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Zarske M, Luu HQ, Deneke C, Knüver MT, Thieck M, Hoang HTT, Bretschneider N, Pham NT, Huber I, Stingl K. Identification of knowledge gaps in whole-genome sequence analysis of multi-resistant thermotolerant Campylobacter spp. BMC Genomics 2024; 25:156. [PMID: 38331708 PMCID: PMC10851486 DOI: 10.1186/s12864-024-10014-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 01/14/2024] [Indexed: 02/10/2024] Open
Abstract
BACKGROUND Campylobacter spp. is the most frequent cause of bacterial food-borne gastroenteritis and a high priority antibiotic resistant bacterium according to the World Health Organization (WHO). European monitoring of thermotolerant Campylobacter spp. does not reflect the global burden of resistances already circulating within the bacterial population worldwide. METHODS We systematically compared whole genome sequencing with comprehensive phenotypic antimicrobial susceptibility, analyzing 494 thermotolerant Campylobacter poultry isolates from Vietnam and Germany. Any discrepancy was checked by repeating the wet lab and improving the dry lab part. Selected isolates were additionally analyzed via long-read Oxford Nanopore technology, leading to closed chromosomes and plasmids. RESULTS Overall, 22 different resistance genes and gene variants (e. g. erm(B), aph(3')-IIIa, aph(2'')-If, catA, lnu(C), blaOXA, sat4) and point mutations in three distinct genes (gyrA, 23S rRNA, rpsL) associated with AMR were present in the Campylobacter isolates. Two AMR genes were missing in the database and one falsely associated with resistance. Bioinformatic analysis based on short-read data partly failed to identify tet(O) and aadE, when the genes were present as duplicate or homologous gene variants. Intriguingly, isolates also contained different determinants, redundantly conferring resistance to chloramphenicol, gentamicin, kanamycin, lincomycin and streptomycin. We found a novel tet(W) in tetracycline sensitive strains, harboring point mutations. Furthermore, analysis based on assemblies from short-read data was impaired to identify full length phase variable aad9, due to variations of the poly-C tract within the gene. The genetic determinant responsible for gentamicin resistance of one isolate from Germany could not be identified. GyrT86I, presenting the main determinant for (fluoro-)quinolone resistance led to a rare atypical phenotype of ciprofloxacin resistance but nalidixic acid sensitivity. Long-read sequencing predicted AMR genes were mainly located on the chromosome, and rarely on plasmids. Predictions from long- and short-read sequencing, respectively, often differed. AMR genes were often organized in multidrug resistance islands (MDRI) and partially located in proximity to transposase genes, suggesting main mobilization of resistance determinants is via natural transformation and transposition in Campylobacter. CONCLUSIONS The results of this study suggest that there is frequent resistance gene duplication, mosaicism, and mutation leading to gene variation and truncation in Campylobacter strains that have not been reported in previous studies and are missing from databases. Furthermore, there is a need for deciphering yet unknown resistance mechanisms and resistance spread in thermotolerant Campylobacter spp. that may pose a challenge to global food safety.
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Affiliation(s)
- Michael Zarske
- Department of Biological Safety, Federal Institute for Risk Assessment (BfR), Diedersdorfer Weg 1, Berlin, D-12277, Germany
| | - Huong Quynh Luu
- National Institute of Veterinary Research (NIVR), 86 Truong Chinh Street, Hanoi, Dong Da District, Vietnam
| | - Carlus Deneke
- Department of Biological Safety, Federal Institute for Risk Assessment (BfR), Diedersdorfer Weg 1, Berlin, D-12277, Germany
| | - Marie-Theres Knüver
- Department of Biological Safety, Federal Institute for Risk Assessment (BfR), Diedersdorfer Weg 1, Berlin, D-12277, Germany
| | - Maja Thieck
- Department of Biological Safety, Federal Institute for Risk Assessment (BfR), Diedersdorfer Weg 1, Berlin, D-12277, Germany
| | - Ha Thi Thu Hoang
- Department of Bacteriology, National Institute of Hygiene and Epidemiology (NIHE), 1 Yersin Street, Hanoi, Trung District, Vietnam
| | - Nancy Bretschneider
- Department of Molecular Biology and Gene Technology, Bavarian Health and Food Safety Authority, Oberschleissheim, D-85764, Germany
| | - Ngoc Thi Pham
- National Institute of Veterinary Research (NIVR), 86 Truong Chinh Street, Hanoi, Dong Da District, Vietnam
| | - Ingrid Huber
- Department of Molecular Biology and Gene Technology, Bavarian Health and Food Safety Authority, Oberschleissheim, D-85764, Germany
| | - Kerstin Stingl
- Department of Biological Safety, Federal Institute for Risk Assessment (BfR), Diedersdorfer Weg 1, Berlin, D-12277, Germany.
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Hovmand N, Christensen HC, Lundbo LF, Sandholdt H, Kronborg G, Darsø P, Anhøj J, Blomberg SNF, Bisgaard AT, Benfield T. Nonspecific symptoms dominate at first contact to emergency healthcare services among cases with invasive meningococcal disease. BMC FAMILY PRACTICE 2021; 22:240. [PMID: 34847878 PMCID: PMC8630890 DOI: 10.1186/s12875-021-01585-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 11/11/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND An early appropriate response is the cornerstone of treatment for invasive meningococcal disease. Little evidence exists on how cases with invasive meningococcal disease present at first contact to emergency medical services. METHODS Retrospective observational study of cases presenting with invasive meningococcal disease from January 1st of 2016 to December 31st of 2020 in the Capital Region of Denmark with a catchment area population of 1,800,000. A single medical emergency center provides services to the region. Data was collected from emergency medical services' call audio files, data from the call receiver registrations, registrations from ambulance personal and electronic health record data from the hospitalization. RESULTS Of 1527 cases suspected of meningitis, 38 had invasive meningococcal disease and had been in contact with the emergency service. Most contacts were to the medical helpline rather than the emergency call center at initial contact to emergency medical services. All were hospitalized within 12 h. At initial contact, fever was present in 28 (74%) of 38 cases, while specific symptoms such as headache (n=12 (32%)), a rash or petechiae (n=9 (23%)) and stiffness of the neck (n=4 (11%)) varied and were infrequent. Cases younger than 18 years of age were more often male and more often presented with fever and rash/petechiae. Only 4 (11%) received prehospital antibiotic treatment. CONCLUSIONS Cases with invasive meningococcal disease presented with fever and unspecific symptoms. Although few were acutely ill at their initial contact, all were admitted within 12 h. We suggest that all feverish cases should be systematically asked about specific symptoms and should be wary of symptom progression to optimize the early management if cases with invasive meningococcal disease.
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Affiliation(s)
- Nichlas Hovmand
- Center for Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark. .,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - Helle Collatz Christensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Emergency Medical Services, Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark
| | - Lene Fogt Lundbo
- Center for Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Håkon Sandholdt
- Center for Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Gitte Kronborg
- Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark
| | - Perle Darsø
- Center for Health, Capital Region of Denmark, Kongens Vaenge 2, 3400, Hillerød, Denmark
| | - Jacob Anhøj
- Diagnostic Center, Copenhagen University Hospital - Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark
| | - Stig Nikolaj Fasmer Blomberg
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Emergency Medical Services, Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark
| | - Asmus Thun Bisgaard
- Emergency Medical Services, Capital Region of Denmark, Telegrafvej 5, 2750, Ballerup, Denmark
| | - Thomas Benfield
- Center for Research & Disruption of Infectious Diseases (CREDID), Department of Infectious Diseases, Copenhagen University Hospital - Amager and Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Pearce J, Peters M, May N, Marshall H, Hein C, Grantham H. Care of the patient with invasive meningococcal disease by prehospital emergency medical service clinicians: a scoping review. BMJ Open 2020; 10:e033447. [PMID: 32114468 PMCID: PMC7050377 DOI: 10.1136/bmjopen-2019-033447] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 11/12/2019] [Accepted: 02/12/2020] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE The objective of this scoping review is to systematically map the literature to identify the scope, depth, key concepts and gaps in the evidence regarding care of the patient with invasive meningococcal disease by emergency medical service (EMS) clinicians. DESIGN Scoping review. This review is reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews reporting guideline. ELIGIBILITY CRITERIA Sources which focused on patients with invasive meningococcal disease (population), where the care of EMS clinicians was the focus (concept), in EMS systems worldwide (context) were eligible for inclusion. SEARCH STRATEGY This review utilised a comprehensive search strategy including MEDLINE, Embase, Emcare, CINAHL, Scopus, Web of Science, Google Scholar and 'grey' literature databases from 1992 to January 2019. The search also included a Google search, a hand-search of relevant journals, screening of reference lists, contact with authors of included sources and use of social media in an attempt to locate all sources of evidence which fit the inclusion criteria of the review. Two reviewers independently screened sources for inclusion. RESULTS The search yielded 1803 unique records, of which 10 were included in the synthesis. No original research papers were identified, with all sources classed as either clinical audit or text and opinion literature. The dominant concept throughout the literature is that early antibiotic therapy is critical in the treatment of invasive meningococcal disease. CONCLUSIONS Overall, there is a very narrow scope and shallow depth of literature on the topic of interest. There are gaps in the evidence regarding the care of the patient with invasive meningococcal disease by EMS clinicians. Despite these shortfalls, current consensus-based guidelines should direct clinical practice. Further research is planned to bridge the gaps in knowledge to support best practice.
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Affiliation(s)
- James Pearce
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- South Australian Ambulance Service, Adelaide, South Australia, Australia
| | - Micah Peters
- Rosemary Bryant AO Research Centre, School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia
| | - Nikki May
- SA Health Library Service, Bedford Park, South Australia, Australia
| | - Helen Marshall
- School of Medicine and Robinson Research Institute, The University of Adelaide, Adelaide, South Australia, Australia
- Vaccinology and Immunology Research Trials Unit, Discipline of Paediatrics, Women's and Children's Hospital Adelaide, North Adelaide, South Australia, Australia
| | - Cindy Hein
- College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia
- South Australian Ambulance Service, Adelaide, South Australia, Australia
| | - Hugh Grantham
- South Australian Ambulance Service, Adelaide, South Australia, Australia
- Faculty of Health Sciences, School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
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Wall ECB, Ajdukiewicz KMB, Bergman H, Heyderman RS, Garner P. Osmotic therapies added to antibiotics for acute bacterial meningitis. Cochrane Database Syst Rev 2018; 2:CD008806. [PMID: 29405037 PMCID: PMC5815491 DOI: 10.1002/14651858.cd008806.pub3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Every day children and adults die from acute community-acquired bacterial meningitis, particularly in low-income countries, and survivors risk deafness, epilepsy and neurological disabilities. Osmotic therapies may attract extra-vascular fluid and reduce cerebral oedema, and thus reduce death and improve neurological outcomes.This is an update of a Cochrane Review first published in 2013. OBJECTIVES To evaluate the effects of osmotic therapies added to antibiotics for acute bacterial meningitis in children and adults on mortality, deafness and neurological disability. SEARCH METHODS We searched CENTRAL (2017, Issue 1), MEDLINE (1950 to 17 February 2017), Embase (1974 to 17 February 2017), CINAHL (1981 to 17 February 2017), LILACS (1982 to 17 February 2017) and registers of ongoing clinical trials (ClinicalTrials.com, WHO ICTRP) (21 February 2017). We also searched conference abstracts and contacted researchers in the field (up to 12 December 2015). SELECTION CRITERIA Randomised controlled trials testing any osmotic therapy in adults or children with acute bacterial meningitis. DATA COLLECTION AND ANALYSIS Two review authors independently screened the search results and selected trials for inclusion. Results are presented using risk ratios (RR) and 95% confidence intervals (CI) and grouped according to whether the participants received steroids or not. We used the GRADE approach to assess the certainty of the evidence. MAIN RESULTS We included five trials with 1451 participants. Four trials evaluated glycerol against placebo, and one evaluated glycerol against 50% dextrose; in addition three trials evaluated dexamethasone and one trial evaluated acetaminophen (paracetamol) in a factorial design. Stratified analysis shows no effect modification with steroids; we present aggregate effect estimates.Compared to placebo, glycerol probably has little or no effect on death in people with bacterial meningitis (RR 1.08, 95% CI 0.90 to 1.30; 5 studies, 1272 participants; moderate-certainty evidence), but may reduce neurological disability (RR 0.73, 95% CI 0.53 to 1.00; 5 studies, 1270 participants; low-certainty evidence).Glycerol may have little or no effect on seizures during treatment for meningitis (RR 1.08, 95% CI 0.90 to 1.30; 4 studies, 1090 participants; low-certainty evidence).Glycerol may reduce the risk of subsequent deafness (RR 0.64, 95% CI 0.44 to 0.93; 5 studies, 922 participants; low to moderate-certainty evidence).Glycerol probably has little or no effect on gastrointestinal bleeding (RR 0.93, 95% CI 0.39 to 2.19; 3 studies, 607 participants; moderate-certainty evidence). The evidence on nausea, vomiting and diarrhoea is uncertain (RR 1.09, 95% CI 0.81 to 1.47; 2 studies, 851 participants; very low-certainty evidence). AUTHORS' CONCLUSIONS Glycerol was the only osmotic therapy evaluated, and data from trials to date have not demonstrated an effect on death. Glycerol may reduce neurological deficiency and deafness.
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Affiliation(s)
- Emma CB Wall
- University College LondonDivision of Infection and ImmunityGower StreetLondonUKWC1E 6BT
| | - Katherine MB Ajdukiewicz
- Pennine Acute Hospitals NHS TrustDepartment of Infectious DiseasesNorth Manchester General HospitalDelaunays Road, CrumpsallManchesterUKMB 5RB
| | - Hanna Bergman
- CochraneCochrane ResponseSt Albans House57‐59 HaymarketLondonUKSW1Y 4QX
| | - Robert S Heyderman
- University of Malawi College of MedicineMalawi‐Liverpool‐Wellcome Clinical Research ProgrammeP. O Box 30096BlantyreChichiriMalawi
| | - Paul Garner
- Liverpool School of Tropical MedicineDepartment of Clinical SciencesPembroke PlaceLiverpoolMerseysideUKL3 5QA
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