Propionibacterium acnes: An Underestimated Pathogen in Implant-Associated Infections.

The role of Propionibacterium acnes in acne and in a wide range of inflammatory diseases is well established. However, P. acnes is also responsible for infections involving implants. Prolonged aerobic and anaerobic agar cultures for 14 days and broth cultures increase the detection rate. In this paper, we review the pathogenic role of P. acnes in implant-associated infections such as prosthetic joints, cardiac devices, breast implants, intraocular lenses, neurosurgical devices, and spine implants. The management of severe infections caused by P. acnes involves a combination of antimicrobial and surgical treatment (often removal of the device). Intravenous penicillin G and ceftriaxone are the first choice for serious infections, with vancomycin and daptomycin as alternatives, and amoxicillin, rifampicin, clindamycin, tetracycline, and levofloxacin for oral treatment. Sonication of explanted prosthetic material improves the diagnosis of implant-associated infections. Molecular methods may further increase the sensitivity of P. acnes detection. Coating of implants with antimicrobial substances could avoid or limit colonization of the surface and thereby reduce the risk of biofilm formation during severe infections. Our understanding of the role of P. acnes in human diseases will likely continue to increase as new associations and pathogenic mechanisms are discovered.

Bovine papillomavirus type 2 detection in the urinary bladder of cattle with chronic enzootic haematuria

The bovine papillomavirus type 2 (BPV-2) involvement in the aetiology of chronic enzootic haematuria associated to bracken fern ingestion has been suggested for a long time. However, a few reports have shown the presence of the BPV-2 in urinary bladder tumors of cattle. The aim of this study was to investigate the presence of the BPV-2 infection in the urinary bladder of cattle with chronic enzootic haematuria in Brazilian cattle herds. Sixty-two urinary bladders were collected from adult cattle in beef herds from the north region of the state of Paraná, Brazil. According to clinical and pathological finds the specimens were distributed in three groups: the group A was constituted by 22 urinary bladders with macroscopic lesions collected at necropsy of cattle with clinical signs of chronic enzootic haematuria; the group B by 30 urinary bladders with macroscopic lesions collected in a slaughterhouse of cows coming from bracken fern-endemic geographical region; and the group C (control) by 10 urinary bladders without macroscopic lesions collected from asymptomatic cattle in a bracken fern-free geographical region. By a semi-nested polymerase chain reaction (PCR) assay, with an internal control, a fragment of the BPV-2 L1 gene with 386 bp length was amplified in 36 (58%) urinary bladder. The rate of BPV-2 positive urinary bladders was 50% (11/22) for group A, 80% (24/30) for group B, and 10% (1/10) for group C (control). The rate of the positive results found in groups A and B that included urinary bladder samples with macroscopic lesions was 67% (35/52) and the detection of the BPV-2 in both groups was significantly higher (P < 0.05) than in the control group. RFLP with Rsa I and Hae III enzymes evaluated the specificity of the BPV-2 amplicons. The PCR internal control that amplified a 626 bp fragment of the ND5 gene of the bovine mitochondrial genome was amplified in all analyzed samples and excluded false-negatives or invalid results in the semi-nested PCR. These results suggest the BPV-2 involvement in the chronic enzootic haematuria aetiology and open the perspective of the development of new strategies for the control of this disease that is the major cause of economical losses in beef herds from many Brazilian geographical regions.

Northern Ireland Point Prevalence Survey of Hospital-acquired Infections and Antimicrobial Use 2012

The PHA�coordinated Northern Ireland's participation in ECDC's National Prevalence Survey on�Hospital-Acquired Infections & on Antimicrobial Use. Hospitals in Northern Ireland participated in data collection between May and June 2012.This report provides a snapshot of the levels of hospital-acquired infections (HAI) and levels of antimicrobial use (AMU) in hospitals in Northern Ireland during 2012.There have been three previous HAI PPS surveys and the last survey was carried out in 2006. It is difficult to compare each survey as the data was collected in a different way. However, after making allowances, there was an overall drop in HAI prevalence of 18% from 2006 to 2012.The PPS data collection was undertaken by hospital teams between May and June 2012 (one hospital deferred data collection until September 2012 because of a move to a new hospital); 16 hospitals surveyed 3,992 eligible patients. The median age of all patients was 66 years. A total of 383 (10 per cent) children under 16 years of age were surveyed.�Key results from this year's survey:The prevalence of HAI was 4.2%. A total of 166 patients were diagnosed with an active HAI with 3 patients having more than one infection.When comparing ward specialties, HAI prevalence was highest for patients in adult intensive care units (ICUs) at 9.1 per cent, followed by care of the elderly wards at 5.7%.The most common types of HCAI were respiratory infections (including pneumonia and infections of the lower respiratory tract) (27.9 per cent of all infections), surgical site infections (18.9 per cent) and urinary tract infections (UTI) (11.8 per cent).Since the last PPS in 2006 there has been a reduction in MRSA infections - from 0.9 per cent �of the hospital population to less than 0.1 per cent in patients; and a five-fold reduction in C. difficile infections (from 1.1 per cent to 0.2 per cent).The prevalence of antimicrobial use was 29.5%.Most antibiotic use (60 per cent) in hospitals was in patients receiving treatment for infections which commenced in the community. Eleven percent of surgical prophylaxis was prescribed for greater than one day.��

The resumption of consumption: a review on tuberculosis

Among all infectious diseases that afflict humans, tuberculosis (TB) remains the deadliest. At present, epidemiologists estimate that one-third of the world population is infected with tubercle bacilli, which is responsible for 8 to 10 million new cases of TB and 3 million deaths annually throughout the world. Approximately 95% of new cases and 98% of deaths occur in developing nations, generally due to the few resources available to ensure proper treatment and where human immunodeficiency virus (HIV) infections are common. In 1882, Dr Robert Koch identified an acid-fast bacterium, Mycobacterium tuberculosis, as the causative agent of TB. Thirty-nine years later, BCG vaccine was introduced for human use, and became the most widely used prophylactic strategy to fight TB in the world. The discovery of the properties of first-line antimycobacterial drugs in the past century yielded effective chemotherapies, which considerably decreased TB mortality rates worldwide. The later introduction of some additional drugs to the arsenal used to treat TB seemed to provide an adequate number of effective antimicrobial agents. The modern, standard short-course therapy for TB recommended by the World Health Organization is based on a four-drug regimen that must be strictly followed to prevent drug resistance acquisition, and relies on direct observation of patient compliance to ensure effective treatment. Mycobacteria show a high degree of intrinsic resistance to most antibiotics and chemotherapeutic agents due to the low permeability of its cell wall. Nevertheless, the cell wall barrier alone cannot produce significant levels of drug resistance. M. tuberculosis mutants resistant to any single drug are naturally present in any large bacterial population, irrespective of exposure to drugs. The frequency of mutants resistant to rifampicin and isoniazid, the two principal antimycobacterial drugs currently in use, is relatively high and, therefore, the large extra-cellular population of actively metabolizing and rapidly growing tubercle bacilli in cavitary lesions will contain organisms which are resistant to a single drug. Consequently, monotherapy or improperly administered two-drug therapies will select for drug-resistant mutants that may lead to drug resistance in the entire bacterial population. Thereby, despite the availability of effective chemotherapy and the moderately protective vaccine, new anti-TB agents are urgently needed to decrease the global incidence of TB. The resumption of TB, mainly caused by the emergence of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains and HIV epidemics, led to an increased need to understand the molecular mechanisms of drug action and drug resistance, which should provide significant insight into the development of newer compounds. The latter should be effective to combat both drug-susceptible and MDR/XDR-TB.

Increased resistance to first-line agents among bacterial pathogens isolated from urinary tract infections in Latin America: time for local guidelines?

Emerging resistance phenotypes and antimicrobial resistance rates among pathogens recovered from community-acquired urinary tract infections (CA-UTI) is an increasing problem in specific regions, limiting therapeutic options. As part of the SENTRY Antimicrobial Surveillance Program, a total of 611 isolates were collected in 2003 from patients with CA-UTI presenting at Latin American medical centers. Each strain was tested in a central laboratory using Clinical Laboratory Standard Institute (CLSI) broth microdilution methods with appropriate controls. Escherichia coli was the leading pathogen (66%), followed by Klebsiella spp. (7%), Proteus mirabilis (6.4%), Enterococcus spp. (5.6%), and Pseudomonas aeruginosa (4.6%). Surprisingly high resistance rates were recorded for E. coli against first-line orally administered agents for CA-UTI, such as ampicillin (53.6%), TMP/SMX (40.4%), ciprofloxacin (21.6%), and gatifloxacin (17.1%). Decreased susceptibility rates to TMP/SMX and ciprofloxacin were also documented for Klebsiella spp. (79.1 and 81.4%, respectively), and P. mirabilis (71.8 and 84.6%, respectively). For Enterococcus spp., susceptibility rates to ampicillin, chloramphenicol, ciprofloxacin, and vancomycin were 88.2, 85.3, 55.9, and 97.1%, respectively. High-level resistance to gentamicin was detected in 24% of Enterococcus spp. Bacteria isolated from patients with CA-UTI in Latin America showed limited susceptibility to orally administered antimicrobials, especially for TMP/SMX and fluoroquinolones. Our results highlight the need for developing specific CA-UTI guidelines in geographic regions where elevated resistance to new and old compounds may influence prescribing decisions.

Preventing infections caused by Pseudomonas - Parent/Carer Information leaflet

Information for parents on preventing infections caused by Pseudomonas

Epidemiology of tuberculosis in Northern Ireland: Annual surveillance report 2009 -2010

This report presents the epidemiological data for tuberculosis cases reported in Northern Ireland.

Northern Ireland Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in Long Term Care Facilities

The Northern Ireland Prevalence Survey of Healthcare-Associated Infections and Antimicrobial Use in Long Term Care Facilities, also known as the 'HALT' survey was conducted as part of the 2013 European Centre for Disease Prevention and Control (ECDC) European HALT survey.In May 2013, 42 Northern Ireland long-term care facilities (nursing and residential homes) participated in a European point prevalence survey of healthcare-associated infections and antimicrobial use. Thirty-one privately owned nursing homes and 11 HSC Trust-controlled residential homes took part.The report and results have highlighted priority areas for future interventions to prevent and control HCAI, antimicrobial stewardship and future local and national prevalence surveys in long-term care facilities. The 2013 European report was published on 5th May 2014.

Epidemiology of tuberculosis in Northern Ireland: Annual surveillance report 2012

This report presents the epidemiological data for tuberculosis cases reported in Northern Ireland.

Epidemiology of tuberculosis in Northern Ireland: Annual surveillance report 2007

This report provides an annual update on the prevalence of tuberculosis in Northern Ireland. It gives a general overview of TB rates and statistics, and looks at both pulmonary and non-pulmonary tuberculosis cases in detail, examining the forms of therapy employed and highlighting any drug resistance. The report also includes a discussion, which considers the specifics of newly diagnosed cases (age, place of birth) and provides some comparative data for the UK and Republic of Ireland.

C. difficile surveillance quarterly report: October-December 2010

This quarterly report provides epidemiological data on C. difficile in Northern Ireland, and includes key points, a comprehensive�overview of all C. diff infections, rates, trends, age-specific information�and statistical process control charts. The report also provides information on surveillance methods and data for each hospital and Health and Social Care Trust in Northern Ireland.

Healthcare associated infections

Information for patients and visitors on the prevention of healthcare associated infections.

Epidemiologie der letalen Missbildungen in der Schweiz. [Epidemiology of fatal abnormalities in Switzerland].

Official certificates of stillbirth and infant death are analysed in the birth cohort of 1979-81. Congenital malformations account for approx. 40% of infant mortality. Cantonal differences in malformation rates are not explained by different incidence of such malformations only, but also by differences in lethality. Incidence of Anencephaly is examined in detail.

Eleven leaflets for patients and visitors on healthcare associated infections - including accessible formats

The following suite of nine leaflets for patients and visitors to healthcare settings include information on healthcare associated infections, C. difficile, MRSA, norovirus, scabies, ESBL resistant bacteria, multi-drug resistant bacteria and laundry and hand hygiene guidance.

Gastrointestinal Infections Annual Surveillance Report 2013

The Public Health Agency (PHA)�has a lead role in protecting the population from infection and environmental hazards through a range of core functions including communicable disease surveillance and monitoring, operational support & advice, and education, training and research.�The effective management of infectious disease depends on high quality surveillance. �Surveillance of communicable gastrointestinal infectious disease provides timely information so that public health action can result.�