Evaluation of CHROMagar CTX, a novel medium for isolating CTX-M-ESBL-positive Enterobacteriaceae while inhibiting AmpC-producing strains

OBJECTIVES

The aim of this study was to evaluate CHROMagar CTX (CHROMagar France), a novel agar for the selective isolation of Enterobacteriaceae expressing the bla(CTX-M) gene in the presence of enteric bacteria expressing AmpC enzymes.

METHODS

A panel of 150 Gram-negative bacteria (mainly Escherichia coli, Enterobacter, Klebsiella, Pseudomonas and Salmonella) isolated from humans and animals were assembled for the purpose of evaluating CHROMagar CTX and comparing it with CHROMagar ECC with the addition of 1, 2, 4 and 8 mg/L cefotaxime or ceftazidime and with bioMérieux extended-spectrum beta-lactamase (ESBL)-Bx agar. CHROMagar CTX was also assessed for its ability to isolate bla(CTX-M) strains from farm animal faeces (n = 342).

RESULTS

The panel contained CTX-M-positive (n = 70) strains (CTX-M types 1, 9, 14 and 15), ESBLs (n = 31) belonging to other families (OXA, PER, SHV, TEM, VEB), strains positive for ampC genes (n = 31), strains that overexpressed ampC (n = 6), non-ESBL/AmpC strains (n = 11) and Klebsiella oxytoca (n = 1). CHROMagar CTX was superior to other agars tested for selective isolation of Enterobacteriaceae expressing the bla(CTX-M) gene with 100% sensitivity and 64.2% specificity for CTX-M strains in the panel and 90.1% of the colonies from animal faeces plated on CHROMagar CTX were CTX-M strains.

CONCLUSIONS

CHROMagar CTX is a valuable agar in situations where it is important to isolate bla(CTX-M) strains in the presence of AmpC strains. The agar may be particularly useful in veterinary studies, where AmpC-producing commensal E. coli can be encountered reasonably frequently in the enteric flora of some animal species and may also be useful, following further evaluation, for samples from humans.

[Comparison of the tuberculin skin test with the interferon-gamma test in the framework of a surroundings investigation in a prison]

After the occurrence of a multidrug-resistant tuberculosis in a prison of Lower Saxony (Germany), 223 contact persons (178 inmates, 45 staff members) were identified. To detect latent tuberculosis infections, all contact persons were tested with the tuberculin skin test (TST) and the interferon-gamma release assay (IGRA). An additional standardised questionnaire on anamnestic information and risk factors was completed by the participants. The statistical analysis included 149 male inmates with a mean age of 39 years. 61.1% of the inmates were born in Germany, 14.8% were born in the USSR or, respectively, its follow-up states. With the TST 29.5% of the inmates were tested positive, whereas with the IGRA the positive rate was 18.1%. For 7 inmates there was a positive IGRA despite a negative TST. The positive predictive value of TST with respect to IGRA was 45.5%, agreement was 79.2% (kappa=0.44). The agreement found in this study is comparable to studies within populations with lower incidence. Numerous investigations outside Europe indicate a high risk of tuberculosis infection among inmates.

Monitoring of PCDD/Fs in a mountain forest by means of active and passive sampling

Polychlorinated dibenzo-p-dioxins and dibenzofurans (PCDD/F) are sampled and investigated in a forested area in Middle-Europe. The campaigns, consisting in active and passive samplings, were conducted in the Bavarian and Bohemian Forest at four sites chosen for their similar soil and forest stand characteristics. Passive sampling was conducted using both semi-permeable membrane devices (SPMDs) and needles of well-exposed dominant spruce trees. Active air sampling was also performed at one site with a low volume air sampler. Correlations were performed to identify relationships and trends of PCDD/F. Lower chlorinated PCDD/F are accumulated in SPMDs, needles collected all compounds among homologues and their PCDD/F pattern is close to that of active sampling. Results of the analysed compounds obtained with the different sampling methods served as a basis for the establishment of advantages and disadvantages of the sampling tools applied and their possible optimisation.

[Reasons for different loss experiences with men and women in private disability insurance]

Women in general have a more unfavourable loss experience in private disability insurance due to biological and social reasons (enhanced rate of malignant and psychic diseases). Contrary to the enhanced rates of orthopaedic diseases and accidents with men, women's diseases are not work-related and therefore are not to be compensated by any extra amounts concerning occupational groups. In spite of the enhanced risk of occupational disability, women are more seldom insured against this risk than men. So--despite the rising female rate--there is still a clear backlog demand.

Absence of the lactase-persistence-associated allele in early Neolithic Europeans

Lactase persistence (LP), the dominant Mendelian trait conferring the ability to digest the milk sugar lactose in adults, has risen to high frequency in central and northern Europeans in the last 20,000 years. This trait is likely to have conferred a selective advantage in individuals who consume appreciable amounts of unfermented milk. Some have argued for the "culture-historical hypothesis," whereby LP alleles were rare until the advent of dairying early in the Neolithic but then rose rapidly in frequency under natural selection. Others favor the "reverse cause hypothesis," whereby dairying was adopted in populations with preadaptive high LP allele frequencies. Analysis based on the conservation of lactase gene haplotypes indicates a recent origin and high selection coefficients for LP, although it has not been possible to say whether early Neolithic European populations were lactase persistent at appreciable frequencies. We developed a stepwise strategy for obtaining reliable nuclear ancient DNA from ancient skeletons, based on (i) the selection of skeletons from archaeological sites that showed excellent biomolecular preservation, (ii) obtaining highly reproducible human mitochondrial DNA sequences, and (iii) reliable short tandem repeat (STR) genotypes from the same specimens. By applying this experimental strategy, we have obtained high-confidence LP-associated genotypes from eight Neolithic and one Mesolithic human remains, using a range of strict criteria for ancient DNA work. We did not observe the allele most commonly associated with LP in Europeans, thus providing evidence for the culture-historical hypothesis, and indicating that LP was rare in early European farmers.

Changed vegetation composition in coniferous forests near to motorways in Southern Germany: the effects of traffic-born pollution

To estimate the effect of traffic emissions on the vegetation composition of coniferous forests near to motorways, three transects of 520 m length were studied by analysing vegetation composition, soil parameters and deposition data in the Munich-area, Southern Germany. The detected patterns suggest that motorways have an impact on the vegetation composition in the neighbourhood of roads. Depending on the wind direction, the influences of the motorways reaches up to 230 m on downwind side and up to 80 m on upwind side. The vegetation is mainly affected by the deposition of nitrogen deriving from fuel combustion and by basic substances added to road salt. By monitoring vegetation changes near to motorways, it is possible to estimate the areas where harmful alterations of the ecosystem can be expected.

Possibilities and limitations of fast GC with narrow-bore columns

In this work, two narrow-bore capillary columns with different internal diameters (I.D.) 0.15 mm (15 m length, 0.15 microm film thickness) and 0.10 mm (10 m length, 0.10 microm film thickness) with the same stationary phase (5% diphenyl 95% dimethylsiloxane), phase ratio and separation power were compared with regard to their advantages, practical limitations and applicability in fast GC on commercially available instrumentation. The column comparison concerns fast GC method development, speed and separation efficiency, the sample transfer into the column utilizing split and splitless inlet, sample capacity, detection (analysing compounds of a wide range of polarities and volatilities--even n-alkanes C16-C28 and selected pesticides) and ruggedness (in the field of ultratrace analysis of pesticide residues in real matrix). Under conditions corresponding to speed/separation efficiency trade-off 0.10 mm I.D. versus 0.15 mm I.D. column provides a speed gain of 1.74, but all other parameters investigated were better for the 0.15 mm I.D. column concerning more efficient sample transfer from inlet to the column using splitless injection, no discrimination with split injection. Better sample capacity (three times higher for the 0.15 mm than for the 0.10 mm I.D. column) resulted in improved ruggedness and simpler fast GC-MS method development.

A double-blind randomized controlled trial comparing alternate forms of high molecular weight hyaluronan for the treatment of osteoarthritis of the knee

OBJECTIVE

To compare the safety and effectiveness of a high molecular weight hyaluronan produced by biological fermentation (Bio-HA) with those of avian-derived hyaluronan that uses cross-linking to achieve high molecular weight (CL-HA).

DESIGN

This was a prospective, multicenter, randomized, double-blind trial evaluating patients with confirmed osteoarthritis of the knee. The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC Index) pain subscale was the primary effectiveness measure (visual analog scale). Both products were administered via three weekly injections, with follow-up evaluations at weeks 3, 6 and 12. Acetaminophen was permitted as rescue medication and quantitated by pill counts.

RESULTS

Analyses were performed on the intent-to-treat population, defined as all patients receiving at least one injection. Of the 321 patients randomized to treatment, 314 patients (98%) completed the final study assessment. Improvement in the average WOMAC Index pain score was 29.8mm (-61.6%) for Bio-HA and 28.8mm (-54.9%) for CL-HA, meeting the prospective criteria for non-inferiority. For the secondary outcome measures, statistically significant differences favored Bio-HA for the number of patients requiring acetaminophen (P=0.013) and patient global satisfaction evaluations (P=0.03). Local reactions differed between the products in that 15 effusions were reported in 13 CL-HA patients (8.1%) after injection, compared to one effusion (0.6%) after Bio-HA injection (P=0.0015).

CONCLUSION

The effectiveness of Bio-HA was not inferior to that of CL-HA. The significantly higher incidence of post-injection effusion in the CL-HA group provides a safety advantage for Bio-HA. These data suggest that Bio-HA has an improved benefit-risk profile compared with CL-HA.

Possibilities and limitations of quadrupole mass spectrometric detector in fast gas chromatography

In this work the application and limitations of a common bench top quadrupole mass spectrometer was evaluated for the qualitative and quantitative measurement of n-alkanes and pesticides of a wide range of volatilities and polarities with fast GC separations using 0.15 mm I.D. narrow-bore capillary columns. It was found that the spectra acquisition rate has a great impact on sensitivity (peak areas, peak shapes and S/N ratios). The quality of the obtained spectra is not significantly influenced in the full scan monitoring mode for the fastest scan rates. For quantitative analysis a selected ion monitoring mode is able to acquire the sufficient number of data-points for the proper peak shape reconstruction and good repeatability of peak areas measurements expressed by RSD (< 5%) for all tested dwell times shorter than 75 ms. However, for shorter dwell times, S/N ratio is lower, while peak areas are not influenced.

Search on ruggedness of fast gas chromatography-mass spectrometry in pesticide residues analysis

In this study, suitability of fast gas chromatography-mass spectrometry (GC-MS) on a narrow-bore column with a programmed temperature vaporizer for the analysis of pesticide residues in non-fatty food was evaluated. The main objectives were ruggedness and stability of chromatographic system with regards to co-extractives injected. The chromatographic matrix induced response enhancement was found to be strongly dependent on the concentration of residues and is reaching up to 700% compared to the pesticides solutions in a neat solvent. However, the responses of pesticides in matrix-matched standards at different concentration levels do not significantly change during 130 injections. Response enhancement/or decrease is influenced by the sample preparation technique. External calibration with matrix-matched calibration standards should, therefore, provide results with good precision also at the concentration level of 0.005 mg kg(-1). Special attention is given to the performance of the chromatographic column and retention gap with regards to peak widths, peak tailing and different sample preparation methods. During approximately 460 matrix sample injections, the performance of the analytical column was acceptable. GC-MS set-up with 0.15 mm i.d. column can be successfully utilized for the pesticide residues analysis.

Fast gas chromatography with solid phase extraction clean-up for ultratrace analysis of pesticide residues in baby food

A sample preparation method based on single solvent phase extraction and solid-phase extraction (SPE-NH2) clean-up is studied in combination with fast capillary gas chromatography (GC) to determine 18 selected pesticides belonging to various chemical classes in apples, the common raw material for baby food production and baby food, at the concentration level < or = 10 microg/kg maximum residual limit (MRL). Possibilities of mass spectrometry (MS) detector and electron capture detector (ECD) in fast gas chromatography (GC) of samples with complex matrice at ultra trace levels of pesticide residues were studied and compared. MS detection in single ion monitoring (SIM) mode provided higher selectivity compared to ECD. Optimisation of extraction as well as the simplifying of the whole process of sample preparation was carried out. Recoveries obtained at concentration level of 5 microg/kg (the required value for limit of quantification (LOQ) in baby food) were >90%, except of dimethoate (77.7%) and captan (46.4%) with MS detection. The obtained LOQs were at least 1 order lower than 5 microg/kg for the majority of compounds. The repeatability of gas chromatography-mass spectrometry (GC-MS) measurements of the matrix matched standards expressed as relative standard deviation was <11% except of captan and cypermethrin.

Practical aspects of splitless injection of semivolatile compounds in fast gas chromatography

Possibilities and practical aspects of implementation of splitless injection of larger volumes for fast GC purposes utilizing narrow-bore column, hydrogen as carrier gas, fast temperature programming under programmed flow conditions and commercial instrumentation were searched. As a model sample semivolatile compounds of a broad range of volatility and polarity (7 n-alkanes and 19 pesticides) were chosen. Peak shapes, peak broadening and peak areas and its repeatability were evaluated under various experimental set-ups (liner/injection technique combinations). Various factors, such as liner design, injection technique, retention gap length, compound volatility and polarity, the solvent used, initial oven temperature influenced compound focusation and/or maximal injection volume. Combination of analytical column (CP-Sil 13 CB 25 m long, 0.15 mm i.d., film thickness 0.4 microm) with normal-bore retention gap (1 m long, 0.32 mm i.d.) allowed maximal injection volume 8 microl for 4 mm i.d. liner used without any peak distortion when solvent recondensation in the retention gap was employed.

Principal component analysis and cluster analysis for measuring the local organisation of human atrial fibrillation

The distribution of atrial electrogram types has been proposed to characterise human atrial fibrillation. The aim of this study was to provide computer procedures for evaluating the local organisation of intracardiac recordings during AF as an alternative to off-line manual classification. Principal component analysis (PCA) reduced the data set to a few representative activations, and cluster analysis (CA) measured the average dissimilarity between consecutive activations of an intracardiac signal. The data set consisted of 106 bipolar signals recorded on 11 patients during electrophysiological studies for catheter ablation. Performances of PCA and CA in distinguishing between organised (type I) and disorganised (type II/III, Wells criteria) were assessed, in comparison with manual reading, by evaluating the predictive parameters of the classification analysis. Both methods gave high accuracy (92% for PCA and 89% for CA), confirming the feasibility of on-line characterisation of AF. Sensitivity was lower than specificity (81% against 98% for PCA, and 77% against 97% for CA), with seven out of eight misclassifications of PCA in common with CA. Differences between manual and computer analysis may be related to the higher resolution of PCA and CA in the measurement of the organisation of atrial activations. These procedures are suitable for providing automatic (by CA) or semi-automatic (by PCA) measures of the extent of local organisation of AF in the pre-ablation treatment phase.

Effects of Oxyrrhis marina (Dinoflagellata), bacteria and vitamin D(2) on population dynamics of Tisbe holothuriae (Copepoda)

Laboratory experiments were performed to determine which food combinations had the most favorable effect on population dynamics of the harpacticoid copepod Tisbe holothuriae. In addition to basic diets of TetraMin (T), rice (R) or a mixture of both (T+R), supplements consisting of the following were given: the heterotrophic dinoflagellate Oxyrrhis marina, a bacterial suspension and vitamin D(2). Results show a beneficial effect of bacteria at a given concentration on T. holothuriae, which is enhanced in combination with vitamin D(2). A higher concentration of bacteria together with vitamin D(2), however, has a reverse effect leading to greater mortality, lower sex ratio and number of ovigerous females, and a dramatic decrease in production of eggs, regardless of the basic diet. We conclude that different concentrations of a given bacterial community may have variable effects on the reproduction of harpacticoid copepods and that, in addition to the bacteria, vitamin D(2) may also play a role in invertebrate nutrition.

Field intercomparison of diffusive samplers for measuring ammonia

Agricultural production systems are recognised as a major source of atmospheric ammonia. Deposition of ammonia and ammonium may contribute to undesired changes in oligotrophic ecosystems. The continuous measurement of atmospheric ammonia requires expensive and sophisticated techniques and is performed only in a very restrict number of ambient air stations in Europe. Therefore, the application of passive samplers, which have the advantage of being easy to handle and cost-efficient, is useful. In the past the comparability of different passive samplers must be considered as rather scarce. In a joint European project under the leadership of the GSF-Forschungszentrum für Umwelt und Gesundheit, Neuherberg, in 1997 a comparison of different passive ammonia monitoring methods was carried out in a prealpine rural site near Garmisch-Partenkirchen. It was considered valuable to include not only well established systems but also methods still being developed. For the comparative test ten working groups with different methods took part. A wet annular denuder system, which has been developed by the Netherlands Energy Research Foundation for on-line measurement of atmospheric ammonia, served as reference of passive methods. The experiment, which started in June and finished in December, showed that most of the passive samplers fulfil the requirements and can be recommended for further measurements. Additional measurements of meteorological parameters were performed to check the influences of different weather conditions on passive sampling.

Ozone measurements along vertical transects in the Alps

To investigate the vertical profiles of air pollutants in the boundary layer, aircraft and balloon-born measurements and measurements using a cable car as an instrument platform have been performed in different parts of the Alps. This on-line monitoring of atmospheric pollutants requires expensive and sophisticated techniques. In order to control ambient air quality in remote regions, where no infrastructure like power supply is available, simple instruments are required. The objective of this study, which was coordinated and evaluated by the GSF-Forschungszentrum für Umwelt und Gesundheit was first, to investigate the vertical distribution of ozone in different parts of the Alps and secondly, in addition to continuous analyser measurements, to test monitoring by means of two types of passive samplers. The selection of these samplers - one for one week use and another one for two week application - was based on a passive sampler intercomparison done in a preliminary study one year earlier.