Emergence of CTX-M Group 1-ESBL producing Klebsiella pneumonia from a tertiary care centre in Karachi, Pakistan.

http://www.jidc.org/index.php/journal/article/view/20818098/422 Background: Extended-spectrum beta-lactamase (ESBL)-producing Klebsiella pneumoniae have been reported previously from Pakistan but the genotypic characteristics of these enzymes is not known. Hence the aim of the study was first to characterise the genotypic content of these beta-lactamases and secondly to assess the clonal relationship of these isolates. Methodology: We analysed 65 non-duplicate ESBL positive, K. pneumoniae isolates prospectively collected based on phenotype as detected using the two-disc method. Isolates were collected from different sources: blood cultures (46.15%; n = 30); tracheal aspirates (24.6%; n = 16); urine (10.7%; n = 7); wound swabs, pus and tissue (18.4%; n = 12). ESBL production was confirmed by the ESBL E-test method and the presence of the blaCTX-M encoding genes was confirmed by polymerase chain reaction. The clonal relationship of clinical isolates was studied by Pulsed Field Gel Electrophoresis. Results: The results showed that 93.84% (n = 61) isolates of K. pneumoniae were positive for the blaCTX-M-1 group. One isolate showed PCR signals for blaCTX-M-25 group. None of our isolates were positive for CTX-M groups 2, 8 and 9. The majority of blaCTX-M positive isolates were genetically unrelated and no epidemic clones were identified. Conclusion: This study reports the emergence of CTX-M groups 1 and 25 producing isolates of K. pneumoniae with genetic diversity in Karachi, Pakistan.

Clinico-epidemiological features of infections caused by CTX-M type extended spectrum beta lactamase-producing Escherichia coli in hospitalised patients

A review of medical records of 45 of 53 hospitalised patients with positive cultures for CTX-M type ESBL-producing Escherichia coli between 01 January and 31 May 2004 was conducted. The mean age of the population studied was 73.1 (+/-14.6) years and the majority (55.6%) had been under the care of the internal medicine or elderly care service. In the majority (77.8%) of instances the isolate was attributed to a clinical infection rather than colonisation and the commonest clinical specimen to yield the organism was urine, which was positive in 57.8% of patients. Acquisition of the organism was categorised as nosocomial in 68.9% of patients; in this subgroup, the median duration of inpatient stay prior to recovery of the organism was 24 (range 3-240) days. Haemodialysis-dependence was the most common of the comorbidities evaluated. The mean number of antibiotics prescribed per patient in the 30 days prior to first isolation of the organism was 1.7 (range 0-4). Furthermore, the mean number of antibiotic-days exposure per patient during this period was 13.9 (range 0-48). The most frequently received class of antibiotic was beta-lactam/beta-lactamase inhibitor combinations. Of 35 infections, 26 (74.2%) were successfully treated. Overall 12 patients with infection died (34.3%); attributable mortality was presumed in seven (20%).

Evaluation of the VITEK 2 AST N-054 test card for the detection of extended-spectrum beta-lactamase production in Escherichia coli with CTX-M phenotypes

A new VITEK 2 antibiotic susceptibility testing (AST) card, AST N-054, was introduced for aerobic gram-negative bacilli in 2007 and has been widely adopted for routine use in the UK. We evaluated its performance for detecting extended-spectrum beta-lactamase (ESBL) production in Escherichia coli.

Failure to produce an anti-poverty strategy: The Committee on the Administration’s Application [2015] NIQB 59, June 30, 2015

This is a note on the Northern Ireland High Court decision of 30 June 2015 that the Northern Ireland Executive had acted unlawfully in failing to fulfil its statutory duty to adopt a strategy setting out proposals for tackling poverty, social exclusion and patterns of deprivation based on objective need.

Unesp Ciência, 2014, ano 6, número 59

Revista elaborada pela Assessoria de Comunicação e Imprensa da Reitoria da UNESP

« Discours sommaire de ce qui est succedé en la guerre que le roy » Charles IX, « soubz la conduicte de monseigneur le duc d'Anjou » Henri de France, « son frère et lieutenant general, a eue contre ses subgectz eslevez, depuis la fin du moys d'aoust 1568 jusques en novembre 1569 ». (Fol. 1-59 r°).

Contient : a « Rursum in te florebit domus » ; b ; c « Qualis flos hyacinthus » ; d (suite)

Recueil de poésies, par « HENRY BAULDE » (fol. 30, 32, 35, 36, 37, 39, 40, 43, 44, 46, 47, 56, 59, 60, 61, 65, 68, 69, 70, 73, 74), « ALAIN CHARRETIER » (fol. 15), « JEHAN DAUTON » (fol. 9), « JEHAN MAROT » (fol. 29, 30), « JEHAN MOLINET » (fol. 77, 85, 90, 93, 94, 95) et « JEHAN ROBERTET » (fol. 1, 75).

Commençant par : « Estant couché soubz ung myrthe plaisant, Et maintz chasteaulx en Espaigne faisant... » et finissant par : « Sans parage ou riens n'est nect, Moulu d'un groz Moulinet. Fin de la complaincte de Grece, composée par le dict Molinet » .