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Hadjirin NF, van Tonder AJ, Blane B, Lees JA, Kumar N, Delappe N, Brennan W, McGrath E, Parkhill J, Cormican M, Peacock SJ, Ludden C. Dissemination of carbapenemase-producing Enterobacterales in Ireland from 2012 to 2017: a retrospective genomic surveillance study. Microb Genom 2023; 9:mgen000924. [PMID: 36916881 PMCID: PMC10132065 DOI: 10.1099/mgen.0.000924] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 11/03/2022] [Indexed: 03/16/2023] Open
Abstract
The spread of carbapenemase-producing Enterobacterales (CPE) is of major public health concern. The transmission dynamics of CPE in hospitals, particularly at the national level, are not well understood. Here, we describe a retrospective nationwide genomic surveillance study of CPE in Ireland between 2012 and 2017. We sequenced 746 national surveillance CPE samples obtained between 2012 and 2017. After clustering the sequences, we used thresholds based on pairwise SNPs, and reported within-host diversity along with epidemiological data to infer recent putative transmissions. All clusters in circulating clones, derived from high-resolution phylogenies, of a species (Klebsiella pneumoniae, Escherichia coli, Klebsiella oxytoca, Enterobacter cloacae, Enterobacter hormaechei and Citrobacter freundii) were individually examined for evidence of transmission. Antimicrobial resistance trends over time were also assessed. We identified 352 putative transmission events in six species including widespread and frequent transmissions in three species. We detected putative outbreaks in 4/6 species with three hospitals experiencing prolonged outbreaks. The bla OXA-48 gene was the main cause of carbapenem resistance in Ireland in almost all species. An expansion in the number of sequence types carrying bla OXA-48 was an additional cause of the increasing prevalence of carbapenemase-producing K. pneumoniae and E. coli.
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Affiliation(s)
- Nazreen F. Hadjirin
- Department of Medicine, University of Cambridge, Box 157, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0QQ, UK
- Nuffield Department of Population Health, University of Oxford, Oxford OX3 7LF, UK
| | - Andries J. van Tonder
- Department of Veterinary Medicine, University of Cambridge, Madingley Rd, Cambridge, CB3 0ES, UK
| | - Beth Blane
- Department of Medicine, University of Cambridge, Box 157, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0QQ, UK
| | - John A. Lees
- MRC Centre for Global Infectious Disease Analysis, School of Public Health, Imperial College London, London, UK
| | - Narender Kumar
- Wellcome Trust Sanger Institute Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
| | - Niall Delappe
- National CPE Reference Laboratory, University Hospital Galway, Galway, Ireland
| | - Wendy Brennan
- National CPE Reference Laboratory, University Hospital Galway, Galway, Ireland
| | - Elaine McGrath
- National CPE Reference Laboratory, University Hospital Galway, Galway, Ireland
| | - Julian Parkhill
- Department of Veterinary Medicine, University of Cambridge, Madingley Rd, Cambridge, CB3 0ES, UK
| | - Martin Cormican
- National CPE Reference Laboratory, University Hospital Galway, Galway, Ireland
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, University of Galway, Galway, Ireland
| | - Sharon J. Peacock
- Department of Medicine, University of Cambridge, Box 157, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0QQ, UK
| | - Catherine Ludden
- Department of Medicine, University of Cambridge, Box 157, Addenbrooke’s Hospital, Hills Rd, Cambridge, CB2 0QQ, UK
- Wellcome Trust Sanger Institute Wellcome Trust Genome Campus, Hinxton, Cambridge, CB10 1SA, UK
- Department of Infection Biology, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK
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2
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Brehony C, McGrath E, Brennan W, Tuohy A, Whyte T, Brisse S, Maiden M, Jolley K, Morris D, Cormican M. An MLST approach to support tracking of plasmids carrying OXA-48-like carbapenemase. J Antimicrob Chemother 2020; 74:1856-1862. [PMID: 31225613 PMCID: PMC6587408 DOI: 10.1093/jac/dkz136] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Revised: 02/28/2019] [Accepted: 03/07/2019] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES The prevalence of infections caused by OXA-48-like carbapenemase-producing organisms in Ireland has increased dramatically since 2011 and is an urgent public health issue. Genome-based high-resolution genotyping was used to analyse clinical isolates submitted to the Irish Carbapenemase-Producing Enterobacteriaceae Reference Laboratory Service for a 13 month period (2016-17). METHODS A total of 109 OXA-48-producing non-duplicate clinical isolates from 16 submitting centres were sequenced. Using a gene-by-gene approach, isolate genomes were characterized by MLST and core genome MLST, and the presence of antimicrobial resistance determinants was determined. Reference mapping and a novel plasmid MLST-type approach was applied to determine plasmid background. RESULTS The OXA-48-like-producing isolates were Escherichia coli (n = 56), Klebsiella spp. (n = 46) and Enterobacter cloacae (n = 7). Amongst the E. coli isolates there were 37 different STs and amongst the Klebsiella spp. isolates there were 27 different STs. blaOXA-48 was present in 105/109 (96.3%) of isolates. Based on mapping analysis and detection of the pOXA-48 IncL-type plasmid replicon and backbone genes, a pOXA-48-like plasmid was identified in 93/109 isolates (85.3%). The remaining isolates (n = 16; 14.7%) harboured blaOXA-48-like genes in unknown environments. Using a gene-by-gene approach two pOXA-48-like plasmid groups with 2/71 pOXA-48-like locus differences between them were identified. CONCLUSIONS In Ireland we found a diversity of genotypes associated with OXA-48-like-producing clinical isolates with the IncL pOXA-48 plasmid type predominating as the blaOXA-48 genetic environment. A plasmid MLST approach can rapidly identify plasmids associated with outbreaks and monitor spread of types temporally and geographically.
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Affiliation(s)
- Carina Brehony
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland
| | - Elaine McGrath
- National CPE Reference Laboratory, University Hospital Galway, Galway, Ireland
| | - Wendy Brennan
- National CPE Reference Laboratory, University Hospital Galway, Galway, Ireland
| | - Alma Tuohy
- National CPE Reference Laboratory, University Hospital Galway, Galway, Ireland
| | - Thomas Whyte
- National CPE Reference Laboratory, University Hospital Galway, Galway, Ireland
| | - Sylvain Brisse
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France
| | - Martin Maiden
- Department of Zoology, University of Oxford, Oxford, UK
| | - Keith Jolley
- Department of Zoology, University of Oxford, Oxford, UK
| | - Dearbháile Morris
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland
| | - Martin Cormican
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland.,National CPE Reference Laboratory, University Hospital Galway, Galway, Ireland
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Doyle RM, O'Sullivan DM, Aller SD, Bruchmann S, Clark T, Coello Pelegrin A, Cormican M, Diez Benavente E, Ellington MJ, McGrath E, Motro Y, Phuong Thuy Nguyen T, Phelan J, Shaw LP, Stabler RA, van Belkum A, van Dorp L, Woodford N, Moran-Gilad J, Huggett JF, Harris KA. Discordant bioinformatic predictions of antimicrobial resistance from whole-genome sequencing data of bacterial isolates: an inter-laboratory study. Microb Genom 2020; 6:e000335. [PMID: 32048983 PMCID: PMC7067211 DOI: 10.1099/mgen.0.000335] [Citation(s) in RCA: 52] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 01/17/2020] [Indexed: 01/21/2023] Open
Abstract
Antimicrobial resistance (AMR) poses a threat to public health. Clinical microbiology laboratories typically rely on culturing bacteria for antimicrobial-susceptibility testing (AST). As the implementation costs and technical barriers fall, whole-genome sequencing (WGS) has emerged as a 'one-stop' test for epidemiological and predictive AST results. Few published comparisons exist for the myriad analytical pipelines used for predicting AMR. To address this, we performed an inter-laboratory study providing sets of participating researchers with identical short-read WGS data from clinical isolates, allowing us to assess the reproducibility of the bioinformatic prediction of AMR between participants, and identify problem cases and factors that lead to discordant results. We produced ten WGS datasets of varying quality from cultured carbapenem-resistant organisms obtained from clinical samples sequenced on either an Illumina NextSeq or HiSeq instrument. Nine participating teams ('participants') were provided these sequence data without any other contextual information. Each participant used their choice of pipeline to determine the species, the presence of resistance-associated genes, and to predict susceptibility or resistance to amikacin, gentamicin, ciprofloxacin and cefotaxime. We found participants predicted different numbers of AMR-associated genes and different gene variants from the same clinical samples. The quality of the sequence data, choice of bioinformatic pipeline and interpretation of the results all contributed to discordance between participants. Although much of the inaccurate gene variant annotation did not affect genotypic resistance predictions, we observed low specificity when compared to phenotypic AST results, but this improved in samples with higher read depths. Had the results been used to predict AST and guide treatment, a different antibiotic would have been recommended for each isolate by at least one participant. These challenges, at the final analytical stage of using WGS to predict AMR, suggest the need for refinements when using this technology in clinical settings. Comprehensive public resistance sequence databases, full recommendations on sequence data quality and standardization in the comparisons between genotype and resistance phenotypes will all play a fundamental role in the successful implementation of AST prediction using WGS in clinical microbiology laboratories.
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Affiliation(s)
- Ronan M. Doyle
- Clinical Research Department, London School of Hygiene and Tropical Medicine, London, UK
- Microbiology Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
| | - Denise M. O'Sullivan
- Molecular and Cell Biology Team, National Measurement Laboratory, Queens Road, Teddington, Middlesex, UK
| | - Sean D. Aller
- Institute for Infection and Immunity, St George’s, University of London, Cranmer Terrace, London, UK
| | - Sebastian Bruchmann
- Pathogen Genomics, Wellcome Sanger Institute, Wellcome Genome Campus, Hinxton, UK
| | - Taane Clark
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Andreu Coello Pelegrin
- Clinical Unit, bioMérieux, La Balme Les Grottes, France
- Vaccine and Infectious Disease Institute, Laboratory of Medical Microbiology, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | | | - Ernest Diez Benavente
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Elaine McGrath
- Carbapenemase-Producing Enterobacterales Reference Laboratory, Department of Medical Microbiology, University Hospital Galway, Galway, Ireland
| | - Yair Motro
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Thi Phuong Thuy Nguyen
- Department of BiNano Technology, College of BiNano Technology, Gachon University, Seoul, Republic of Korea
| | - Jody Phelan
- Department of Infection Biology, London School of Hygiene and Tropical Medicine, London, UK
| | - Liam P. Shaw
- Nuffield Department of Medicine, University of Oxford, John Radcliffe Hospital, Oxford, UK
| | | | | | - Lucy van Dorp
- UCL Genetics Institute, Department of Genetics, Evolution and Environment, University College London, Gower Street, London, UK
| | - Neil Woodford
- NIS Laboratories, National Infection Service, Public Health England, London, UK
| | - Jacob Moran-Gilad
- School of Public Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Jim F. Huggett
- Molecular and Cell Biology Team, National Measurement Laboratory, Queens Road, Teddington, Middlesex, UK
- School of Biosciences and Medicine, Faculty of Health and Medical Science, University of Surrey, Guildford, UK
| | - Kathryn A. Harris
- Microbiology Department, Great Ormond Street Hospital NHS Foundation Trust, London, UK
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Stroka J, von Holst C, Anklam E, Reutter M, Barmark A, Brera C, Burdaspal P, Daily S, Declercq B, de Jong J, Eckstein H, Eklund E, Felgueiras I, Goto T, Hagler W, Joerissen U, Lew H, Ligi-Martins M, MacDonald S, Macho L, Marzna I, McGrath E, Michelet JY, Nordkvist E, Noutio K, Pascale M, Roos A, Schwadorf K, Spanjer M, Szymanski L, Visconti A, Walsh M, Werner G, Whitaker T, Wilson D, Worswick R. Immunoaffinity Column Cleanup with Liquid Chromatography Using Post-Column Bromination for Determination of Aflatoxin B1 in Cattle Feed: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.6.1179] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
A collaborative study was conducted to evaluate the effectiveness of an immunoaffinity column cleanup liquid chromatography (LC) method for determination of aflatoxin B1 in cattle feed at a possible future European regulatory limit (1 ng/g). The test portion was extracted with acetone–water (85 + 15), filtered, diluted with water, and applied to an immunoaffinity column. The column was washed with water to remove interfering compounds, and the purified aflatoxin B1 was eluted with methanol. Aflatoxin B1 was separated and determined by reversed-phase liquid chromatography (RP–LC) and detected by fluorescence after post column derivatization (PCD) involving bromination. PCD was achieved with either pyridinium hydrobromide perbromide (PBPB), used by 14 laboratories, or an electrochemical cell and addition of bromide to the mobile phase, used by 7 laboratories. Both derivatization techniques were not significantly different when compared by the t-test; the method was statistically evaluated for all laboratories together (bromination and PBPB). The cattle feed samples, both spiked and naturally contaminatedwithaflatoxinB1, were sent to 21 laboratories in 14 different countries (United States, Japan, and Europe). Test portions were spiked at levels of 1.2 and 3.6 ng/g for aflatoxin B1. Recoveries ranged from 74 to 157%. Based on results for spiked samples (blind pairs at 2 levels) as well as naturally con-taminated samples (blind pairs at 3 levels), the relative standard deviation for repeatability (RSDr) ranged from 5.9 to 8.7%. The relative standard deviation for reproducibility (RSDR) ranged from 17.5 to 19.6%. The method showed acceptable within-and between-laboratory precision for this matrix, as evidenced by HORRAT values, at the target levels of determination for aflatoxin B1. No major differences in RSD were observed, showing that the composition of the feeds was not a factor for the samples tested and that the method was applicable for all materials used.
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Affiliation(s)
- Joerg Stroka
- European Commission, Directorate General Joint Research Centre, Institute for Reference Materials and Measurements, Retieseweg, B-2440 Geel, Belgium
| | - Christoph von Holst
- European Commission, Directorate General Joint Research Centre, Institute for Reference Materials and Measurements, Retieseweg, B-2440 Geel, Belgium
| | - Elke Anklam
- European Commission, Directorate General Joint Research Centre, Institute for Reference Materials and Measurements, Retieseweg, B-2440 Geel, Belgium
| | - Matthias Reutter
- Institut für Tiergesundheit und Lebensmittelqualität der Landwirtschaftskammer Schleswig Holstein, Landwirtschaftliche Untersuchungs-und Forschungsanstalt, Gutenbergstrasse 75-77, D-24116 Kiel, Germany
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5
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Mahon BM, Brehony C, Cahill N, McGrath E, O'Connor L, Varley A, Cormican M, Ryan S, Hickey P, Keane S, Mulligan M, Ruane B, Jolley KA, Maiden MC, Brisse S, Morris D. Detection of OXA-48-like-producing Enterobacterales in Irish recreational water. Sci Total Environ 2019; 690:1-6. [PMID: 31299565 DOI: 10.1016/j.scitotenv.2019.06.480] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Revised: 06/27/2019] [Accepted: 06/27/2019] [Indexed: 06/10/2023]
Abstract
The rapid dissemination of carbapenemase-producing Enterobacterales (CPE) is a major public health concern. The role that the aquatic environment plays in this dissemination is underexplored. This study aimed to examine seawater as a reservoir for CPE. Seawater sampling took place at a bathing site throughout the 2017 bathing season. Each 30 L sample (n = 6) was filtered using the CapE filtration system. Wastewater samples (200 mL) (pre-treatment (n = 3) and post-treatment (n = 3)) were obtained from a nearby secondary wastewater treatment plant, during the same time period. All samples were examined for CPE. Whole genome sequencing of confirmed CPE was carried out using Illumina sequencing. Isolate genomes were hosted in corresponding BIGSdb databases and analyses were performed using multiple web-based tools. CPE was detected in 2/6 seawater samples. It was not detected in any wastewater samples. OXA-48-like-producing ST131 Escherichia coli (Ec_BM707) was isolated from a seawater sample collected in May 2017 and OXA-48-like-producing ST101 Klebsiella pneumoniae (Kp_BM758) was isolated from a seawater sample collected in August 2017. The genomes of the environmental isolates were compared to a collection of previously described Irish clinical OXA-48-like-producing Enterobacterales (n = 105). Ec_BM707 and Kp_BM758 harboured blaOXA-48 on similar mobile genetic elements to those identified in the clinical collection (pOXA-48 fragment in Ec_BM707 and IncL(pOXA-48) plasmid in Kp_BM758). Genetic similarities were observed between Ec_BM707 and several of the clinical ST131 E. coli, with allele matches at up to 98.2% of 2513 core genome multilocus sequence type (cgMLST) loci. In contrast, Kp_BM758 and the 34 clinical K. pneumoniae were genetically distant. The source of the CPE at this site was not identified. The detection of OXA-48-like-producing ST131 E. coli and OXA-48-like-producing ST101 K. pneumoniae in Irish recreational water is a concern. The potential for contamination of the aquatic environment to contribute to dissemination of CPE in Europe warrants further study.
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Affiliation(s)
- Bláthnaid M Mahon
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland; Centre for One Health, Ryan Institute, National University of Ireland Galway, Ireland.
| | - Carina Brehony
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland
| | - Niamh Cahill
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland; Centre for One Health, Ryan Institute, National University of Ireland Galway, Ireland
| | - Elaine McGrath
- Carbapenemase-Producing Enterobacterales Reference Laboratory, Department of Medical Microbiology, University Hospital Galway, Galway, Ireland
| | - Louise O'Connor
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland; Centre for One Health, Ryan Institute, National University of Ireland Galway, Ireland
| | - Aine Varley
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland
| | - Martin Cormican
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland; Centre for One Health, Ryan Institute, National University of Ireland Galway, Ireland; Carbapenemase-Producing Enterobacterales Reference Laboratory, Department of Medical Microbiology, University Hospital Galway, Galway, Ireland
| | - Sinead Ryan
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland
| | - Paul Hickey
- Environmental Health Service, HSE West, Galway, Ireland
| | - Shane Keane
- Environmental Health Service, HSE West, Galway, Ireland
| | | | | | - Keith A Jolley
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Martin C Maiden
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Sylvain Brisse
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France
| | - Dearbháile Morris
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland Galway, Ireland; Centre for One Health, Ryan Institute, National University of Ireland Galway, Ireland
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6
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O’ Sullivan S, Kelly E, Collins O, McGrath E, Waqas S. Flu Flying in August. Ir Med J 2019; 112:1011. [PMID: 31652033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Affiliation(s)
- S O’ Sullivan
- Acute Medical Unit, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
| | - E Kelly
- Acute Medical Unit, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
| | - O Collins
- Acute Medical Unit, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
| | - E McGrath
- Acute Medical Unit, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
| | - S Waqas
- Acute Medical Unit, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland
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7
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Cahill N, O'Connor L, Mahon B, Varley Á, McGrath E, Ryan P, Cormican M, Brehony C, Jolley KA, Maiden MC, Brisse S, Morris D. Hospital effluent: A reservoir for carbapenemase-producing Enterobacterales? Sci Total Environ 2019; 672:618-624. [PMID: 30974353 PMCID: PMC6525273 DOI: 10.1016/j.scitotenv.2019.03.428] [Citation(s) in RCA: 68] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Revised: 03/26/2019] [Accepted: 03/26/2019] [Indexed: 05/03/2023]
Abstract
Antimicrobial resistance is a major public health concern. Carbapenemase-producing Enterobacterales (CPE) represent a significant health threat as some strains are resistant to almost all available antibiotics. The aim of this research was to examine hospital effluent and municipal wastewater in an urban area in Ireland for CPE. Samples of hospital effluent (n = 5), municipal wastewater before (n = 5) and after (n = 4) the hospital effluent stream joined the municipal wastewater stream were collected over a nine-week period (May-June 2017). All samples were examined for CPE by direct plating onto Brilliance CRE agar. Isolates were selected for susceptibility testing to 15 antimicrobial agents in accordance with EUCAST criteria. Where relevant, isolates were tested for carbapenemase-encoding genes by real-time PCR. CPE were detected in five samples of hospital effluent, one sample of pre-hospital wastewater and three samples of post-hospital wastewater. Our findings suggest hospital effluent is a major contributor to CPE in municipal wastewater. Monitoring of hospital effluent for CPE could have important applications in detection and risk management of unrecognised dissemination of CPE in both the healthcare setting and the environment.
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Affiliation(s)
- Niamh Cahill
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland; Centre for Health from Environment, Ryan Institute, National University of Ireland, Galway, Ireland.
| | - Louise O'Connor
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland; Centre for Health from Environment, Ryan Institute, National University of Ireland, Galway, Ireland
| | - Bláthnaid Mahon
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland; Centre for Health from Environment, Ryan Institute, National University of Ireland, Galway, Ireland
| | - Áine Varley
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland
| | - Elaine McGrath
- Carbapenemase-Producing Enterobacterales Reference Laboratory, Department of Medical Microbiology, University Hospital Galway, Galway, Ireland
| | - Phelim Ryan
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland
| | - Martin Cormican
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland; Centre for Health from Environment, Ryan Institute, National University of Ireland, Galway, Ireland; Carbapenemase-Producing Enterobacterales Reference Laboratory, Department of Medical Microbiology, University Hospital Galway, Galway, Ireland
| | - Carina Brehony
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland
| | - Keith A Jolley
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Martin C Maiden
- Department of Zoology, University of Oxford, Oxford, United Kingdom
| | - Sylvain Brisse
- Biodiversity and Epidemiology of Bacterial Pathogens, Institut Pasteur, Paris, France
| | - Dearbháile Morris
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland; Centre for Health from Environment, Ryan Institute, National University of Ireland, Galway, Ireland
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8
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Kihlström L, Burris M, Dobbins J, McGrath E, Renda A, Cordier T, Song Y, Prendergast K, Serrano Arce K, Shannon E, Himmelgreen D. Food Insecurity and Health-Related Quality of Life: A Cross-Sectional Analysis of Older Adults in Florida, U.S. Ecol Food Nutr 2018; 58:45-65. [PMID: 30582362 DOI: 10.1080/03670244.2018.1559160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Individuals 65 years or older will comprise an estimated 20.0% of the U.S. population by 2030. This study investigated the association between food insecurity and health-related quality of life (HRQoL) among an older adult population (n = 234). HRQoL was measured using Healthy Days, a validated survey tool developed by the Centers of Disease Control and Prevention. Food-insecure individuals were more likely to report ≥14 physically unhealthy days (OR = 1.49, 95% CI 0.47-4.78) and ≥14 days with activity limitations (OR = 4.07, 95% CI 0.68-24.1). Although nonsignificant, the findings highlight food insecurity as a potentially important social determinant of health throughout the life course, including at an older age.
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Affiliation(s)
- L Kihlström
- a Department of Anthropology , University of South Florida , Tampa , FL , USA.,b Department of Family and Community Health , University of South Florida , Tampa , FL , USA
| | - M Burris
- a Department of Anthropology , University of South Florida , Tampa , FL , USA
| | - J Dobbins
- c Humana, Inc ., Louisville , KY , USA
| | - E McGrath
- c Humana, Inc ., Louisville , KY , USA
| | - A Renda
- c Humana, Inc ., Louisville , KY , USA
| | - T Cordier
- c Humana, Inc ., Louisville , KY , USA
| | - Y Song
- c Humana, Inc ., Louisville , KY , USA
| | | | - K Serrano Arce
- a Department of Anthropology , University of South Florida , Tampa , FL , USA
| | - E Shannon
- e Feeding Tampa Bay , Tampa , FL , USA
| | - D Himmelgreen
- a Department of Anthropology , University of South Florida , Tampa , FL , USA
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9
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Mahon BM, Brehony C, McGrath E, Killeen J, Cormican M, Hickey P, Keane S, Hanahoe B, Dolan A, Morris D. Indistinguishable NDM-producing Escherichia coli isolated from recreational waters, sewage, and a clinical specimen in Ireland, 2016 to 2017. ACTA ACUST UNITED AC 2018; 22:30513. [PMID: 28449738 PMCID: PMC5476983 DOI: 10.2807/1560-7917.es.2017.22.15.30513] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2017] [Accepted: 04/12/2017] [Indexed: 12/22/2022]
Abstract
In this study, New Delhi metallo-beta-lactamase (NDM)-producing Enterobacteriaceae were identified in Irish recreational waters and sewage. Indistinguishable NDM-producing Escherichia coli by pulsed-field gel electrophoresis were isolated from sewage, a fresh water stream and a human source. NDM-producing Klebsiella pneumoniae isolated from sewage and seawater in the same area were closely related to each other and to a human isolate. This raises concerns regarding the potential for sewage discharges to contribute to the spread of carbapenemase-producing Enterobacteriaceae.
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Affiliation(s)
- Bláthnaid M Mahon
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland
| | - Carina Brehony
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland
| | - Elaine McGrath
- Carbapenemase-Producing Enterobacteriaceae Reference Laboratory, Department of Medical Microbiology, University Hospital Galway, Galway, Ireland.,Department of Medical Microbiology, University Hospital Galway, Galway, Ireland
| | - James Killeen
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland
| | - Martin Cormican
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland.,Carbapenemase-Producing Enterobacteriaceae Reference Laboratory, Department of Medical Microbiology, University Hospital Galway, Galway, Ireland.,Department of Medical Microbiology, University Hospital Galway, Galway, Ireland
| | - Paul Hickey
- Environmental Health Service, HSE West, Galway, Ireland
| | - Shane Keane
- Environmental Health Service, HSE West, Galway, Ireland
| | - Belinda Hanahoe
- Department of Medical Microbiology, University Hospital Galway, Galway, Ireland
| | - Ann Dolan
- Galway County Council, Galway, Ireland
| | - Dearbháile Morris
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland
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10
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Ryan L, Molloy M, Evans L, Quinn A, Burke E, McGrath E, Cormican M. Antimicrobial-resistant Faecal Organisms in Algae Products Marketed as Health Supplements. Ir Med J 2017; 110:624. [PMID: 29169006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
Dietary supplements are increasingly popular in Irish society. One of these is blue-green algae which is used with a variety health benefits in mind. A batch of Chlorella powder was found to be contaminated with Salmonella species in Ireland in 2015. This prompted additional testing of a total of 8 samples of three different products (Chlorella, Spirulina and Super Greens), for other faecal flora and antimicrobial resistance in any bacteria isolated. All 8 samples cultured enteric flora such as Enterococci, Enterobacteriaceae and Clostridium species. Antimicrobial susceptibility testing revealed one isolate with extended-spectrum ?-lactamase (ESBL) activity and one with carbapenemase activity. Clinicians caring for vulnerable patients should be aware of the potential risk of exposure to antimicrobial resistant bacteria associated with these products.
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Affiliation(s)
- L Ryan
- Department of Microbiology, Galway University Hospital, Galway, Ireland
| | - M Molloy
- Department of Microbiology, Galway University Hospital, Galway, Ireland
| | - L Evans
- Department of Microbiology, Galway University Hospital, Galway, Ireland
| | - A Quinn
- Department of Microbiology, Galway University Hospital, Galway, Ireland
| | - E Burke
- Department of Microbiology, Galway University Hospital, Galway, Ireland
| | - E McGrath
- Department of Microbiology, Galway University Hospital, Galway, Ireland
| | - M Cormican
- School of Medicine, National University of Ireland, Galway
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11
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Grundmann H, Glasner C, Albiger B, Aanensen DM, Tomlinson CT, Andrasević AT, Cantón R, Carmeli Y, Friedrich AW, Giske CG, Glupczynski Y, Gniadkowski M, Livermore DM, Nordmann P, Poirel L, Rossolini GM, Seifert H, Vatopoulos A, Walsh T, Woodford N, Monnet DL, Koraqi A, Lacej D, Apfalter P, Hartl R, Glupczynski Y, Huang TD, Strateva T, Marteva-Proevska Y, Andrasevic AT, Butic I, Pieridou-Bagatzouni D, Maikanti-Charalampous P, Hrabak J, Zemlickova H, Hammerum A, Jakobsen L, Ivanova M, Pavelkovich A, Jalava J, Österblad M, Dortet L, Vaux S, Kaase M, Gatermann SG, Vatopoulos A, Tryfinopoulou K, Tóth Á, Jánvári L, Boo TW, McGrath E, Carmeli Y, Adler A, Pantosti A, Monaco M, Raka L, Kurti A, Balode A, Saule M, Miciuleviciene J, Mierauskaite A, Perrin-Weniger M, Reichert P, Nestorova N, Debattista S, Mijovic G, Lopicic M, Samuelsen Ø, Haldorsen B, Zabicka D, Literacka E, Caniça M, Manageiro V, Kaftandzieva A, Trajkovska-Dokic E, Damian M, Lixandru B, Jelesic Z, Trudic A, Niks M, Schreterova E, Pirs M, Cerar T, Oteo J, Aracil B, Giske C, Sjöström K, Gür D, Cakar A, Woodford N, Hopkins K, Wiuff C, Brown DJ. Occurrence of carbapenemase-producing Klebsiella pneumoniae and Escherichia coli in the European survey of carbapenemase-producing Enterobacteriaceae (EuSCAPE): a prospective, multinational study. The Lancet Infectious Diseases 2017; 17:153-163. [DOI: 10.1016/s1473-3099(16)30257-2] [Citation(s) in RCA: 392] [Impact Index Per Article: 56.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 07/07/2016] [Accepted: 07/12/2016] [Indexed: 12/20/2022]
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12
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O'Connor C, Philip RK, Kelleher J, Powell J, O'Gorman A, Slevin B, Woodford N, Turton JF, McGrath E, Finnegan C, Power L, O'Connell NH, Dunne CP. The first occurrence of a CTX-M ESBL-producing Escherichia coli outbreak mediated by mother to neonate transmission in an Irish neonatal intensive care unit. BMC Infect Dis 2017; 17:16. [PMID: 28056822 PMCID: PMC5217319 DOI: 10.1186/s12879-016-2142-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Accepted: 12/20/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Escherichia coli (E. coli) comprise part of the normal vaginal microflora. Transfer from mother to neonate can occur during delivery resulting, sometimes, in neonatal bacterial disease. Here, we aim to report the first outbreak of CTX-M ESBL-producing E. coli with evidence of mother-to-neonate transmission in an Irish neonatal intensive care unit (NICU) followed by patient-to-patient transmission. METHODS Investigation including molecular typing was conducted. Infection was defined by clinical and laboratory criteria and requirement for antimicrobial therapy with or without positive blood cultures. Colonisation was determined by isolation without relevant symptoms or indicators of infection. RESULTS Index case was an 8-day-old baby born at 34 weeks gestation who developed ESBL-producing E. coli infections at multiple body sites. Screening confirmed their mother as colonised with ESBL-producing E. coli. Five other neonates, in the NICU simultaneously with the index case, also tested positive. Of these, four were colonised while one neonate developed sepsis, requiring antimicrobial therapy. The second infected neonate's mother was also colonised by ESBL-producing E. coli. Isolates from all eight positive patients (6 neonates, 2 mothers) were compared using pulsed-field gel electrophoresis (PFGE). Two distinct ESBL-producing strains were implicated, with evidence of transmission between mothers and neonates for both strains. All isolates were confirmed as CTX-M ESBL-producers. There were no deaths associated with the outbreak. CONCLUSIONS Resources were directed towards control interventions focused on hand hygiene and antimicrobial stewardship, which ultimately proved successful. Since this incident, all neonates admitted to the NICU have been screened for ESBL-producers and expectant mothers are screened at their first antenatal appointment. To date, there have been no further outbreaks.
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Affiliation(s)
- Ciara O'Connor
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland.,Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Roy K Philip
- Department of Paediatrics, University Maternity Hospital Limerick, Limerick, Ireland
| | - John Kelleher
- Department of Paediatrics, University Maternity Hospital Limerick, Limerick, Ireland
| | - James Powell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Alan O'Gorman
- Infection Prevention and Control Team, University Hospital Limerick, Limerick, Ireland
| | - Barbara Slevin
- Infection Prevention and Control Team, University Hospital Limerick, Limerick, Ireland
| | - Neil Woodford
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, Public Health England, London, UK
| | - Jane F Turton
- Antimicrobial Resistance and Healthcare Associated Infections (AMRHAI) Reference Unit, Public Health England, London, UK
| | - Elaine McGrath
- Antimicrobial Resistance and Microbial Ecology Group, School of Medicine, National University of Ireland, Galway, Ireland
| | - Cathriona Finnegan
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Lorraine Power
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - Nuala H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland.,Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - Colum P Dunne
- Centre for Interventions in Infection, Inflammation and Immunity (4i), Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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13
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McGrath E, Espie C, Power A, Murphy A, Newell J, Kelly C, Duffy N, Gunning P, Gibson I, O’Donnell M. [OP.4C.06] SLEEP TO LOWER ELEVATED BLOOD PRESSURE. J Hypertens 2016. [DOI: 10.1097/01.hjh.0000491462.58358.ca] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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14
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O'Connor C, Cormican M, Boo TW, McGrath E, Slevin B, O'Gorman A, Commane M, Mahony S, O'Donovan E, Powell J, Monahan R, Finnegan C, Kiernan MG, Coffey JC, Power L, O'Connell NH, Dunne CP. An Irish outbreak of New Delhi metallo-β-lactamase (NDM)-1 carbapenemase-producing Enterobacteriaceae: increasing but unrecognized prevalence. J Hosp Infect 2016; 94:351-357. [PMID: 27624807 DOI: 10.1016/j.jhin.2016.08.005] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2016] [Accepted: 08/05/2016] [Indexed: 02/04/2023]
Abstract
BACKGROUND Carbapenemase-producing Enterobacteriaceae (CPE) may cause healthcare-associated infections with high mortality rates. New Delhi metallo-β-lactamase-1 (NDM-1) is among the most recently discovered carbapenemases. AIM To report the first outbreak of NDM-1 CPE in Ireland, including microbiological and epidemiological characteristics, and assessing the impact of infection prevention and control measures. METHODS This was a retrospective microbiological and epidemiological review. Cases were defined as patients with a CPE-positive culture. Contacts were designated as roommates or ward mates. FINDINGS This outbreak involved 10 patients with a median age of 71 years (range: 45-90), located in three separate but affiliated healthcare facilities. One patient was infected (the index case); the nine others were colonized. Nine NDM-1-producing Klebsiella pneumoniae, an NDM-1-producing Escherichia coli and a K. pneumoniae carbapenemase (KPC)-producing Enterobacter cloacae were detected between week 24, 2014 and week 37, 2014. Pulsed-field gel electrophoresis demonstrated similarity. NDM-1-positive isolates were meropenem resistant with minimum inhibitory concentrations (MICs) ranging from 12 to 32 μg/mL. All were tigecycline susceptible (MICs ≤1 μg/mL). One isolate was colistin resistant (MIC 4.0 μg/mL; mcr-1 gene not detected). In 2015, four further NDM-1 isolates were detected. CONCLUSION The successful management of this outbreak was achieved via the prompt implementation of enhanced infection prevention and control practices to prevent transmission. These patients did not have a history of travel outside of Ireland, but several had frequent hospitalizations in Ireland, raising concerns regarding the possibility of increasing but unrecognized prevalence of NDM-1 and potential decline in value of travel history as a marker of colonization risk.
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Affiliation(s)
- C O'Connor
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - M Cormican
- School of Medicine National University of Ireland Galway, Galway, Ireland; Carbapenemase-Producing Enterobacteriaceae (CPE) Reference Laboratory, Department of Medical Microbiology, University Hospital Galway, Galway, Ireland
| | - T W Boo
- School of Medicine National University of Ireland Galway, Galway, Ireland; Carbapenemase-Producing Enterobacteriaceae (CPE) Reference Laboratory, Department of Medical Microbiology, University Hospital Galway, Galway, Ireland
| | - E McGrath
- Carbapenemase-Producing Enterobacteriaceae (CPE) Reference Laboratory, Department of Medical Microbiology, University Hospital Galway, Galway, Ireland
| | - B Slevin
- Department of Infection Prevention and Control, University Hospital Limerick, Limerick, Ireland
| | - A O'Gorman
- Department of Infection Prevention and Control, University Hospital Limerick, Limerick, Ireland
| | - M Commane
- Department of Infection Prevention and Control, University Hospital Limerick, Limerick, Ireland
| | - S Mahony
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - E O'Donovan
- Department of Infection Prevention and Control, University Hospital Limerick, Limerick, Ireland
| | - J Powell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - R Monahan
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - C Finnegan
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - M G Kiernan
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - J C Coffey
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - L Power
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland
| | - N H O'Connell
- Department of Clinical Microbiology, University Hospital Limerick, Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland
| | - C P Dunne
- Centre for Interventions in Infection, Inflammation & Immunity (4i) and Graduate Entry Medical School, University of Limerick, Limerick, Ireland.
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15
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Chabannon C, Caunday-Rigot O, Faucher C, Slaper-Cortenbach I, Calmels B, Lemarie C, Mahalatchimy A, McGrath E, Rial-Sebbag E. Accreditation and regulations in cell therapy. ACTA ACUST UNITED AC 2016. [DOI: 10.1111/voxs.12205] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- C. Chabannon
- Centre de Thérapie Cellulaire; Département de Biologie du Cancer; Institut Paoli-Calmettes; Marseille France
- Aix-Marseille Université; Marseille France
- Inserm CBT-1409; Centre d'Investigations Cliniques en Biothérapie de Marseille; Marseille Cedex 9 France
| | - O. Caunday-Rigot
- Unité de Thérapie Cellulaire et banque de Tissus; CHRU de Nancy; Nancy France
| | - C. Faucher
- Centre de Thérapie Cellulaire; Département de Biologie du Cancer; Institut Paoli-Calmettes; Marseille France
| | - I. Slaper-Cortenbach
- Cell Therapy Facility; Department of Clinical Pharmacy; University Medical Center; Utrecht The Netherlands
| | - B. Calmels
- Centre de Thérapie Cellulaire; Département de Biologie du Cancer; Institut Paoli-Calmettes; Marseille France
- Inserm CBT-1409; Centre d'Investigations Cliniques en Biothérapie de Marseille; Marseille Cedex 9 France
| | - C. Lemarie
- Centre de Thérapie Cellulaire; Département de Biologie du Cancer; Institut Paoli-Calmettes; Marseille France
- Inserm CBT-1409; Centre d'Investigations Cliniques en Biothérapie de Marseille; Marseille Cedex 9 France
| | - A. Mahalatchimy
- Centre for Global Health Policy; School of Global Studies; University of Sussex; Falmer nr Brighton UK
| | | | - E. Rial-Sebbag
- Université de Toulouse 3; Toulouse France
- Inserm UMR 1027; Toulouse France
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16
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McGrath E. Outcome of JACIE standard application in collection and processing units. Transfus Apher Sci 2014. [DOI: 10.1016/s1473-0502(14)50005-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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17
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Rajpurkar M, McGrath E, Joyce J, Boldt-MacDonald K, Chitlur M, Lusher J. Therapeutic and prophylactic ethanol lock therapy in patients with bleeding disorders. Haemophilia 2013; 20:52-7. [PMID: 23906245 DOI: 10.1111/hae.12241] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/28/2013] [Indexed: 11/28/2022]
Abstract
Obtaining a reliable venous access is a limiting factor for early initiation of clotting factor prophylaxis and immune tolerance induction. To circumvent this issue, central venous access devices (CVADs) are increasingly being used. Catheter-related infections (CRIs) remain the primary complication of insertion of CVAD. Thus, newer strategies for treatment and prevention of CRI are needed. Ethanol lock therapy (ELT) has been used to treat and prevent CRI in non-bleeding disorder patients. The aim of this study was to assess the efficacy of ELT in treating and preventing CRI in bleeding disorder patients. The medical charts of patients with bleeding disorders who underwent ELT for antimicrobial resistant CRIs were reviewed and data were analysed. ELT was effective in catheter salvage in 87% of patients with antimicrobial resistant CRI by a wide variety of pathogens. Prophylactic therapy with ethanol lock was associated with catheter dysfunction especially in mediports. ELT should be considered prior to removal of catheters in bleeding disorder patients with resistant CRIs. Further studies are needed for using prophylactic ethanol lock in prevention of CRIs in bleeding disorder patients.
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Affiliation(s)
- M Rajpurkar
- Division of Haematology and Oncology, Carman and Ann Adams Department of Pediatrics, Children's Hospital of Michigan, Detroit, MI, USA; Wayne State University, Detroit, MI, USA
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18
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Boo TW, O'Connell N, Power L, O'Connor M, King J, McGrath E, Hill R, Hopkins KL, Woodford N. First report of IMI-1-producing colistin-resistant Enterobacter clinical isolate in Ireland, March 2013. ACTA ACUST UNITED AC 2013; 18. [PMID: 23929227 DOI: 10.2807/1560-7917.es2013.18.31.20548] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We report the first case in Ireland of an IMI-1 carbapenemase-producing Enterobacter asburiae, which was resistant to both colistin and fosfomycin. The circumstances under which this isolate was acquired were unclear. Several reports of IMI-producing Enterobacter spp. have emerged in recent years, and colistin resistance in Enterobacteriaceae is also increasingly reported. Laboratories should be aware of the unusual antibiograms of IMI-producing isolates.
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Affiliation(s)
- T W Boo
- Department of Medical Microbiology, Galway University Hospitals, HSE West, Ireland.
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Birks S, Altinkaya M, Altinkaya A, Pilkington G, Kurian KM, Crosby C, Hopkins K, Williams M, Donovan L, Birks S, Eason A, Bosak V, Pilkington G, Birks S, Holliday J, Corbett I, Pilkington G, Keeling M, Bambrough J, Simpson J, Higgins S, Dogra H, Pilkington G, Kurian KM, Zhang Y, Bradley M, Schmidberger C, Hafizi S, Noorani I, Price S, Dubocq A, Jaunky T, Chatelain C, Evans L, Gaissmaier T, Pilkington GJ, An Q, Hurwitz V, Logan J, Bhangoo R, Ashkan K, Gullan A, Beaney R, Brazil L, Kokkinos S, Blake R, Singleton A, Shaw A, Iyer V, Kurian KM, Jeyapalan JN, Morley IC, Hill AA, Mumin MA, Tatevossian RG, Qaddoumi I, Ellison DW, Sheer D, Frary A, Price S, Jefferies S, Harris F, Burnet N, Jena R, Watts C, Haylock B, Leow-Dyke S, Rathi N, Wong H, Dunn J, Baborie A, Crooks D, Husband D, Shenoy A, Brodbelt A, Walker C, Bahl A, Larsen J, Craven I, Metherall P, McKevitt F, Romanowski C, Hoggard N, Jellinek DA, Bell S, Murray E, Muirhead R, James A, Hanzely Z, Jackson R, Stewart W, O'Brien A, Young A, Bell S, Hanzely Z, Stewart W, Shepherd S, Cavers D, Wallace L, Hacking B, Scott S, Bowyer D, Elmahdi A, Frary AJ, O'Donovan DG, Price SJ, Kia A, Przystal JM, Nianiaris N, Mazarakis ND, Mintz PJ, Hajitou A, Karakoula K, Phipps K, Harkness W, Hayward R, Thompson D, Jacques T, Harding B, Darling J, Warr T, Leow-Dyke S, Rathi N, Haylock B, Crooks D, Jenkinson M, Walker C, Brodbelt A, Zhou L, Ercolano E, Ammoun S, Schmid MC, Barczyk M, Hanemann CO, Rowther F, Dawson T, Ashton K, Darling J, Warr T, Maherally Z, Hatherell KE, Kroese K, Hafizi S, Pilkington GJ, Singh P, McQuaid S, Al-Rashid S, Prise K, Herron B, Healy E, Shoakazemi A, Donnelly M, McConnell R, Harney J, Conkey D, McGrath E, Lunsford L, Kondziolka D, Niranjan A, Kano H, Hamilton R, Flannery T, Majani Y, Smith S, Grundy R, Rahman R, Saini S, Hall G, Davis C, Rowther F, Lawson T, Ashton K, Potter N, Goessl E, Darling J, Warr T, Brodbelt A, Jenkinson M, Walker C, Leow-Dyke S, Haylock B, Dunn J, Wilkins S, Smith T, Petinou V, Nicholl I, Singh J, Lea R, Welsby P, Spiteri I, Sottoriva A, Marko N, Tavare S, Collins P, Price SJ, Watts C, Su Z, Gerhard A, Hinz R, Roncaroli F, Coope D, Thompson G, Karabatsou K, Sofat A, Leggate J, du Plessis D, Turkheimer F, Jackson A, Brodbelt A, Jenkinson M, Das K, Crooks D, Herholz K, Price SJ, Whittle IR, Ashkan K, Grundy P, Cruickshank G, Berry V, Elder D, Iyer V, Hopkins K, Cohen N, Tavare J, Zilidis G, Tibarewal P, Spinelli L, Leslie NR, Coope DJ, Karabatsou K, Green S, Wall G, Bambrough J, Brennan P, Baily J, Diaz M, Ironside J, Sansom O, Brunton V, Frame M, Young A, Thomas O, Mohsen L, Frary A, Lupson V, McLean M, Price S, Arora M, Shaw L, Lawrence C, Alder J, Dawson T, Hall G, Rada L, Chen K, Shivane A, Ammoun S, Parkinson D, Hanemann C, Pangeni RP, Warr TJ, Morris MR, Mackinnon M, Williamson A, James A, Chalmers A, Beckett V, Joannides A, Brock R, McCarthy K, Price S, Singh A, Karakoula K, Dawson T, Ashton K, Darling J, Warr T, Kardooni H, Morris M, Rowther F, Darling J, Warr T, Watts C, Syed N, Roncaroli F, Janczar K, Singh P, O'Neil K, Nigro CL, Lattanzio L, Coley H, Hatzimichael E, Bomalaski J, Szlosarek P, Crook T, Pullen NA, Anand M, Birks S, Van Meter T, Pullen NA, Anand M, Williams S, Boissinot M, Steele L, Williams S, Chiocca EA, Lawler S, Al Rashid ST, Mashal S, Taggart L, Clarke E, Flannery T, Prise KM. Abstracts from the 2012 BNOS Conference. Neuro Oncol 2012. [DOI: 10.1093/neuonc/nos198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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20
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Golden-Mason L, Madrigal-Estebas L, McGrath E, Conroy MJ, Ryan EJ, Hegarty JE, O'Farrelly C, Doherty DG. Altered natural killer cell subset distributions in resolved and persistent hepatitis C virus infection following single source exposure. Gut 2008; 57:1121-8. [PMID: 18372499 DOI: 10.1136/gut.2007.130963] [Citation(s) in RCA: 119] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Natural killer (NK) cells may be impaired in patients with persistent hepatitis C virus (HCV) infection, but studies to date have yielded inconsistent findings due to patient and virus heterogeneity and difficulties obtaining appropriate controls. AIMS To overcome these variables, we have examined numbers, phenotypes, cytotoxic activities and cytokine profiles of circulating NK cells from Irish women who acquired infection through administration of HCV genotype 1b-contaminated anti-D immunoglobulin from a single source and matched controls. RESULTS Comparing 29 women who developed persistent infection with 21 who spontaneously resolved infection and 26 controls, we found that NK cell numbers were consistently lower in the persistently infected group (p = 0.02 and 0.002). This decrease was due to depletions of NK cells expressing low levels of CD56 (CD56(dim) NK cells; p = 0.004 and 0.0001), whilst CD56(bright) NK cells were expanded (p = 0.004 and 0.0001). Compared to HCV resolvers, CD56(dim) NK cells from persistently infected patients less frequently expressed CD16 and more frequently expressed NKG2A/C/E. These phenotypic changes did not significantly affect natural or interleukin-2-induced cytotoxicity by peripheral blood mononuclear cells against K562 and Daudi targets. Greater frequencies of CD56(bright) NK cells from chronic HCV patients produced interferon-gamma compared with HCV responders (p = 0.05) and controls (p = 0.0001) after phorbol ester stimulation in vitro. CONCLUSIONS Alterations in NK subset distributions in chronic HCV infection may explain why previous reports of impaired NK cell functions were difficult to confirm. Altered NK cell functions may contribute to impaired cellular immune responses and chronicity of disease following HCV infection.
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Affiliation(s)
- L Golden-Mason
- Education & Research Centre, St Vincent's University Hospital, Dublin, Ireland
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Samson D, Slaper-Cortenbach I, Pamphilon D, McGrath E, McDonald F, Urbano Ispizua A. Current status of JACIE accreditation in Europe: a special report from the Joint Accreditation Committee of the ISCT and the EBMT (JACIE). Bone Marrow Transplant 2007; 39:133-41. [PMID: 17245423 DOI: 10.1038/sj.bmt.1705564] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
JACIE (Joint Accreditation Committee of the ISCT and the EBMT) launched its first official inspection programme in January 2004. Since then, 35 centres in Europe have been inspected. Almost all were found to be functioning at a high level of excellence, with the majority having only minor deficiencies in compliance with the standards. In one-third of centres there were more significant deficiencies. The most common deficiencies were in quality management, and a survey of the applicant centres confirmed this was the area where centres experienced most difficulty in preparation for accreditation. Following correction of deficiencies, 28 centres have at the time of writing achieved full accreditation. Implementation of JACIE required a significant investment of time and resources by applicant centres. The majority required at least 18 months to prepare for accreditation and 85% needed to employ a quality manager and/or data manager on an ongoing basis. However, all centres felt their programme had benefited from the implementation of JACIE. In addition to the inspection and accreditation of individual centres, JACIE maintains an educational programme including training courses for inspectors and for centre preparation. JACIE is also working closely with other international organisations working in cellular therapy to develop international standards for all aspects of stem cell transplant. The recent implementation of Directive 2004/23/EC has provided an impetus for the implementation of JACIE in EU member states and in particular the requirements for safety of imported tissues and cells have emphasised the need for global harmonisation.
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Affiliation(s)
- D Samson
- JACIE Accreditation Office, EBMT Secretariat, Hospital Clínic de Barcelona, Barcelona, Spain
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Navasardyan T, Adams GS, Ahmidouch A, Angelescu T, Arrington J, Asaturyan R, Baker OK, Benmouna N, Bertoncini C, Blok HP, Boeglin WU, Bosted PE, Breuer H, Christy ME, Connell SH, Cui Y, Dalton MM, Danagoulian S, Day D, Dodario T, Dunne JA, Dutta D, El Khayari N, Ent R, Fenker HC, Frolov VV, Gan L, Gaskell D, Hafidi K, Hinton W, Holt RJ, Horn T, Huber GM, Hungerford E, Jiang X, Jones M, Joo K, Kalantarians N, Kelly JJ, Keppel CE, Kubarovski V, Li Y, Liang Y, Malace S, Markowitz P, McGrath E, McKee P, Meekins DG, Mkrtchyan H, Moziak B, Niculescu G, Niculescu I, Opper AK, Ostapenko T, Reimer P, Reinhold J, Roche J, Rock SE, Schulte E, Segbefia E, Smith C, Smith GR, Stoler P, Tadevosyan V, Tang L, Ungaro M, Uzzle A, Vidakovic S, Villano A, Vulcan WF, Wang M, Warren G, Wesselmann F, Wojtsekhowski B, Wood SA, Xu C, Yuan L, Zheng X, Zhu H. Onset of quark-hadron duality in pion electroproduction. Phys Rev Lett 2007; 98:022001. [PMID: 17358596 DOI: 10.1103/physrevlett.98.022001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2006] [Indexed: 05/14/2023]
Abstract
A large data set of charged-pion (pi+/-) electroproduction from both hydrogen and deuterium targets has been obtained spanning the low-energy residual-mass region. These data conclusively show the onset of the quark-hadron duality phenomenon, as predicted for high-energy hadron electroproduction. We construct several ratios from these data to exhibit the relation of this phenomenon to the high-energy factorization ansatz of electron-quark scattering and subsequent quark-->pion production mechanisms.
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Affiliation(s)
- J.G. Powles
- a The Physics Laboratories , University of Kent , Canterbury , England
| | - E. McGrath
- a The Physics Laboratories , University of Kent , Canterbury , England
| | - K.E. Gubbins
- b Chemical Engineering Department , Cornell University , Ithaca , N.Y. , U.S.A
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Muñoz RF, Hollon SD, McGrath E, Rehm LP, VandenBos GR. On the AHCPR depression in primary care guidelines. Further considerations for practitioners. Agency for Health Care Policy and Research.AHCPR. Am Psychol 1994. [PMID: 8122817 DOI: 10.1037//0003-066x.49.1.42] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The majority of cases of clinical depression go unrecognized and untreated, despite the fact that depression is an eminently treatable disorder. The Agency for Health Care Policy and Research (AHCPR) recently published a set of clinical practice guidelines focused on depression in primary care settings. The review of the literature on which the guidelines are based is thorough and appropriate and should enhance the detection of depression and the quality of pharmacotherapy for depression. However, the guidelines encourage primary care physicians to provide pharmacotherapy to their depressed patients as the first line of treatment. The wisdom of this recommendation is questioned and revisions to the guidelines are suggested. Specifically, patients should be informed of the broad array of treatment options available and provided with a more balanced presentation of the potential benefits of psychotherapy for depression. Patients should decide which treatment alternative they wish to undergo.
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Affiliation(s)
- R F Muñoz
- University of California, Department of Psychiatry, San Francisco General Hospital 94110
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Muñoz RF, Hollon SD, McGrath E, Rehm LP, VandenBos GR. On the AHCPR depression in primary care guidelines. Further considerations for practitioners. Agency for Health Care Policy and Research.AHCPR. Am Psychol 1994; 49:42-61. [PMID: 8122817 DOI: 10.1037/0003-066x.49.1.42] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The majority of cases of clinical depression go unrecognized and untreated, despite the fact that depression is an eminently treatable disorder. The Agency for Health Care Policy and Research (AHCPR) recently published a set of clinical practice guidelines focused on depression in primary care settings. The review of the literature on which the guidelines are based is thorough and appropriate and should enhance the detection of depression and the quality of pharmacotherapy for depression. However, the guidelines encourage primary care physicians to provide pharmacotherapy to their depressed patients as the first line of treatment. The wisdom of this recommendation is questioned and revisions to the guidelines are suggested. Specifically, patients should be informed of the broad array of treatment options available and provided with a more balanced presentation of the potential benefits of psychotherapy for depression. Patients should decide which treatment alternative they wish to undergo.
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Affiliation(s)
- R F Muñoz
- University of California, Department of Psychiatry, San Francisco General Hospital 94110
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Abstract
In a survey of 283 deliveries in Swaziland, active syphilis (positive results in the Treponema pallidum haemagglutination assay (TPHA) and the rapid plasma reagin (RPR) test) was found in 37 (13.1%) and possibly active infection (positive TPHA but negative RPR test results) in a further 87 (30.7%). The perinatal mortality of untreated mothers with active disease was 21.9% (7/32). The RPR test carried out antenatally by nurses had a sensitivity of 36% (13/36) and predictive accuracy of 48% (13/27). Awareness of this incidence of syphilis led to improved antenatal clinic measures and the prophylactic treatment of all newborn infants. More comprehensive serology is discussed and the prophylactic treatment of mothers considered. The need for health education aiming at safer sexual practices is of paramount importance in a society facing the arrival of the human immunodeficiency virus.
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Affiliation(s)
- L F Guinness
- Department of Obstetrics and Gynaecology, Mbabane Government Hospital, Swaziland
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Colon-Otero G, Sando JJ, Sims JL, McGrath E, Jensen DE, Quesenberry PJ. Inhibition of hemopoietic growth factor-induced proliferation by adenosine diphosphate-ribosylation inhibitors. Blood 1987; 70:686-93. [PMID: 2957001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
The effects of adenosine diphosphate (ADP) ribosylation inhibitors on hematopoietic growth factor-induced proliferation were examined. Significant inhibition of interleukin-3 (IL-3), colony-stimulating factor 1, and lung conditioned media-induced clonal agar growth of normal murine hematopoietic cells by 10 mmol/L nicotinamide (NAM), 10 mmol/L 3-aminobenzamide (3AB), and 5 mmol/L N1-methylnicotinamide (1MN) was noted. Nicotinic acid, a related compound that does not inhibit ADP ribosylation, failed to inhibit the growth factor-mediated proliferation. NAM (10 mmol/L), 3AB (10 mmol/L), and 1MN (5 mmol/L) also prevented IL-3 and phorbol ester-stimulated 3H-thymidine incorporation into the IL-3-responsive FDC-P1 cell line. Exposure of FDC-P1 cells to 10 mmol/L NAM led to a significant decrease in nuclear poly-(ADP-ribose) levels. Exposure of FDC-P1 cells to 5 mmol/L 1MN did not affect the interaction of the phorbol ester receptor, protein kinase-C (PK-C), with the cell membrane as determined by assay of phorbol ester binding in cytosol and membrane preparations. Nor did it affect the catalytic activity of PK-C as determined by assaying the in vitro phosphorylation of histone H1 by cytosolic kinase preparations from FDC-P1 as well as EL4 thymoma cells. 1MN markedly enhanced the inhibitory effects of phorbol esters on DNA synthesis of EL4 cells even at concentrations (1.25 mmol/L) that had no effects on DNA synthesis in the absence of phorbol esters. Our findings demonstrate that (a) active ADP ribosylation inhibitors interfere with growth factor-induced proliferation of murine hematopoietic cells and (b) the inhibition occurs at a step that follows the activation and translocation of PK-C and is more closely linked to DNA synthesis.
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Quesenberry P, Song ZX, McGrath E, McNiece I, Shadduck R, Waheed A, Baber G, Kleeman E, Kaiser D. Multilineage synergistic activity produced by a murine adherent marrow cell line. Blood 1987; 69:827-35. [PMID: 3493043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023] Open
Abstract
We reported previously that a cell line (TC-1) derived from adherent marrow cells produced colony-stimulating factor 1 (CSF-1) and a separate activity that acts synergistically with CSF-1 to stimulate giant macrophage colonies. We now report that an activity in TC-1 conditioned media (CM) separate from CSF-1 also synergizes multilineage colony formation by pure interleukin 3 (IL 3) and a crude source of granulocyte-macrophage colony-stimulating activity (GM-CSA) (murine lung-conditioned media). IL 3-induced megakaryocyte colony formation is also synergized. The CSF-1-dependent synergistic activity is not blocked by antibodies to IL 3 and is characterized as a nondialyzable (mol wt cutoff 3,000), heat-stable (56 degrees C, 30') activity that binds to DE-52 cellulose under conditions in which IL 3 does not. This material has an apparent mol wt of approximately 200,000 by Sephadex G100 chromatography, and the bulk of it binds to Concanavalin A (Con A) and elutes off with alpha-methyl mannoside, indicating that it is a glycoprotein. As reported separately, these purified active fractions also have a pre-B cell-inducing activity. In addition, a non-IL 3 activity stimulates proliferation of the factor-dependent cell lines FDC-P1 and DA-1. These data indicate that an adherent marrow cell line produces a growth factor(s) that synergizes with IL 3, GM-CSA, and CSF-1 and induces pre-B cell formation. This may be an important regulator of early multilineage lymphohemopoiesis.
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Quesenberry PJ, Ihle JN, McGrath E. The effect of interleukin 3 and GM-CSA-2 on megakaryocyte and myeloid clonal colony formation. Blood 1985; 65:214-7. [PMID: 3917313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
Two separate helper T cell-derived lymphokines, interleukin 3 and granulocyte-macrophage colony-stimulating activity-2, were found to stimulate a broad and similar range of hemopoietic colonies in in vitro soft agar cultures including granulocyte, macrophage, granulocyte-macrophage, megakaryocyte, and mixed megakaryocyte colonies. Both lymphokines were potent stimulators of in vitro megakaryocyte colony formation. At plateau levels of IL-3, megakaryocyte colony formation was increased by biologic activity in pokeweed mitogen spleen-conditioned media.
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Abstract
Using data from the Bern Sex-role Inventory, this study examined the hypothesis that male and female physicians are perceived differently both by their patients and by other physicians and medical students. This hypothesis was confirmed. Not only were significant differences in profiles of male and female physicians noted, but differences were also found among the three groups surveyed. Further, some of the differences in perception of male and female physicians were related to the sex rather than the group identity of respondents. Female patients, and to some extent female medical students, tended to view women physicians most often as androgynous and feminine. Male medical students tended to view women physicians in reverse pattern, i.e., most often feminine and then androgynous. Male physicians viewed the woman physician most often as feminine, like medical students, and then as undifferentiated. Both male and female patients and medical students tended to view the male physician most often as undifferentiated and masculine. Male physicians viewed their male colleagues most often as clearly masculine. Implications of these differences for residents' training and quality of patients' care are discussed.
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McGrath E, Constable A. New prescription: intensive care. Time 1982; 120:48. [PMID: 10256191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
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McGrath E, Zimet CN. Similarities and predictors of specialty interest among female medical students. J Am Med Womens Assoc (1972) 1977; 32:361-2, 367-73. [PMID: 198455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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