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Inhibitory Effect against Listeria monocytogenes of Carbon Nanoparticles Loaded with Copper as Precursors of Food Active Packaging. Foods 2022; 11:foods11192941. [PMID: 36230015 PMCID: PMC9562255 DOI: 10.3390/foods11192941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/06/2022] [Accepted: 09/15/2022] [Indexed: 11/17/2022] Open
Abstract
Human listeriosis is a serious foodborne disease of which outbreaks are occurring increasingly frequently in Europe. Around the world, different legal requirements exist to guarantee food safety. Nanomaterials are increasingly used in the food industry as inhibitors of pathogens, and carbon nanomaterials are among the most promising. In the present study, novel carbon nanoparticles loaded with copper (CNP-Cu) were prepared, and their antimicrobial activity against Listeria monocytogenes was assessed. CNPs of two sizes were synthesized and characterized by dynamic light scattering (DLS), electrophoretic light scattering (ELS) and electron microscopy (EM). The minimum inhibitory concentration (MIC) of CNP-Cu was determined in accordance with the available standard. To get insights into its mechanism of action, the release of copper ions into a cell media was assessed by inductively coupled plasma optical emission (ICP-OE), and the ability of loaded CNPs to generate cytotoxic reactive oxygen species (ROS) was evaluated by EPR spectroscopy. Finally, the extent of release of copper in a food simulant was assessed. The results demonstrated the antimicrobial effectiveness of CNP-Cu, with growth inhibition up to 85% and a release of copper that was more pronounced in an acidic food simulant. Overall, the results indicate CNP-Cu as a promising agent for the design of active food packaging which is able to improve food shelf-life.
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Vallejo P, Cilla G, López-Olaizola M, Vicente D, Marimón JM. Epidemiology and Clinical Features of Listeriosis in Gipuzkoa, Spain, 2010-2020. Front Microbiol 2022; 13:894334. [PMID: 35755994 PMCID: PMC9218358 DOI: 10.3389/fmicb.2022.894334] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 04/29/2022] [Indexed: 12/28/2022] Open
Abstract
Background Listeriosis continues to be one of the most important notifiable foodborne diseases. Nonetheless, in Spain, there are few data on the molecular epidemiology of Listeria monocytogenes infections in recent years. Aim To describe clinical features and the molecular epidemiology of human listeriosis over an 11-year period (2010–2020) in Gipuzkoa, Northern Spain. Methods A total of 111 isolates, all but one from invasive disease, were studied. Serotyping (agglutination and multiplex polymerase chain reaction [PCR]) and multilocus sequence typing were performed for all isolates. Antibiotic susceptibility was assessed by the broth microdilution method. Results The average annual incidence of listeriosis in non-pregnancy-associated cases was 1.55 per 100,000 population, with a 1-month mortality rate of 22.2%. In pregnant women, the average incidence was 0.45 cases per 1,000 pregnancies. Twenty-four sequence types were identified, serotype 4b ST1 (24.3%) being the most frequent followed by 1/2b ST87 (18.9%), which caused two long outbreaks in 2013–2014. A significant association was observed between ST219 and meningitis (p < 0.001). All isolates were susceptible to ampicillin as well as other antibiotics used in listeriosis treatment. Conclusion Despite current control measures, listeriosis continues to be an important cause of mortality in the elderly, preterm birth, and miscarriages in pregnant women. Improvements in the control and diagnosis of listeriosis are needed to reduce the impact of this infection on vulnerable populations.
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Affiliation(s)
- Pedro Vallejo
- Microbiology Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain.,Department of Preventive Medicine, University of the Basque Country (UPV/EHU), San Sebastián, Spain
| | - Gustavo Cilla
- Microbiology Department, Infectious Diseases Area, Biodonostia Health Research Institute, Vaccine Preventable Diseases Group, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
| | - Maddi López-Olaizola
- Microbiology Department, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
| | - Diego Vicente
- Department of Preventive Medicine, University of the Basque Country (UPV/EHU), San Sebastián, Spain.,Microbiology Department, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Biodonostia Health Research Institute, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
| | - José María Marimón
- Department of Preventive Medicine, University of the Basque Country (UPV/EHU), San Sebastián, Spain.,Microbiology Department, Infectious Diseases Area, Respiratory Infection and Antimicrobial Resistance Group, Biodonostia Health Research Institute, Osakidetza Basque Health Service, Donostialdea Integrated Health Organization, San Sebastián, Spain
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3
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Bacterial and Viral Infection and Sepsis in Kidney Transplanted Patients. Biomedicines 2022; 10:biomedicines10030701. [PMID: 35327510 PMCID: PMC8944970 DOI: 10.3390/biomedicines10030701] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 03/14/2022] [Accepted: 03/15/2022] [Indexed: 02/05/2023] Open
Abstract
Kidney transplanted patients are a unique population with intrinsic susceptibility to viral and bacterial infections, mainly (but not exclusively) due to continuous immunosuppression. In this setting, infectious episodes remain among the most important causes of death, with different risks according to the degree of immunosuppression, time after transplantation, type of infection, and patient conditions. Prevention, early diagnosis, and appropriate therapy are the goals of infective management, taking into account that some specific characteristics of transplanted patients may cause a delay (the absence of fever or inflammatory symptoms, the negativity of serological tests commonly adopted for the general population, or the atypical anatomical presentation depending on the surgical site and graft implantation). This review considers the recent available findings of the most common viral and bacterial infection in kidney transplanted patients and explores risk factors and outcomes in septic evolution.
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Douchy T, Lagrou K, Jochmans I, Sainz Barriga M, Monbaliu D, Pirenne J, Debaveye Y. Solid organ donation after death from listeria encephalitis: A case report. Transpl Infect Dis 2020; 22:e13295. [PMID: 32303115 DOI: 10.1111/tid.13295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 04/06/2020] [Accepted: 04/12/2020] [Indexed: 11/30/2022]
Abstract
Despite organ shortage, organs from donors with listeria infections have been discarded for transplantation. We present the first-reported case of liver transplantation following listeria encephalitis. The patient was admitted with progressing neurological symptoms after an episode of gastroenteritis. Rhombo-encephalitis was diagnosed, and Listeria monocytogenes was found to be the causative pathogen. Despite proper antibiotic treatment and rapid clearance of bacteremia, he continued to deteriorate and became brain dead, after which organ donation was performed. At procurement, he had been treated with amoxicillin for 9 days. The recipient was treated with pipercillin/tazobactam for 21 days. Besides an anastomotic biliary stricture, necessitating endoscopic dilatation and stenting, further clinical course was uneventful and she is doing well eleven months post-transplant. Our case suggests that listeria encephalitis is not an absolute contra-indication to solid organ donation. We suggest that donors should be treated with adequate antibiotics for at least 48h prior to procurement and advocate confirmation of sterile blood cultures as a prerequisite for donation. According to listeriosis guidelines, we suggest that the recipient should be treated with targeted antibiotics for at least 2 weeks. The risk of transmission should, however, always be balanced carefully against the suspected waiting list mortality.
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Affiliation(s)
- Thomas Douchy
- Department of abdominal transplant surgery, University hospitals Leuven, Leuven, Belgium
| | - Katrien Lagrou
- Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.,Clinical Department of Laboratory Medicine, University hospitals Leuven, Leuven, Belgium
| | - Ina Jochmans
- Department of abdominal transplant surgery, University hospitals Leuven, Leuven, Belgium.,Lab of Abdominal Transplantation, Transplantation Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Mauricio Sainz Barriga
- Department of abdominal transplant surgery, University hospitals Leuven, Leuven, Belgium.,Lab of Abdominal Transplantation, Transplantation Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Diethard Monbaliu
- Department of abdominal transplant surgery, University hospitals Leuven, Leuven, Belgium.,Lab of Abdominal Transplantation, Transplantation Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Jacques Pirenne
- Department of abdominal transplant surgery, University hospitals Leuven, Leuven, Belgium.,Lab of Abdominal Transplantation, Transplantation Group, Department of Microbiology, Immunology, and Transplantation, KU Leuven, Leuven, Belgium
| | - Yves Debaveye
- Department of Intensive Care Medicine, University hospitals Leuven, Leuven, Belgium
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5
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Caruso M, Fraccalvieri R, Pasquali F, Santagada G, Latorre LM, Difato LM, Miccolupo A, Normanno G, Parisi A. Antimicrobial Susceptibility and Multilocus Sequence Typing of Listeria monocytogenes Isolated Over 11 Years from Food, Humans, and the Environment in Italy. Foodborne Pathog Dis 2020; 17:284-294. [PMID: 31718307 DOI: 10.1089/fpd.2019.2723] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Due to the increasing number of studies reporting the detection of antimicrobial-resistant isolates of Listeria monocytogenes, we sought to determine the antimicrobial susceptibility of L. monocytogenes isolates collected in Italy and find potential correlations to their serotypes and multilocus sequence types (MLST). The antimicrobial susceptibility of 317 L. monocytogenes isolates collected from food, humans, and the environment from 1998 to 2009 was assessed by minimum inhibitory concentration (MIC). Serotyping and MLST was also performed on all isolates. Potential correlations among antimicrobial resistance profiles, serotyping, and MLST were statistically evaluated. Twenty-four percent of L. monocytogenes isolates were resistant to oxacillin, 28.7% intermediate to clindamycin, and 24.3% to ciprofloxacin. The majority of isolates with elevated MIC to oxacillin was of environmental origin and belonged to serotype 4b/4e and ST2. Isolates with intermediate MIC values to clindamycin and ciprofloxacin were mostly of food and human origin and belonged to serotype 4b/4e and ST9. Regarding the time frame of isolate collection, comparing the last 3 years (2007-2009) to previous years (1998-2006), an increase was observed in the percentage of resistant and intermediate isolates per year. This trend strongly suggests the need for increasing attention on the prevalence of antimicrobial resistance in L. monocytogenes in Italy. To predict future resistance trends, the monitoring of clinical intermediate resistance might represent a useful tool especially for antibiotics associated to multiple-step mechanisms of acquired resistance. A specific focus should be addressed to antimicrobial-resistant isolates of serotype 4b, repeatedly associated with food-borne outbreaks.
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Affiliation(s)
- Marta Caruso
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | - Rosa Fraccalvieri
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | - Frédérique Pasquali
- Department of Agricultural and Food Sciences, Alma Mater Studiorum-University of Bologna, Bologna, Italy
| | - Gianfranco Santagada
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | - Laura M Latorre
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | - Laura M Difato
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | - Angela Miccolupo
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
| | | | - Antonio Parisi
- Istituto Zooprofilattico Sperimentale della Puglia e della Basilicata, Foggia, Italy
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Meropenem versus Cefotaxime and Ampicillin as Empirical Antibiotic Treatment in Adult Bacterial Meningitis: a Quality Registry Study, 2008 to 2016. Antimicrob Agents Chemother 2019; 63:AAC.00883-19. [PMID: 31501148 DOI: 10.1128/aac.00883-19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2019] [Accepted: 08/22/2019] [Indexed: 11/20/2022] Open
Abstract
Cefotaxime, alone or with ampicillin, is frequently used in empirical treatment of acute bacterial meningitis (ABM). Meropenem is a less extensively investigated alternative. The aim of the study was to investigate the effects of empirical treatment with meropenem compared to cefotaxime plus ampicillin on outcome in ABM. The study was based on data from the Swedish quality register for ABM collected between January 2008 and December 2016. Propensity score matching was performed to adjust for baseline differences between the groups. Mortality within 30 days was the primary outcome. The treatment regimens of interest were administered to 623 patients; 328 were given cefotaxime plus ampicillin whereas 295 received meropenem. Using propensity score matching, the 30-day mortality rates were 3.2% in the cefotaxime plus ampicillin group and 3.6% in the meropenem group. For matched cases, the odds ratio (OR) for 30-day mortality for meropenem versus cefotaxime plus ampicillin was 1.15 (confidence interval [CI], 0.41 to 3.22; P = 0.79). The OR for 90-day mortality was 1.47 (CI, 0.62 to 3.52; P = 0.38) and for unfavorable outcome was 1.10 (CI, 0.75 to 1.63; P = 0.62). The findings of our study indicate that meropenem is an effective empirical treatment option for adults with community-acquired ABM. However, to spare carbapenems, guidelines should continue to recommend third-generation cephalosporins as an empirical treatment for the majority of patients with ABM.
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Roedel A, Dieckmann R, Brendebach H, Hammerl JA, Kleta S, Noll M, Al Dahouk S, Vincze S. Biocide-Tolerant Listeria monocytogenes Isolates from German Food Production Plants Do Not Show Cross-Resistance to Clinically Relevant Antibiotics. Appl Environ Microbiol 2019; 85:e01253-19. [PMID: 31375490 PMCID: PMC6805086 DOI: 10.1128/aem.01253-19] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 07/24/2019] [Indexed: 01/02/2023] Open
Abstract
Contamination of food during processing is recognized as a main transmission route of Listeria monocytogenes To prevent microbial contamination, biocides are widely applied as disinfectants in food processing plants. However, there are concerns about the development of antimicrobial resistance in foodborne pathogens due to widespread biocide usage. In our study, 93 L. monocytogenes isolates from German food production facilities were (i) tested for biocide and antibiotic susceptibility using broth microdilution assays, (ii) analyzed for links between reduced biocide susceptibility and antibiotic resistance, and (iii) characterized by whole-genome sequencing, including the detection of genes coding for biocide tolerance, antibiotic resistance, and other virulence factors. Fifteen L. monocytogenes isolates were tolerant to benzalkonium chloride (BAC), and genes conferring BAC tolerance were found in 13 of them. Antibiotic resistance was not associated with biocide tolerance. BAC-tolerant isolates were assigned to 6 multilocus sequence type (MLST) clonal complexes, and most of them harbored internalin A pseudogenes with premature stop codons or deletions (n = 9). Our study demonstrated a high genetic diversity among the investigated isolates including genotypes that are frequently involved in human infections. Although in vitro adaptation studies to biocides have raised concerns about increasing cross-resistance to antibiotics, our results do not provide evidence for this phenomenon in field isolates.IMPORTANCE Foodborne pathogens such as L. monocytogenes can persist in food production environments for a long time, causing perennial outbreaks. Hence, bacterial pathogens are able to survive cleaning and disinfection procedures. Accordingly, they may be repeatedly exposed to sublethal concentrations of disinfectants, which might result in bacterial adaptation to these biocides. Furthermore, antibiotic coresistance and cross-resistance are known to evolve under biocide selection pressure in vitro Hence, antimicrobial tolerance seems to play a crucial role in the resilience and persistence of foodborne pathogens in the food chain and might reduce therapeutic options in infectious diseases.
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Affiliation(s)
- A Roedel
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - R Dieckmann
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - H Brendebach
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - J A Hammerl
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - S Kleta
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - M Noll
- University of Applied Sciences and Arts, Institute for Bioanalysis, Coburg, Germany
| | - S Al Dahouk
- German Federal Institute for Risk Assessment, Berlin, Germany
| | - S Vincze
- German Federal Institute for Risk Assessment, Berlin, Germany
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8
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Pupo I, Lepe JA, Smani Y, Aznar J. Comparison of the in vitro activity of ampicillin and moxifloxacin against Listeria monocytogenes at achievable concentrations in the central nervous system. J Med Microbiol 2017; 66:713-720. [PMID: 28598305 DOI: 10.1099/jmm.0.000486] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
PURPOSE The aim of this study was to compare the in vitro activity of ampicillin and moxifloxacin against six isolates selected from 154 invasive clinical isolates of Listeria monocytogenes and evaluate their intra- and extracellular activities with achievable central nervous system concentrations obtained using Monte Carlo simulations with conventional and unconventional dosages. METHODOLOGY The MICs and minimal bactericidal concentrations (MBCs) of ampicillin and moxifloxacin were determined by using the broth microdilution method. The intra- and extracellular activities were compared using time-kill curves and inhibition of intracellular growth assays. RESULTS The MICs50/90 of ampicillin were 0.125/0.5 mg l-1 and the MBC50/90 was ≥16 mg l-1, while the moxifloxacin MICs50/90 were 0.25/0.5 mg l-1 and the MBC50/90 was 0.5 mg l-1. Ampicillin did not show any extracellular bactericidal activity at 24 h, although bactericidal activity was detected at 48 h. For moxifloxacin, the bactericidal effect was evident after 6 h of incubation. Both antibiotics achieved significant reductions in intracellular inoculum after 1-24 h of incubation; however, moxifloxacin becomes bactericidal more rapidly, producing a much greater reduction in the inoculum in the first hour than ampicillin. There were no differences among the MIC and MBC values of moxifloxacin and ampicillin among the strains belonging to different serotypes and/or epidemic clones. This fact was also found in the intra- and extracellular studies. CONCLUSION The results of this study demonstrated the faster bactericidal activity of moxifloxacin at achievable central nervous system concentrations against intra- and extracellular forms of L. monocytogenes in comparison with ampicillin.
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Affiliation(s)
- Inmaculada Pupo
- Infectious Diseases, Microbiology and Preventive Medicine Clinical Unit, University Hospital Virgen del Rocío, Seville, Spain
| | - Jose A Lepe
- Infectious Diseases, Microbiology and Preventive Medicine Clinical Unit, University Hospital Virgen del Rocío, Seville, Spain.,Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Seville, Spain
| | - Younes Smani
- Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Seville, Spain
| | - Javier Aznar
- Infectious Diseases, Microbiology and Preventive Medicine Clinical Unit, University Hospital Virgen del Rocío, Seville, Spain.,Institute of Biomedicine of Seville (IBiS), University Hospital Virgen del Rocío/CSIC/University of Seville, Seville, Spain.,Microbiology Department, University of Seville, Spain
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9
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Sapuan S, Kortsalioudaki C, Anthony M, Chang J, Embleton ND, Geethanath RM, Gray J, Greenough A, Lal MK, Luck S, Pattnayak S, Reynolds P, Russell AB, Scorrer T, Turner M, Heath PT, Vergnano S. Neonatal listeriosis in the UK 2004-2014. J Infect 2016; 74:236-242. [PMID: 27867063 DOI: 10.1016/j.jinf.2016.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2016] [Revised: 09/20/2016] [Accepted: 11/10/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To define the clinical features and outcomes of neonatal listeriosis, and identify the maternal risk factors to seek scope for improvement. METHODS Neonatal listeriosis was identified prospectively from a United Kingdom neonatal infection surveillance network (neonIN) between 2004 and 2014. The participating neonatal units completed a study-specific proforma. RESULTS The incidence of neonatal listeriosis was 3.4 per 100,000 live births. Of the 21 cases identified, 19 were confirmed with a median gestational age of 33 weeks and a median birth weight of 1960 g. The majority had clinical features (95%, 18/19), presented within the first 24 h (95%, 18/19), and received penicillin empirically (94%, 18/19). The neonatal case-fatality rate was 21% (24% if probable cases were included). A proportion of mothers were investigated (60%, 12/18) and diagnosed with listeriosis (58%, 7/12); 32% (6/19) were treated with antibiotics but only 33% (6/12) included penicillin. DISCUSSION Despite its rarity and the prompt and appropriate use of antibiotics neonatal listeriosis has a high case-fatality rate. There is room for improvement in the adherence to the empiric antibiotic choice for puerperal sepsis, according to the national guidelines as this, would target listeriosis. Strategies should be in place to prevent pregnancy-associated listeriosis in higher risk population.
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Affiliation(s)
- Shari Sapuan
- Paediatric Infectious Diseases Research Group, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Mail Point J2C, London, SW17 0RE, UK.
| | - Christina Kortsalioudaki
- Paediatric Infectious Diseases Research Group, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Mail Point J2C, London, SW17 0RE, UK.
| | - Mark Anthony
- Children's Services, John Radcliffe Hospital, Oxford University Hospitals NHSFT, Newborn Care Unit, Headington, Oxford, OX3 9DU, UK.
| | - John Chang
- Croydon Health Services NHS Trust, St George's University of London, Croydon University Hospital, 530 London Rd, Croydon, Surrey, CR7 7YE, UK.
| | - Nicholas D Embleton
- Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Newcastle upon Tyne, NE1 4LP, UK.
| | - Ruppa M Geethanath
- City Hospital Sunderland NHSFT, Sunderland Royal Hospital, Kayll Road, Sunderland, SR4 7TP, UK.
| | - Jim Gray
- Birmingham Children's Hospital NHSFT, Birmingham Children's Hospital, Steelhouse Lane, Birmingham, B4 6NH, UK.
| | - Anne Greenough
- King's College London, King's Health Partners, Royal College of Paediatrics and Child Health, Neonatal Intensive Care Unit, King's College Hospital, 4th Floor Golden Jubilee Wing, Denmark Hill, SE5 9RS, UK.
| | - Mithilesh K Lal
- Department of Neonatal Medicine, The James Cook University Hospital, Marton Road, Middlesbrough, TS4 3BW, UK.
| | - Suzanne Luck
- Kingston Hospital NHS Trust, Galsworthy Rd, Kingston upon Thames, KT2 7QB, UK.
| | - Santosh Pattnayak
- Kent Neonatal Transport Service, Medway NHS Foundation Trust, Gillingham Kent, ME7 5NY, UK.
| | - Peter Reynolds
- Department of Paediatrics, St. Peter's Hospital, Ashford and St. Peter's Hospitals NHSFT, Royal Holloway University of London, Surrey & Sussex Neonatal ODN, Guildford Road, Surrey, KT16 0PZ, UK.
| | - Allison B Russell
- Birmingham Women's NHSFT, West Midlands Maternity and Children's Strategic Clinical Network, Mindelsohn Way, Birmingham, B15 2TG, UK.
| | - Timothy Scorrer
- Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Portsmouth Hospitals NHS Trust, Southwick Hill Road, Portsmouth, PO6 3LY, UK.
| | - Mark Turner
- Women's and Children's Health, University of Liverpool, Liverpool Women's NHSFT, Institute of Translational Medicine, Crown St, Liverpool, L8 7SS, UK.
| | - Paul T Heath
- Paediatric Infectious Diseases Research Group, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Mail Point J2C, London, SW17 0RE, UK.
| | - Stefania Vergnano
- Paediatric Infectious Diseases Research Group, St George's University of London, Jenner Wing, Level 2, Room 2.215E, Mail Point J2C, London, SW17 0RE, UK; Paediatric Infectious Diseases, Bristol Royal Hospital for Children, University of Bristol, Level 6, UH Bristol Education and Research Centre, Upper Maudlin Street, Bristol BS2 8AE, UK.
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