic-phenotypic concordance from WGS data should be changed to epidemiological cut-off values in order to improve differentiation of wild-type from non-wild-type isolates (harbouring an acquired resistance). Clinical breakpoints should be a secondary comparator. This assessment will reveal whether genetic predictions could also be used to guide clinical decision making. Internationally agreed principles and quality control (QC) metrics will facilitate early harmonization of analytical approaches and interpretive criteria for WGS-based predictive AST. Only data sets that pass agreed QC metrics should be used in AST predictions. Minimum performance standards should exist and comparative accuracies across different WGS laboratories and processes should be measured. To facilitate comparisons, a single public database of all known resistance loci should be established, regularly updated and strictly curated using minimum standards for the inclusion of resistance loci. For most bacterial species the major limitations to widespread adoption for WGS-based AST in clinical laboratories remain the current high-cost and limited speed of inferring antimicrobial susceptibility from WGS data as well as the dependency on previous culture because analysis directly on specimens remains challenging. For most bacterial species there is currently insufficient evidence to support the use of WGS-inferred AST to guide clinical decision making. WGS-AST should be a funding priority if it is to become a rival to phenotypic AST. This report will be updated as the available evidence increases.
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Affiliation(s)
- M J Ellington
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London, UK
| | - O Ekelund
- Department of Clinical Microbiology and the EUCAST Development Laboratory, Kronoberg Region, Central Hospital, Växjö, Sweden
| | - F M Aarestrup
- National Food Institute, Research Group for Genomic Epidemiology, Technical University of Denmark, 2800 Kgs. Lyngby, Denmark
| | - R Canton
- Servicio de Microbiología, Hospital Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - M Doumith
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London, UK
| | - C Giske
- Department of Laboratory Medicine, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden
| | - H Grundman
- University Medical Centre Freiburg, Infection Prevention and Hospital Hygiene, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - H Hasman
- Statens Serum Institute, Department of Microbiology and Infection Control, Copenhagen, Denmark
| | - M T G Holden
- School of Medicine, Medical & Biological Sciences, North Haugh, University of St Andrews, UK
| | - K L Hopkins
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London, UK
| | - J Iredell
- Westmead Institute for Medical Research, University of Sydney and Marie Bashir Institute, Sydney, NSW, Australia
| | - G Kahlmeter
- Department of Clinical Microbiology and the EUCAST Development Laboratory, Kronoberg Region, Central Hospital, Växjö, Sweden
| | - C U Köser
- Department of Medicine, University of Cambridge, Cambridge, UK
| | - A MacGowan
- Department of Medical Microbiology, North Bristol NHS Trust, Southmead Hospital, Bristol, UK
| | - D Mevius
- Central Veterinary Institute (CVI) part of Wageningen University and Research Centre (WUR), Lelystad, The Netherlands; Department of Infectious Diseases and Immunology, Utrecht University, Utrecht, The Netherlands
| | - M Mulvey
- National Microbiology Laboratory, Winnipeg, Manitoba, Canada
| | - T Naas
- French National Reference Centre for Antibiotic Resistance, Bacteriology-Hygiene unit, Hôpital Bicêtre, APHP, LabEx LERMIT, University Paris Sud, Le Kremlin-Bicêtre, France
| | - T Peto
- Nuffield Department of Medicine, John Radcliffe Hospital, University of Oxford, Oxford, UK
| | - J-M Rolain
- PU-PH des Disciplines Pharmaceutiques, 1-URMITE CNRS IRD UMR 6236, IHU Méditerranée Infection, Valorization and Transfer, Aix Marseille Université, Faculté de Médecine et de Pharmacie, Marseille, France
| | - Ø Samuelsen
- Norwegian National Advisory Unit on Detection of Antimicrobial Resistance, University Hospital of North Norway, Department of Microbiology and Infection Control, Tromsø, Norway
| | - N Woodford
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, National Infection Service, Public Health England, London, UK.
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Freeman R, Ironmonger D, Puleston R, Hopkins K, Welfare W, Hope R, Staves P, Shemko M, Hopkins S, Cleary P, Patel B, Muller-Pebody B, Li X, Alvarez-Buylla A, Hawkey P, Johnson A, Woodford N, Oliver I. Enhanced surveillance of carbapenemase-producing Gram-negative bacteria to support national and international prevention and control efforts. Clin Microbiol Infect 2016; 22:896-897. [DOI: 10.1016/j.cmi.2016.07.020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 07/15/2016] [Accepted: 07/16/2016] [Indexed: 11/29/2022]
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Schmidt K, Mwaigwisya S, Crossman LC, Doumith M, Munroe D, Pires C, Khan AM, Woodford N, Saunders NJ, Wain J, O'Grady J, Livermore DM. Identification of bacterial pathogens and antimicrobial resistance directly from clinical urines by nanopore-based metagenomic sequencing. J Antimicrob Chemother 2016; 72:104-114. [PMID: 27667325 DOI: 10.1093/jac/dkw397] [Citation(s) in RCA: 200] [Impact Index Per Article: 25.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Revised: 08/09/2016] [Accepted: 08/21/2016] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVES The introduction of metagenomic sequencing to diagnostic microbiology has been hampered by slowness, cost and complexity. We explored whether MinION nanopore sequencing could accelerate diagnosis and resistance profiling, using complicated urinary tract infections as an exemplar. METHODS Bacterial DNA was enriched from clinical urines (n = 10) and from healthy urines 'spiked' with multiresistant Escherichia coli (n = 5), then sequenced by MinION. Sequences were analysed using external databases and bioinformatic pipelines or, ultimately, using integrated real-time analysis applications. Results were compared with Illumina data and resistance phenotypes. RESULTS MinION correctly identified pathogens without culture and, among 55 acquired resistance genes detected in the cultivated bacteria by Illumina sequencing, 51 were found by MinION sequencing directly from the urines; with three of the four failures in an early run with low genome coverage. Resistance-conferring mutations and allelic variants were not reliably identified. CONCLUSIONS MinION sequencing comprehensively identified pathogens and acquired resistance genes from urine in a timeframe similar to PCR (4 h from sample to result). Bioinformatic pipeline optimization is needed to better detect resistances conferred by point mutations. Metagenomic-sequencing-based diagnosis will enable clinicians to adjust antimicrobial therapy before the second dose of a typical (i.e. every 8 h) antibiotic.
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Affiliation(s)
- K Schmidt
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - S Mwaigwisya
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - L C Crossman
- SequenceAnalysis.co.uk, Norwich Research Park, Norwich, UK
| | - M Doumith
- AMRHAI Reference Unit, National Infection Service, Public Health England, London, UK
| | - D Munroe
- Microbiology Department, Norfolk and Norwich University Hospital, Norwich, UK
| | - C Pires
- Brunel University London, Uxbridge, UK
| | - A M Khan
- Brunel University London, Uxbridge, UK
| | - N Woodford
- AMRHAI Reference Unit, National Infection Service, Public Health England, London, UK
| | | | - J Wain
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - J O'Grady
- Norwich Medical School, University of East Anglia, Norwich, UK
| | - D M Livermore
- Norwich Medical School, University of East Anglia, Norwich, UK.,AMRHAI Reference Unit, National Infection Service, Public Health England, London, UK
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Day MJ, Doumith M, Abernethy J, Hope R, Reynolds R, Wain J, Livermore DM, Woodford N. Population structure of Escherichia coli causing bacteraemia in the UK and Ireland between 2001 and 2010. J Antimicrob Chemother 2016; 71:2139-42. [PMID: 27150395 PMCID: PMC4954928 DOI: 10.1093/jac/dkw145] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Revised: 03/01/2016] [Accepted: 03/26/2016] [Indexed: 01/23/2023] Open
Abstract
OBJECTIVES Escherichia coli is the most common agent of bacteraemia, bacterial gastroenteritis and urinary tract infections (UTIs). Lineages causing UTIs and gastrointestinal disease are well defined, but less is known about those causing bacteraemia. We therefore investigated the population structure of E. coli from bacteraemia in the UK and Ireland between 2001 and 2010. METHODS E. coli isolates (n = 2166) were submitted to the BSAC Bacteraemia Surveillance Programme from 18 UK and Irish centres from 2001 to 2010. Genotypes were analysed by MLST using the Achtman scheme; MICs, blaCTX-M group and patient demographics were previously determined in the BSAC surveillance. RESULTS Four hundred and forty-eight STs were identified, but five of these, and their associated clonal complexes (CCs), accounted for 58.4% (1264 of 2166) of isolates: CC73 was the most common (20.7%), followed by CC131 (13.9%), CC95 (11.3%), CC69 (6.9%) and CC12 (5.5%). All these, except CC69 (group D), belong to phylogenetic group B2. CC131 isolates were much more often MDR than other STs were: they rose from 2.9% of isolates in 2001 to 20.5%-20.7% in 2007-08 and then declined to 14.3% in 2010. Resistance rates to cephalosporins, aminoglycosides and fluoroquinolones remained below 10% in other major CCs throughout. CONCLUSIONS The five most prevalent bacteraemia STs have all been associated previously with UTIs. They dominated in all years, but their proportions fluctuated, most notably for ST131, a globally disseminated high-risk clone that is often MDR.
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Affiliation(s)
- M J Day
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - M Doumith
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - J Abernethy
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - R Hope
- National Infection Service, Public Health England, London NW9 5EQ, UK
| | - R Reynolds
- Department of Medical Microbiology, Southmead Hospital, Bristol BS10 5NB, UK
| | - J Wain
- Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - D M Livermore
- National Infection Service, Public Health England, London NW9 5EQ, UK Norwich Medical School, University of East Anglia, Norwich NR4 7TJ, UK
| | - N Woodford
- National Infection Service, Public Health England, London NW9 5EQ, UK
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Doumith M, Mushtaq S, Livermore DM, Woodford N. New insights into the regulatory pathways associated with the activation of the stringent response in bacterial resistance to the PBP2-targeted antibiotics, mecillinam and OP0595/RG6080. J Antimicrob Chemother 2016; 71:2810-4. [DOI: 10.1093/jac/dkw230] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 05/13/2016] [Indexed: 11/13/2022] Open
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Langlois N, McKelvie H, Beh P, Stables S, Lynch M, Woodford N, Ranson D, Drayton J, Mowll J, O'Donnell C, Parsons S. The coronial autopsy – Where are we heading? Pathology 2016. [DOI: 10.1016/j.pathol.2015.12.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Boo, TW, McGrath, E, Davitt, J, Grogan, J, O'Sullivan, N, Hopkins, KL, Meunier, D, Woodford N, Cormican M. Cross-transmission of Escherichia coli producing OXA-181 in hospitalized patients and failure of carbapenemase detection by commercial and in-house PCR assays. J Med Microbiol 2016; 65:99-100. [DOI: 10.1099/jmm.0.000187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- T. W. Boo,
- Department of Clinical Microbiology, Galway University Hospitals, Saolta University Health Care Group, Ireland
- Infection Prevention and Control Service, Galway University Hospitals, Saolta University Health Care Group, Ireland
- Discipline of Bacteriology, School of Medicine, NUI Galway, Ireland
| | - E. McGrath,
- Department of Clinical Microbiology, Galway University Hospitals, Saolta University Health Care Group, Ireland
| | - J. Davitt,
- Infection Prevention and Control Service, Galway University Hospitals, Saolta University Health Care Group, Ireland
| | - J. Grogan,
- Department of Microbiology, Our Lady's Children Hospital, Crumlin, Dublin 12, Ireland
| | - N. O'Sullivan,
- Department of Microbiology, Our Lady's Children Hospital, Crumlin, Dublin 12, Ireland
| | - K. L. Hopkins,
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, Public Health England National Infections Service, London, UK
| | - D. Meunier,
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, Public Health England National Infections Service, London, UK
| | - N. Woodford
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, Public Health England National Infections Service, London, UK
| | - M. Cormican
- Department of Clinical Microbiology, Galway University Hospitals, Saolta University Health Care Group, Ireland
- Infection Prevention and Control Service, Galway University Hospitals, Saolta University Health Care Group, Ireland
- Discipline of Bacteriology, School of Medicine, NUI Galway, Ireland
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Ciesielczuk H, Doumith M, Hope R, Woodford N, Wareham DW. Characterization of the extra-intestinal pathogenic Escherichia coli ST131 clone among isolates recovered from urinary and bloodstream infections in the United Kingdom. J Med Microbiol 2015; 64:1496-1503. [DOI: 10.1099/jmm.0.000179] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- H. Ciesielczuk
- Antimicrobial Research Group, Centre for Immunology and Infectious Disease, Blizard Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, UK
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, Colindale, UK
- Department of Clinical Microbiology, Royal Free Hospital, Pond Street, London, UK
| | - M. Doumith
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, Colindale, UK
| | - R. Hope
- Centre for Infectious Disease Surveillance and Control, Healthcare Associated Infection and Antimicrobial Resistance Department, Public Health England, Colindale, UK
| | - N. Woodford
- Antimicrobial Resistance and Healthcare Associated Infections Reference Unit, Public Health England, Colindale, UK
| | - D. W. Wareham
- Antimicrobial Research Group, Centre for Immunology and Infectious Disease, Blizard Institute, Bart's and the London School of Medicine and Dentistry, Queen Mary University of London, UK
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O'Connor C, Powell J, Finnegan C, O'Gorman A, Barrett S, Hopkins K, Pichon B, Hill R, Power L, Woodford N, Coffey J, Kearns A, O'Connell N, Dunne C. Incidence, management and outcomes of the first cfr-mediated linezolid-resistant Staphylococcus epidermidis outbreak in a tertiary referral centre in the Republic of Ireland. J Hosp Infect 2015; 90:316-21. [DOI: 10.1016/j.jhin.2014.12.013] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 12/06/2014] [Indexed: 02/06/2023]
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Hansen D, Retegan C, Woodford N, Vinluan J, Beiles CB. Comparison of the Victorian Audit of Surgical Mortality with coronial cause of death. ANZ J Surg 2015; 86:437-41. [PMID: 26017918 DOI: 10.1111/ans.13185] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Victorian Audit of Surgical Mortality (VASM) is designed to improve the level of patient care by educating surgeons of areas for improvement in patient management during a surgical admission. Coronial data obtained via the National Coronial Information System were used as an independent method to validate the cause of death as determined by the treating surgeon. METHOD The audit prospectively collected 4905 cases that underwent peer assessment and 842 (17%) received an in-depth second-line assessment of which 200 (24%) also underwent a coronial review. Using the coronial assessment as the reference standard, retrospective comparison of coronial diagnoses compared with the audit case outcomes was conducted to determine the overall accuracy of the stated cause of death. The degree of agreement was also analysed based on whether the patient received a full autopsy (internal examination) or an external examination only. The time taken to obtain the coronial and audit case closure was also analysed. RESULTS Overall, 195 of the 200 cases had a cause of death identified by the coroner. In 82%, the cause of death reported to VASM by the treating surgeon matched the cause of death determined by the coroner. Concordance was not affected by the extent of post-mortem performed. Time taken to finalize cases was slightly shorter for the coronial process, but unclosed coronial findings resulted in the exclusion of 103 cases. CONCLUSION The causes of death data in VASM are accurate when compared with the coronial data independent of whether the coronial investigation included a complete autopsy.
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Affiliation(s)
- Dylan Hansen
- Victorian Audit of Surgical Mortality, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Claudia Retegan
- Victorian Audit of Surgical Mortality, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Noel Woodford
- Victorian Institute of Forensic Medicine, Monash University, Melbourne, Victoria, Australia
| | - Jessele Vinluan
- Victorian Audit of Surgical Mortality, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
| | - Charles B Beiles
- Victorian Audit of Surgical Mortality, Royal Australasian College of Surgeons, Melbourne, Victoria, Australia
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Leditschke J, Rose T, Cordner S, Woodford N, Pollanen M. The development of a protocol for post-mortem management of Ebola virus disease in the setting of developed countries. Forensic Sci Med Pathol 2015; 11:262-7. [PMID: 25616524 DOI: 10.1007/s12024-014-9652-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/26/2014] [Indexed: 10/24/2022]
Abstract
The management of the recent Ebola virus disease (EVD) epidemic continues to pose currently insuperable challenges to health care providers in the resource-deprived countries of West Africa. In an age where air travel facilitates rapid movement of people between countries and continents, there is an urgent requirement for health systems around the globe to develop management strategies and protocols in the event that EVD cases are suspected or confirmed. Departments of forensic pathology play an important, and underestimated, role in public health service delivery, particularly at times of novel infectious disease emergence. This role can include disease identification, characterization, and notification, as well as close engagement with agencies responsible for disease surveillance and treatment provision. A mass outbreak of EVD in the Western world is considered highly unlikely; however, there is clear responsibility on departments of forensic pathology to develop protocols for rapid assessment of sporadic or suspected cases while ensuring the health and safety of mortuary and pathology personnel. The Ontario Forensic Pathology Service and the Victorian Institute of Forensic Medicine have collaborated on the development of a protocol for management of EVD cases presenting at a scene or in the mortuary. It is hoped that this trans-national, inter-departmental exercise will serve as a model for future co-operative endeavors. The protocol has been distributed to forensic pathology departments around Australia and may be modified to accommodate local resource capabilities.
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Green H, Bright-Thomas R, Barry P, Woodford N, Isalska B, Horsley A, Kenna D, Jones A. P199 Molecular Analysis Demonstrates Shared Strains Of Mycobacterium Abscessus Isolates In Cystic Fibrosis Patients Attending A Single Centre. Thorax 2014. [DOI: 10.1136/thoraxjnl-2014-206260.328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Morgan B, Alminyah A, Cala A, O׳Donnell C, Elliott D, Gorincour G, Hofman P, Iino M, Makino Y, Moskata A, Robinson C, Rutty GN, Sajantila A, Vallis J, Woodford N, Woźniak K, Viner M. Use of post-mortem computed tomography in Disaster Victim Identification. Positional statement of the members of the Disaster Victim Identification working group of the International Society of Forensic Radiology and Imaging; May 2014. ACTA ACUST UNITED AC 2014. [DOI: 10.1016/j.jofri.2014.06.001] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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Green H, Bright-Thomas R, Barry P, Horsley A, Isalska B, Woodford N, Kenna D, Jones A. 160 Molecular profiling demonstrates clustering of Mycobacterium abscessus isolates in CF patients from a single centre. J Cyst Fibros 2014. [DOI: 10.1016/s1569-1993(14)60296-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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37
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Betts JW, Phee LM, Woodford N, Wareham DW. Activity of colistin in combination with tigecycline or rifampicin against multidrug-resistant Stenotrophomonas maltophilia. Eur J Clin Microbiol Infect Dis 2014; 33:1565-72. [PMID: 24781003 DOI: 10.1007/s10096-014-2101-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 03/25/2014] [Indexed: 11/25/2022]
Abstract
The antimicrobial treatment of Stenotrophomonas maltophilia infections is complicated by intrinsic multidrug resistance and a lack of reliable susceptibility data. We assessed the activity of colistin (COL), rifampicin (RIF) and tigecycline (TGC) alone and in combination using a range of in vitro susceptibility testing methodologies and a simple invertebrate model of S. maltophilia infection (Galleria mellonella). Synergy [fractional inhibitory concentration indices (FICIs) ≤0.5] between COL and either RIF or TGC was observed against 92 % and 88 % of 25 S. maltophilia isolates, respectively, despite resistance to one or another of the single agents alone. In time-kill assays, COL combined with either RIF or TGC was superior to single agents, but only the COL/RIF regimen was reliably bactericidal. The in vitro findings correlated with treatment outcomes in G. mellonella, with heightened survival observed for larvae treated with COL/RIF or COL/TGC compared with COL, RIF or TGC alone. COL combined with RIF was the most effective combination overall in both in vitro and in vivo (p < 0.05) assays. Given the difficulty in selecting appropriate therapy for S. maltophilia infections, regimens consisting of COL combined with RIF or TGC could be considered for clinical use.
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Affiliation(s)
- J W Betts
- Antimicrobial Research Group, Centre for Immunology and Infectious Disease, Blizard Institute, Queen Mary, University of London, Blizard Building, 4 Newark Street, Whitechapel, London, E1 2AT, UK
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Anjum M, Lemma F, Cork D, Meunier D, Murphy N, North S, Woodford N, Haines J, Randall L. Isolation and Detection of Extended Spectrum β-Lactamase (ESBL)-ProducingEnterobacteriaceaefrom Meat using Chromogenic Agars and Isothermal Loop-Mediated Amplification (LAMP) Assays. J Food Sci 2013; 78:M1892-8. [DOI: 10.1111/1750-3841.12297] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 09/23/2013] [Indexed: 11/28/2022]
Affiliation(s)
- M.F. Anjum
- Animal Health and Veterinary Laboratories Agency (Weybridge); New Haw Addlestone Surrey KT15 3NB United Kingdom
| | - F. Lemma
- Animal Health and Veterinary Laboratories Agency (Weybridge); New Haw Addlestone Surrey KT15 3NB United Kingdom
| | - D.J. Cork
- Animal Health and Veterinary Laboratories Agency (Weybridge); New Haw Addlestone Surrey KT15 3NB United Kingdom
| | - D. Meunier
- Antimicrobial Resistance and Healthcare Assoc. Infections (AMRHAI) Reference Unit; Public Health England; London NW9 5EQ United Kingdom
| | - N. Murphy
- Antimicrobial Resistance and Healthcare Assoc. Infections (AMRHAI) Reference Unit; Public Health England; London NW9 5EQ United Kingdom
| | - S.E. North
- Animal Health and Veterinary Laboratories Agency (Weybridge); New Haw Addlestone Surrey KT15 3NB United Kingdom
| | - N. Woodford
- Antimicrobial Resistance and Healthcare Assoc. Infections (AMRHAI) Reference Unit; Public Health England; London NW9 5EQ United Kingdom
| | - J. Haines
- Leatherhead Food Research; Leatherhead Surrey KT22 7RY
| | - L.P. Randall
- Animal Health and Veterinary Laboratories Agency (Weybridge); New Haw Addlestone Surrey KT15 3NB United Kingdom
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Ciesielczuk H, Hornsey M, Choi V, Woodford N, Wareham DW. Development and evaluation of a multiplex PCR for eight plasmid-mediated quinolone-resistance determinants. J Med Microbiol 2013; 62:1823-1827. [DOI: 10.1099/jmm.0.064428-0] [Citation(s) in RCA: 99] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
The objective of this study was to develop and validate an expanded multiplex PCR assay for the simultaneous detection of eight plasmid-mediated quinolone-resistance determinants in Enterobacteriaceae. Primers were designed to amplify conserved fragments of qnrABCDS, qepA, oqxAB and aac(6′)-Ib-cr genes and were optimized in uniplex and multiplex PCR assays with control template DNA. The assay was used to determine the prevalence of plasmid-mediated quinolone resistance (PMQR) genes in 174 ciprofloxacin-resistant and 43 ciprofloxacin-susceptible extraintestinal pathogenic Escherichia coli isolates. Each resistance gene could be detected alone and in combination. PMQR determinants were detected in 65 ciprofloxacin-resistant isolates (37 %) and one ciprofloxacin-susceptible isolate (2 %). Prevalences of the identified determinants were: aac(6′)-Ib-cr, 34.5 %; qnrS, 1.1 %; qepA, 1.1 %; and oqxAB, 0.6 %. In conclusion, we developed an eight-target multiplex PCR for the accurate detection of PMQR genes and confirmed that PMQR prevalence remains low among human Escherichia coli clinical isolates in the UK.
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Affiliation(s)
- H. Ciesielczuk
- Antimicrobial Resistance and Healthcare Associated Infections Reference Laboratory, Public Health England, London NW9 5EQ, UK
- Antimicrobial Research Group, Centre for Immunology and Infectious Disease, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London E1 2AT, UK
| | - M. Hornsey
- Department of Life Sciences, Whitelands College, University of Roehampton, Holybourne Avenue, London SW15 4JD, UK
- Antimicrobial Research Group, Centre for Immunology and Infectious Disease, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London E1 2AT, UK
| | - V. Choi
- Singapore General Hospital, Singapore 169037, Singapore
- Antimicrobial Research Group, Centre for Immunology and Infectious Disease, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London E1 2AT, UK
| | - N. Woodford
- Antimicrobial Resistance and Healthcare Associated Infections Reference Laboratory, Public Health England, London NW9 5EQ, UK
- Antimicrobial Research Group, Centre for Immunology and Infectious Disease, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London E1 2AT, UK
| | - D. W. Wareham
- Antimicrobial Research Group, Centre for Immunology and Infectious Disease, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary, University of London, London E1 2AT, UK
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Woodford N, Wareham DW, Guerra B, Teale C. Carbapenemase-producing Enterobacteriaceae and non-Enterobacteriaceae from animals and the environment: an emerging public health risk of our own making? J Antimicrob Chemother 2013; 69:287-91. [DOI: 10.1093/jac/dkt392] [Citation(s) in RCA: 170] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
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Ashiru-Oredope D, Kessel A, Hopkins S, Ashiru-Oredope D, Brown B, Brown N, Carter S, Charlett A, Cichowka A, Faulding S, Gallagher R, Johnson A, McNulty C, Moore M, Patel B, Puleston R, Richman C, Ridge K, Robotham J, Sharland M, Stephens P, Stokle L, Towers K, Underhill J, West T, Whitney L, Wight A, Woodford N, Young T. Antimicrobial stewardship: English Surveillance Programme for Antimicrobial Utilization and Resistance (ESPAUR). J Antimicrob Chemother 2013; 68:2421-3. [DOI: 10.1093/jac/dkt363] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
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Drew R, Turton J, Hill R, Livermore D, Woodford N, Paulus S, Cunliffe N. Emergence of carbapenem-resistant Enterobacteriaceae in a UK paediatric hospital. J Hosp Infect 2013; 84:300-4. [DOI: 10.1016/j.jhin.2013.05.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2012] [Accepted: 05/13/2013] [Indexed: 11/30/2022]
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43
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Boo TW, O'Connell N, Power L, O'Connor M, King J, McGrath E, Hill R, Hopkins KL, Woodford N. First report of IMI-1-producing colistin-resistant Enterobacter clinical isolate in Ireland, March 2013. ACTA ACUST UNITED AC 2013; 18. [PMID: 23929227 DOI: 10.2807/1560-7917.es2013.18.31.20548] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the first case in Ireland of an IMI-1 carbapenemase-producing Enterobacter asburiae, which was resistant to both colistin and fosfomycin. The circumstances under which this isolate was acquired were unclear. Several reports of IMI-producing Enterobacter spp. have emerged in recent years, and colistin resistance in Enterobacteriaceae is also increasingly reported. Laboratories should be aware of the unusual antibiograms of IMI-producing isolates.
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Affiliation(s)
- T W Boo
- Department of Medical Microbiology, Galway University Hospitals, HSE West, Ireland.
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44
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Tonkic M, Bedenic B, Goic-Barisic I, Katic S, Kalenic S, Kaufmann ME, Woodford N, Punda-Polic V. First Report of CTX-M Extended-Spectrum Beta- Lactamase-Producing Isolates from Croatia. J Chemother 2013; 19:97-100. [PMID: 17309859 DOI: 10.1179/joc.2007.19.1.97] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Affiliation(s)
- M Tonkic
- University Hospital and School of Medicine Split, Croatia.
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45
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Glasner C, Albiger B, Buist G, Tambić Andrasević A, Canton R, Carmeli Y, Friedrich AW, Giske CG, Glupczynski Y, Gniadkowski M, Livermore DM, Nordmann P, Poirel L, Rossolini GM, Seifert H, Vatopoulos A, Walsh T, Woodford N, Donker T, Monnet DL, Grundmann H. Carbapenemase-producing Enterobacteriaceae in Europe: a survey among national experts from 39 countries, February 2013. ACTA ACUST UNITED AC 2013; 18. [PMID: 23870096 DOI: 10.2807/1560-7917.es2013.18.28.20525] [Citation(s) in RCA: 180] [Impact Index Per Article: 16.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
The spread of carbapenemase-producing Enterobacteriaceae (CPE) is a threat to healthcare delivery, although its extent differs substantially from country to country. In February 2013, national experts from 39 European countries were invited to self-assess the current epidemiological situation of CPE in their country. Information about national management of CPE was also reported. The results highlight the urgent need for a coordinated European effort on early diagnosis, active surveillance, and guidance on infection control measures.
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Affiliation(s)
- C Glasner
- Department of Medical Microbiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Livermore DM, Hope R, Reynolds R, Blackburn R, Johnson AP, Woodford N. Declining cephalosporin and fluoroquinolone non-susceptibility among bloodstream Enterobacteriaceae from the UK: links to prescribing change? J Antimicrob Chemother 2013; 68:2667-74. [DOI: 10.1093/jac/dkt212] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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47
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Mushtaq S, Woodford N, Hope R, Adkin R, Livermore DM. Activity of BAL30072 alone or combined with -lactamase inhibitors or with meropenem against carbapenem-resistant Enterobacteriaceae and non-fermenters. J Antimicrob Chemother 2013; 68:1601-8. [DOI: 10.1093/jac/dkt050] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
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Barantsevich EP, Churkina IV, Barantsevich NE, Pelkonen J, Schlyakhto EV, Woodford N. Emergence of Klebsiella pneumoniae producing NDM-1 carbapenemase in Saint Petersburg, Russia. J Antimicrob Chemother 2013; 68:1204-6. [PMID: 23315490 DOI: 10.1093/jac/dks503] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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50
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Cantón R, Akóva M, Carmeli Y, Giske CG, Glupczynski Y, Gniadkowski M, Livermore DM, Miriagou V, Naas T, Rossolini GM, Samuelsen Ø, Seifert H, Woodford N, Nordmann P. Rapid evolution and spread of carbapenemases among Enterobacteriaceae in Europe. Clin Microbiol Infect 2012; 18:413-31. [PMID: 22507109 DOI: 10.1111/j.1469-0691.2012.03821.x] [Citation(s) in RCA: 631] [Impact Index Per Article: 52.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Plasmid-acquired carbapenemases in Enterobacteriaceae, which were first discovered in Europe in the 1990s, are now increasingly being identified at an alarming rate. Although their hydrolysis spectrum may vary, they hydrolyse most β-lactams, including carbapenems. They are mostly of the KPC, VIM, NDM and OXA-48 types. Their prevalence in Europe as reported in 2011 varies significantly from high (Greece and Italy) to low (Nordic countries). The types of carbapenemase vary among countries, partially depending on the cultural/population exchange relationship between the European countries and the possible reservoirs of each carbapenemase. Carbapenemase producers are mainly identified among Klebsiella pneumoniae and Escherichia coli, and still mostly in hospital settings and rarely in the community. Although important nosocomial outbreaks with carbapenemase-producing Enterobacteriaceae have been extensively reported, many new cases are still related to importation from a foreign country. Rapid identification of colonized or infected patients and screening of carriers is possible, and will probably be effective for prevention of a scenario of endemicity, as now reported for extended-spectrum β-lactamase (mainly CTX-M) producers in all European countries.
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Affiliation(s)
- R Cantón
- Servicio de Microbiología and CIBER en Epidemiología y Salud Pública, Instituto Ramón y Cajal de Investigación Sanitaria and Hospital Universitario Ramón y Cajal, Madrid, Spain
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