Antibiotic resistance in invasive Streptococcus pneumoniae isolates identified in Scotland between 1999 and 2007

Data from 4727 invasive isolates of Streptococcus pneumoniae submitted to the Scottish Haemophilus, Legionella, Meningococcus and Pneumococcus Reference Laboratory between 1999 and 2007 were analysed to establish susceptibility profiles to penicillin, erythromycin and cefotaxime. Pneumococcal resistance to penicillin over the study period remained low, with only 0.2 % (n=7/4727) of isolates falling into this category (MIC ≥2 mg l−1). These isolates have been sporadic, and have mainly represented serogroup 14 (ST9) and 9 (ST156). In comparison, the ‘intermediate sensitivity’ group (MIC 0.12–1 mg l−1) ranged between 2 and 6 % per year, the majority from serogroup 9 (ST156). Over the study period, we found that 12 % (n=585/4727) of isolates were erythromycin-resistant (MIC >0.5 mg l−1), with the majority (n=467; 80 %) of these isolates identified as serogroup 14 (ST9). Cephalosporin resistance (cefotaxime MIC >1 mg l−1) was found in only 0.06 % (n=2/3135) of isolates. Internationally recognized clones (Pneumococcal Molecular Epidemiology Network) accounted for 35 % (n=28/81) of the penicillin non-susceptible isolates and 75 % (n=248/330) of the macrolide-resistant isolates, with ST9 and ST306 predominating. Between 1999 and 2007 we found that 11.6 % (n=18/155) of the penicillin non-susceptible isolates and 4.8 % (n=28/585) of the macrolide-resistant isolates were from serogroups not covered by the 7-valent conjugate pneumococcal vaccine in use in the UK since 2006. Susceptibility to first-line antimicrobial agents for invasive pneumococcal disease in Scotland remained high over the period 1999–2007.

Occurrence of antibiotic resistance genes in reclaimed water and river water in the Werribee Basin, Australia

The purpose of this study was to investigate the occurrence of antibiotic resistance genes (ARGs) in water used for irrigation in the Werribee River Basin, Australia, including river water and reclaimed effluent water (reclaimed water). Samples of reclaimed water, collected over a one-year period, were screened for the occurrence of ARGs using PCR detection assays. The presence of ARGs in the reclaimed water samples were contrasted with that of water samples taken from the Werribee River Basin, collected over the same time period, from five points selected for varying levels of urban and agricultural impact. Of the 54 river water samples collected, 2 (4%), 2 (4%), 0 and 0 were positive for methicillin, sulfonamide, gentamicin and vancomycin-resistant genes, respectively, while 6 of 11 reclaimed water samples were positive for methicillin (9%) and sulfonamide (45%). The presence/absence of ARGs did not appear to correlate with other measured water quality parameters. The low detection of ARGs in river water indicates that, regardless of its poor quality, the river has not yet been severely contaminated with ARGs. The greater prevalence of ARGs in reclaimed water indicates that this important agricultural water source will need to be monitored into the future.

A prescription for resistance: management of Staphylococcal skin abscesses by general practitioners in Australia

Objectives: We investigated the management of staphylococcal abscesses (boils) by general practitioners (GPs) in the context of rising antibiotic resistance in community strains of Staphylococcus aureus.
Design, Setting, Participants: We analyzed patient-reported management of 66 cases of uncomplicated skin abscesses from the frequency matched methicillinresistant S. aureus (MRSA) and methicillin-sensitive S. aureus (MSSA) Community- Onset Staphylococcus aureus Household Cohort (COSAHC) study (Melbourne, Australia, 2008–2012). Susceptibilities in all cases were known: 50/66 abscesses were caused by MRSA. In order to investigate GP-reported management of staphylococcal abscesses, we surveyed a random subset of GPs, from the COSAHC study (41), and of GPs (39) who used the same community-based pathology service (December 2011– May 2012). Main outcome measures: Patient outcomes, antibiotics prescribed, antibiotic resistance profiles of infecting strains, rates of incision and drainage (I&D), and attitudes to ordering microbiological cultures.
Results: MRSA was three times more likely to be cultured from an abscess than MSSA. Patient-reported management revealed 100% were prescribed antibiotics and only 60.6% had I&D. Of those 85% who remembered their prescription(s), 81% of MRSA cases and 23% of MSSA cases initially received inactive antibiotics. Repeat GP visits where antibiotics were changed occurred in 45 MRSA and 7 MSSA cases, although at least 33% of subsequent prescriptions were inactive for the MRSA infections. Patients treated with I&D and antibiotics did no better than those treated with only I&D, regardless of the antibiotic activity. In the GP surveys, 89% reported I&D, with or without antibiotics, to be their preferred management. Only 29.9% of GPs would routinely swab abscesses.

The role of the print media in informing the community about safety in public hospitals in Victoria, Australia: the case of `golden staph`

Objective. In this article the authors explore how the print media contribute to information and education of the community on issues of safety and quality in the health services, since this is an important avenue of such information and education for many members of the community. Study design. The authors undertook a qualitative study of a random sample of articles in the Australian print press between 1996 and 2004 where ‘golden staph’ was presented as a major issue of risk to the safety of consumers of health services. The content of each article was examined with reference to several criteria including title, the source of the article, and the metaphorical language employed by the journalist.
Results. Results show that while the articles are substantially accurate as sources of information on concrete events, they do not serve as sources of education on issues of safety, typically apportioning blame and serving to maintain the status quo.
Conclusion. The authors conclude that print media are not a good source of community education in areas of safety and quality and do not assist members of the community to participate in addressing issues of safety in health services.

Community onset staphylococcus aureus infections in Melbourne

Objective: To investigate the relative importance of methicillin resistant Staphylococcus aureus (MRSA) in the community in Melbourne by describing circulating S. aureus strains and infection characteristics.

Methods: Patients with any community-onset S. aureus infection were identified via clinical specimens submitted to a community-based pathology service in 2006. The referring doctors confirmed community onset and defined site and severity of each infection. Patient isolates were characterised by antibiotic resistance subtype and presence of the Panton-Valentine leukocidin gene (pvl).

Results: Between April and September 2006, 2,094 S. aureus isolates were processed. Of these, 133 (6.4%) were multiresistant MRSA (mMRSA) and 110 (5.3%) were resistant to less than 3 non-betalactam antibiotics (non-multiresistant MRSA or nmMRSA). We followed-up all nmMRSA (34) and mMRSA (15) confirmed community-onset infections, and a random subset of eligible patients with MSSA infections (57), for whom clinical data were available from referring doctors (82% response).

The majority of isolates were from skin infections (99/106), but drainage was performed in less than one third of cases (29/99). Antibiotics were prescribed for 89% (95%CI: 82, 94) of infections. The isolates were resistant to the prescribed antibiotic 100% of the time for mMRSA infections and 80% for nmMRSA. Those with infections caused by MRSA had on average one additional visit to their doctor compared with MSSA infections.

Ten nmMRSA clones were identified, including one new pvl positive nmMRSA. Of the 29 nmMRSA isolates, 14 were pvl positive (48%; 95%CIs: 30%, 66%) compared with 16% of MSSA and 0% mMRSA.

Patients with an infection caused by pvl positive strains (23) were younger ((mean age 23 years (95%CI: 16, 30) compared with the 55 years (95%CI: 50, 61)). Infection site also varied with presence of pvl; more pvl positive infections were found in the axilla (17.9% compared with 0%) and head and neck (35.7% compared with 8.2%), and less for the leg or foot (21.4% compared with 55.7%).

Conclusions: We estimate that 3.5% of community-onset S. aureus infections in Melbourne in 2006 were caused by MRSA, and 70 to 90% of patients with MRSA infections were treated initially with antibiotics to which their isolate was resistant. pvl positive isolates of S. aureus were associated with younger age and axillary or head and neck infections.

The ΔF508-CFTR mutation results in increased biofilm formation by Pseodomonas aeruginosa by increasing iron availability

Enhanced antibiotic resistance of Pseudomonas aeruginosa in the cystic fibrosis (CF) lung is thought to be due to the formation of biofilms. However, there is no information on the antibiotic resistance of P. aeruginosa biofilms grown on human airway epithelial cells or on the effects of airway cells on biofilm formation by P. aeruginosa. Thus we developed a coculture model and report that airway cells increase the resistance of P. aeruginosa to tobramycin (Tb) by >25-fold compared with P. aeruginosa grown on abiotic surfaces. Therefore, the concentration of Tb required to kill P. aeruginosa biofilms on airway cells is 10-fold higher than the concentration achievable in the lungs of CF patients. In addition, CF airway cells expressing ΔF508-CFTR significantly enhanced P. aeruginosa biofilm formation, and ΔF508 rescue with wild-type CFTR reduced biofilm formation. Iron (Fe) content of the airway in CF is elevated, and Fe is known to enhance P. aeruginosa growth. Thus we investigated whether enhanced biofilm formation on ΔF508-CFTR cells was due to increased Fe release by airway cells. We found that airway cells expressing ΔF508-CFTR released more Fe than cells rescued with WT-CFTR. Moreover, Fe chelation reduced biofilm formation on airway cells, whereas Fe supplementation enhanced biofilm formation on airway cells expressing WT-CFTR. These data demonstrate that human airway epithelial cells promote the formation of P. aeruginosa biofilms with a dramatically increased antibiotic resistance. The ΔF508-CFTR mutation enhances biofilm formation, in part, by increasing Fe release into the apical medium.

Environmental impact assessment of the sewage outfall at Davis Station, East Antarctica

During the summer 2009/10, an environmental impact assessment of the sewage outfall was conducted at Davis Station, East Antarctica. An investigation of the nature and extent of impacts to the marine environment associated with current sewage treatment and effluent discharge practices included ecological surveys of macrobiological communities, physico-chemical analysis of sediments and receiving waters, microbiological analysis, and histopathological analysis of fish. Ecotoxicological testing using local invertebrates to determine effluent toxicity was interpreted alongside dispersal modelling data of the discharge plume to determine the potential extent of impacts and inform recommendations on the level of treatment and dilution of sewage required to minimise impacts. No evidence of impacts was detected on soft sediment infaunal or epifaunal communities, and only low levels of contamination and accumulation were found in sediments and waters in the immediate vicinity of the outfall and in the direction of primary current flow. In contrast, sterol biomarkers and faecal coliforms (E. coli) were detected in sediments collected adjacent to the outfall and in most water column samples. Marine invertebrates (Abatus and Laternula) also tested positive for E. coli and antibiotic resistance mechanisms were present in Laternula indicating the introduction and dispersal through the water column of foreign microbes and bacteria associated with human effluent. Fish (Trematomus bernacchii) close to the outfall showed significant histological alterations in all major tissues (liver, gill, gonad, muscle) resulting from exposure to sewage. Effluent was toxic to amphipods (Paramoera walkeri) and microgastropods (Skenella paludionoides), with reduced survival in concentrations as low as 3.125% over a 21d exposure period. Acute effects were also observed in both species following 24h exposure, with 100% mortality at the highest effluent concentrations tested (68%). The application of these results to support and guide decisions regarding the planned installation of new sewage treatment facilities at Davis will be discussed.

Community-onset Staphylococcus aureus infections presenting to general practices in South-eastern Australia

Community-acquired Staphylococcus aureus infections are a public health concern, yet little is known about infections that do not present to hospital. We identified community-onset S. aureus infections via specimens submitted to a community-based pathology service. Referring doctors confirmed eligibility and described infection site, severity and treatment. Isolates were characterized on antibiotic resistance, PFGE, MLST/SCCmec, and Panton–Valentine leukocidin (PVL), representing 106 community-onset infections; 34 non-multiresistant methicillin-resistant S. aureus (nmMRSA) (resistant to <3 non-β-lactam antibiotics), 15 multiply antibiotic-resistant MRSA (mMRSA) and 57 methicillin-sensitive S. aureus (MSSA). Most (93%) were skin and soft tissue infections. PVL genes were carried by 42% of nmMRSA isolates [95% confidence interval (CI) 26–61] and 15% of MSSA (95% CI 8–28). PVL was associated with infections of the trunk, head or neck (56·4% vs. 24·3%, P= 0·005) in younger patients (23 vs. 52 years, P< 0·001), and with boils or abscesses (OR 8·67, 95% CI 2·9–26·2), suggesting underlying differences in exposure and/or pathogenesis.

Sphingobacterium pakistanensis sp. nov., a novel plant growth promoting rhizobacteria isolated from rhizosphere of Vigna mungo

The taxonomic status of a bacterium, strain NCCP-246(T), isolated from rhizosphere of Vigna mungo, was determined using a polyphasic taxonomic approach. The strain NCCP-246(T) can grow at 16-37 °C (optimum 32 °C), at pH ranges of 6-8 (optimum growth occurs at pH 7) and in 0-4 % (w/v) NaCl. Phylogenetic analysis based upon on 16S rRNA gene sequence comparison revealed that strain NCCP-246(T) belonged to genus Sphingobacterium. Strain NCCP-246(T) showed highest similarity to the type strain of Sphingobacterium canadense CR11(T) (97.67 %) and less than 97 % with other species of the genus. The DNA-DNA relatedness value of strain NCCP-246(T) with S. canadense CR11(T) and Sphingobacterium thalpophilum JCM 21153(T) was 55 and 44.4 %, respectively. The chemotaxonomic data revealed the major menaquinone as MK-7 and dominant cellular fatty acids were summed feature 3 [C16:1 ω7c/C16:1 ω6c] (37.07 %), iso-C15:0 (28.03 %), C16:0 (11.85 %), C17:0 cyclo (8.84 %) and C14:0 (2.42 %). The G+C content of the strain was 39.2 mol%. On the basis of DNA-DNA hybridization, phylogenetic analyses, physiological and, biochemical data, strain NCCP-246(T) can be differentiated from the validly named members of genus Sphingobacterium and thus represents as a new species, for which the name, Sphingobacterium pakistanensis sp. nov. is proposed with the type strain NCCP-246(T) (= JCM18974 (T) = KCTC 23914(T)).

The environmental impact of sewage and wastewater outfalls in Antarctica: an example from Davis station, East Antarctica

We present a comprehensive scientific assessment of the environmental impacts of an Antarctic wastewater ocean outfall, at Davis station in East Antarctica. We assessed the effectiveness of current wastewater treatment and disposal requirements under the Protocol on Environmental Protection to the Antarctic Treaty. Macerated wastewater has been discharged from an outfall at Davis since the failure of the secondary treatment plant in 2005. Water, sediment and wildlife were tested for presence of human enteric bacteria and antibiotic resistance mechanisms. Epibiotic and sediment macrofaunal communities were tested for differences between sites near the outfall and controls. Local fish were examined for evidence of histopathological abnormalities. Sediments, fish and gastropods were tested for uptake of sewage as measured by stable isotopes of N and C. Escherichia coli carrying antibiotic resistance determinants were found in water, sediments and wildlife (the filter feeding bivalve Laternula eliptica). Fish (Trematomus bernacchii) within close proximity to the outfall had significantly more severe and greater occurrences of histopathological abnormalities than at controls, consistent with exposure to sewage. There was significant enrichment of (15)N in T. bernacchii and the predatory gastropod Neobuccinum eatoni around the outfall, providing evidence of uptake of sewage. There were significant differences between epibiotic and sediment macrofaunal communities at control and outfall sites (<1.5 km), when sites were separated into groups of similar habitat types. Benthic community composition was also strongly related to habitat and environmental drivers such as sea ice. The combined evidence indicated that the discharge of wastewater from the Davis outfall is causing environmental impacts. These findings suggest that conditions in Antarctic coastal locations, such as Davis, are unlikely to be conducive to initial dilution and rapid dispersal of wastewater as required under the Protocol on Environmental Protection to the Antarctic Treaty. Current minimum requirements for wastewater treatment and disposal in Antarctica are insufficient to ameliorate these risks and are likely to lead to accumulation of contaminants and introduction of non-native microbes and associated genetic elements. This new understanding suggests that modernised approaches to the treatment and disposal of wastewater are required in Antarctica. The most effective solution is advanced levels of wastewater treatment, which are now possible, feasible and a high priority for installation. As a direct outcome of the study, a new advanced treatment system is being installed at Davis, effectively avoiding environmental risks.