Podcasts about Enterobacteriaceae

Drs. Pier Giorgio Cojutti and Navaneeth Narayanan join Dr. Megan Klatt to break down what you need to know about amoxicillin/clavulanate dosing. Tune in to learn more about the PK/PD of amoxicillin and clavulanic acid, how we landed on certain ratios for the treatment of common infections, strategies to optimize dosing for serious infections, and more! References: Oral amoxicillin and amoxicillin-clavulanic acid: properties, indications and usage. Clin Microbiol Infect. 2020 Jul;26(7):871-879. doi: 10.1016/j.cmi.2019.11.028. Epub 2019 Dec 4. PMID: 31811919. New formulations of amoxicillin/clavulanic acid: a pharmacokinetic and pharmacodynamic review. Clin Pharmacokinet. 2005;44(11):1097-115. doi: 10.2165/00003088-200544110-00001. PMID: 16231964. Non-linear absorption pharmacokinetics of amoxicillin: consequences for dosing regimens and clinical breakpoints. J Antimicrob Chemother. 2016 Oct;71(10):2909-17. doi: 10.1093/jac/dkw226. Epub 2016 Jun 20. PMID: 27330071. Augmentin (amoxicillin/clavulanate) in the treatment of community-acquired respiratory tract infection: a review of the continuing development of an innovative antimicrobial agent. J Antimicrob Chemother. 2004 Jan:53 Suppl 1:i3-20. doi: 10.1093/jac/dkh050. PMID: 14726431. Is the standard dose of amoxicillin-clavulanic acid sufficient? BMC Pharmacol Toxicol. 2014 Jul 21:15:38. doi: 10.1186/2050-6511-15-38. PMID: 25047044. MIC of amoxicillin/clavulanate according to CLSI and EUCAST: discrepancies and clinical impact in patients with bloodstream infections due to Enterobacteriaceae. J Antimicrob Chemother. 2017 May 1;72(5):1478-1487. doi: 10.1093/jac/dkw562. PMID: 28093484. Amoxicillin-Clavulanate Breakpoints Against Enterobacterales: Rationale for Revision by the Clinical and Laboratory Standards Institute. Clin Infect Dis. 2024 Aug 16;79(2):516-523. doi: 10.1093/cid/ciae201. PMID: 38626241. Amoxicillin-Clavulanate Breakpoints Against Haemophilus influenzae: Rationale for Revision by the Clinical and Laboratory Standards Institute. Clin Infect Dis. 2025 Feb 24;80(2):481-482. doi: 10.1093/cid/ciae246. PMID: 38709848. No evidence of difference in mortality with amoxicillin versus co-amoxiclav for hospital treatment of community-acquired pneumonia. J Infect. 2024 Jun;88(6):106161. doi: 10.1016/j.jinf.2024.106161. Epub 2024 Apr 23. PMID: 38663754. Population pharmacokinetics and dosing simulations of amoxicillin in obese adults receiving co-amoxiclav. J Antimicrob Chemother. 2020 Dec 1;75(12):3611-3618. doi: 10.1093/jac/dkaa368. PMID: 32888018. Comprehensive guidance for antibiotic dosing in obese adults: 2022 update. Pharmacotherapy. 2023 Mar;43(3):226-246. doi: 10.1002/phar.2769. Epub 2023 Feb 18. PMID: 36703246.

In this episode of Infection Control Matters, Martin Kiernan speaks with Dr. Nicole Stoesser about a large-scale, multi-centre study exploring the role of hospital sink infrastructure in antimicrobial resistance and pathogen dissemination. Representing the collaborative NITCAR-led "Sinkbug Consortium" we discuss surprising findings from 29 UK hospitals—including widespread antibiotic residues in sink traps—and reflect on the implications for sink design, waste disposal practices, and infection prevention strategies The paper we discuss is here: Rodger G, Chau K, Aranega Bou P, Moore G, Roohi A, The SinkBug Consortium, et al. Survey of healthcare-associated sink infrastructure, and sink trap antibiotic residues and biochemistry, in 29 UK hospitals. J Hosp Infect 2025. https://doi.org/10.1016/j.jhin.2025.02.002. Information on Nitcar: https://nitcollaborative.org.uk/wp/ Other papers of interest: Aranega-Bou P, George RP, Verlander NQ, Paton S, Bennett A, Moore G, et al. Carbapenem-resistant Enterobacteriaceae dispersal from sinks is linked to drain position and drainage rates in a laboratory model system. J Hosp Infect 2019;102(1):63-9. https://doi.org/10.1016/j.jhin.2018.12.007 Grabowski M, Lobo JM, Gunnell B, Enfield K, Carpenter R, Barnes L, et al. Characterizations of handwashing sink activities in a single hospital medical intensive care unit. J Hosp Infect 2018;100(3):e115-e22. https://doi.org/10.1016/j.jhin.2018.04.025

In this episode of Infection Control Matters, Martin Kiernan speaks with Dr. Nicole Stoesser about a large-scale, multi-centre study exploring the role of hospital sink infrastructure in antimicrobial resistance and pathogen dissemination. Representing the collaborative NITCAR-led "Sinkbug Consortium" we discuss surprising findings from 29 UK hospitals—including widespread antibiotic residues in sink traps—and reflect on the implications for sink design, waste disposal practices, and infection prevention strategies The paper we discuss is here: Rodger G, Chau K, Aranega Bou P, Moore G, Roohi A, The SinkBug Consortium, et al. Survey of healthcare-associated sink infrastructure, and sink trap antibiotic residues and biochemistry, in 29 UK hospitals. J Hosp Infect 2025. https://doi.org/10.1016/j.jhin.2025.02.002. Information on Nitcar: https://nitcollaborative.org.uk/wp/ Other papers of interest: Aranega-Bou P, George RP, Verlander NQ, Paton S, Bennett A, Moore G, et al. Carbapenem-resistant Enterobacteriaceae dispersal from sinks is linked to drain position and drainage rates in a laboratory model system. J Hosp Infect 2019;102(1):63-9. https://doi.org/10.1016/j.jhin.2018.12.007 Grabowski M, Lobo JM, Gunnell B, Enfield K, Carpenter R, Barnes L, et al. Characterizations of handwashing sink activities in a single hospital medical intensive care unit. J Hosp Infect 2018;100(3):e115-e22. https://doi.org/10.1016/j.jhin.2018.04.025

Send us a textDr. Marianne Holm, MD, Ph.D. is Vice President of the Infectious Diseases Program area, at the Novo Nordisk Foundation ( https://novonordiskfonden.dk/en/ ) where she is responsible for supporting the development and implementation of new strategic initiatives and research programs, and developing partnerships that contribute to the global visibility and impact of the foundation's activities within Infectious Diseases, and this responsibility includes supporting multiple cross disciplinary initiatives in Antimicrobial Resistance (AMR).Dr. Holm is a medical doctor and epidemiologist, who previously led the department of epidemiology and public health research at the International Vaccine Institute (IVI) in Seoul, where she was responsible for the coordination and implementation of several large development programs funded by the Fleming Fund, working with local governments and healthcare institutions to build capacity in AMR surveillance in low- and middle- income countries in the Asian region. Prior to joining IVI in 2018, Dr. Holm worked for 4 years at the School of Public Health at the University of Hong Kong working in the health services research unit coordinating the School's evidence based practice education program.Dr. Holm has been a member of the coordination group of the WHO Technical Advisory Group and Coordination Group on Vaccines and AMR. She is also a member of the Global Burden of Disease (GBD) Collaborator Network as well as the Surveillance and Epidemiology of Drug Resistant Infections Consortium (SEDRIC) network.Dr. Holm received her MD and Ph.D. from University of Copenhagen and Master of Science (MSc), Epidemiology, London School of Hygiene and Tropical Medicine, U. of London.IMPORTANT EPISODE LINK - Gram-Negative Antibiotic Discovery Innovator (Gr-ADI) - https://gcgh.grandchallenges.org/challenge/innovations-gram-negative-antibiotic-discovery The Gram-Negative Antibiotic Discovery Innovator (Gr-ADI) is tripartite initiative of the Novo Nordisk Foundation, the Bill & Melinda Gates Foundation and Wellcome Trust, that will focus on discovery of direct-acting small-molecule antibiotics with broad-spectrum activity against Enterobacteriaceae (a large family of Gram-negative bacteria that includes Salmonella, Escherichia coli, Shigella and Klebsiella), with Klebsiella spp. selected as an initial targeted pathogen. Klebsiella organisms can lead to a wide range of disease states, notably pneumonia, urinary tract infections, sepsis, meningitis, diarrhea, peritonitis and soft tissue infections. The program aims to address the lack of novel antibiotics for gram-negative bacteria and the public health threat posed by antimicrobial resistance (AMR).#NovoNordiskFoundation #GramNegativeAntibioticDiscoveryInnovator #BillAndMelindaGatesFoundation #WellcomeTrust #AMR #AntimicrobialResistance #Enterobacteriaceae #Klebsiella #Salmonella #EscherichiaColi #Shigella #InfectiousDiseases #MarianneHolm #Vaccines #MultidrugEffluxPumps #ProgressPotentialAndPossibilities #IraPastor #Podcast #Podcaster #ViralPodcast #STEM #Innovation #Technology #Science #ResearchSupport the show

Ads for Ozempic, Wegovy, and Zepbound are all over our televisions (at least here in the US). But are these injectables really the key to losing weight and keeping it off? In this episode, I'm digging into all of the science surrounding these popular weight-loss drugs, including - the differences between each of them - how they work (and don't work) - the unwanted side effects that come from using these medications - natural ways to increase your body's production of GLP-1 ... and more! --- Show Notes: References: Coursework from Master's in Human Nutrition & Functional Medicine Program at the University of Western States Efficacy and safety of GLP-1 receptor agonists versus SGLT-2 inhibitors in overweight/obese patients with or without diabetes mellitus: a systematic review and network meta-analysis Weight regain and cardiometabolic effects after withdrawal of semaglutide: The STEP 1 trial extension Weight Loss Medications: GLP-1 Agonists and How They Work How Much Does Ozempic Cost? With & Without Insurance Zepbound vs. Ozempic: 5 Differences Between These Weekly Injections What Are Incretin Mimetics, and How Do They Affect Weight Loss, Blood Sugar, and Type 2 Diabetes? Strategies for minimizing muscle loss during use of incretin‐mimetic drugs for treatment of obesity The Positive Effects of Yerba Maté (Ilex paraguariensis) in Obesity Anti-obesity effects of Yerba Mate (Ilex Paraguariensis): a randomized, double-blind, placebo-controlled clinical trial The effect of psyllium on fasting blood sugar, HbA1c, HOMA IR, and insulin control: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials Soluble fibers from psyllium improve glycemic response and body weight among diabetes type 2 patients (randomized control trial) Increased glucagon-like peptide-1 secretion may be involved in antidiabetic effects of ginsenosides Modulation of glucagon-like peptide-1 release by berberine: in vivo and in vitro studies The effects of berberine on inflammatory markers in Chinese patients with metabolic syndrome and related disorders: a meta‑analysis of randomized controlled trials Berberine is a novel cholesterol-lowering drug working through a unique mechanism distinct from statins A High Dose of Dietary Berberine Improves Gut Wall Morphology, Despite an Expansion of Enterobacteriaceae and a Reduction in Beneficial Microbiota in Broiler Chickens Berberine enhances the AMPK activation and autophagy and mitigates high glucose-induced apoptosis of mouse podocytes Curcumin induces secretion of glucagon-like peptide-1 through an oxidation-dependent mechanism --- 135: What You Should Know Before Starting Ozempic Sign up for a 1:1 Discovery Call Join the Compass Method DIY Program Jump inside my Rock the Bloat Minicourse Get my Core-Gi Workout Program with the exclusive listener discount! Join my Brain Rewiring Masterclass You can learn more about me by following on IG @imperfectlypaigewellness or by checking out my blog, freebies, and offers on my website: https://imperfectlypaigewellness.com Please share with #PaigeTalksWellness to help get the word out about the show - and join the Imperfect Health Fam over on Facebook.

Carbapenemase producers are a nightmare for clinicians. Not only are they resistant to carbapenems, a last resort β-lactam antibiotic, they are notorious for developing multidrug and pandrug resistances resulting in limited to no treatment options.  In this episode of Communicable, hosts Angela Huttner and Thomas Tängdén sit down with Dr. David Paterson (National University of Singapore) and Dr. Souha Kanj (American University of Beirut Medical Center, Lebanon), two ID physicians from regions where carbapenem-resistant Enterobacteriaceae or CRE, and carbapenem-resistant Acinetobacter are widespread.  The episode begins with the history and emergence of CRE and reviews current epidemiology, diagnosis (including the Ambler classification of β-lactamases) and treatment options. Lessons and insights from personal experiences are shared to reflect the current clinical challenges caused by carbapenem-resistant bacteria and the importance of infection prevention and control measures to mitigate further spread. This episode was edited by Kathryn Hostettler and peer-reviewed by Dr. Filippo Medioli of Policlinico di Modena, Italy. For more related content on the WHO Priority Pathogens List and new antibiotics in the pipeline, check out our previous episodes, Communicable E3 and E10 (see Literature).Literature Communicable E3 - The New WHO Priority Pathogens List: which bugs to target first? June 2024. https://communicable.transistor.fm/episodes/communicable-e3-the-new-who-priority-pathogens-list-which-bacteria-to-target-first  Communicable E10 - Pipeline update: new antibiotics & other antimicrobials that you might actually use. Sep 2024. https://communicable.transistor.fm/episodes/communicable-e10-pipeline-update-new-antibiotics-other-antimicrobials-that-you-might-actually-use  Wagenlehner FM, et al. Cefepime-Taniborbactam in Complicated Urinary Tract Infection. N Engl J Med 2024 Feb. doi: 10.1056/NEJMoa2304748 Cohn J, et al. Accelerating antibiotic access and stewardship: a new model to safeguard public health. Lancet Infect Dis 2024 Sep. doi:  10.1016/S1473-3099(24)00070-7 Timsit JF, et al. When should I start broad-spectrum antibiotics? Intensive Care Med 2024 Sep. doi: 10.1007/s00134-024-07654-7  Paterson DL. Antibacterial agents active against Gram Negative Bacilli in phase I, II, or III clinical trials. Expert Opin Investig Drugs 2024 Apr. doi: 10.1080/13543784.2024.2326028 

In this podcast, I talk about how we used Oxford Nanopore Technologies' MinION device to track an outbreak of multi-drug resistant organisms in a hospital. All my posts have links to online resources that you might find useful, and ⁠⁠you can find the link to this particular blog here⁠⁠⁠⁠.

We're back with another game of 'Would you rather?' Where we pose a scenario, and our guests give us their views. This episode really challenges the basis of some of the beliefs and practices regarding antimicrobials. Some of the questions are so tricky, who knows if there even is a correct answer. What we do know is... it depends.About our Guest: Prof. Andrew Whitelaw worked as a consultant pathologist in clinical microbiology at Groote Schuur Hospital from 2003 – 2012. In December 2012 took up the post of Head of Department of Medical Microbiology at the University of Stellenbosch / Tygerberg Hospital. His early research revolved around molecular characterization of ESBLs in members of the Enterobacteriaceae, and he has been involved in a number of studies and activities related to antimicrobial resistance (AMR) and infection control over the last decade, both for community as well as hospital acquired pathogens. Most relevant among these would be his involvement in the South African Antibiotic Stewardship Programme (SAASP), The Infection Control Society of Southern Africa, and the SA Ministerial Advisory Committee on AMR. Ongoing research interests focus on antimicrobial resistance in Enterobacteriaceae and Staphylococcus aureus, including molecular epidemiology and mechanisms of resistance as well as clinical impact and control of AMR. He is also involved in studies describing the human microbiota and in particular the effect of antimicrobials on the microbiota.Resources from this episode:SASCM C. difficile infection guidelinesWE'D LOVE YOUR FEEDBACK ON THIS EPISODE – Visit the Microbe Mail website to sign up for updates Follow on:Instagram: Microbe_MailX/Twitter: @microbemailFacebook: MicrobeMailTiktok: @microbe.mailWatch this episode on our new YouTube channel: Microbe MailE-mail us: mail.microbe@gmail.comDon't forget to also have a listen to these featured episodes:Episode 43: Communicating antimicrobial therapy to patientsEpisode 38: Would you rather?: The mycology versionEpisode 35: Would you rather?: The virology versionEpisode 33: Would you rather?:The Bacterial version

Episode 168: UTI in MalesFuture Dr. Tran gives a summary of UTIs in Males, including epididymitis, orchitis, urethritis, prostatitis, and pyelonephritis. Diagnosis and treatment were briefly described and some differences with female patients were mentioned by Dr. Arreaza.  Written by Di Tran, MS-3, Ross University School of Medicine. Editing and comments by Hector Arreaza, MD.You are listening to Rio Bravo qWeek Podcast, your weekly dose of knowledge brought to you by the Rio Bravo Family Medicine Residency Program from Bakersfield, California, a UCLA-affiliated program sponsored by Clinica Sierra Vista, Let Us Be Your Healthcare Home. This podcast was created for educational purposes only. Visit your primary care provider for additional medical advice.WHAT ARE URINARY TRACT INFECTIONS?Urinary Tract Infection (UTI) is an infection of any part of the urinary tract system. It may involve any part of the renal system, the kidneys, the ureters, the bladder, the prostate, and the urethra.  Different from men, a woman may get a UTI more easily due to their anatomical difference. A woman's urethra is shorter and lies close in proximity to both the vagina and the anus, which allows easy access for bacteria to travel up to the bladder.UTI is further subdivided into two different categories, depending on where the infection takes place within the urinary tract:Lower Tract Infection – cystitis and urethritis when the infection occurs on the bladder and the urethra, respectively.  Common infections are a result of bacteria migrating from the skin (and also from sexual organs) to the urethra and ending up in the bladder.In males, other forms of lower tract infection can result in prostatitis, epididymitis, and orchitis.Upper Tract Infection - aka pyelonephritis, is a more concerning infection that involves the upper parts of the urinary system, in other words, the ureters, and kidneys.AGE DIFFERENCES IN UTI FOR MEN:For men, the incidence of UTI increases with age. Dr. John Brusch reports UTI rarely develops in young males and the prevalence of bacteriuria is 0.1% or less.  Men who are 15-50 years of age often have urethritis due to sexually transmitted infection (STI), mainly by Neisseria gonorrhoeae and Chlamydia trachomatis.  Symptoms include frequency, urgency, and dysuria (most common).Men who are 50 years or older, especially those with prostatic hyperplasia, will have signs and symptoms of incomplete bladder emptying, hesitancy, slow stream, difficulty initiating urination, and dribbling after urinating. Due to the enlargement of the prostate gland, there will be partial blockage of urine flow from the bladder, which in turn, creates a reservoir where bacteria can grow and cause an infection. The most common offending microorganism for this age group is Escherichia coli.Interestingly, while UTIs are rare among men under 60, by the age of 80, both women and men have similar incidence rates. The bladder tends to have a higher residual volume in older males because the prostate grows no matter what, it´s just a part of aging for males. Some may end up with more or less lower urinary tract symptoms, but the prostate is enlarged in general.Other risk factors for UTI in males are men who are not circumcised, urethral strictures, fistulas, hydronephrosis (or dilated ureters overfilled with urine due to failure of drainage to the bladder), and the use of urinary catheters. DIFFERENT TYPES OF UTIs IN MALES:EPIDIDYMITIS:The infection starts from the retrograde ascending route from the prostatic urethra, backing up to the vas deferens, and eventually ending in the epididymis.In men who are younger than 35 years of age, the usual pathogens are C. trachomatis and N. gonorrhoeae (sexually transmitted).In men who are older than 35 years of age, the usual offending agents are Enterobacteriaceae and gram-positive cocci (E. coli as mentioned previously).ORCHITIS:This unique UTI is caused by viral pathogens, such as mumps, coxsackie B, Epstein-Barr (EBV), and varicella (VZV) viruses.  Several studies have shown that patients having orchitis have a history of epididymitis. Fortunately, this infection is uncommon, and it was the main reason to develop the MMR vaccine. It is caused by viruses other than mumps, so you can still have orchitis even if you are vaccinated. Antibiotics are not prescribed for viral orchitis.BACTERIAL CYSTITIS:Having a similar pathophysiology of ascending infection mechanism, male patients in this category often present frequency, urgency, dysuria, nocturia, and suprapubic pain. On a side note, having hematuria is concerning, especially without symptoms, because it's automatically a red flag that should prompt an immediate evaluation in search of other causes besides infection, such as underlying malignancy. Possible etiologies are calculi, glomerulonephritis, and even schistosomiasis infection that can ultimately result in squamous cell carcinoma of the bladder. Arreaza: Let me share a little anecdote about hematuria. One Sunday when I was a resident I woke up with hematuria. Of course, I immediately went to urgent care, knowing hematuria means trouble in men. I had a urine dipstick test, which was normal. The first thing the nurse practitioner asked me was, “Did you eat any beets?”, and I never eat beets, but that day I had a full bag of beet chips. So, yes, that was the cause of my pseudo-hematuria. Lesson learned: Always ask about beets when you have a patient with painless hematuria with a normal dipstick. PROSTATITIS:This is an infection of the prostate gland. The most common offending agent is E. coli. Acute prostatitis will present with signs of “acute” infection, such as fever, chills, and suprapubic pain. On rectal exam, we will find a prostate that is warm, swollen, boggy, and very tender. Make sure you perform a gentle prostate exam as you may spread bacteria to the blood and cause bacteremia and potentially sepsis. Patients are normally very sick and it is not your typical cystitis, but it is more severe. Chronic Prostatitis can arise from different causes, ranging from retrograde ascending infection, “chronic” exposure to urinary pathogens, and even autoimmune etiologies. The majority of patients often are asymptomatic.   URETHRITIS:This infection is further classified into two groups, gonococcal and non-gonococcal. For gonococcal urethritis, N. gonorrhoeae is the most common pathogen. Agents of non-gonococcal urethritis include C. trachomatis, Ureaplasma, trichomonas, and Herpes Simplex Virus (HSV).  Patients often present symptoms of dysuria, pruritus, and purulent penile discharge.PYELONEPHRITIS:Following a retrograde ascending mechanism, an infection may travel from the bladder and make its way to the kidney, causing damage and inflammation to the renal parenchyma. According to Dr. John Brusch, E. coli is responsible for approximately 25% of cases in males. Pyelonephritis presents with chills, fever, nausea/vomiting, flank pain/costovertebral angle tenderness, and dysuria.  Other findings include pyuria and bacteriuria.  Pyelonephritis is a common cause of sepsis. Diagnosis of UTIs.URINE STUDIES: Urine culture remains the gold standard for diagnosis of UTI. Other studies include suprapubic aspiration, catheterization, midstream clean catch, and Gram stain. Imaging studies are not always needed, but you may order plain films, ultrasonography, CT scans, and MRIs.  It will depend on the severity of your case and your clinical judgment.UTIs in women: In males, we should perform urine culture and susceptibility studies. However, in women, urine studies are not needed all the time, they should be reserved for women with recurrent infection, treatment failure, history of resistant isolates, or atypical presentation. This is done to confirm the diagnosis and guide antibiotic selection.Interestingly, in a recent evidence review, published in the American Family Physician journal, women can self-diagnose their uncomplicated cystitis. All that is needed is having typical symptoms (frequency, urgency, dysuria/burning sensation, nocturia, suprapubic pain), without vaginal discharge. If you have those elements, you have enough information to diagnose, or even the patient can self-diagnose, an uncomplicated UTI without further testing, but in males, you should ALWAYS perform urine studies.TREATMENTS:Men with UTI should ALWAYS receive antibiotics, with urine culture and susceptibility results guiding the antibiotic choice. Laboratory results will help us determine the best treatment plan. UTIs are often treated with a variety of antibiotics.  Dr. Robert Shmerling, of Harvard Medical School, states that most uncomplicated lower tract infections can be eradicated with a week of treatment with antibiotics. Common antibiotics for UTI are fluoroquinolones, trimethoprim-sulfamethoxazole (TMP-SMZ), minocycline, or nitrofurantoin.On another hand, if it's an upper tract infection or prostatitis, the course of treatment can be extended for longer periods. For those patients who are hemodynamically unstable or have severe upper UTI, hospital admission is required to monitor for complications and IV antibiotics.UTIs in males are less frequent than UTIs in females, except when patients are 80 years and older when the incidence is similar in both sexes. UTIs in males must prompt further evaluation because if left untreated, they can have detrimental effects on your patients' health. As a take-home point, UTI in males is less common than in females, and it requires urine studies or other studies to identify the etiology and guide treatment. Antibiotics are always used, and you may guide your treatment depending on the results. Imaging is not always needed, but use your clinical judgment to make a more specific diagnosis and detect complications promptly. __________Conclusion: Now we conclude episode number 168, “UTI is Males.” Future Dr. Tran described the different anatomical areas that can be infected in males with UTI. She reminded us that UTIs in males always need to be treated with antibiotics and urine cultures are done to guide treatment. Dr. Arreaza mentioned a few differences in the diagnosis and treatment of UTIs in females. For example, women can self-diagnose an uncomplicated cystitis, and urine studies or antibiotics are not always needed in women. This week we thank Hector Arreaza and Di Tran. Audio editing by Adrianne Silva.Even without trying, every night you go to bed a little wiser. Thanks for listening to Rio Bravo qWeek Podcast. We want to hear from you, send us an email at RioBravoqWeek@clinicasierravista.org, or visit our website riobravofmrp.org/qweek. See you next week! _____________________References:Shmerling, R. H. (2022, December 5). Urinary tract infection in men. Harvard Health Publishing. https://www.health.harvard.edu/a_to_z/urinary-tract-infection-in-men-a-to-z.Brusch, J. L. (2023a, March 27). Urinary tract infection (UTI) in males. emedicine.medscpae.com. https://emedicine.medscape.com/article/231574-overview.Kurotschka PK, Gágyor I, Ebell MH. Acute Uncomplicated UTIs in Adults: Rapid Evidence Review. Am Fam Physician. 2024;109(2):167-174. https://www.aafp.org/pubs/afp/issues/2024/0200/acute-uncomplicated-utis-adults.htmlRoyalty-free music used for this episode: Tropicality by Gushito, downloaded on July 20, 2023, from https://www.videvo.net/royalty-free-music/

Salmonella and Shigella species are almost made to be confused—two bacterial infections in the Enterobacteriaceae family that are spread by food and dirty conditions, cause gastroenteritis, and start with S! To make matters more confusing, they look similar on microscopy. While they are more common in developing communities, they are also seen in the United States. Here, we will give you the tools to keep these bugs and their presentations straight. After listening to this AudioBrick, you should be able to: Differentiate the microscopic and growth characteristics and habitat of Salmonella typhi, Salmonella spp other than S typhi, and Shigella. Describe the host (risk) factors, mode of transmission, and pathobiology of diseases caused by these organisms. Describe the clinical manifestations of diseases caused by these organisms. Discuss concerns of antibiotic resistance related to these organisms. You can also check out the original brick on Salmonella and Shigella. from our Microbiology collection, which is available for free. Learn more about Rx Bricks by signing up for a free USMLE-Rx account: www.usmle-rx.com You will get 5 days of full access to our Rx360+ program, including nearly 800 Rx Bricks.  After the 5-day period, you will still be able to access over 150 free bricks, including the entire collections for General Microbiology and Cellular and Molecular Biology. *** If you enjoyed this episode, we'd love for you to leave a review on Apple Podcasts.  It helps with our visibility, and the more med students (or future med students) listen to the podcast, the more we can provide to the future physicians of the world. Follow USMLE-Rx at: Facebook: www.facebook.com/usmlerx Blog: www.firstaidteam.com Twitter: https://twitter.com/firstaidteam Instagram: https://www.instagram.com/firstaidteam/ YouTube: www.youtube.com/USMLERX Learn how you can access over 150 of our bricks for FREE: https://usmlerx.wpengine.com/free-bricks/

In this episode, we review the high-yield topic of⁠ ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Enterobacteriaceae ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠from the Microbiology section. Follow ⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠Medbullets⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠⁠ on social media: Facebook: www.facebook.com/medbullets Instagram: www.instagram.com/medbulletsofficial Twitter: www.twitter.com/medbull --- Send in a voice message: https://podcasters.spotify.com/pod/show/medbulletsstep1/message

Synes du også resistens er vanskelig? Fatt mot og bli med oss i Pestpodden på en reise gjennom resistensen! I anledning Antibiotikauken 2023 har vi nemlig to spesialepisoder. I del èn får du en enkel intro til antimikrobiell resistens - mens i del to intervjuer vi en av verdens fremste eksperter og forskere på feltet; Adam Roberts. Gled deg!Referanser:1.Barlow M, Hall BG. Phylogenetic analysis shows that the OXA beta-lactamase genes have been on plasmids for millions of years. J Mol Evol. 2002;55(3):314-21.2.D'Costa VM, King CE, Kalan L, Morar M, Sung WW, Schwarz C, et al. Antibiotic resistance is ancient. Nature. 2011;477(7365):457-61.3. Holmes AH, Moore LS, Sundsfjord A, Steinbakk M, Regmi S, Karkey A, et al. Understanding the mechanisms and drivers of antimicrobial resistance. Lancet. 2016;387(10014):176-87.4.Woerther PL, Andremont A, Kantele A. Travel-acquired ESBL-producing Enterobacteriaceae: impact of colonization at individual and community level. J Travel Med. 2017;24(suppl_1):S29-s34.5.NORM/NORM-VET 2022. Usage of Antimicrobial Agents and Occurrence of Antimicrobial Resistance in Norway. Tromsø / Oslo 2023. ISSN:1502-2307 (print) / 1890-9965 (electronic). . 2022.7. https://atlas.ecdc.europa.eu/public/index.aspx?Dataset=27&HealthTopic=48.Antimicrobial Resistance C. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-55. Hosted on Acast. See acast.com/privacy for more information.

Microbe Mail recorded a collaborative episode with the ID:IOTS podcast. Jame, Callum and I talk about the challenge of multidrug resistant Gram negative bacterial infections, particularly from the perspective of a low- middle income setting, with poor access to the newer antimicrobial agents. Callum is a medical microbiology and infectious diseases registrar working in Edinburgh, Scotland who has recently completed a medical education fellowship. Jame is an ex-Scottish newly Oxford, England, based infectious diseases and clinical pharmacology.You can find Jame and Callum's podcast here: https://idiotspodcasting.buzzsprout.com/ Links: References:Metallo-β-lactamase resistance in Enterobacteriaceae is an artefact of currently utilized antimicrobial susceptibility testing methods Best practices: Appropriate use of the new β-lactam/β-lactamase inhibitor combinations, ceftazidime-avibactam and ceftolozane-tazobactam in South AfricaColistin Monotherapy versus Colistin plus Meropenem Combination Therapy for the Treatment of Multidrug-Resistant Acinetobacter baumannii Infection: A Meta-AnalysisIDSA AMR Guidance ESCMID Gram Negative Treatment Guidelines Visit the Microbe Mail website to sign up for updates E-mail: mail.microbe@gmail.comInstagram: Microbe_Mail Twitter: @microbemail

Jame and Callum are joined by Vin from Microbe Mail to discuss the management of Difficult to Treat Resistance (DTR) Gram negative infections in South Africa.If you haven't already check out Microbe mail for a high quality infection podcast linking the lab and clinical management.... wait that sounds familiar!Vin is a associate Professor in Clinical Microbiology at the University of the Witwatersrand, Johannesburg, South Africa and a practising clinical microbiologist with the National Health Laboratory Service. She is passionate about microbes (of course), antimicrobial resistance, antimicrobial stewardship, diagnostics, healthcare associated infections, fungal infections, One Health...let's just say it's a very long list!References:Metallo-β-lactamase resistance in Enterobacteriaceae is an artefact of currently utilized antimicrobial susceptibility testing methods Best practices: Appropriate use of the new β-lactam/β-lactamase inhibitor combinations, ceftazidime-avibactam and ceftolozane-tazobactam in South AfricaColistin Monotherapy versus Colistin plus Meropenem Combination Therapy for the Treatment of Multidrug-Resistant Acinetobacter baumannii Infection: A Meta-AnalysisSupport the showQuestions, comments, suggestions to idiotspodcasting@gmail.com or Tweet us @IDiots_podPrep notes for completed episodes can be found here: https://1drv.ms/u/s!AsaWoPQ9qJLShugmB2EOm8FMePNBtA?e=IKApb5If you are enjoying the podcast please leave a review on your preferred podcast app!Feel like giving back? Donations of caffeine gratefully received!https://www.buymeacoffee.com/idiotspod

Join Jame and Callum and they discuss some of the other Enterobacterales Gram negatives. Particularly breaking down them into their families and into Lactose fermenters and non-fermenters. Jame has a small breakdown around our Twitter handle near the end.Comments suggestions and criticisms to idiotspodcasting@gmail.com or @IDiots_pod Some lists:Chromosomal AmpC Carriers (high-risk): HECK YES·         Hafnia alvei, Enterobacter cloacae, Citrobacter freundii, Klebsiella aerogenes, Yersinia enterocoliticaLower Risk Chromosomal AMPC: Vulgar Providencia Store AMPC·         Proteus Vulgaris, Providencia, Serratia, Acinetobacter, Morganella, Providencia Intrinsic Colistin Resistance: ·         Burkholderia cepacia (Nonfermenter), Proteus, Providencia, Serratia Biochemical mimics of Salmonella (also can group)·         Hafnia, Morganella,Proteus Cat 3 organisms: ·         Salmonella typhi/paratyphi, Shigella dysenteriae type 1, E.coli O157, Yersinia PestisSome useful resources:SMI ID 16: identification of Enterobacteriaceaehttps://www.gov.uk/government/publications/smi-id-16-identification-of-enterobacteriaceae Janda JM, Abbott SL. 2021. The changing face of the family Enterobacteriaceae (order: “Enterobacterales”): new members, taxonomic issues, geographic expansion, and new diseases and disease syndromes. Clin Microbiol Rev 34:e00174-20. https://doi.org/10.1128/CMR.00174-20 

Dr. Don and Professor Ben talk about the risks from getting kissed by your dog.Dr. Don - not risky

Dr. Don and Professor Ben talk about the risks from getting kissed by your dog. Dr. Don - not risky

In this episode, Keith S. Kaye, MD, MPH; Lilian Abbo, MD, FIDSA; and Jason M. Pogue, PharmD, discuss HABP/VABP and gram-negative resistance including:Epidemiology and burden of nosocomial bacterial pneumoniaPatient-specific risk factors for MDR pathogensImproving outcomes with the use of antibiogramsRecommended empiric therapy for clinically suspected VABPAntimicrobial resistance in HABP/VABPAlgorithms for gram-negative organism antibiotic-susceptibility testingUsing rapid diagnostic tests for HABP/VABPNew antimicrobial agents for MDR gram-negative infections with discussion of the 2021 IDSA guidance, and the following studies:ASPECT-NP: ceftolozane/tazobactam vs meropenemREPROVE: ceftazidime/avibactam vs meropenemRESTORE-IMI-1 imipenem/cilastatin/relebactam vs colistin + imipenemRESTORE-IMI-2: imipenem/cilastatin/relebactam vs piperacillin/tazobactamAPEKS-NP: cefiderocol vs meropenemCREDIBLE-CR: cefiderocol vs best available therapyProgram Director:Keith S. Kaye, MD, MPHChiefDivision of Allergy, Immunology and Infectious DiseasesProfessor of MedicineRutgers Robert Wood Johnson Medical SchoolNew Brunswick, New JerseyFaculty:Lilian Abbo, MD, FIDSAAssociate Chief Medical Officer in Infectious DiseasesJackson Health SystemProfessor of Infectious DiseasesDepartment of Medicine & Miami Transplant InstituteUniversity of Miami Miller School of MedicineMiami, FloridaJason M. Pogue, PharmDClinical ProfessorDepartment of Clinical PharmacyUniversity of Michigan College of PharmacyInfectious Diseases Clinical PharmacistMichigan MedicineAnn Arbor, MichiganContent based on a CME program supported by an educational grant from Merck Sharp & Dohme Corp.Follow along with a downloadable slideset at:https://bit.ly/3CEop6hLink to full program https://bit.ly/3i781lf

Popular antioxidant linked to pain relief University of Naples (Italy), November 22, 2021 People with pain of unknown causes who took alpha-lipoic acid (ALA) experienced less pain than a placebo group, a double-blind study in  Biomedicine & Pharmacotherapy revealed.1 This most recent trial enrolled 210 nondiabetic men and women with mild or moderate joint pain, neuropathic pain or muscle pain of unknown cause. Participants received 800 mg or 400 mg ALA per day or a daily placebo.  The results? People who received ALA had a significant improvement in their pain after two months of intake, while the placebo group didn't report a difference. ALA was similarly effective for all sources of pain considered. It was also shown to be safe and well-tolerated. (NEXT) Mental Qigong can be just as rewarding as its physical cousin In recent decades modern scientific techniques have fully documented the health benefits of the ancient meditation technique of Qigong. One example of physical Qigong is the technique Wu Qin Xi (five animals play), in which participants sequentially move through poses that represent the form of different animals, holding each pose for several minutes. During each phase individuals seek to regulate their breathing and still their minds. Although this is a challenging endeavor the benefits are significant. Effective Qigong practice can reduce feelings of depression and anxiety, decrease blood pressure and increase feelings of relaxation and attention. This raises the question: do the effects of these two types of Qigong manifest themselves the same in the brain, or differently? This is what the University of Mainz, wanted to find out.  (NEXT) Study links stress to Crohn's disease flare-ups McMaster University (Ontario), November 20, 2021 A possible link between psychological stress and Crohn's disease flare-ups has been identified by a McMaster University-led study. Researchers using mouse models found that stress hormones suppressed the innate immune system that normally protects the gut from invasive Enterobacteriaceae, a group of bacteria including E. coli which has been linked to Crohn's disease. (NEXT) Meta-analysis finds benefits for dietary supplements among breast cancer patients Hallym University (South Korea), November 19 2021 A meta-analysis published in Cancers found associations between improved breast cancer prognosis and the intake of multivitamins and other nutrients. The meta-analysis included 63 studies that evaluated the association between dietary factors and breast cancer recurrence, breast cancer mortality and/or mortality from any cause during the studies' follow- up periods among a total of 120,167 breast cancer patients.  (NEXT) Physical activity may improve Alzheimer's disease outcomes by lowering brain inflammation University of California at San Francisco, November 22, 2021 No one will disagree that an active lifestyle is good for you, but it remains unclear how physical activity improves brain health, particularly in Alzheimer's disease. The benefits may come about through decreased immune cell activation, according to new research published in JNeurosci. (NEXT) Aspirin is linked with increased risk of heart failure University of Freiburg (Germany), November 23, 2021 Aspirin use is associated with a 26% raised risk of heart failure in people with at least one predisposing factor for the condition. That's the finding of a study published today in a journal of the European Society of Cardiology (ESC). This is the first study to report that among individuals with at least one risk factor for heart failure, those taking aspirin were more likely to subsequently develop the condition than those not using the medication. (OTHER NEWS NEXT) Plant-derived antiviral drug is effective in blocking highly infectious SARS-CoV-2 Delta variant, say scientists University of Nottingham, November 22, 2021 A plant-based antiviral treatment for Covid-19, recently discovered by scientists at the University of Nottingham, has been found to be just as effective at treating all variants of the virus SARS-CoV-2, even the highly infectious Delta variant. The study showed that a novel natural antiviral drug called thapsigargin (TG), recently discovered by the same group of scientists to block other viruses, including the original SARS-CoV-2, was just as effective at treating all of the newer SARS-CoV-2 variants, including the Delta variant. In their previous studies* the team showed that the plant-derived antiviral, at small doses, triggers a highly effective broad-spectrum host-centred antiviral innate immune response against three major types of human respiratory viruses, including SARS-CoV-2. “Together, these results point to the antiviral potential of TG as a post-exposure prophylactic and an active therapeutic agent.” (NEXT) In Memory of JFK: The First U.S. President to be Declared a Terrorist and Threat to National Security (entire article is here) By Cynthia Chung, The Saker Blog, November 22, 2021 In April 1954, Kennedy stood up on the Senate floor to challenge the Eisenhower Administration's support for the doomed French imperial war in Vietnam, foreseeing that this would not be a short-lived war.[1] In July 1957, Kennedy once more took a strong stand against French colonialism, this time France's bloody war against Algeria's independence movement, which again found the Eisenhower Administration on the wrong side of history. Rising on the Senate floor, two days before America's own Independence Day, Kennedy declared: “The most powerful single force in the world today is neither communism nor capitalism, neither the H-bomb nor the guided missile – it is man's eternal desire to be free and independent. The great enemy of that tremendous force of freedom is called, for want of a more precise term, imperialism – and today that means Soviet imperialism and, whether we like it or not, and though they are not to be equated, Western imperialism. Thus, the single most important test of American foreign policy today is how we meet the challenge of imperialism, what we do to further man's desire to be free. On this test more than any other, this nation shall be critically judged by the uncommitted millions in Asia and Africa, and anxiously watched by the still hopeful lovers of freedom behind the Iron Curtain. If we fail to meet the challenge of either Soviet or Western imperialism, then no amount of foreign aid, no aggrandizement of armaments, no new pacts or doctrines or high-level conferences can prevent further setbacks to our course and to our security.”[2] In September 1960, the annual United Nations General Assembly was held in New York. Fidel Castro and a fifty-member delegation were among the attendees and had made a splash in the headlines when he decided to stay at the Hotel Theresa in Harlem after the midtown Shelburne Hotel demanded a $20,000 security deposit. He made an even bigger splash in the headlines when he made a speech at this hotel, discussing the issue of equality in the United States while in Harlem, one of the poorest boroughs in the country. Kennedy would visit this very same hotel a short while later, and also made a speech: “Behind the fact of Castro coming to this hotel, [and] Khrushchev…there is another great traveler in the world, and that is the travel of a world revolution, a world in turmoil…We should be glad [that Castro and Khrushchev] came to the United States. We should not fear the twentieth century, for the worldwide revolution which we see all around us is part of the original American Revolution.”[3] What did Kennedy mean by this? The American Revolution was fought for freedom, freedom from the rule of monarchy and imperialism in favour of national sovereignty. What Kennedy was stating, was that this was the very oppression that the rest of the world wished to shake the yoke off, and that the United States had an opportunity to be a leader in the cause for the independence of all nations. On June 30th, 1960, marking the independence of the Republic of Congo from the colonial rule of Belgium, Patrice Lumumba, the first Congolese Prime Minister gave a speech that has become famous for its outspoken criticism of colonialism. Lumumba spoke of his people's struggle against “the humiliating bondage that was forced upon us… [years that were] filled with tears, fire and blood,” and concluded vowing “We shall show the world what the black man can do when working in liberty, and we shall make the Congo the pride of Africa.” Shortly after, Lumumba also made clear, “We want no part of the Cold War… We want Africa to remain African with a policy of neutralism.”[4] As a result, Lumumba was labeled a communist for his refusal to be a Cold War satellite for the western sphere. Rather, Lumumba was part of the Pan-African movement that was led by Ghanaian President Kwame Nkrumah(who later Kennedy would also work with), which sought national sovereignty and an end to colonialism in Africa. Lumumba “would remain a grave danger,” Dulles said at an NSC meeting on September 21, 1960, “as long as he was not yet disposed of.”[5] Three days later, Dulles made it clear that he wanted Lumumba permanently removed, cabling the CIA's Leopoldville station, “We wish give [sic] every possible support in eliminating Lumumba from any possibility resuming governmental position.”[6] Lumumba was assassinated on Jan. 17th, 1961, just three days before Kennedy's inauguration, during the fog of the transition period between presidents, when the CIA is most free to tie its loose ends, confident that they will not be reprimanded by a new administration that wants to avoid scandal on its first days in office. Kennedy, who clearly meant to put a stop to the Murder Inc. that Dulles had created and was running, would declare to the world in his inaugural address on Jan. 20th, 1961, “The torch has been passed to a new generation of Americans.” La Resistance Along with inheriting the responsibility of the welfare of the country and its people, Kennedy was to also inherit a secret war with communist Cuba run by the CIA. The Bay of Pigs set-up would occur three months later. Prouty compares the Bay of Pigs incident to that of the Crusade for Peace; the Bay of Pigs being orchestrated by the CIA, and the Crusade for Peace sabotaged by the CIA, in both cases to ruin the U.S. president's (Eisenhower and Kennedy) ability to form a peaceful dialogue with Khrushchev and decrease Cold War tensions. Both presidents' took onus for the events respectively, despite the responsibility resting with the CIA. However, Eisenhower and Kennedy understood, if they did not take onus, it would be a public declaration that they did not have any control over their government agencies and military. Further, the Bay of Pigs operation was in fact meant to fail. It was meant to stir up a public outcry for a direct military invasion of Cuba. On public record is a meeting (or more aptly described as an intervention) with CIA Deputy Director for Plans Richard Bissell, Joint Chiefs Chairman Lyman Lemnitzer, and Navy Chief Admiral Burke basically trying to strong-arm President Kennedy into approving a direct military attack on Cuba. Admiral Burke had already taken the liberty of positioning two battalions of Marines on Navy destroyers off the coast of Cuba “anticipating that U.S. forces might be ordered into Cuba to salvage a botched invasion.”[7] (This incident is what inspired the Frankenheimer movie “Seven Days in May.”) Kennedy stood his ground. “They were sure I'd give in to them,” Kennedy later told Special Assistant to the President Dave Powers. “They couldn't believe that a new president like me wouldn't panic and try to save his own face. Well they had me figured all wrong.”[8] Incredibly, not only did the young president stand his ground against the Washington war hawks just three months into his presidential term, but he also launched the Cuba Study Group which found the CIA to be responsible for the fiasco, leading to the humiliating forced resignation of Allen Dulles, Richard Bissell and Charles Cabell. (For more on this refer to my report.) Unfortunately, it would not be that easy to dethrone Dulles, who continued to act as head of the CIA, and key members of the intelligence community such as Helms and Angleton regularly bypassed McCone (the new CIA Director) and briefed Dulles directly.[9] But Kennedy was also serious about seeing it through all the way, and vowed to “splinter the CIA into a thousand pieces and scatter it to the winds.” * * * There is another rather significant incident that had occurred just days after the Bay of Pigs, and which has largely been overshadowed by the Cuban fiasco in the United States. From April 21-26th, 1961, the Algiers putsch or Generals' putsch, was a failed coup d'état intended to force President de Gaulle (1959-1969) not to abandon the colonial French Algeria. The organisers of the putsch were opposed to the secret negotiations that French Prime Minister Michel Debré had started with the anti-colonial National Liberation Front (FLN). On January 26th, 1961, just three months before the attempted coup d'état, Dulles sent a report to Kennedy on the French situation that seemed to be hinting that de Gaulle would no longer be around, “A pre-revolutionary atmosphere reigns in France… The Army and the Air Force are staunchly opposed to de Gaulle…At least 80 percent of the officers are violently against him. They haven't forgotten that in 1958, he had given his word of honor that he would never abandon Algeria. He is now reneging on his promise, and they hate him for that. de Gaulle surely won't last if he tries to let go of Algeria. Everything will probably be over for him by the end of the year—he will be either deposed or assassinated.”[10] The attempted coup was led by Maurice Challe, whom de Gaulle had reason to conclude was working with the support of U.S. intelligence, and Élysée officials began spreading this word to the press, which reported the CIA as a “reactionary state-within-a-state” that operated outside of Kennedy's control.[11] Shortly before Challe's resignation from the French military, he had served as NATO commander in chief and had developed close relations with a number of high-ranking U.S. officers stationed in the military alliance's Fontainebleau headquarters.[12] In August 1962 the OAS (Secret Army Organization) made an assassination attempt against de Gaulle, believing he had betrayed France by giving up Algeria to Algerian nationalists. This would be the most notorious assassination attempt on de Gaulle (who would remarkably survive over thirty assassination attempts while President of France) when a dozen OAS snipers opened fire on the president's car, which managed to escape the ambush despite all four tires being shot out. After the failed coup d'état, de Gaulle launched a purge of his security forces and ousted General Paul Grossin, the chief of SDECE (the French secret service). Grossin was closely aligned with the CIA, and had told Frank Wisner over lunch that the return of de Gaulle to power was equivalent to the Communists taking over in Paris.[13] In 1967, after a five-year enquête by the French Intelligence Bureau, it released its findings concerning the 1962 assassination attempt on de Gaulle. The report found that the 1962 assassination plot could be traced back to the NATO Brussels headquarters, and the remnants of the old Nazi intelligence apparatus. The report also found that Permindex had transferred $200,000 into an OAS bank account to finance the project. As a result of the de Gaulle exposé, Permindex was forced to shut down its public operations in Western Europe and relocated its headquarters from Bern, Switzerland to Johannesburg, South Africa, it also had/has a base in Montreal, Canada where its founder Maj. Gen. Louis M. Bloomfield (former OSS) proudly had his name amongst its board members until the damning de Gaulle report. The relevance of this to Kennedy will be discussed shortly. As a result of the SDECE's ongoing investigation, de Gaulle made a vehement denunciation of the Anglo-American violation of the Atlantic Charter, followed by France's withdrawal from the NATO military command in 1966. France would not return to NATO until April 2009 at the Strasbourg-Kehl Summit. In addition to all of this, on Jan. 14th, 1963, de Gaulle declared at a press conference that he had vetoed British entry into the Common Market. This would be the first move towards France and West Germany's formation of the European Monetary System, which excluded Great Britain, likely due to its imperialist tendencies and its infamous sin City of London. Former Secretary of State Dean Acheson telegrammed West German Chancellor Konrad Adenauer directly, appealing to him to try to persuade de Gaulle to back track on the veto, stating “if anyone can affect Gen. de Gaulle's decision, you are surely that person.” Little did Acheson know that Adenauer was just days away from signing the Franco-German Treaty of Jan 22nd, 1963 (also known as the ÉlyséeTreaty), which had enormous implications. Franco-German relations, which had long been dominated by centuries of rivalry, had now agreed that their fates were aligned. (This close relationship was continued to a climactic point in the late 1970s, with the formation of the European Monetary System, and France and West Germany's willingness in 1977 to work with OPEC countries trading oil for nuclear technology, which was sabotaged by the U.S.-Britain alliance. The Élysée Treaty was a clear denunciation of the Anglo-American forceful overseeing that had overtaken Western Europe since the end of WWII. On June 28th, 1961, Kennedy wrote NSAM #55. This document changed the responsibility of defense during the Cold War from the CIA to the Joint Chiefs of Staff and would have (if seen through) drastically changed the course of the war in Vietnam. It would also have effectively removed the CIA from Cold War military operations and limited the CIA to its sole lawful responsibility, the collecting and coordination of intelligence. By Oct 11th, 1963, NSAM #263, closely overseen by Kennedy[14], was released and outlined a policy decision “to withdraw 1,000 military personnel [from Vietnam] by the end of 1963” and further stated that “It should be possible to withdraw the bulk of U.S. personnel by 1965.” The Armed Forces newspaper Stars and Stripes had the headline U.S. TROOPS SEEN OUT OF VIET BY '65. It would be the final nail in the coffin. Treason in America “Treason doth never prosper; what is the reason? Why, if it prosper, none dare call it treason.” – Sir John Harrington By Germany supporting de Gaulle's exposure of the international assassination ring, his adamant opposition to western imperialism and the role of NATO, and with a young Kennedy building his own resistance against the imperialist war of Vietnam, it was clear that the power elite were in big trouble. On November 22nd, 1963 President Kennedy was brutally murdered in the streets of Dallas, Texas in broad daylight. With the assassination of Ngo Dinh Diem, likely ordained by the CIA, on Nov. 2nd, 1963 and Kennedy just a few weeks later, de facto President Johnson signed NSAM #273 on Nov. 26th, 1963 to begin the reversal of Kennedy's policy under #263. And on March 17th, 1964, Johnson signed NSAM #288 that marked the full escalation of the Vietnam War and involved 2,709,918 Americans directly serving in Vietnam, with 9,087,000 serving with the U.S. Armed Forces during this period. The Vietnam War would continue for another 12 years after Kennedy's death, lasting a total of 20 years for Americans, and 30 years if you count American covert action in Vietnam. Two days before Kennedy's assassination, a hate-Kennedy handbill was circulated in Dallas accusing the president of treasonous activities including being a communist sympathizer. On November 29th, 1963 the Warren Commission was set up to investigate the murder of President Kennedy. The old Congressman Hale Boggs of Louisiana was a member of that Warren Commission. Boggs became increasingly disturbed by the lack of transparency and rigour exhibited by the Commission and became convinced that many of the documents used to incriminate Oswald were in fact forgeries. In 1965 Rep. Boggs told New Orleans District Attorney Jim Garrison that Oswald could not have been the one who killed Kennedy.[15] It was Boggs who encouraged Garrison to begin the only law enforcement prosecution of the President's murder to this day. Nixon was inaugurated as President of the United States on Jan 20th, 1969. Hale Boggs soon after called on Nixon's Attorney General John Mitchell to have the courage to fire J. Edgar Hoover.[16] It wasn't long thereafter that the private airplane carrying Hale Boggs disappeared without a trace. Jim Garrison was the District Attorney of New Orleans from 1962 to 1973 and was the only one to bring forth a trial concerning the assassination of President Kennedy. In Jim Garrison's book “On the Trail of the Assassins”, J. Edgar Hoover comes up several times impeding or shutting down investigations into JFK's murder, in particular concerning the evidence collected by the Dallas Police Department, such as the nitrate test Oswald was given and which exonerated him, proving that he never shot a rifle the day of Nov 22nd, 1963. However, for reasons only known to the government and its investigators this fact was kept secret for 10 months.[17]It was finally revealed in the Warren Commission report, which inexplicably didn't change their opinion that Oswald had shot Kennedy. Another particularly damning incident was concerning the Zapruder film that was in the possession of the FBI and which they had sent a “copy” to the Warren Commission for their investigation. This film was one of the leading pieces of evidence used to support the “magic bullet theory” and showcase the direction of the headshot coming from behind, thus verifying that Oswald's location was adequate for such a shot. During Garrison's trial on the Kennedy assassination (1967-1969) he subpoenaed the Zapruder film that for some peculiar reason had been locked up in some vault owned by Life magazine (the reader should note that Henry Luce the owner of Life magazine was in a very close relationship with the CIA). This was the first time in more than five years that the Zapruder film was made public. It turns out the FBI's copy that was sent to the Warren Commission had two critical frames reversed to create a false impression that the rifle shot was from behind. When Garrison got a hold of the original film it was discovered that the head shot had actually come from the front. In fact, what the whole film showed was that the President had been shot from multiple angles meaning there was more than one gunman. When the FBI was questioned about how these two critical frames could have been reversed, they answered self-satisfactorily that it must have been a technical glitch… There is also the matter of the original autopsy papers being destroyed by the chief autopsy physician, James Humes, to which he even testified to during the Warren Commission, apparently nobody bothered to ask why… This would explain why the Assassination Records Review Board (ARRB), reported in a July 1998 staff report their concern for the number of shortcomings in the original autopsy, that “One of the many tragedies of the assassination of President Kennedy has been the incompleteness of the autopsy record and the suspicion caused by the shroud of secrecy that has surrounded the records that do exist.” [emphasis added] The staff report for the Assassinations Records Review Board contended that brain photographs in the Kennedy records are not of Kennedy's brain and show much less damage than Kennedy sustained. There is a lot of spurious effort to try to ridicule anyone who challenges the Warren Commission's official report as nothing but fringe conspiracy theory. And that we should not find it highly suspect that Allen Dulles, of all people, was a member and pretty much leader of said commission. The reader should keep in mind that much of this frothing opposition stems from the very agency that perpetrated crime after crime on the American people, as well as abroad. When has the CIA ever admitted guilt, unless caught red-handed? Even after the Church committee hearings, when the CIA was found guilty of planning out foreign assassinations, they claimed that they had failed in every single plot or that someone had beaten them to the punch, including in the case of Lumumba. The American people need to realise that the CIA is not a respectable agency; we are not dealing with honorable men. It is a rogue force that believes that the ends justify the means, that they are the hands of the king so to speak, above government and above law. Those at the top such as Allen Dulles were just as adamant as Churchill about protecting the interests of the power elite, or as Churchill termed it, the “High Cabal.” Interestingly, on Dec. 22nd, 1963, just one month after Kennedy's assassination, Harry Truman published a scathing critique of the CIA in The Washington Post, even going so far as to state “There is something about the way the CIA has been functioning that is casting a shadow over our historic position [as a] free and open society, and I feel that we need to correct it.”[18] The timing of such a scathing quote cannot be stressed enough. Dulles, of course, told the public not to be distressed, that Truman was just in entering his twilight years. In addition, Jim Garrison, New Orleans District Attorney at the time, who was charging Clay Shaw as a member of the conspiracy to kill Kennedy, besides uncovering his ties to David Ferrie who was found dead in his apartment days before he was scheduled to testify, also made a case that the New Orleans International Trade Mart (to which Clay Shaw was director), the U.S. subsidiary of Permindex, was linked to Kennedy's murder. Col. Clay Shaw was an OSS officer during WWII, which provides a direct link to his knowing Allen Dulles. Garrison did a remarkable job with the odds he was up against, and for the number of witnesses that turned up dead before the trial… This Permindex link would not look so damning if we did not have the French intelligence SDECE report, but we do. And recall, in that report Permindex was caught transferring $200,000 directly to the bankroll of the OAS which attempted the 1962 assassination on de Gaulle. Thus, Permindex's implication in an international assassination ring is not up for debate. In addition, the CIA was found heavily involved in these assassination attempts against de Gaulle, thus we should not simply dismiss the possibility that Permindex was indeed a CIA front for an international hit crew. In fact, among the strange and murderous characters who converged on Dallas in Nov. 1963 was a notorious French OAS commando named Jean Souetre, who was connected to the plots against President de Gaulle. Souetre was arrested in Dallas after the Kennedy assassination and expelled to Mexico, not even kept for questioning.[19] What Does the Future Hold? After returning from Kennedy's Nov. 24th funeral in Washington, de Gaulle and his information minister Alain Peyrefitte had a candid discussion that was recorded in Peyrefitte's memoire “C'était de Gaulle,” the great General was quoted saying: “What happened to Kennedy is what nearly happened to me… His story is the same as mine. … It looks like a cowboy story, but it's only an OAS [Secret Army Organization] story. The security forces were in cahoots with the extremists. …Security forces are all the same when they do this kind of dirty work. As soon as they succeed in wiping out the false assassin, they declare the justice system no longer need be concerned, that no further public action was needed now that the guilty perpetrator was dead. Better to assassinate an innocent man than to let a civil war break out. Better an injustice than disorder. America is in danger of upheavals. But you'll see. All of them together will observe the law of silence. They will close ranks. They'll do everything to stifle any scandal. They will throw Noah's cloak over these shameful deeds. In order to not lose face in front of the whole world. In order to not risk unleashing riots in the United States. In order to preserve the union and to avoid a new civil war. In order to not ask themselves questions. They don't want to know. They don't want to find out. They won't allow themselves to find out.” The American people would do well to remember that it was first John F. Kennedy, acting as the President to the United States, who was to be declared a terrorist and threat to his country's national security. Thus is it not natural that those who continue to defend the legacy of Kennedy should be regarded today as threat, not truly to the nation's security, but a threat to the very same grouping responsible for Kennedy's death and whom today have now declared open war on the American people. This will be the greatest test the American people have ever been confronted with, and it will only be through an understanding of how the country came to where it is today that there can be sufficient clarity as to what the solutions are, which are not to be found in another civil war. To not fall for the trapping of further chaos and division, the American people will only be able to rise above this if they choose to ask those questions, if they choose to want to know, to want to find out the truth of things they dared not look at in the past for fear of what it would reveal. “Whenever the government of the United States shall break up, it will probably be in consequence of a false direction having been given to public opinion. This is the weak point of our defenses, and the part to which the enemies of the system will direct all their attacks. Opinion can be so perverted as to cause the false to seem true; the enemy, a friend, and the friend, an enemy; the best interests of the nation to appear insignificant, and the trifles of moment; in a word, the right the wrong, the wrong the right. In a country where opinion has sway, to seize upon it, is to seize upon power. As it is a rule of humanity that the upright and well-intentioned are comparatively passive, while the designing, dishonest, and selfish are the most untiring in their efforts, the danger of public opinion's getting a false direction is four-fold, since few men think for themselves.” -James Fenimore Cooper (1789-1851( We must dare to be among the few who think for ourselves. (NEXT) VAERS Data Reveals 50 X More Ectopic Pregnancies Following COVID Shots than Following ALL Vaccines for Past 30 Year Health Impact News, November 22, 2021 While the latest data dump into the government's Vaccine Adverse Event Reporting System (VAERS) showed 2,620 fetal deaths, which are more fetal deaths than are reported following ALL vaccines for the past 30 years in VAERS, one “symptom” that is tracked in VAERS that it did not account for is an ectopic pregnancy which also results in a fetal death. Ectopic pregnancy, also called extrauterine pregnancy, is when a fertilized egg grows outside a woman's uterus, somewhere else in their belly. It can cause life-threatening bleeding and needs medical care right away. I performed a search in VAERS for ectopic pregnancies following COVID-19 shots for the past 11 months, and there have been 52 cases where a woman received a COVID-19 shot and then was found to have an ectopic pregnancy. Next, I performed the exact same search but excluded COVID-19 “vaccines” and it returned a result of 30 cases where a woman received an FDA-approved vaccine and then reported an ectopic pregnancy following ALL vaccines for the past 30+ years, which is about 1 per year. That means that following COVID-19 injections into child-bearing women for the past 11 months has seen a 50 X increase in ectopic pregnancies compared to child-bearing women receiving vaccines for the past 30+ years. (NEXT) Massive study reveals editorial bias and nepotism in biomedical journals University of Rennes, November 23, 2021 Scientific journals are expected to consider research manuscripts dispassionately and without favor. But a study published in the journal PLOS Biology reveals that a subset of journals may be exercising considerable bias and favoritism. To identify journals that are suspected of favoritism, the authors explored nearly 5 million articles published between 2015 and 2019 in a sample of 5,468 of biomedical journals indexed in the National Library of Medicine. Their results reveal that in most journals, publications are distributed across a large number of authors, as one might hope. However, the authors identify a subset of biomedical journals where a few authors, often members of that journal's editorial board, were responsible for a disproportionate number of publications. In addition, the articles authored by these “hyper-prolific” individuals were more likely to be accepted for publication within 3 weeks of their submission, suggesting favoritism in journals' editorial procedures. Why would this matter? Such “nepotistic journals,” suspected of biased editorial decision-making, could be deployed to game productivity-based metrics, which could have a serious knock-on effect on decisions about promotion, tenure and research funding. (NEXT) Hurricanes expected to linger over Northeast cities, causing greater damage More storms like Hurricane Sandy could be in the East Coast's future, potentially costing billions of dollars in damage and economic losses. Rowan University, November 22, 2021 By the late 21st century, northeastern U.S. cities will see worsening hurricane outcomes, with storms arriving more quickly but slowing down once they've made landfall. As storms linger longer over the East Coast, they will cause greater damage along the heavily populated corridor, according to a new study. The new study analyzed more than 35,000 computer-simulated storms. To assess likely storm outcomes in the future The researchers found that future East Coast hurricanes will likely cause greater damage than storms of the past. The research predicted that a greater number of future hurricanes will form near the East Coast, and those storms will reach the Northeast corridor more quickly. The simulated storms slow to a crawl as they approach the East Coast, allowing them to produce more wind, rain, floods, and related damage in the Northeast region. The longest-lived tropical storms are predicted to be twice as long as storms today.

In this final episode at ICPIC 2021 (Geneva), Martin Kiernan talks to Professor Andreas Voss  from the Radboud University Medical Centre (Radboudumc) and Canisus-Wilhelmina Ziekenhuis in the Netherlands. Andreas is always a sought after speaker for his engaging style whilst getting to the heart of the matter. To get the most from this podcast, you might need to look at the papers we mention below. Endoscopes Benowitz I, Moulton-Meissner HA, Epstein L, Arduino MJ. Gastrointestinal Flexible Endoscopes: Infection Control Risks, Lessons Learned from Outbreaks, and Centers for Disease Control and Prevention Guidance. Gastrointestinal Endoscopy Clinics of North America. 2020;30(4):723-33 https://www.sciencedirect.com/science/article/abs/pii/S1052515720300702?via%3Dihub Sinks De Geyter D, Blommaert L, Verbraeken N, Sevenois M, Huyghens L, Martini H, et al. The sink as a potential source of transmission of carbapenemase-producing Enterobacteriaceae in the intensive care unit. Antimicrob Resist Infect Control. 2017;6:24. https://www.ncbi.nlm.nih.gov/pubmed/34111433 Decreased other infections (STD and Norovirus) Nelson B. The positive effects of covid-19. BMJ. 2020;369:m1785. http://www.bmj.com/content/369/bmj.m1785.abstract Bruggink LD, Garcia-Clapes A, Tran T, Druce JD, Thorley BR. Decreased incidence of enterovirus and norovirus infections during the COVID-19 pandemic, Victoria, Australia, 2020. Commun Dis Intell (2018). 2021 Jan 29;45. doi: 10.33321/cdi.2021.45.5. PMID: 33573536. Impact on ocular health Bahkir, Fayiqa Ahamed; Grandee, Srinivasan Subramanian Impact of the COVID-19 lockdown on digital device-related ocular health, Indian Journal of Ophthalmology: November 2020 - Volume 68 - Issue 11 - p 2378-2383 doi: 10.4103/ijo.IJO_2306_20 Dog-assisted therapy Edner A, Lindstrom-Nilsson M, Melhus A. Low risk of transmission of pathogenic bacteria between children and the assistance dog during animal-assisted therapy if strict rules are followed. J Hosp Infect. 2021;115:5-9. https://www.journalofhospitalinfection.com/article/S0195-6701(21)00178-X/fulltext Lace up masks Wang X, Lin F, Wang Z, Hu J, Li X, Zhu B, et al. The defects of lace-up surgical masks and related solutions in operating rooms. J Hosp Infect. 2021;115:64-70. https://www.journalofhospitalinfection.com/article/S0195-6701(21)00237-1/fulltext#relatedArticles Migrane and mask wearing Bharatendu C, Ong JJY, Goh Y, Tan BYQ, Chan ACY, Tang JZY, et al. Powered Air Purifying Respirator (PAPR) restores the N95 face mask induced cerebral hemodynamic alterations among Healthcare Workers during COVID-19 Outbreak. J Neurol Sci. 2020;417:117078. https://www.jns-journal.com/action/showPdf?pii=S0022-510X%2820%2930415-9 A nose for pneumonia Chen, C.-Y., Lin, W.-C. & Yang, H.-Y. Diagnosis of ventilator-associated pneumonia using electronic nose sensor array signals: solutions to improve the application of machine learning in respiratory research. Respir Res 2020;21:45 (2020). https://doi.org/10.1186/s12931-020-1285-6 Social media for epidemiologists Hammer CC, Boender TS, Thomas DR. Social media for field epidemiologists (#SoMe4epi): How to use Twitter during the #COVID19 pandemic. Int J Infect Dis. 2021. https://linkinghub.elsevier.com/retrieve/pii/S1201-9712(21)00437-9 Use of Emoji in communication Lotfinejad, N., Assadi, R., Aelami, M. H. & Pittet, D. Emojis in public health and how they might be used for hand hygiene and infection prevention and control. Antimicrob Resist Infect Control 2020;9:27. https://doi.org/10.1186/s13756-020-0692-2  On Call IPC Services Humphreys H. Infection prevention and control advice out-of-hours. J Hosp Infect. 2020;105(4):795-6. https://www.journalofhospitalinfection.com/article/S0195-6701(20)30262-0/fulltext Handshake/Fist Bump Sklansky M, Nadkarni N, Ramirez-Avila L. Banning the handshake from the health care setting. JAMA. 2014;311(24):2477-8. https://jamanetwork.com/journals/jama/article-abstract/1873637 Mela S, Whitworth DE. The fist bump: a more hygienic alternative to the handshake. Am J Infect Control. 2014;42(8):916-7. http://www.ncbi.nlm.nih.gov/pubmed/25087144   Elbow or hand Liu H, Gao L, Sun C. Elbow instead of hand: is it more helpful or harmful? J Public Health (Oxf). 2020. https://www.ncbi.nlm.nih.gov/pubmed/32529204

In this final episode at ICPIC 2021 (Geneva), Martin Kiernan talks to Professor Andreas Voss  from the Radboud University Medical Centre (Radboudumc) and Canisus-Wilhelmina Ziekenhuis in the Netherlands. Andreas is always a sought after speaker for his engaging style whilst getting to the heart of the matter. To get the most from this podcast, you might need to look at the papers we mention below. Endoscopes Benowitz I, Moulton-Meissner HA, Epstein L, Arduino MJ. Gastrointestinal Flexible Endoscopes: Infection Control Risks, Lessons Learned from Outbreaks, and Centers for Disease Control and Prevention Guidance. Gastrointestinal Endoscopy Clinics of North America. 2020;30(4):723-33 https://www.sciencedirect.com/science/article/abs/pii/S1052515720300702?via%3Dihub Sinks De Geyter D, Blommaert L, Verbraeken N, Sevenois M, Huyghens L, Martini H, et al. The sink as a potential source of transmission of carbapenemase-producing Enterobacteriaceae in the intensive care unit. Antimicrob Resist Infect Control. 2017;6:24. https://www.ncbi.nlm.nih.gov/pubmed/34111433 Decreased other infections (STD and Norovirus) Nelson B. The positive effects of covid-19. BMJ. 2020;369:m1785. http://www.bmj.com/content/369/bmj.m1785.abstract Bruggink LD, Garcia-Clapes A, Tran T, Druce JD, Thorley BR. Decreased incidence of enterovirus and norovirus infections during the COVID-19 pandemic, Victoria, Australia, 2020. Commun Dis Intell (2018). 2021 Jan 29;45. doi: 10.33321/cdi.2021.45.5. PMID: 33573536. Impact on ocular health Bahkir, Fayiqa Ahamed; Grandee, Srinivasan Subramanian Impact of the COVID-19 lockdown on digital device-related ocular health, Indian Journal of Ophthalmology: November 2020 - Volume 68 - Issue 11 - p 2378-2383 doi: 10.4103/ijo.IJO_2306_20 Dog-assisted therapy Edner A, Lindstrom-Nilsson M, Melhus A. Low risk of transmission of pathogenic bacteria between children and the assistance dog during animal-assisted therapy if strict rules are followed. J Hosp Infect. 2021;115:5-9. https://www.journalofhospitalinfection.com/article/S0195-6701(21)00178-X/fulltext Lace up masks Wang X, Lin F, Wang Z, Hu J, Li X, Zhu B, et al. The defects of lace-up surgical masks and related solutions in operating rooms. J Hosp Infect. 2021;115:64-70. https://www.journalofhospitalinfection.com/article/S0195-6701(21)00237-1/fulltext#relatedArticles Migrane and mask wearing Bharatendu C, Ong JJY, Goh Y, Tan BYQ, Chan ACY, Tang JZY, et al. Powered Air Purifying Respirator (PAPR) restores the N95 face mask induced cerebral hemodynamic alterations among Healthcare Workers during COVID-19 Outbreak. J Neurol Sci. 2020;417:117078. https://www.jns-journal.com/action/showPdf?pii=S0022-510X%2820%2930415-9 A nose for pneumonia Chen, C.-Y., Lin, W.-C. & Yang, H.-Y. Diagnosis of ventilator-associated pneumonia using electronic nose sensor array signals: solutions to improve the application of machine learning in respiratory research. Respir Res 2020;21:45 (2020). https://doi.org/10.1186/s12931-020-1285-6 Social media for epidemiologists Hammer CC, Boender TS, Thomas DR. Social media for field epidemiologists (#SoMe4epi): How to use Twitter during the #COVID19 pandemic. Int J Infect Dis. 2021. https://linkinghub.elsevier.com/retrieve/pii/S1201-9712(21)00437-9 Use of Emoji in communication Lotfinejad, N., Assadi, R., Aelami, M. H. & Pittet, D. Emojis in public health and how they might be used for hand hygiene and infection prevention and control. Antimicrob Resist Infect Control 2020;9:27. https://doi.org/10.1186/s13756-020-0692-2  On Call IPC Services Humphreys H. Infection prevention and control advice out-of-hours. J Hosp Infect. 2020;105(4):795-6. https://www.journalofhospitalinfection.com/article/S0195-6701(20)30262-0/fulltext Handshake/Fist Bump Sklansky M, Nadkarni N, Ramirez-Avila L. Banning the handshake from the health care setting. JAMA. 2014;311(24):2477-8. https://jamanetwork.com/journals/jama/article-abstract/1873637 Mela S, Whitworth DE. The fist bump: a more hygienic alternative to the handshake. Am J Infect Control. 2014;42(8):916-7. http://www.ncbi.nlm.nih.gov/pubmed/25087144   Elbow or hand Liu H, Gao L, Sun C. Elbow instead of hand: is it more helpful or harmful? J Public Health (Oxf). 2020. https://www.ncbi.nlm.nih.gov/pubmed/32529204

Salmonella and Shigella species are almost made to be confused—two bacterial infections in the Enterobacteriaceae family that are spread by food and dirty conditions, cause gastroenteritis, and start with S! To make matters more confusing, they look similar on microscopy. While they are more common in developing communities, they are also seen in the United States. Here, we will give you the tools to keep these bugs and their presentations straight. After listening to this AudioBrick, you should be able to: Differentiate the microscopic and growth characteristics and habitat of Salmonella typhi, Salmonella spp other than S typhi, and Shigella. Describe the host (risk) factors, mode of transmission, and pathobiology of diseases caused by these organisms. Describe the clinical manifestations of diseases caused by these organisms. Discuss concerns of antibiotic resistance related to these organisms. You can also check out the original brick on Salmonella and Shigella. from our Microbiology collection, which is available for free. Learn more about Rx Bricks by signing up for a free USMLE-Rx account: www.usmle-rx.com You will get 5 days of full access to our Rx360+ program, including nearly 800 Rx Bricks.  After the 5-day period, you will still be able to access over 150 free bricks, including the entire collections for General Microbiology and Cellular and Molecular Biology. *** If you enjoyed this episode, we'd love for you to leave a review on Apple Podcasts.  It helps with our visibility, and the more med students (or future med students) listen to the podcast, the more we can provide to the future physicians of the world. Follow USMLE-Rx at: Facebook: www.facebook.com/usmlerx Blog: www.firstaidteam.com Twitter: https://twitter.com/firstaidteam Instagram: https://www.instagram.com/firstaidteam/ YouTube: www.youtube.com/USMLERX Learn how you can access over 150 of our bricks for FREE: https://usmlerx.wpengine.com/free-bricks/

Dr. Jill Cowper (@jillcowper), and Dr. Jesse Sutton, join host Dr. Zahra Kassamali Escobar (@zkePharmD) to discuss the data behind use of oral beta-lactams as step-down therapy for bacteremia and other serious infections.  Learn more about the Society of Infectious Diseases Pharmacists: https://sidp.org/About Twitter: @SIDPharm (https://twitter.com/SIDPharm) Instagram: @SIDPharm (https://www.instagram.com/sidpharm/) Facebook: https://www.facebook.com/sidprx LinkedIn: https://www.linkedin.com/company/sidp/ References: Sutton J, Stevens V, Chang NN et al. Oral β-Lactam Antibiotics vs Fluoroquinolones or Trimethoprim-Sulfamethoxazole for Definitive Treatment of Enterobacterales Bacteremia From a Urine Source. JAMA Netw Open. 2020 Oct 1;3(10):e2020166. Punjabi C, Tien V, Meng C, et al. Oral Fluoroquinolone or Trimethoprim-Sulfamethoxazole vs ß-Lactams as Step-Down Therapy for Enterobacteriaceae Bacteremia: Systematic Review and Meta-analysis, Open Forum Infect Dis 2019; 6(10):ofz364. Tamma PD, Conley AT, Cosgrove SE, et al. Association of 30-Day Mortality With Oral Step-Down vs Continued Intravenous Therapy in Patients Hospitalized With Enterobacteriaceae Bacteremia. JAMA Intern Med 2019; 179(3):316-323. Mercuro NJ, Stogsdill P, Wungwattana M. Retrospective analysis comparing oral stepdown therapy for enterobacteriaceae bloodstream infections: fluoroquinolones versus beta-lactams. Int J Antimicrob Agents 2018;51(5)687-692. Kutob LF, Justo JA, Bookstaver BA et al. Effectiveness of oral antibiotics for definitive therapy of Gram-negative bloodstream infections. Int J Antimicrob Agents 2016 Nov;48(5):498-503. Mogle BT, Beccari MV, Steele JM, et al. Clinical considerations for oral beta-lactams as step-down therapy for Enterobacteriaceae bloodstream infections. Expert Opin Pharmacother. 2019 Jun;20(8):903-907. Migils C, Rhodes NJ, Kuti JL, et al. Defining the impact of severity of illness on time above the MIC threshold for cefepime in Gram-negative bacteraemia: a 'Goldilocks' window. Int J Antimicrob Agents 2017;50(3):487-490. Sandberg T, Englund G, Lincoln K, Nilsson LG. Randomised double-blind study of norfloxacin and cefadroxil in the treatment of acute pyelonephritis. Eur J Clin Microbiol Infect Dis. 1990;9(5):317-323. Mahoney MV, Swords KE. Fluoroquinolones: Friends or Foe? Clin Infect Dis. Clin Infect Dis. 2021 Feb 19:ciab150. Arensman K, Shields M, Beganovic M, et al. Fluoroquinolone versus beta-lactam oral step-down therapy for uncomplicated streptococcal bloodstream infections. Antimicrob Agents Chemother 2020;64(11):e01515-20.  Seaton RA, Ritchie ND, Robb F, et al. From 'OPAT' to 'COpAT': implications of the OVIVA study for ambulatory management of bone and joint infection. J Antimicrob Chemother. 2019 Aug 1;74(8):2119-2121.

Welcome back to USMLE Listen This is MICROBIOLOGY Chapter 6: Enterobacteriaceae! Whether you're on a run or driving, this is The PERFECT podcast to initiate your auditory learning for the USMLE Step 1! In this episode, it's all about USMLE-important Gram Enterobacteriacaea Important exam related information on gram-negative bacteria in the ENTEROBACTERIACEAE FAMILY which include E.coli, Klebsiella, Shigella, Yersinia, Proteus, Salmonella, Haemophilus, Gardnerella, Pasteurella, and Bacteroides. We will also go over bacterial infections caused by ANIMAL AND HUMAN BITES as well as the different bacteria that cause ENDOCARDITIS! Review EACH USMLE critical Enterobacteriaceae: Features Transmission & Predisposing Factors Pathogenesis Diseases Associated Treatment Important to Know Info! As always, you can email us at USMLElisten@gmail.com for your questions, anything you need to be cleared, or suggestions on how we can improve and initiate your auditory learning for the USMLE Step 1. Sources for USMLE LISTEN include First Aid, Osmosis, Uworld, and Kaplan study guides. This is Mark Labella, you can follow or message me on Instagram at markjlabella. See you in the next episode for your auditory learning at USMLE LISTEN!

Dr Nasir Saleem discusses his article, "Endoscopic transmission of carbapenem-resistant Enterobacteriaceae: implications for Food and Drug Administration approval and postmarket surveillance of endoscopic devices" from the January issue.

This episode covers enterobacteriaceae!

Enterobacteriaceae--shigella --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Enterobacteriaceae-- e.coli.--- Kass concept of significant bacteriuria --- This episode is sponsored by · Anchor: The easiest way to make a podcast. https://anchor.fm/app

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.10.17.343541v1?rss=1 Authors: Chen, C., Xu, S., Li, Y. Abstract: Global public health is increasingly threatened by the fast emergence of antibiotic resistance, and novel types of antibiotics are urgently needed. Metazoans have evolved their own antimicrobial mechanism, such as human group IIA secreted phospholipase A (sPLA2), which can efficiently inhibit the growth of gram-positive bacteria, but with much lower efficiency toward gram-negative bacteria. Here, we verified the antibacterial activity of a plant lipase, PLIP1 from Arabidopsis thaliana, against the gram-negative bacteria Escherichia coli, which belongs to the WHO priority 1 (critical) pathogen Enterobacteriaceae family. We also explored the potential of evolving PLIP1 as a more potent antimicrobial agent towards E. coli. Our results imply the possibility of using plant lipases as a potential antimicrobial and shed light on the future exploration of plant enzymes for novel and more efficient antibacterial agents. Copy rights belong to original authors. Visit the link for more info

Dr. Mercurio reviews antimicrobial susceptibility testing methods and explains how this data reported with culture results can be best used to make informed antibiotic treatment decisions. Dr. Mercurio begins by discussing the difference between MIC and MBC, and the misconceptions about MIC values for different antibiotic agents. Next, she reviews recent changes in the susceptibility breakpoints for several bacterial organisms, including Enterococcus spp., Staphylococcus aureus, Enterobacteriaceae, and Pseudomonas. Lastly, she reviews the resistance issues with the “SPACE/SPICE” bacteria as well as inducible clindamycin resistance, and closes with comments on heteroresistance issues in bacterial populations.

Link to bioRxiv paper: http://biorxiv.org/cgi/content/short/2020.07.24.215889v1?rss=1 Authors: Matlock, W., Chau, K. K., AbuOun, M., Stubberfield, E., Barker, L., Kavanagh, J., Pickford, H., Gilson, D., Smith, R. P., Gweon, H. S., Hoosdally, S. J., Swann, J., Sebra, R., Bailey, M. J., Peto, T. E. A., Crook, D. W., Anjum, M. F., Read, D. S., Walker, A. S., Stoesser, N., Shaw, L. P., REHAB Consortium Abstract: IncF plasmids are diverse and of great clinical significance, often carrying genes conferring antimicrobial resistance (AMR) such as extended-spectrum {beta}-lactamases, particularly in Enterobacteriaceae. Organising this plasmid diversity is challenging, and current knowledge is largely based on plasmids from clinical settings. Here, we present a network community analysis of a large survey of IncF plasmids from environmental (influent, effluent, and upstream/downstream waterways surrounding wastewater treatment works) and livestock settings. We use a tractable and scalable methodology to examine the relationship between plasmid metadata and network communities. This reveals how niche (sampling compartment and host genera) partition and shape plasmid diversity. We also perform pangenome-style analyses on network communities. We show that such communities define unique combinations of core genes, with limited overlap. Building plasmid phylogenies based on alignments of these core genes, we demonstrate that plasmid accessory function is closely linked to core gene content. Taken together, our results suggest that stable IncF plasmid backbone structures can persist in environmental settings while allowing dramatic variation in accessory gene content that may be linked to niche adaptation. The recent association of IncF plasmids with AMR likely reflects their suitability for rapid niche adaptation. Copy rights belong to original authors. Visit the link for more info

Welcome back to episode 405 of the Whole View. (0:27) Today Stacy and Sarah are talking about a super interesting topic submitted a listener. Which, if you didn't know this already, we love it when you email us. Sarah shared some behind the scenes information on where listener questions come from. There are Stacy's requests, listener questions, and the really challenging listener questions. The question in discussion in this episode is one of those really hard ones that has been in the queue for a long time. Sarah was able to pull together the information for this show because she actually did a lot of research on this topic for her gut microbiome book. And of course, Sarah did extra research to address the many facets of this challenging question. Stacy is excited about this science rich show.   Listener Question Is the EWG's dirty dozen list based on strong science? (3:37) My husband listened to two episodes of the Skeptoid podcast on organic vs. conventional farming. Mr. Dunning said that we are being duped into paying extra for organic produce. It is sprayed with larger amounts of pesticides than those used in conventional farming and the organic pesticides have been shown to cause disease. My husband believes Mr. Dunning because he provides references and appears to be liberal and non-biased in other podcasts.   I have been purchasing organic produce according to the Environmental Working Group's dirty dozen list. It says on the Activist Facts website that "There’s really only one thing you need to know about the Environmental Working Group when it comes to its studies of toxins: 79 percent of members of the Society of Toxicology (scientists who know a little something about toxins) who rated the group say that the Environmental Working Group overstates the health risk of chemicals. I am walking around with holes in my shirts, and I haven't gotten the air conditioning fixed in my car, so that I can afford organic food. Am I wasting my money? I feel like I cannot trust anyone but you.   Preface Stacy wanted to refer listeners to listen back to previous episodes for information on how both Stacy and Sarah have evolved the way they purchase and prioritize their own foods within their budget. (5:06) Neither Stacy nor Sarah buys everything organically. Nothing that Stacy and Sarah are going to discuss in this episode is intended to be a judgment on you or your family or what you did in the past or what you are doing now. This is all education so that you can be empowered to make the choices that are best for your family at the correct time for you. Where Stacy's family is today, ten years later, is a lot different than where they were ten years ago. The goal of this episode is to help you so that you can walk away and ask questions. There is a larger philosophy that each family needs to adapt to what works best for them. No one is perfect. If you are starting in your journey, you don't need to forego the necessities to have organic food. There is a way to prioritize your budget in a way that is consistent with what your family believes in. Healthy living choices are so personal.   Foundational Choices & Next Level Choices Sarah wanted to emphasize that there are foundational health principles. Nutrient density diet, eating a lot of fruits and vegetables, getting enough sleep, managing stress, and living an active lifestyle. Then Sarah thinks of the next level steps like adding some biohacks, supplements, purchasing grass-fed beef, and organic fruits and vegetables. We need to first make sure that we are focusing on the foundational principles and adding in the next level choice if and when it makes sense. Eating organic is beyond the basic principles, but is overall a better choice. The EWG's overall approach is in many ways more rigorous than the American regulatory agencies. The EWG tends to align with the European Union, Health Canada, and these other regions of the world where the criterion for approving a chemical or pesticide is firmer. In America, the thought process is that chemicals are assumed fine unless proven bad. In Europe, a chemical is not ok until proven safe.   Conventional Evaluation of Pesticide Safety The FDA's safety assessment for chemicals in foods have a variety of criteria. (13:11) They look at acute chronic and subchronic toxicity, carcinogenicity, genotoxicity, reproductive and developmental toxicity, neurotoxicity, and immunotoxicity. Pesticides also go through additional impact evaluation on the environment and ecology. The vast majority of the studies evaluating the effects of pesticides show problems to human health only with occupational exposure, rather than the much lower exposure the majority of us would have simply by eating produce from crops treated with these chemicals. However, there are some challenges with this. We can see high exposure in rodents causing all kinds of problems. The assumption is that acute exposure is not the same as low dose chronic exposure.   Where the Standards Differ One of the challenges that we have in evaluating pesticides is that our exposure is already so vast. There are no humans that don't already have multiple points of exposure to pesticides. There are studies that are linking the chronic low dose exposure to pesticide residues that have correlated pesticide exposure in the food supply with a number of health issues. In the United States, there are 72 pesticides that are routinely used that are completely banned or are in the process of being completely phased out in Europe. Of the pesticides used in USA agriculture in 2016, 322 million pounds were of pesticides banned in the EU. Twenty-six million pounds were of pesticides banned in Brazil and 40 million pounds were of pesticides banned in China. Pesticides banned in the EU account for more than a quarter of all agricultural pesticide use in the USA. It is important to understand that the European Union is looking at the same science as the EPA. And they are making a different judgment based on the strength of the data. We have a challenge that our metric is, 'is it toxic' and 'does it cause cancer'. WHO Guidelines for Safety of Chemicals in Food are much more thorough, and add to the above. They include general system toxicity, allergy and hypersensitivity, and GI Tract Considerations (includes microbiome).   Pesticides and the Microbiome (Sarah’s Biggest Concern) Microbial diversity is generally considered to be the most important measurable criteria for a healthy microbiome. (24:31) The more different species you have, they tend to keep each other in balance. The bacteria basically control the growth of each other. We are also looking for the growth of these really important probiotic strains. In addition, we are looking for completely absent levels of pathogens. We are also looking at the balance between the two main phylum of bacteria in the gut. It is important to understand that rodent studies are actually really good studies for understanding the gut microbiome. We would want to eventually be able to do a similar study in humans. But what Sarah wants to emphasize is that these rodent studies are a really good model for understanding what is happening in humans. Let’s go through some of the most commonly-used pesticides in agriculture for food crops. Permethrin is a broad-spectrum chemical often used as an insecticide for cotton, corn, alfalfa, and wheat crops—unfortunately, it’s also lethal to bees. It’s also used to treat lice, ticks, and scabies.  For more on this, visit this link here. PEM has higher antibacterial activity against some beneficial bacteria, (including Lactobacillus paracasei and Bifidobacterium). Than against pathogens (such as Staphylococcus aureus and Escherichia coli, which only respond to higher concentrations of PEM). Carbendazim (CBZ) is a broad-spectrum benzimidazole fungicide, widely used in agriculture. In mice, 28 days of exposure to CBZ resulted in gut dysbiosis. It suppresses the growth of some of the most important probiotic families while increasing the growth of some problematic families of bacteria. And it decreases bacterial diversity. To learn more about this pesticide, see here. Epoxiconazole (EPO) is a broad-spectrum fungicide often used on grain crops, and that works by inhibiting the metabolism of fungal cells. It reduces the production of conidia—the asexual spores of a fungus that facilitate reproduction. In rats, EPO for 90 days decreased the relative abundance of Firmicutes and increased the abundance of Bacteroidetes and Proteobacteria, while also selectively enriching Lachnospiraceae and Enterobacteriaceae. To learn more about this pesticide, see here.   More Commonly Used Pesticides Imazalil (IMZ) is a systemic fungicide used to combat fungi on vegetables and fruit (especially citrus), as well as tubers during storage. (30:39) In mice, IMZ exposure (at doses of 100 mg per kg of body weight daily for up to 14 days) reduced the cecal relative abundance of Bacteroidetes, Firmicutes, and Actinobacteria, while also reducing microbiota richness and diversity. The IMZ-treated mice also exhibited colonic inflammation. In another study of mice, low-dose, environmentally relevant exposure to IMZ (0.1, 0.5, or 2.5 mg per kg of body weight daily) for 15 weeks resulted in gut microbiota changes. These changes included reduced mucus secretion, decreased the expression of genes related to cystic fibrosis transmembrane conductance regulator (CTFR) in the ileum and colon, and generally disturbed intestinal barrier function. Stacy shared her perspective on how she looks at this information. Think through the way how these pesticides are more heavily used on grains. Chlorphyrifos (CPF) is an extremely common organophosphate pesticide used to kill insects and worms, by interfering with acetylcholine signaling and disrupting their nerve processes. It’s commonly used on fruit and vegetable crops, as well as vineyards. This is one that was going to be banned in the USA, but Scott Pruitt reversed the planned ban. You can learn more about this here. Sarah shared on this study, this study, this study, and this study. This information should stimulate a reevaluation of the use of these chemicals in the food supply. Diazinon is an organophosphate insecticide used on a variety of crops—including fruit trees, rice, sugarcane, nuts, potatoes, and corn. You can learn more about this pesticide here. It causes different changes in male rodents versus female rodents. The researchers speculated that these differences—with male mice experiencing the most severe changes—were due to sex-dependent gut microbiota profiles present before treatment. You can read more about this study here.   Two More Commonly Used Pesticides Propamocarb (PMEP) is a systemic fungicide used to control root, leaf, and soil diseases caused by oomycetes (water molds) by interfering with fatty acid and phospholipid biosynthesis and therefore changing the membrane in fungi. (41:41) It can accumulate in fruit at high levels, thus reaching humans.  You can find more information on this pesticide here. In mice, 28 days of exposure to PMEP (at levels of 300 mg/L in drinking water) induced gut dysbiosis and changes in 20 fecal metabolites, including SCFAs, succinate, bile acids, and TMA. You can read more about this study here. Glyphosate is a broad-spectrum herbicide that can kill both grasses and leafy weeds. It works by inhibiting an enzyme (5-enolpyruvylshikimic acid-3-phosphate synthase, or EPSP synthase), which is used by bacteria, archaea, fungi, algae, some protozoans and plants to synthesize folates (vitamin B9), ubiquinone, menaquinones (vitamin K2), phenolic compounds, and the aromatic amino acids tyrosine, tryptophan, and phenylalanine. The pathway this affects doesn’t exist in animals, which is part of why glyphosate has historically been considered to have low toxicity in animals.  Now that we understand that we have at least as many bacterial cells living within our body as we do human cells and that those bacteria are essential to our health, the relevance of glyphosate exposure comes into focus. Many bacterially-derived compounds that benefit human health are produced via the shikimate pathway. One rat study evaluated the impact on the microbiome of two weeks of glyphosate consumption, and showed a dose-dependent increase in fecal pH attributable to a reduction in acetic acid production, implying the metabolomic impact of glyphosate exposure.   More on Glyphosate It's not that glyphosate is necessarily directly impacting our cells, but it is dramatically impacting the gut microbiome at levels that we are already being exposed to in the food supply. (48:50) In studies in poultry, cattle, and pigs, glyphosate exposure increases the ratio of pathogenic bacteria to probiotic microbes, reducing Bifidobacteria, Lactobacillus, and Enterococcus while increasing Salmonella and Clostridium. In a long-term rat study, the impact on the gut microbiome was evaluated following nearly two years of glyphosate exposure via drinking water at three different doses. Glyphosate caused a large increase in the Bacteroidetes family S24-7 (associated with obesity and inflammation) and a decrease in Lactobacillus species in females (more modest changes in males). It also altered the Firmicutes to Bacteroidetes ratio to one more closely associated with chronic disease. The authors concluded “our data suggests that the exposure to an environmental concentration of [Roundup] residues could have a role in the current epidemic of gut dysbiosis”. This occurs even at levels well below the US ADI of 1.75 mg/kg body weight /day.  There is no strong dose-response. Sarah wants to emphasize that our glyphosate exposure in food is quite high. It is definitely above the cusp for an impact on our gut microbiome composition. The FDA has a report where they have been mandated to measure glyphosate residue in the food supply. In their 2016 report they measured measurable levels of glyphosate residues in 63% of corn food crops and in 67% of soybean food crops. However, they did not say how much residue was there. The 2018 report goes to a dead link now. A Swiss study of foods purchased at a grocery store showed that legumes had the highest concentrations of glyphosate residues, up to 2.95 mg/kg. United Kingdom government testing of glyphosate residues in wholegrain bread showed levels up to 0.9 mg/kg. A study of foods purchased in Philadelphia, USA metropolitan area showed 59 percent of honey samples contained glyphosate residues, and 36 percent of soy sauce contained glyphosate residues. Third-party testing of popular breakfast cereals, crackers, and cookies by the Detox Project and Food Democracy Now! showed alarming levels of glyphosate residues in all products. Roundup Ready GMOs have the highest level of glyphosate residues. Studies prove that our current levels of exposure are sufficient for measurable amounts of glyphosate to get into our bodies.  One study showed that 44% of city dwellers in 18 countries in Europe had detectable glyphosate residues in their urine, despite Europe’s more aggressive campaign against GMO foods. A pilot study in the United States of America evaluating 131 urine samples from across the country detected glyphosate residues in the urine of 86.7% of them. The highest observed detection frequency in the Midwest was at 93.3% and the lowest in the South at 69.2%.   How to Look at this Science The EWG is looking at this much more broad group of criteria and they are taking a very similar standpoint to the European Union. (58:09) A small effect is still an effect and we need to be concerned about it. When Sarah does a deep dive look to look at the impact on the gut microbiome this is where Sarah sees the biggest area of concern. Sarah thinks it is especially important because it is not currently part of the criteria by the FDA and the EPA for whether or not these chemicals are going to be approved for use. This is the thing that Sarah really thinks needs to change. The good news is that a healthy gut microbiome and high fiber consumption can actually protect us from absorbing a lot of these pesticides.  There have been studies that showed that lactobacilli can help reduce how much pesticide on our food gets into our bodies.  There are also studies that show that higher fiber consumption can at least partially reverse the gut dysbiosis. As we get back to the heart of this question, there are studies that show that the answer is no. High vegetable consumption is still really important because it does support a healthy gut microbiome, to begin with. And a healthy gut microbiome is going to protect us in a lot of ways. For example, they can protect us against heavy metals. Even if we can't afford organic to not let that dissuade us from eating that high vegetable consumption because of this. Sarah sees this as an exciting two-way street. Even though pesticide residues are impacting the composition of our guts, the composition of our gut is influenced by more than just that. It is influenced by how many fruits and vegetables we eat, mushrooms, nuts and seeds, variety, how much fish, how quality the olive oil is that we are consuming, etc. All of these things help to determine the composition of our gut microbiome. Doing all of these foundational things becomes more important when we are not necessarily in a position to be able to seek out and afford the highest food quality. It is still really important to eat a vegetable-rich diet. That's why Sarah wants to classify all of this science as the next level. The foundational principle is still eating a lot of fruits and vegetables, even if our only access to that is conventional. Beyond that, yes the Dirty Dozen and Clean Fifteen lists from the EWG are a wonderful tool. Not that Sarah agrees with everything the EWG has said, Sarah thinks that these are spot on in the sense of trying to minimize our exposure to pesticide residues.   How to Limit Pesticide Exposure Stacy feels that the podcast referenced and the information they are sharing aren't so far apart. (1:02:10) Sarah and Stacy discussed a point shared in the documentary Food Inc. that really hit this information home. We do the best that we can with what we can, and become educated on what other things we can do to support healthy living. Nothing is ever perfect. Prioritize the foods you purchase and do the best you can. It is not good to stress about these things. The dirty dozen list includes strawberries, spinach, kale, nectarines, apples, grapes, peaches, cherries, pears, tomatoes, celery and potatoes The clean fifteen list includes avocados, sweet corn, pineapple, onions, papaya, sweet peas (frozen), eggplants, asparagus, cauliflower, cantaloupes, broccoli, mushrooms, cabbage, honeydew melon, and kiwifruit. If you are going to get something off the dirty dozen conventional, look at ways that you can wash that food very well or ways you can peel the food to remove the majority of the pesticide residue. USDA certification is very expensive, so a lot of small family farms are growing organically, but don't have the certification. Talk to farmers and find out how they are growing their food. Stacy can't handle the sight of bugs in her fresh vegetables. Eating fruits and vegetables is a good thing. Perfection is not the goal. Neither Stacy nor Stacy eats 100% organic, they both do the best that they can. Sarah has found that the prices at her local farmer's market are best. Develop relationships with your local farmers, and shop at the end of the market. Stacy subscribes to Hungry Harvest, which has a waiting list right now. Sarah prescribes to MisFit Market, there is also one called Imperfect Produce. One of the things that Sarah loves about her subscription is the surprise element of it, which forces her to get creative with her meal planning. At Stacy's house they meal plan when their box arrives, based on what they received. Stacy shared more information on their meal planning process as a family, and how focused they have become to make sure they are not wasting food. Building relationships with your local farmers is a point that Stacy echoed from Sarah. Buying things in season or frozen can also be a helpful way to save money. Stacy's organic box is at least 30% off had they purchased those items at a grocery store regularly. The thing that Stacy most loves about Hungry Harvest is that they give back to the community.   Closing Thoughts Stacy thanked Sarah for all the research she did for this show! (1:23:13) If you have any follow up questions on all of this, you are welcome to email Stacy and Sarah using the contact forms on their blogs. You can comment on social media posts as well. Stacy and Sarah are always happy to hear from you! If you have been loving this show, please help spread the word to others by sharing a link to an episode you enjoyed with a family or friend, or leave a review. Stacy and Sarah so greatly appreciate your support! Thank you again for tuning in! Next week is another science-heavy show that builds off of this week's episode. We will be back again next week! (1:25:57)

En el programa de esta semana concluimos por los momentos nuestra serie dedicada a la resistencia a los carbapenemicos hablando sobre  las opciones terapéuticas y específicamente sobre el tratamiento combinado de dos o mas drogas.   Referencias: Carrara E y colaboradores. Combination versus monotherapy for the treatment of infections due to carbapenem-resistant Enterobacteriaceae. Curr Op Infect Dis December 2018. 31(6):594-599. Ana Maria Peri y colaboradores. Antimicrobial treatment challenges in the era of carbapenem resistance. Diagnostic Microbiology and Infectious Disease 94 (2019) 413–425. Yohei Doi. Treatment Options for Carbapenem-resistant Gramnegative Bacterial Infections. Clin Infect Dis 2019; 69(S7): S565-75.   La Frase de la Semana: Le pertenece esta semana a Charles Bukowski, poeta, novelitas, escritor de cuentos de origen agermano-americano nacido el 16 de agosto de 1920 en Alemania y fallecido el 9 de marzo de 1994 en los Ángeles, Estados Unidos. La Frase dice: “Estamos aquí para reírnos del destino y vivir tan bien nuestra vida que la muerte tiemble al recibirnos”  

Your hosts, Terry and Marc ListenEN_The_Link-20191115-WEE15 Canada welcomes genocide lawsuit against Myanmar, says Freeland Foreign Affairs Minister Chrystia Freeland and Marie-Claude Bibeau, Minister of International Development and La Francophonie, arrive at the National Press Theatre to make an announcement and hold a media availability on Canada's response to the Rohingya crisis in Ottawa on Wednesday, May 23, 2018. (Sean Kilpatrick/THE CANADIAN PRESS) Gambia has launched a lawsuit against Myanmar (formerly Burma) claiming that state has committed genocide against their Rohingya minority. In Canada, a unanimous vote in the House of Commons recognized the crimes against the Rohingya as genocide in 2018 Levon spoke with Canadian legal expert Payam Akkhavan, a former U.N. prosecutor and professor of International Law at McGill University in Montreal. Levon reached him on his mobile phone in The Hague (full story here) Superbugs could kill hundreds of thousands, cost billions in just 30 years A computer-generated image shows a group of carbapenem-resistant Enterobacteriaceae bacteria. This increase in antibiotic-resistant infections is expected to cost Canada 396,000 lives, $120 billion in hospital expenses and $388 billion in gross domestic product over the next three decades. The expert CCA panel calculated that resistant infections contributed to over 14,000 deaths in Canada in 2018, and of those, 5,400 were directly attributable to the infections(Centers for Disease Control/Associated Press) A shocking new report by a variety of medical experts in a variety of fields, along with social and economic experts, has said the incidence of anti-biotic resistant bacteria will increase to 40% by 2030. Currently some 26 percent of infections are already resistant. They calculate between now and 2050, the so-called "superbugs" will result in almost 400,000 deaths in Canada as infections will no longer be able to be treated. They say medical and hospital costs combined with lost productivity will cost the economy over 500 Billion dollars in that time Marc spoke with Gerry Wright, director of the Michael DeGroote Centre of Infectious Disease Research at McMaster University in Hamilton Ontario. (full story here) Remembering the horror that led to "In Flanders Fields" The remains of a German observation position on April 22, 1915. By this time, the countryside was devastated by millions of artillery shells fired by both sides near Ypres since 1914. Human losses were also staggering on both sides. Canadian John McCrae wrote "In Flanders Fields" on May 3. (Photo Credit: Archives Canada MIKAN no. 3397986) It is arguable one of the most famous poems of war. "In Flanders Fields" was written by a Canadian medical officer, Col John McCrae on the back of an ambulance during a brief respite from his work trying to save the many wounded and maimed. At the time he had just learned of the death of a close personal friend during a battle. He himself would die just three years later of pneumonia partly due to his working himself to exhaustion. Terry spoke to actor David Calderisi who talks about the poem, and reads it aloud. (full story here) Video of show window.jQuery || document.write('

Durante el programa de la semana pasada (EP 164) hablamos de las betalactamasas de espectro extendido y comentamos de donde habían surgido, como se definen, y cual es la epidemiologia asociada a las mismas. En el programa de esta semana (EP 165) hablamos del  diagnostico y opciones de tratamiento de la infecciones causadas por enterobacterias productoras de betalactamasas de espectro extendido.   Referencias:   David M Livermore y colaboradores. Are susceptibility tests enough, or should laboratories still seek ESBLs and carbapenemases directly?  J Antimicrob Chemother 2012; 67:1569-1577 Gutierrez-Gutierrez y J Rodriguez-Bano.Current options for the treatment of infections due to extended- spectrum beta-lactamase-producing Enterobacteriaceae in different groups of patients. Clin Microbiol Infect 2019; 25 (8): 932-942. Vardakas KZ y colaboradores. Carbapenems versus alternative antibiotics for the treatment of bacteraemia due to Enterobacteriaceae producing extended-spectrum β-lactamases: a systematic review and meta-analysis. J Antimicrob Chemother 2012; 67(12):2793-80 Palacios-Baena ZR y colaboradores. Empiric Therapy With Carbapenem-Sparing Regimens for Bloodstream Infections due to Extended-Spectrum β-Lactamase-Producing Enterobacteriaceae: Results From the INCREMENT Cohort. Clin Infect Dis 2017; 65 (10) 1615-1623. Belen Gutieerez-Gutierrez y colaboradores. Ertapenem for the treatment of bloodstream infections due to ESBL-producing Enterobacteriaceae: a multinational pre-registered cohort study. J Antimicrob Chemother 2016; 71: 1672-1680. Harris PNA y colaboradores. Effect of Piperacillin-Tazobactam vs Meropenem on 30-Day Mortality for Patients With E coli or Klebsiella pneumoniae Bloodstream Infection and Ceftriaxone ResistanceA Randomized Clinical Trial. JAMA 2018; 320 (10): 984-994.   La Frase de la Semana:   Esta semana tomamos la frase de la periodista y escritora española Rosa Montero nacida en Madrid el 3 de Enero de 1951. Como nota interesante para los infectologos, a causa de la tuberculosis estuvo desde los cinco años hasta los 9 recluida en casa dedicándose  a leer y escribir La Frase dice:   “La vida es un pequeño espacio de luz entre dos nostalgias: la de lo que aun no has vivido y al de lo que ya no vas a poder vivir. Y el momento justo de la acción es tan confuso, tan resbaladizo y tan efímero que lo desperdicias mirando con aturdimiento alrededor”  

  In this episode of Smart Healthcare Safety from ECRI Institute, we're talking with two ECRI Institute experts about endoscope reprocessing. Inadequate reprocessing of flexible endoscopes led to 30,000 patients being called for follow-up testing between 2005 and 2012, according to one estimate. Contaminated endoscopes can spread infections like HIV and hepatitis B and C, and even in the absence of an outbreak, media coverage of a recall can damage the facility's reputation. ECRI Institute's James Davis and Jackie Ferenschak discuss why endoscopes are difficult to reprocess effectively and strategies for helping staff succeed. In ECRI’s Top 10 Health Technology Hazards for 2019, we identified mishandling flexible endoscopes after disinfection on the list as a potential source of danger that we believe warrants attention. Members of the Healthcare Risk Control and PSO Plus programs can login to see our complete guidance on endoscope reprocessing.

El episodio de esta semana lo dedicamos a comentar ciertas controversias y recomendaciones sobre el tratamiento de infecciones urinarias.    Referencias: Ainsley Moore y colaboradores. Canadian Task Force on Preventive Health Care Recommendations on screening for asymptomatic bacteriuria in pregnancy. CMAJ 2018 July 9;190:E823-30. doi: 10.1503/cmaj.171325. The role of asymptomatic bacteriuria in young women with recurrent urinary tract infections: to treat or not to treat? Cai et al . Clin Infect Dis 2012: 55: 772-777.  .Asymptomatic bacteriuria treatment is associated with a higher prevalence of antibiotic resistant strains in women with urinary tract infection. Cai et al. Clin Infect Dis 2015; 61: 1655-1661. Krumpe PE, Cohn S, Garreltes J, et al. Intravenous and oral mono- or combination-therapy in the treatment of severe infections: ciprofloxacin versus standard antibiotic therapy. J Antimicrob Chemother. 1999;43(suppl A):117-128. Sandberg T, Skoog G, Hermansson AB, et al. Ciprofloxacin for 7 days versus 14 days in women with acute pyelonephritis: a randomised, open-label and double-blind, placebo-controlled, non-inferiority trial. Lancet. 2012;380(9840):484-490. doi: 10.1016/S0140-6736(12)60608-4. Talan DA, Stamm WE, Hooton TM, et al. Comparison of ciprofloxacin (7 days) and trimethoprim-sulfamethoxazole (14 days) for acute uncomplicated pyelonephritis pyelonephritis in women: a randomized trial. JAMA. 2000;283(12):1583-1590. Kutob LF, Justo JA, Bookstaver PB, Kohn J, Albrecht H, Al-Hasan MN. Effectiveness of oral antibiotics for definitive therapy of Gram-negative bloodstream infections. Int J Antimicrob Agents. 2016;48(5):498-503. doi: 10.1016/j.ijantimicag.2016.07.013. Mercuro NJ, Stogsdill P, Wungwattana M. Retrospective analysis comparing oral stepdown therapy for enterobacteriaceae bloodstream infections: fluoroquinolones versus beta-lactams. Int J Antimicrob Agents. 2018;51(5):687-692. doi: 10.1016/j.ijantimicag.2017.12.007.  Rieger KL, Bosso JA, MacVane SH, Temple Z, Wahlquist A, Bohm N. Intravenous-only or intravenous transitioned to oral antimicrobials for Enterobacteriaceae-associated bacteremic urinary tract infection. Pharmacotherapy. 2017;37(11):1479-1483. doi: 10.1002/phar.2024. Nelson AN, Justo JA, Bookstaver PB, Kohn J, Albrecht H, Al-Hasan MN. Optimal duration of antimicrobial therapy for uncomplicated Gram-negative bloodstream infections. Infection. 2017;45(5):613-620. doi: 10.1007/s15010-017-1020-5.     La Frase de la Semana: Esta semana la tomamos del escrito español Chufo Llorens. Y la frase dice: La distancia es al amor lo que el viento al fuego: apaga el pequeño, pero aviva el grande.  

Aunque en el tratamiento de infecciones causadas por microorganismos productores de beta-lactamasa de espectro extendido (BLEE) se favorece tradicionalmente el uso de carbapenemicos existe la esperanza que otros antibióticos puedan ser efectivos. De eso se trata el Estudio Merino, cuyos resultados fueron dados a conocer recientemente en Europa.  Referencias:    Vardakas KZ y colaboradores. Carbapenems versus alternative antibiotics for the treatment of bacteraemia due to Enterobacteriaceae producing extended-spectrum β-lactamases: a systematic review and meta-analysis. J Antimicrob Chemother  Dec 2012. Shiber S y colaboradores. b-Lactam/b-lactamase inhibitors versus carbapenems for the treatment of sepsis: systematic review and meta-analysis of randomized controlled trials. J Antmicrob Chemother Jan 2015. Son SK y colaboradores. Clinical effectiveness of carbapenems versus alternative antibiotics for treating ESBL-producing Enterobacteriaceae bacteraemia: a systematic review and meta-analysis. J Antimicrob Chemother May 28, 2018. Combo antibiotic found inferior for MDR bloodstream infections   La Frase de la Semana: La tomamos de Aristóteles.Vivió en la Antigua Grecia entre el 384 y el 322 a.C. pero su pensamiento ha influido de manera directa a occidente por más de dos milenios. Pero de todo lo que escribió, solo nos ha llegado una pequeña parte. Escribió más de 200 tratados de diferentes temas, que comprendía, además de la filosofía, las matemáticas, la política, la retórica o incluso la biología.   “Cualquiera puede enfadarse, eso es algo muy sencillo. Pero enfadarse con la persona adecuada, en el grado exacto, en el momento oportuno, con el propósito justo y del modo correcto. Eso, ciertamente, no resulta tan sencillo”  

En el program de esta semana hablamos sobre Pseudomonas aeruginosa y el rol en el tratamiento que tendría el ceftolozano / tazobactam  sobre todo el lo referente a cepas multiresistentes y como los diversos mecanismos de resistencia que este tipo de bacterial puede manifestar pueden afectar la sensibilidad a dicho antimicrobiano. Referencias: A.P Magiorakos y colaboradores. Multidrug-resistant, extensively drug-resistant and pandrug-resistant bacteria: an international expert proposal for interim standard definitions for acquired resistance. Clin Microbiol Infect. 2012; 18 (3) 268-81. Gabriel Cabot y colaboradores. Pseudomonas aeruginosa Ceftolozane-Tazobactam Resistance Development Requires Multiple Mutations Leading to Overexpression and Structural Modification of AmpC. Antimicrob Agent Chemother 2014; June 58 (6): 3091-9. Pablo A. Fraile-Ribot y colaboradores. Mechanisms leading to in vivo ceftolozane/tazobactam resistance development during the treatment of infections caused by MDR Pseudomonas aeruginosa. J Antimicrob Chemother 2017; 73: 658-663.  Yu Mi Wi y colaboradores. Activity of Ceftolozane-Tazobactam against Carbapenem- Resistant, Non-Carbapenemase-Producing Pseudomonas aeruginosa and Associated Resistance Mechanisms. Antimicrob Agents Chemother 2017; 62 (1).  Andrew Walkty y colaboradores. In vitro activity of ceftolozane/tazobactam versus antimicrobial non-susceptible Pseudomonas aeruginosa clinical isolates including MDR and XDR isolates obtained from across Canada as part of the CANWARD study, 2008–16. J Antimicrob Chemother 2018; 73: 703-708. Tommaso Giani y colaboradores. Italian nationwide survey on Pseudomonas aeruginosa from invasive infections: activity of ceftolozane/tazobactam and comparators, and molecular epidemiology of carbapenemase producers. J Antimicrob Chemother 2018; 73: 664-671. David M. Livermore y colaboradores. Activity of ceftazidime/avibactam against problem Enterobacteriaceae and Pseudomonas aeruginosa in the UK, 2015–16. J Antimicrob Chemother 2018. 73: 648-657.   La Frase de la Semana:   Y esta semana no puede ser sino de Stephen Hawkings debido a queel británico murió este martes (la madrugada del miércoles en Inglaterra), a sus 76 años. Fue uno de los físicos más importantes de la cosmología moderna y se destacó por su teoría sobre agujeros negros y por sus esfuerzos matemáticos para unificar la teoría general de la relatividad de Einstein con los conocimientos emergentes de la física cuántica. La frase dice:  “El peor enemigo del conocimiento no es la ignorancia, es la ilusión del conocimiento”        

El programa de esta semana es variado. Empezamos por discutir las implicaciones de la bacteriemia por bacilos Gram-negativos resistentes en pacientes con trasplantes de medula ósea. Posteriormente comentamos un articulo sobre el tiempo apropiado de tratamiento en bacteriemia por bacilos Gram-negativos. También comentamos los beneficios del tratamiento combinado vs. el tratamiento simple con oseltamivir en la infección por Influenza. Finalmente hablamos sobre neumonía adquirida en la comunidad, sobre fosfomicina, y nitrofurantoina.   Referencias:   Diana Averbuch y colaboradores. Antimicrobial Resistance in Gram-Negative Rods Causing Bacteremia in Hematopoietic Stem Cell Transplant Recipients: Intercontinental Prospective Study of the Infectious Diseases Working Party of the European Bone Marrow Transplantation Group. Clin Infect Diseases 2017.   Julio A. Ramirez y colaboradores. Adults Hospitalized with Pneumonia in the United States: Incidence, Epidemiology, and Mortality. Clin Infect Dis 2017.   Darunee Chotiprasitsakul  y colaboradores Comparing the Outcomes of Adults With  Enterobacteriaceae Bacteremia Receiving Short-Course  Versus Prolonged-Course Antibiotic therapy in a  Multicenter, Propensity Score–Matched Cohort . Clin Infect Dis 2017   John H Beigel y colaboradores. Oseltamivir, amantadine, and ribavirin combination antiviral therapy versus oseltamivir monotherapy for the treatment of influenza: a multicentre, double-blind, randomised phase 2 trial. Lancet Infect Dis. Dec 2017.   Fiona Fransen y colaboradores. Pharmacodynamics of fosfomycin against ESBL- and/or carbapenemase-producing Enterobacteriaceae. J Antimicrob Chemother. Dec 2017.   Fiona Fransen y colaboradores.  Pharmacodynamics of nitrofurantoin at different pH levels against pathogens involved in urinary tract infections. J Antimicrob Chemother. December 2007     La Frase de la Semana:  La tomamos del poeta Chileno Pablo Neruda. Pablo Neruda Era el seudónimo y, más tarde, el nombre legal del poeta, diplomático y político chileno Ricardo Eliécer Neftalí Reyes Basoalto (12 de julio de 1904 - 23 de septiembre de 1973). Derivó su seudónimo del poeta checo Jan Neruda. Pablo Neruda ganó el Premio Nobel de Literatura en 1971  “Algún día en cualquier parte, en cualquier lugar indefectiblemente te encontrarás a ti mismo, y ésa, sólo ésa, puede ser la más feliz o la más amarga de tus horas”.      

This time on the ‘Gluten Free RN’ podcast, Nadine explores the connection between gluten intolerance and antibiotic-resistant threats. Because damaged intestines compromise the immune system, undiagnosed celiac patients are more likely to develop infections that necessitate antibiotics.  Nadine summarizes the 2013 CDC report, Antibiotic Resistance Threats in the United States, explaining the three microorganisms identified in the report with a Threat Level of Urgent. Listen and learn how to protect yourself and your family from the public health threat posed by these bacteria!  What’s Discussed:  The prevalence of undiagnosed celiac disease and gluten intolerance 30-50% of the population carry the HLA-DQ2 and/or DQ8 genes The importance of healthy intestinal tissue 70-90% of the immune system is in your intestines The soldier analogy Healthy villi are like rested soldiers with loaded weapons on a clear day who can easily take out antigens that don’t belong Damaged villi are like soldiers on a bender with inadequate weaponry, operating in smoke and fire – they either don’t work at all or fire randomly at antigens The need for a more judicious approach to prescribing antibiotics Overuse of antibiotics wipes out good microbiome along with bad How to rebuild microbiome Kombucha High-quality probiotics Fermented foods Apple cider vinegar The need for IgA and IgG testing to complement a celiac panel The public health threat posed by antibiotic-resistant bacteria The 2013 CDC report details 2 million illnesses and 23,000 deaths yearly The connection between damaged intestines and a higher risk of bacterial infection requiring antibiotics The three microorganisms with a Threat Level of Urgent Clostridium difficile (causes profuse diarrhea, 14,000 deaths/year) Carbapenem-resistant Enterobacteriaceae (50% fatal, 600 deaths/year) Neisseria gonorrhoeae The causes of inflammation in your intestines Gluten Dairy Sugar Why Nadine has concerns about the potential pandemic and huge loss of life presented by large numbers of undiagnosed celiac patients who are susceptible to bacterial infections  Resources Mentioned:   CDC Report: Antibiotic Resistance Threats in the United States, 2013 Enterolab Website Cyrex Laboratories Website PubMed Connect with Nadine:  Instagram Facebook Contact via Email Books by Nadine: Dough Nation: A Nurse's Memoir of Celiac Disease from Missed Diagnosis to Food and Health Activism

Lauren Petersen, PhD, is a postdoctoral associate working for Dr. George Weinstock and investigating the microbiome. Our knowledge of the 100 trillion microorganisms that inhabit the human body is still very limited, but the advent of next-generation sequencing technology has allowed researchers to start understanding what kind of microorganisms inhabit the human body and identifying the types of genes these organisms carry. As part of the NIH-funded Human Microbiome Project, her lab is focused on developing and applying the latest technologies to characterize the microbiome and its impact on human health. One of her main projects is metatranscriptomic analysis whereby they are attempting to characterize gene expression of an entire community from human samples such as stool and saliva. Gaining information on what signals or environmental factors can trigger changes in global gene expression of an entire microbial community may provide us with the tools to better treat certain types of diseases in humans. Lauren is currently working on the Athlete Microbiome Project. By collecting stool and saliva samples from a cohort of highly fit professional cyclists, she will make an attempt to understand how their microbiomes may differ from those of the general population. The goal is to characterize the species present, the genes they carry, and how gene expression is modulated in athletes who push their bodies to the limit. Here’s the outline of this interview with Lauren Petersen: [00:00:28] George Weinstock, PhD. [00:01:27] Jeremy Powers interview. [00:01:43] Jeff Kendall-Weed. [00:02:15] Why care about the gut microbiome? [00:03:32] Metabolic functions. [00:03:51] NIH Human Microbiome Project. [00:04:39] Phase II longitudinal study. [00:06:01] Microbial diversity. [00:07:33] Lyme and antibiotics. [00:08:15] Chronic Fatigue Syndrome. [00:09:35] Gordon conferences - Rob Knight. [00:10:27] American Gut Project. [00:10:48] Firmicutes and Bacteroidetes. [00:11:05] Enterobacteriaceae. [00:11:59] Fecal transplant. [00:13:16] Screening donors. [00:13:32] DIY. [00:13:52] C. diff. [00:14:14] Transplants started in the 50s. [00:14:47] IBS. [00:16:12] Healthy donor. [00:17:43] Within a month, Lauren was feeling a lot better. [00:18:13] Instantaneous improvement on the bike. [00:19:22] No more stomach issues, "more energy than I knew what to do with". [00:19:54] Retest data showed perfect match with donor. [00:20:56] Sequencing large vs. small intestinal microbes. [00:21:28] FDA has no idea what to do. [00:23:02] Strategies for maintaining a healthy gut microbiome. [00:23:31] Whole foods, lots of fruit and vegetables. [00:23:48] No gels. [00:24:26] Athlete Microbiome Project. [00:26:34] Microbiome doping? [00:27:05] Ruminococcus - starch digester. [00:28:26] Enterotype - the dominate species in the gut. [00:28:56] Prevotella. [00:30:14] Teasing apart the cause and the effect. [00:32:28] Endotoxins released during intense exercise. [00:32:49] 25 participants at the time of recording, I'm number 26! [00:33:29] Matching cohort of healthy controls. [00:34:28] Ibis World Cup racer. [00:35:01] uBiome. [00:35:08] My app. [00:35:54] The problem with 16S sequencing. [00:36:16] Missing bifidobacteria. [00:37:05] A combination of methods is required for accurate testing. [00:38:30] New commercially available test? [00:39:11] Probiotic quality. [00:40:04] Testing probiotics. [00:41:37] Bifido doesn't like oxygen (or your stomach). [00:42:02] Lactobacillus is more resilient. [00:42:50] Bifido love fructooligosaccharides. [00:43:36] Lack of association with dietary restrictions. [00:44:53] Feed your microbiome!

Cronobacter spp. sind opportunistische pathogene Erreger, die insbesondere nach der Aufnahme kontaminierter Lebensmittel schwere Infektionen mit hohen Letalitätsraten bei Neugeborenen und immungeschwächten Erwachsenen hervorrufen können. Um spezifische immunchemische Nachweisverfahren für diese Keimgruppe zu etablieren, wurden in der vorliegenden Arbeit monoklonale Antikörper (mAK) zum Nachweis von Cronobacter spp. generiert und umfassend charakterisiert. Zur Präparation der Immunogene wurden Cronobacter-Keime mit Polymyxin B behandelt und anschließend wurden Mäuse entweder mit dem durch Zentrifugation erhaltenem Zellpellet (Ghosts) oder mit dem zellfreien Überstand (Lysat) dieser Präparationen immunisiert. Beide Präparationen erwiesen sich als hoch immunogen, die nachweisbaren Titer lagen üblicherweise bei > 1:10.000. Insgesamt konnten 14 stabile Hybridomzelllinien (sieben je Ansatz) etabliert werden. Die Intra- bzw. Inter-Genus-Spezifität und Affinität der entsprechenden mAK wurde umfassend unter Verwendung von indirekten EIA-Verfahren überprüft. Für Studien zur Epitopspezifität der generierten mAK wurden Immunoblots und Immunfluoreszenz-Analysen eingesetzt. Alle mAK, die aus der Immunisierung mit Cronobacter-Ghosts resultierten, zeichneten sich durch ein sehr breites Reaktionsspektrum aus, Kreuzreaktionen wurden vorzugsweise mit Vertretern aus der Familie der Enterobacteriaceae aber auch mit anderen gramnegativen Keimen beobachtet. Für alle mAK konnten Proteine als antigene Determinanten identifiziert werden, die relativen Molekulargewichte reaktiver Proteinbanden lagen üblicherweise im Bereich von > 40 kDa. Demgegenüber zeigten sechs der sieben mAK, die aus der Immunisierung von Mäusen mit Polymyxin B generierten Lysat-Präparationen resultierten, eine hohe Affinität für die O-spezifische Seitenkette der Cronobacter-typischen Lipopolysaccharide (LPS): mAK 2G4 αL reagierte hochspezifisch mit dem C. turicensis-Stamm (MHI 21026; Serotyp O1). Im indirekten EIA war dieser Erreger bei Keimzahlen von ca. 104 KbE/ml noch nachweisbar. Für die weiteren fünf mAK, die alle spezifisch mit C. sakazakii des Serotyps O1 reagierten, wurden im indirekten EIA Nachweisgrenzen im Bereich von 105-107 KbE/ml ermittelt. Alle mAK gegen LPS gehören zum IgG-Subtyp und reagierten in der Immunfluoreszenz mit lebenden Cronobacter-Keimen.

Cronobacter sakazakii ist ein ubiquitäres Gram-negatives Stäbchenbakterium, das neben anderen Lebensmitteln vor allem in Milchpulver vorkommt und insbesondere bei Neonaten zu nekrotisierender Enterocolitis (NEC), Bakteriämie und Meningitis führen kann. Trotz der umfangreichen Forschung der letzten Jahre ist nach wie vor wenig über die Pathogenese von Cronobacter spp. sowie potentielle Virulenzfaktoren bekannt. Um neue Erkenntnisse über Pathogenitätsmechanismen von C. sakazakii zu erhalten, wurden in dieser Arbeit 28 Transposoninsertionsmutanten des klinischen Isolats C. sakazakii ES5 in drei unterschiedlichen Zelllinien auf ihre Fähigkeit an die eukaryotischen Zellen zu adhärieren, in sie einzudringen und in ihnen zu proliferieren, untersucht. Die inaktivierten Gene dieser Mutanten codieren für Proteine des Energiestoffwechsels, der Zellwand und des Biofilms, der Motilität der Bakterien und der Carotinoidbiosynthese. Angelehnt an den in vivo Infektionsweg von C. sakazakii - orale Infektion des Organismus, primäre lokale Infektion im Darm, systemische Infektion über die Invasion in Makrophagen und schließlich das Überschreiten der Blut-Hirn-Schranke und die Infektion des Gehirns - wurden für die Studie Caco-2 Darmepithelzellen, RAW-264.7 Makrophagen-Zellen sowie HBMEC Hirnendothelzellen ausgewählt. Beim Screening aller drei Zelllinien konnte festgestellt werden, dass die Flagellenstruktur betreffende Mutationen bei C. sakazakii ES5 zu fast 100%iger Attenuation der Invasion der Wirtszellen führen. Dies lässt auf die Bedeutung der Flagellen als Pathogenitätsfaktor schließen. Bedingt sein könnte die Attenuierung durch die verminderte Motilität der Bakterien, durch die instabile Interaktion von Flagellen mit den eukaryotischen Zellen selbst oder möglicherweise durch die fehlende Sekretion von Virulenzfaktoren durch das Typ-III-Flagellen-Sekretionssystem. Weiterführende Untersuchungen zu der Motilität der Transposoninsertionsmutanten zeigten, dass die Flagellenfunktion bei C. sakazakii ES5 durch Suppression reguliert zu sein scheint, da die bei C. sakazakii ES5 vorhandene Hemmung des Flagellen-vermittelten Swimmings im Weichagar z.B. unter Zugabe von steril filtriertem Überstand einer C. sakazakii ES5-Kultur wieder aufgehoben werden konnte. Des Weiteren fielen zwei Mutanten mit verminderter Serumresistenz durch reduzierte Virulenz auf, sowie eine Mutante, deren unterbrochenes Gen für einen putativen Reifungsfaktor der 30S-Untereinheit der Ribosomen codiert. Bei diesen drei Mutanten könnten die inaktivierten Gene für potentielle Virulenzfaktoren codieren und sollten näher untersucht werden. Transposonmutanten aus der orthologen Gruppe für Energiestoffwechsel zeigten ebenfalls eine verminderte Invasion. Diese Stämme hatten bei der biochemischen Charakterisierung der Metabolisierung definierter Kohlenstoffquellen bei den Aminosäuren und den Zwischenprodukten des Intermediärstoffwechsels ein vom Wildtyp ES5 abweichendes Metabolisierungsmuster. Die Unterbrechungen im Citratzyklus führten z.B. zur schwächeren Verstoffwechselung von L-Glutamat, dafür wurde L-Asparagin besser als Substrat verwertet. Somit konnte die Fähigkeit zur Anpassung durch Umstellung des Metabolismus bei C. sakazakii ES5 bestätigt werden. Weiterhin ergab der Vergleich des Kohlenstoff-Metabolismus von Cronobacter spp. mit dem von Salmonella enterica sv. Typhimurium einige interessante Unterschiede: C. sakazakii konnte im Gegensatz zu S. Typhimurium eine Vielzahl in der Umwelt vorkommender C-Quellen zur Energiegewinnung nutzen, was darauf schließen lässt, dass das ubiquitäre Bakterium Cronobacter spp. ursprünglich mit Pflanzen assoziiert war. Glucose-6-Phosphat, ein wichtiges Stoffwechselzwischenprodukt, das bei pathogenen Enterobacteriaceae neben Glucose und Mannose intrazellulär als die bevorzugte Kohlenstoffquelle gilt, wurde von C. sakazakii dagegen in vitro nicht metabolisiert. Es bleibt zu klären, ob C. sakazakii in der Lage ist, intrazellulär seinen Stoffwechsel umzustellen und Glucose-6-Phosphat als C-Quelle zu nutzen. C. sakazakii ist ein gelb pigmentiertes Bakterium und synthetisiert die Pigmente über Carotinoid-Biosynthese. In den Infektionsversuchen zeigte sich, dass pigmentlose Mutanten in der Invasion von RAW-264.7-Zellen attenuiert sind. In diesem Zusammenhang konnte auch festgestellt werden, dass bei der de novo Carotinoid-Synthese das CrtY-Protein (Lycopin-ß-Cyclase) die ß-Cyclisierung von Lycopin zu ß-Carotin ausführt. Nach Komplementierung der crtY-Mutante zeigte sich erneut die wildtypische gelbe Pigmentierung der Bakterienkolonien von C. sakazakii ES5crtY::Tn5/pUC19-crtY, anstatt der pinken Koloniefärbung der Mutante. Die Reduzierung der Invasion in HBMEC-Zellen um mehr als 30% konnte durch die Komplementation des crtY-Gens aufgehoben werden: die konstitutive Expression des Gens führte zu einem Invasionswert von 122% des Wildtyps. Im Rahmen dieser Arbeit konnten durch Infektionsexperimente in drei Zelllinien der Infektionsweg von C. sakazakii ES5 nachgestellt, neue potentielle Virulenz-assoziierte Faktoren identifiziert und die Fähigkeit der spezifischen Anpassung an das intrazelluläre Milieu als ein wichtiges Pathogenitätsmerkmal bestätigt werden.

Hide contamination represents a main source of microbiological contamination of carcass surface. In order to reduce the potential health risks for the consumer the EU implemented measures in the context of the regulations no. 852/-, 853/- and 854/2004. These imply that only clean cattle are suitable for slaughter in order to eliminate the risk of meat contamination via hide or skin. Food business operators are responsible for ensuring that the requirements are met. One problem is, that the meaning of cleanliness is not defined clearly enough. Therefore some European states implemented regulations for the grading of hide cleanliness. The main objective of the own analysis was to point out the correlation between the level of hide contamination and the total bacteria count of the surfaces of the carcasses. Therefore an ascending hide cleanliness classification system for beef cattle was developed which is based on two vertical hide regions, an area measure as well as aspects of cleanliness and humidity based on three major-classes for hide-cleanliness. In total 180 female bovine cattle were classified by their hide, digitally photographed from four perspectives (two standing and two stunned) as well as slaughtered and examined in a group of equal or very similar level of conta- mination on test days. The sampling technique was based on stalked sponge swabs, which were pulled over four exactly defined locations of the freshly flayed carcass twice (front and back side) through a self-developed oblong template measuring 100 cm2. The four incre- mental samples per animal were pooled and tested for the hygiene indicators aerobic colony count as well as for Enterobacteriaceae count and Escherichia coli count. Analyzing the data set statistically all logarithmized aerobic colony counts were normally distributed. Three ordinal scores for aerobic colony count were defined (Score1:0bis≤2log10 cm-2,Score2:2bis≤ 3log10 cm-2 andScore3:>3log10 cm-2) and tested in conjunction with the three major classes of hide contamination. The general finding was that the amount of animals with low total bacteria count (Score 1) decreased with higher major class. The amount of cattle with moderate Summary 119 bacteria content (Score 2) increased slightly with the major class. The amount of animals with high total bacteria count (Score 3) increased substantially with the major class. It could be shown that major-class-I included a statistically significant lower amount of animals with high total bacteria count compared to major-class-II. The same held for the comparison of major-class-II and -III as well as of major- class-I and -III. E. coli and Enterobacteriaceae could be evidenced only on about a third of the carcasses and thus be analyzed in combination with the major-classes and the three Scores. Applying the reduced population respectively the same correlation could be confirmed approximately. Overall the described correlations can be taken as indication that the considered colony counts rise with an increasing visual level of contamination. In case of development and implementation of a regulation system in Germany the application of a maximum of three ascending classes of hide contamination appears to be justifiable. Furthermore the terms „clean“ and „cleanliness“ should be complemented with attributes as „sufficient(ly)“.

Vincent, Elio, and Michael consider a fungal pathogen of insects that acquired a gene from its host that facilitates infection, and presence of gram-negative nosocomial pathogens on community surfaces near hospitals in Brooklyn. 

Summary of the April 15, 2014 issue, including articles on U.S. trends in prevalence and control of diabetes, quantifying delirium severity, virtual autopsy versus traditional medical autopsy, high-energy extracorporeal shock-wave therapy for shoulder tendinitis, and point-of-care tests for detecting albuminuria, as well as the USPSTF recommendation statement on vitamin supplementation to prevent cardiovascular disease and cancer and commentaries on the Physician Value-Based Payment Modifier program, the National Institutes of Health Clinical Center's experience with a carbapenem-resistant Enterobacteriaceae outbreak, and the American Board of Obstetrics and Gynecology's recent decision to reverse its stance on gynecologists treating men.

Vincent and Michael meet up with Ellen Jo Baron to talk about working in a clinical microbiology laboratory.

Nach einer zwölftägigen Adaption an die Einzelhaltung wurden sechs der 12 Katzen der Versuchsgruppe an vier aufeinanderfolgenden Tagen jeweils 100 Flöhe aufgesetzt. Es wurden Blutproben entnommen und ein rotes und ein weißes Blutbild, sowie der Hämatokrit und der Hämoglobingehalt bestimmt. Die Konzentrationen von Cortisol, Cortison und Corticosteron im Blut wurden durch HPLC bestimmt. Kot der Katzen wurde täglich gesammelt und die Konzentration von 11-Oxoätiocholanolon mittels kompetitivem EIA gemessen. Ebenso wurden die Gesamtkeimzahl, Enterobacteriaceae-, die Clostridien-, die Anaerobier- und die Aerobierzahl im Kot bestimmt. Das Verhalten wurde auf Videobänder aufgezeichnet. Es wurden je eine 2-stündige Ruhe- und Aktivitätsphase analysiert.

Due to technical reasons, milk powder and powdered infant formulae (PIF) are not sterile products. In order to achieve the requirements set by the Swiss and European regulations for microbiologic criteria extensive epidemiological studies are needed on each individual plant level. In this way contamination routes can be identified and appropriate measurements taken. A legally reglemented pasteurization process eliminates Enterobacteriaceae. Therefore recontamination must now be focussed on. PIF contaminated with Cronobacter spp. can lead to severe infections in neonates such a sepsis, meningitis or necrotizing enterocolitis. The reported prevalence of commercially available PIF appears to be gradually decreasing from estimates of 14% in 1988 to 2.0-2.5%, where it now seems to have become stabilized. In order to make a reasonable estimate concerning the prevalence of Cronobacter spp. on an individual plant level, 950 samples (raw material, finished products, environmental samples) were analysed. The high prevalence of 16% comes from the intentional sampling of critical raw material and environment samples. The PFGE analysis, however, did not reveal any correlation between raw material and environmental samples which would indicate a possible contamination via finished products. 470 PIF Enterobacteriaceae isolates were identified through biochemical tests as well as by rpoB sequencing. E. cloacae (35%), Pantoea spp. (11%) and K. pneumoniae (8%) were the most prevalent genus and species. In order to reveal possible contamination routes, a subtyping was conducted. The species E. cloacae, which can be found in the same niches as Cronobacter spp., could be used as a significant hygienic indicator organism. To complete the epidemiological picture, 363 milk based samples were analysed (raw milk, milk concentrate, milk powder). Raw milk contains Enterobacteriaceae but no Cronobacter spp. were detected. However, 12/172 samples of milk powder contained Cronobacter spp. due to recontamination (during the packaging process and/or further processing steps). In order to increase the sensitivity and specificity of today’s available analysis for the detection of Cronobacter spp. methodological improvements had to be undertaken. The currently used enrichment media (mLST, EE) contain components of too selective nature which can therefore lead to false negative results. The new “Cronobacter Screening Broth” (CSB) contains sucrose and 5-bromo-4-chloro-3-indolyl-α-D-Glucopyranoside which now leads to a sensitivity of 100% and a negative predicting value of 100% as well. The change in colour of the broth indicates a presumptively positive result whereby only these samples need to be streaked onto chromogenic agar. The visual intermediate result leads to a reduction in costs and working time. In order to increase specificity as well as the commercial pressure of fast product release, a PCR-based system where positive and negative results are clearly available in short time is recommended. Several real-time PCR based systems for detection of Cronobacter spp. have become commercially available. Two systems (one open platform (Biotecon Diagnostics, Potsdam, Germany) and one dedicated system (BioControl, Bellvue, USA)) generated neither false positive nor false negative results. Both systems were able to detect 9 target and 13 non-target strains. The dedicated system has the advantage of shorter hands-on and analysis time. In addition, contaminations due to handling faults are reduced. The existing rpoB based Cronobacter species PCR was upgraded for the recently described species C. condimenti which can now be detected with high reliability. Additional epidemiological data is needed in order to monitor the microbiological situation in industrial plants constantly as well as consequently. Based on information on individual plant level it is possible to implement adequate measurements such as HEPA filters, exact time for adding heat labile ingredients, personal and material flow, air management and cleaning (type, time). Scientific support is needed concerning adequate analytical methods, formation of biofilm, desiccation data, types of enrichment media, sample size as well as additional epidemiological data. Our recent study concerning genetic diversity showed that different Cronobacter isolates from one sample can contain different PFGE fingerprints. This observation suggests that analysis of one isolate per sample may not be sufficient for trace back studies. The analysis of at least five colony forming units per sample is suggested. This example shows that through a close collaboration between industrial companies and scientific institutes, knowledge can be actively turned into practice. – This helps prevent pre-term babies and newborns from falling ill to Cronobacter spp.

Ziel der vorliegenden Arbeit war es, eine Bestandserhebung zur Hygiene im Verpflegungsbereich von Kindertageseinrichtungen vorzunehmen. Zu diesem Zweck erfolgten mikrobiologische Untersuchungen der angebotenen Lebensmittel sowie Abklatschuntersuchungen beim Personal (Hände) und im Umfeld der Küche. Insgesamt wurden zwölf Kindertageseinrichtungen einbezogen, die vier verschiedene Verpflegungssysteme repräsentierten: (1) Zubereitung der Mahlzeiten in einer einrichtungseigenen Küche durch Fachkräfte – Selbstkochküchen, (2) Verpflegung durch ein Catering-Unternehmen (Warm-, Kaltanlieferung, Tiefkühl-kost), eventuell mit Zubereitung von Beilagen durch die einrichtungseigene Küche, (3) Anschluß an eine andere Einrichtung zur Gemeinschaftsverpflegung (Altenheim) und (4) Zubereitung der Mahlzeiten durch Eltern in der Küche der Einrichtung oder Mitbringen von in der Haushaltsküche der Eltern zubereiteten Speisen – Elterninitiativen. Das Alter der ver-pflegten Kinder lag zwischen einem halben Jahr und sechs Jahren, mit dem Altersschwerpunkt bei unter drei Jahren. Nach einer Erhebung der aktuellen Hygienepraktiken in den einzelnen Einrichtungen wurden im Zeitraum Juli 2008 bis Dezember 2009 regelmäßig insgesamt 371 Lebensmittelproben entnommen und auf Hygiene-Indikatorkeime (aerobe mesophile Keime, Enterobacteriaceae, Escherichia coli) sowie auf die Anwesenheit relevanter pathogener Keime (Staphylococcus aureus, Salmonellen, Listeria monocytogenes, Bacillus cereus, Verotoxinogene Escherichia coli, in Sonderfällen auch Cronobacter spp.) untersucht. Außerdem wurden unter Verwendung von RODAC-Platten insgesamt etwa 1300 Abklatschuntersuchungen des Umfelds (Küchen- und Personalhygiene) durchgeführt. Die Ergebnisse wurden den Einrichtungen laufend schriftlich mitgeteilt, besprochen und ggf. Korrekturmaßnahmen vorgeschlagen. Dieses Vorgehen wurde zwar von den Kindertageseinrichtungen positiv bewertet, jedoch nicht immer in dem beabsichtigten Ausmaß umgesetzt. Die Resultate der Lebensmitteluntersuchungen auf Hygiene-Indikatorkeime waren bis auf einzelne Ausnahmen (eine Elterninitiative und zwei durch Caterer verpflegten Einrichtungen) gut; Krankheitserreger (Salmonellen, L. monocytogenes, Verotoxinogene E. coli, Cronobac-ter spp.) wurden nicht, bzw. nur in Zahlen, die im allgemeinen keine Gesundheitsgefährdung darstellen (S. aureus, B. cereus), nachgewiesen. Es fiel allerdings auf, daß B. cereus sowohl aus Lebensmitteln, als auch im Zusammenhang mit den weiter unten erwähnten Abklatschuntersuchungen häufig isoliert werden konnte. Die Ergebnisse der Abklatschuntersuchungen wiesen auf Mängel hinsichtlich der Händehygiene und des hygienischen Zustands von Oberflächen, wie Arbeitsflächen, Servierwagen, Eßtische etc., hin, die zum Teil durch die vorgeschlagenen Korrekturmaßnahmen eliminiert werden konnten.

Im Escherichia coli Stamm ECOR31 konnte erstmals eine atypische Insertionsstelle der weit verbreiteten Pathogenitätsinsel Yersinia-HPI beschrieben werden. Statt dem asnT-tRNA-Gen findet sich am Integrase-Ende der HPI eine weitere, offenbar horizontal transferierte Region, die RegX genannt wurde. Diese besitzt eine Größe von 24196 Basenpaaren und unterscheidet sich mit einem G+C-Gehalt von 47,9% vom E. coli-Kerngenom. Weder auf DNA noch auf Protein-Ebene existieren höhere Homologien zu E. coli-DNA. Nach Anfertigung einer Cosmid-Bank wurde die gesamte Region sequenziert und annotiert. RegX weist eine mosaikartige Struktur auf, mit Punktmutationen, Deletionen und Insertionen. Sie besteht aus 22 offenen Leserastern und alle potentiellen Gene und deren Translationsprodukte wurden durch Vergleiche mit der NCBI-Datenbank charakterisiert. Die Transkription verschiedener Gen-Cluster und deren Operonstruktur wurde mittels RT-PCR nachgewiesen. Die DNA-Region enthält eine interessante Anhäufung von putativen Aufnahme-Systemen für divalente Metallionen, wie Eisen, Zink, Mangan. Zudem beheimatet die Region X Regulatorgene ähnlich zu Fur und Zur und Zink-abhängige Enzyme. Im Gesamtvergleich der Region X ergeben sich die höchsten Homologien zu Teilen des Plasmids pLVPK von Klebsiella pneumoniae CG43 30. Anhand der strukturellen Unterschiede der Sequenzen mit Punktmutationen und Rekombinations-Ereignissen kann der anhaltende Wandel bakterieller Genome nachvollzogen werden. Des Weiteren wurde die Verbreitung dieser Region unter klinisch relevanten Enterobacteriaceae und Pseudomonaceae untersucht. Von 530 gescreenten Bakterien konnte ein Klebsiella pneumoniae Stamm isoliert werden, der in der groben Struktur identisch zu der untersuchten Region von ECOR31 ist. In diesem Isolat, das aus der Blutkultur eines Patienten mit Sepsis stammt, konnte sowohl die gesamte Region X, als auch die benachbarte Yersinia-HPI und die atypische Insertionsstelle der HPI nachgewiesen werden. Es ist davon auszugehen, dass die untersuchte Region auf einem konjugativen Klebsiella-Plasmid lokalisiert ist und so zusammen mit der HPI horizontal zwischen verschiedenen Spezies übertragen werden kann.

B. cereus zählt zu den wichtigsten Verursachern von Qualitätsminderung und Verderb bei Lebensmitteln. Daneben wächst die Bedeutung Toxin-bildender B. cereus Stämme als Auslöser Lebensmittel-bedingter Erkrankungen, die zwei Formen einer gastrointestentinalen Erkrankung hervorrufen können: das diarrhoeische Syndrom, welches durch verschiedene Enterotoxinkomplexe (HBL, Nhe) induziert wird, und das emetische Syndrom, welches durch ein Dodekadepsipetid (Cereulid) ausgelöst wird. In komplexen Lebensmitteln werden vielfach Gewürze als Vektor für B. cereus - Kontaminationen angesehen. Jedoch sind kaum Studien über Gewürze als mögliche Eintragsquelle für B. cereus in Lebensmittel publiziert. Auch liegen nur wenig aktuelle Daten aus dem europäischen Raum über die tatsächliche Belastung von Gewürzen mit diesem Erreger vor. Ziel dieser Arbeit war es, das Vorkommen und die Toxizität von B. cereus in Gewürzen analysieren, um eine aktuelle Übersicht über die Kontamination mit diesem Erreger für eine Bewertung der mikrobiologischen Sicherheit von Gewürzen zu gewinnen. Hierfür wurden insgesamt 60 Gewürzproben zwölf verschiedener Gewürzsorten untersucht. Zunächst wurde mittels kultureller Verfahren die aerobe mesophile Gesamtkeimzahl sowie die Belastung mit Enterobacteriaceae und präsumtiven B. cereus bestimmt. Um auch kleinste Mengen des Erregers sicher nachweisen zu können, wurde zudem ein Real-Time PCR Assay als Alternative zur zeitaufwendigen und diagnostisch ungenauen konventionellen MPN- Methode erarbeitet. Im weiteren Verlauf der Arbeit wurden 151 präsumtive Kolonien, die aus den untersuchten Gewürzproben (n=60) isoliert wurden, mittels biochemischer und molekularbiologischer Analyse als B. cereus bestätigt. Anschließend wurde die Toxigenität und Toxizität der Isolate mittels PCR, immunchemischer Nachweisverfahren (ELISA, RPLA) sowie im Zellkulturtest charakterisiert. Darüberhinaus wurde im Challenge-Test mit marinierten Fleischerzeugnissen untersucht, inwieweit eine Kontamination von Lebensmitteln mit B. cereus tatsächlich aus der Verwendung kontaminierter Gewürze resultiert. Nach mikrobiologischer Analyse der Gewürzprodukte (n=60), waren nahezu alle der Proben als mikrobiologisch unbedenklich einzustufen. Kein Produkt hat den von der DGHM und der Europäischen Kommission empfohlenen Richtwert für B. cereus in Gewürzen von 103 KbE/g überschritten. Mit dem Real-Time PCR-Assay wurde zudem eine zuverlässige Alternative zum konventionellen MPN - Verfahren erarbeitet, der es ermöglichte auch kleinste B. cereus Mengen nach selektiver Anreicherung in den Gewürzproben zu identifizieren. Dies ist insbesondere im Hinblick auf das gesundheitsgefährdende Potential pathogener B. cereus von Bedeutung. So wurden 81% der Isolate (n=151), die aus den Gewürzen gewonnen wurden als diarrhöische und/oder emetische Toxinbildner identifiziert. Zudem wurde gezeigt, dass eine B. cereus Kontamination von Lebensmitteln durchaus aus der Verwendung damit hergestellter, belasteter Gewürze resultieren kann. Jedoch ist das Risiko für den Verbraucher hinsichtlich einer Lebensmittelvergiftung durch kontaminierte Gewürze als gering einzustufen. Zwar wurde B. cereus in 70 % der insgesamt 60 untersuchten Proben detektiert, allerdings in Keimzahlen, die nach derzeitigem Stand der Wissenschaft keine Lebensmittelvergiftung auslösen können. Dennoch ist das Gesundheitsrisiko, das von toxinbildenden B. cereus ausgeht nicht zu unterschätzen, da sie als Sporenbildner Erhitzungsprozesse von Lebensmitteln überleben, wieder auskeimen und sich vermehren können. Das Vorkommen von B. cereus in Gewürzen ist somit unter den Gesichtspunkten eines vorbeugenden Verbraucherschutzes und der Qualitätssicherung zu betrachten, nicht zuletzt da es auch angesichts eines stetig wachsenden Welthandels im Zuge der Globalisierung immer dringlicher wird eine mikrobiologisch unbedenkliche Ware zu gewährleisten. Letztendlich sind weitere Untersuchungen mit größeren Probenzahlen für eine besserere Risikoabschätzung unumgänglich. Mit dem Real-Time PCR Assay steht hierfür eine schnelle und zuverlässige Methode zur Verfügung, die einen Erregernachweis direkt aus Gewürzproben erlaubt.

Sally Hargreaves discusses highlights from the March issue: a review about the emergence of multidrug-resistant Enterobacteriaceae that produce extended-spectrum β-lactamases (ESBLs) within the community setting, an important cause of urinary-tract infections. Also discussed is a feature and the editorial about human papilloma (HPV) vaccination programmes, and the review about Whipple's disease, a condition which is both rare and poorly understood.

In der vorliegenden Arbeit wurde in zwei Mastdurchgängen ein Teich als Schwimmmöglichkeit im Vergleich mit offenen Tränken in Hinblick auf eine artgemäße Entenhaltung unter Berücksichtigung hygienischer Bedingungen untersucht. Dabei wurde ein besonderes Augenmerk auf ethologische und gesundheitliche Parameter gelegt. In den beiden durchgeführten Mastdurchgängen wurden zwei Gruppen (1. Durchgang: n = 124, 2. Durchgang: n = 129 pro Gruppe) vergleichend gegenübergestellt. Die Gruppen wurden in zwei Abteilen mit sowohl einem kleinen Stall (20 m2) als auch Zugang zu einem Außenbereich mit Grasfläche (zusammen 300 m2) gehalten. Die Mastdauer betrug beim 1. Durchgang 47 und beim 2. Durchgang 50 Tage. Beide Durchgänge besaßen den gleichen Aufbau. Die beiden Gruppen wurden als Kontrollgruppe und Versuchsgruppe bezeichnet, wobei der Kontrollgruppe im Stall Nippeltränken und im Außenbereich Rundtränken sowie der Versuchsgruppe zusätzlich noch ein Teich zur Verfügung stand. Es wurden Verhaltensbeobachtungen in Form von Direktbeobachtung durchgeführt, die jeden 2. Tag stattfanden, sowie Videobeobachtungen, die einmal pro Woche dreimal täglich stattfanden. Des Weiteren erfolgte einmal pro Woche bei 20 willkürlich gewählten Tieren pro Gruppe eine Blutabnahme, um Hämatokrit, Hämoglobin- und IgY-Gehalt zu bestimmen. Außerdem wurde ebenfalls wöchentlich während der Blutabnahme das Gefieder bezüglich Verschmutzung und Qualität bonitiert sowie die Nasenlöcher auf Verstopfungen und Augen auf Veränderungen untersucht. Bei der letzten Blutentnahme vor der Schlachtung wurde zusätzlich die Gefiederqualität begutachtet. Schließlich wurden noch von den Nippeltränken, den Rundtränken, direkt nach sowie zwei und vier Stunden nach der Reinigung, und dem Teich, je vor und nach der Reinigung, einmal wöchentlich 20 ml-Wasserproben gezogen. Von diesen wurde die Gesamtkeimzahl und der Gehalt an Enterobacteriaceae bestimmt. Außerdem wurden die Proben noch im Speziellen auf Salmonellen untersucht. Am Teich konnte vermehrt arttypisches Badeverhalten und wasserassoziiertes Verhalten wie die arttypische Futteraufnahme in Form von Seihen und Gründeln sowie Putzen mit Tränkewasser beobachtet werden. Auch wurde die Gefiederpflege ohne Wasser verstärkt angeregt, was zu einem deutlich saubereren Gefieder und besserer Gefiederqualität führte. Vor allem Bauch- und Brustgefieder waren bei der Versuchsgruppe weniger verschmutzt als bei der Kontrollgruppe. Des Weiteren führte die Nutzung des Teiches zu einer 6 Zusammenfassung 179 verminderten Anzahl an Tieren mit verstopften Nasenlöchern und geröteten bzw. verschmutzten Augen. Bezüglich der Gesamtkeimzahl sowie dem Gehalt an Enterobacteriaceae kann keine einheitliche Aussage gemacht werden, da zum Teil die Keimzahlen am Teich nach 48 Stunden Benutzung höher lagen als an den Rundtränken nach vier Stunden Benutzung, zum Teil war aber auch das Gegenteil der Fall. Meist waren diese beiden Werte höher als an den Nippeltränken. Der Wasserverbrauch am Teich lag bereits ohne die Wassermenge, die zur Reinigung benötigt wurde, bedeutend höher als an Rundtränke und Nippeltränke. Trotz unterschiedlichem Wasserverbrauch ergaben sich nur selten signifikante Unterschiede zwischen den Gruppen bezüglich Hämoglobingehalt und Hämatokrit. Auch beim Nachweis des Plasmagehalts an IgY konnte man zwischen den Gruppen keine signifikanten Unterschiede feststellen. Das Bereitstellen eines Teiches bringt vor allem für das Wohlbefinden und die Gesundheit der Tiere durchaus Vorteile. Ein Einsatz in der Praxis ist allerdings aus wirtschaftlichen Gründen aufgrund des hohen Wasserbedarfs und Arbeitsaufwands vermutlich nicht durchsetzbar. Die Freilandhaltung und insbesondere die Weidehaltung bietet ebenfalls eine Möglichkeit zur intensiven Beschäftigung und kann für Kleinstbetriebe oder Hobbyhalter aus ethologischer Sicht empfohlen werden.

Zusammenfassung In der vorliegenden Arbeit sollte die Quelle der Kontamination von Würsten mit Lactobacillaceae im Produktionsverlauf herausgefunden werden. Der Betrieb hatte Probleme mit erhöhten Lactobacillaceaezahlen, so dass einzelne Verpackungen vor dem Mindesthaltbarkeitsdatum verdorben waren. In der vorliegenden Untersuchung wurden Würste nach den Arbeitsschritten „Brühen“, „Abkühlen“, „Würsteltrenner“ und „Verpacken“ entnommen und die Gesamtkeimzahl, die Enterobacteriaceae- und die Lactobacillaceaezahl bestimmt. Im Weiteren sind Proben mittels Abklatschplatten von den Euro-Kisten, den Verpackungsmaschinen und vom Würsteltrenner extrahiert worden. An Hand von Tupferproben wurden die Gestelle und die Messer des Würsteltrenners auf die oben genannten Keime untersucht. Außerdem sind Proben von der Kistenwaschanlage und dem Kühlraum auf L. monocytogenes überprüft und weitere Material- und Umgebungsproben auf Campylobacter spp. kontrolliert worden. Als Eingang der Kontamination wurde der Würsteltrenner ausfindig gemacht. Hier zeigten 28,9 % der Wurstproben einen Gehalt an Lactobacillaceae zwischen 101 und 105 KbE/g. Im Vergleich dazu waren es nach dem Brühen nur 2,2 % und nach dem Abkühlen 6,5 % der Proben. Auch an Hand der Umgebungsproben dieses Gerätes wurde eine deutliche Kontamination festgestellt. Durch die Beobachtungen im Betrieb während der Probennahme fiel auf, dass besonders das Reinigungsmanagement nicht optimal verlief. So waren beispielsweise vor Produktionsbeginn, also an frisch gereinigten Geräten, noch deutliche Wurstreste unter den Messerschienen des Würsteltrenners erkennbar. Daher sollte besonders das Hygiene- und Reinigungsmanagement in Bezug auf die Häufigkeit und Gründlichkeit hin verändert werden. Der Schwerpunkt sollte hierbei auf der Schulung der Mitarbeiter beruhen.

Einige Stämme des Darmbakteriums Escherichia coli sind in der Lage Shiga- Toxine zu produzieren, die gastrointestinale Erkrankungen auslösen können. Wiederkäuer, vor allem Rinder, Schafe und Ziegen gelten als Hauptreservoir für STEC. STEC-Infektionen treten weltweit vor allem in Ländern mit hoch entwickelter Landwirtschaft auf. Als wichtigste Infektionsquelle gelten vor allem rohe oder nicht ausreichend erhitzte Lebensmittel tierischen Ursprungs wie unzureichend gegartes Rinderhackfleisch, Rohmilch und Rohmilchprodukte. Aber auch Rohwürste wurden bereits mit humanen Infektionen in Verbindung gebracht. Vorrangiges Ziel dieser Studie war es, mögliche STEC- Kontaminationsquellen in zwei Rohwurst- produzierenden Betrieben abzuklären. Begleitend wurden mikrobiologische Untersuchungen durchgeführt sowie die Wasseraktivität und der pH- Wert gemessen. Ein Betrieb umfasst Schlachtung, Zerlegung und Produktion sowohl in der konventionellen Herstellungsschiene wie auch in der Bio- Produktion. Der zweite untersuchte Betrieb ist ein reiner Biobetrieb. Insgesamt wurden 323 Proben aus Betrieb 1 untersucht. 206 Proben stammen aus der Bio-, 117 aus der konventionellen Produktion. Dabei wurden Rinder- Schlachttierkörper, Proben aus der Zerlegung sowie kurz- und langgereifte Rohwürste in unterschiedlichen Reifungsstadien ausgewählt. Für den STEC- Nachweis wurden sowohl die Lebensmittel und die nach der Schlachtung und Zerlegung entnommenen Tupferproben nach Anreicherung in modifizierter Tryptose- Soja- Bouillon (mTSB) auf das Vorhandensein des Shiga Toxin- Gens mittels PCR und anschließender Gelektrophorese gemäß der Amtlichen Sammlung nach §64 LFBG (L.07.18) untersucht. Der Nachweis von Enterobacteriaceae, E.coli, Milchsäurebakterien und Laktobazillen erfolgte in Anlehnung an die Amtliche Methode nach §64 LFBG. Der pH- Wert und die Wasseraktivität wurde gemäß der amtlichen Sammlung nach §64 LFBG ermittelt. Der Warnwert bezüglich Enterobacteriaceae nach DGHM wurde von 25,5% der untersuchten fertigen Würste überschritten. Konventionell hergestellte Produkte waren dabei mit 42,9% der fertigen Produkte über dem DGHM- Warnwert erheblich mehr belastet als Bio- Produkte (11,5%). Der DGHM- Warnwert bezüglich E. coli wurde von 6,4% der fertig gereiften Produkte überschritten. Säuernde Mikroorganismen waren in den untersuchten Produkten zu wenig vorhanden. In 8 der 323 untersuchten Proben wurde STEC nachgewiesen. Insgesamt 5 der 96 beprobten Schlachttierkörper (Rind) waren STEC- positiv: 4 Tiere aus der Bio-Produktion und 1 Tier aus der konventionellen Produktion. 3 von 62 untersuchten kurzgereiften Rohwürsten waren STEC- positiv: 1 aus der Bio- Produktion und zwei aus der konventionellen Produktion. Alle untersuchten Proben aus der Zerlegung und alle langgereiften Rohwürste reagierten STEC- negativ. Aus Betrieb 2 wurden 108 Proben untersucht. Hier wurde nur bei einem Endprodukt Enterobacteriaceae über dem DGHM- Warnwert festgestellt. In keinem Endprodukt fanden sich E. coli. In keiner Probe wurde STEC nachgewiesen.

In dieser Studie wurden Untersuchungen zu einer tierfreundlichen Wasserversorgung von Pekingmastenten unter hygienischen Aspekten durchgeführt. Insgesamt fanden fünf Versuchsdurchgänge statt. In den Versuchsdurchgängen I, II und V waren die Cherry-Valley-Pekingenten in sechs Abteilen zu je 192 Tieren untergebracht; in Versuchsdurchgang III und IV waren es 226 Tiere pro Abteil. In den Versuchsdurchgängen II, III und IV konnten die Tiere zusätzlich zum Stall einen überdachten Außenbereich nutzen. Da sich durch den Außenbereich die Gesamtnutzungsfläche vergrößerte, wurden in Versuchsdurchgang III und IV mehr Tiere (226) pro Abteil eingestallt. Die Mastdauer betrug 44 bis 47 Tage. In diesen fünf Versuchsdurchgängen stand vor allem die Erprobung von offenen Tränken in Form von Rundtränken, sowie der Einbau von Duschen als Badeersatzmöglichkeit, im Vordergrund. Die Duschen kamen nur in den Versuchsdurchgängen I und IV zum Einsatz. In allen Versuchsdurchgängen wurden Nippeltränken und Rundtränken als Tränkevarianten verwendet. Um bei den Rundtränken den Wasserverbrauch und die Tränkewasserhygiene zu optimieren, wurde die Anzahl der Rundtränken ebenso variiert wie auch ihre zeitliche Verfügbarkeit. Es wurden in jedem Versuchsdurchgang zu Mastbeginn (28.- 30. Masttag) und zu Mastende (41.- 45. Masttag) aus den angebotenen Tränkevarianten Wasserproben entnommen und diese mikrobiologisch auf Gesamtkeimzahl, Enterobacteriaceae-Gehalte, sowie zusätzlich noch qualitativ auf Salmonellen untersucht. Außerdem erfolgten Blutentnahmen zur Bestimmung des IgY-Gehaltes im Plasma, sowie Messungen zur Bestimmung des Ammoniakgehaltes im Stall. Es wurden bei der quantitativen Bestimmung der durchschnittlichen Gesamtkeimzahlen sowie der durchschnittlichen Enterobacteriaceae-Gehalte für die jeweiligen Tränkewasser-Proben zu Mastbeginn höhere Werte gemessen als zu Mastende. Betrachtet man die Medianwerte der Gesamtkeimgehalte, so lagen diese an den Nippeltränken zwischen 165.000 KbE/ml und 980.000 KbE/ml zu Mastanfang und zwischen 260.000 KbE/ml und 705.000 KbE/ml zu Mastende. An den Rundtränken hingegen bewegten sich die medianen Werte zu Beginn der Mast zwischen 415.000 KbE/ml und 16.800.000 KbE/ml und am Ende der Mast zwischen 72.500 KbE/ml und 3.075.000 KbE/ml. Viele der untersuchten Tränkewasser-Proben waren frei von Enterobacteriaceae, die medianen Werte derjenigen Proben, in denen Enterobacteriaceae nachgewiesen werden konnten, lagen zwischen 25.000 KbE/ml und 75.000 KbE/ml. Bei der qualitativen Untersuchung des Tränkewassers auf Salmonellen konnten sowohl aus den Tränkewasserproben der Nippeltränken, als auch aus den Proben der Rundtränken, Salmonellen isoliert werden. Hierbei stellte S.Indiana das am häufigsten isolierte Serovar dar. Die gemessenen durchschnittlichen Schadgaskonzentrationen lagen zu Mastbeginn an den Nippeltränken bei 10,10 ppm, an den Duschen bei 9,40 ppm und an den Rundtränken bei 6,82 ppm. Gegen Mastende erhöhten sich die Werte an den Nippeltränken auf 10,99 ppm, an den Duschen auf 10,90 ppm und an den Rundtränken auf 7,14 ppm. Die durchschnittlichen IgY-Gehalte im Blutplasma betrugen zu Mastbeginn zwischen 5,66 mg/ml und 12,45 mg/ml, zu Mastende lagen sie durchschnittlich zwischen 9,92 mg/ml und 18,11 mg/ml. Tendenziell zeigte sich im Blutplasma mit zunehmenden Alter der Tiere eine Erhöhung der IgY-Werte. Die Mortalität lag in allen fünf Versuchsdurchgängen unter 5 %. Aus hygienischer Sicht kann festgestellt werden, dass offene Tränken in Form von Rundtränken, die zeitlich begrenzt angeboten und regelmäßig gereinigt werden, sich als Alternative zu Nippeltränken anbieten, da sich die Keimbelastung der Tiere bei unterschiedlichen Tränkevarianten nicht wesentlich unterschied und keine negativen Einflüsse der Rundtränken auf die Tiergesundheit festgestellt werden konnten.

Es wurde eine tiergerechte Wasserversorgung von Pekingenten unter hygienischen Aspekten untersucht. Insgesamt fanden fünf Versuchsdurchgänge statt, wobei nur die Ver¬suchsdurchgänge (VG) III bis V in dieser Studie berücksichtigt wurden. In jedem Versuchs¬durchgang, mit einer Mastdauer von 47 bis 49 Tagen, wurden je 1.152 Cherry-Valley-Pekingenten gehalten, die auf sechs Stallabteile aufgeteilt waren. In diesen drei Versuchsdurchgängen (III bis V) stand die Erprobung verschiedener Tränkevarianten (Nippel-, Rinnen-, und modifizierte Rundtränke) im Vordergrund. Diese Tränkevarianten wurden in Versuchsdurchgang III als Kombinationen – Nippel/Nippel, Nippel/Rinne, Nippel/Rund 24h – rund um die Uhr den Enten angeboten. In den Versuchsdurchgängen IV und V kam nur noch die modifizierte Rundtränke als offene Tränkevariante mit teilweise zeitlich begrenztem Zugang zum Einsatz. So wurde in Versuchsdurchgang IV die modifizierte Rundtränke mit 24h-,8h- und 4h Zugang zusätzlich zu Nippeltränken angeboten, in Versuchsdurchgang V erneut mit 4h- und 2h Zugang sowie einer Kontrollgruppe, denen nur Nippeltränken zur Verfügung standen. Es wurden, jeweils zu Mastbeginn (21.-28. Tag) und zu Mastende (46.-47. Tag) in den Versuchsdurchgängen III-V Wasserproben aus jeder Tränkevariante ge¬zogen und mikrobiologisch auf Enterobacteriaceae-Gehalt, Ge¬samtkeimzahl, sowie qualitativ auf Salmonella-Serovare untersucht. Des Weiteren erfolgten Blut¬entnahmen zur Bestimmung des IgY-Gehaltes im Plasma (mittels neu entwickeltem Sandwich-ELISA) sowie die Bestimmung der Ammoniakkonzentration in der Stallluft. Bei der qualitativen Untersuchung des Tränkewassers auf Salmonella-Serovare konnte aus jeder Tränkevariante Salmonellen isoliert werden. Alle isolierten Serovare konnten als humanpathogene Keime identifiziert werden. S. Saintpaul stellte das häufigste gefundene Serovar dar. Dage¬gen wurde das für den Menschen bedeutsa¬mere Serovar S. Typhimurium nur einmal isoliert. Es wurden bei der quantitativen Bestimmung auf Enterobacteriaceae-Gehalt und Ge¬samtkeimzahl immer zu Mastbeginn höhere Werte gemessen als zu Mastende. Die Messungen in Versuchsdurchgang III (VG III) zu Mastbeginn ergaben durchschnittlich 0 KbE/ml an Enterobacteriaceae in Nippeltränken (vgl. VG IV: 100.000 KbE/ml; bzw. VG V: 0 KbE/ml), bei Rinnentränken lag der Enterobacteriaceae-Gehalt in VG III bei 20.400.000 KbE/ml; an den 24h Rundtränken konnte zu Mastbeginn ein Enterobacteriaceae-Gehalt (VG III) von 4.350.000 KbE/ml (vgl. VG IV: 5.425.000 KbE/ml) festgestellt werden. Des Weiteren konnte zu Mastbeginn an der 8h zugänglichen Rundtränke ein Enterobacteriaceae-Gehalt von 1.335.000 KbE/ml gemessen werden (VG IV), wogegen an der 4h zugänglichen Rundtränke in VG IV 8.875.000 KbE/ml (vgl VG V: 125.000 KbE/ml) festgestellt wurden. An den 2h zugänglichen, modifizierten Rundtränken lag der durchschnittliche Enterobacteriaceae-Gehalt bei 600.000 KbE/ml (VG V). An allen Tränkevarianten konnte über alle drei Versuchsdurchgängen hinweg zum Mastende hin eine Abnahme an Enterobacteriaceae festgestellt werden. Bei Mastbeginn wurde als durchschnittliche Gesamtkeimzahl in VG III 0 KbE/ml (vgl. VG IV: 5.510.000 KbE/ml bzw. VG V: 605.000 KbE/ml) an Nippeltränken ermittelt, an Rinnentränken 83.075.000 KbE/ml (VG III) und an den 24h Rundtränken in VG III 74.500.000 KbE/ml (vgl. VG IV: 73.500.000 KbE/ml). Die Gesamtkeimzahlen konnten in Rundtränken mit einer zeitlichen Zugangsbegrenzung von 8h, 4h und 2h nicht reduziert werden. Die Gesamtkeimzahlen sanken in den Tränken, wie schon bei den Enterobacteriaceae, zu Mastende ab. Die gemessenen Schadgaskonzentrationen, bewegten sich zu Mastbeginn zwischen minimal 3,00 ppm an einer Nippeltränke und maximal 14,00 ppm jeweils an einer Rinnen- und einer 24h Rundtränke. Diese Werte stiegen zu Mastende deutlich an. So ergaben sich zu Mastende Ammoniakwerte von minimal 8,00 ppm an einer Nip¬peltränke und maxi¬mal 32,00 ppm an einer Rinnentränke. Die mittleren IgY-Gehalte im Blutplasma betrugen zu Mastbeginn minimal 3,66 mg/ml an der Tränkekombination Nippel/Rinne in Versuchsdurchgang III und maximal 9,72 mg/ml an der Kombination Nippel/Rund 2h in Versuchsdurchgang V. Die mittleren IgY-Konzentrationen beliefen sich zu Mastende auf minimal 15,26 mg/ml an der Tränkekombination Nip¬pel/Nippel in Versuchsdurchgang III und maximal 26,05 mg/ml an der Kombination Nippel/24h Rundtränke in Versuchsdurchgang IV. Zu Mastbeginn und zu Mastende war keine Korrelation zwischen dem IgY-Gehalt im Plasma der Tiere und dem Gehalt an Enterobacteriaceae sowie dem Gesamtkeimgehalt in offenen Tränken, festzustellen. Es bestand eine signifikante Korrelation zwischen den IgY–Gehalten und den gemes¬senen Ammoniakwerten zu Mastbeginn. Zu Mastende korrelier¬ten diese Parameter nicht signifikant miteinander. Aus hygienischer Sicht kann festgestellt werden, dass sich keine erheblichen Differenzen zwischen den einzelnen offenen Tränken in Bezug auf die Gesamtkeimzahl oder An¬zahl an Enterobacteriaceae ergab. Alle Werte lagen weit über den Richtwerten der Trinkwasserverordnung. Doch diese hohen gemessenen Keimzah¬len in den Tränkevarian¬ten nehmen scheinbar keinen Einfluss auf die IgY–Gehalte im Plasma der Enten.

Durch den hohen Stellenwert des Verbraucherschutzes in der heutigen Gesellschaft ist es für jedes Lebensmittelunternehmen, neben den gesetzlichen Verpflichtungen, ein Muss, einwandfreie, nicht kontaminierte und qualitativ hochwertige Lebensmittel herzustellen und in den Verkehr zu bringen. Hierzu bedarf es entsprechender Hygiene-Sicherungssysteme. Ein solches, in Form eines Hazard Analysis and Critical Control (HACCP)-Konzeptes, war ein Ziel dieser Arbeit und wurde beispielhaft für einen kleinen milchverarbeitenden Betrieb erstellt. Hierzu wurden u. a. bakterielle Proben an vorher ausgewählten Prozessstufen gezogen und untersucht. Anhand dieser wurde versucht, Schwachstellen zu erkennen und gleichzeitig wurde ein besonderes Augenmerk auf die Untersuchung von Indikatorkeimen (Enterobacteriaceae, Coliformen, E. coli) gerichtet, da auf EU-Ebene beabsichtigt wird, die im Milchbereich seit Jahrzehnten etablierte Untersuchung auf Coliforme als Hygieneindikatoren durch andere Parameter (Enterobacteriaceae, E. coli) zu ersetzen oder z. T. zu eliminieren. Für die Erarbeitung des HACCP-Konzeptes wurde der bestehende Hygienestatus in der Molkerei bewertet, die Prozessabläufe überprüft und ein Fließdiagramm erstellt. Anschließend wurde jede Prozessstufe bearbeitet, eine Risiko- und Gefahrenanalyse und eine geeignete Dokumentation dazu erstellt. Durch diese Maßnahmen wurden Schwachstellen beim Betriebsablauf aufgedeckt. Hauptsächlich waren das Rekontaminationsstellen. Darüber hinaus wurden Probleme bei der praktischen Umsetzung des HACCP-Konzeptes behoben. Während der Erstellung des HACCP-Konzeptes und in der Folge wurden die mikrobiologische Proben gezogen. Fünf ausgewählte Weichkäsesorten wurden an sieben Punkten im Fertigungsprozess auf ihren Gehalt an Coliformen, Enterobacteriaceae, Escherichia coli, Salmonellen, Listerien und koagulasepositive Staphylokokken untersucht. Die Untersuchungen fanden an Prozessstufen statt, die zuvor als besonders kritisch eingestuft wurden. Die Untersuchungsergebnisse der Salmonellen und Listerien (neg. in 25 ml) und der koagulasepositiven Staphylokokken (< 10/ml) waren innerhalb der Vorgaben der MilchV. Bei den Listerien wurden in 52,11 % der Proben L. innocua gefunden. In einer Camembert-Probe zum Zeitpunkt des Warenausgangs überstieg der Gehalt an E. coli (> 1,1 x 107) die Anforderungen der MilchV deutlich. Im Vergleich der Enterobacteriaceae zu den coliformen Keimen stellte sich heraus, dass die Werte der Enterobacteriaceae in 34 von 71 Fällen (47,88 %) höher waren, als die der Coliformen. 9 Mal (12,68 %) war der Wert des Untersuchungsergebnisses etwa identisch und bei 28 Proben (39,44 %) waren die Werte der Coliformen höher. Der Unterschied betrug, bis auf zwei Ausnahmen, eine Zehnerpotenz. Anhand der eigenen Untersuchungsergebnisse erscheint es nur bedingt sinnvoll die Coliformen durch die Enterobacteriaceae als Markerkeim in der pasteurisierten Milch zu ersetzen. Sollte, wie im Entwurf vorgesehen, die Untersuchung von Weichkäse auf den Gehalt an coliformen Keimen wegfallen, bedeutet dies einen klaren Rückschritt in der Produkthygiene und damit auch im Hinblick auf den Verbraucherschutz.

Examinations concerning the microbiological and hygienic quality of marinated meat preparations in order to determine guidelines to control the best-before-date In this study 52 marinades, 5 seasoning mixtures and 1 lemon seasoning were surveyed at the time of delivery and again following 4 weeks of refrigeration at + 6 °C ± 2°C. An analysis was also performed on self-made meat preparations consisting of pork respectively venison marinated in three different marinades. The marinated meat samples were produced and examined in duplicate to increase statistical accuracy. The examinations were carried out after 1 and 2 weeks of cold storage and after 6 weeks of deep freezing in order to determine the best-before-date of these self-service-products. The effect of an interruption in the cold chain was also examined as follows: 3 hours interruption for cold storage products and 5 hours for frozen products. This procedure was chosen to simulate the interruptions occuring during transport from dealer to customer or from customer to customer. All samples were examined in the following three categories: sensory examination, microbiological survey, and pH value. The sensory examination included “general characteristics”, “external qualities”, “consistency”, “appearance”, “odor”, “taste” and “haptic consistency”. Taste and haptic consistency were only determined for the marinades and seasoning mixtures, as the marinated meat could only be examined in raw condition and could therefore not be analysed concerning taste. The microbiological survey included the examination of total viable count, B. cereus, Enterobacteriaceae, E. coli, C. perfringens, lactic acid bacteria, coagulase-positive staphylococci and salmonellae. The pH-value was measured by means of a pH-meter if possible. In the case of oil-containing marinades the pH-value was determined using pH-indicator paper. According to the sensory examinations, neither the marinades nor the seasoning mixtures had to be rejected after the initial examination nor after the 4 weeks storage. The high intensity of taste can be explained by the very spicy character of the concentrated marinades. The marinades are generally meant to be used as a taste enhancing component in meat preparations and are not intended for direct consumption. The sensory examination of the marinated pork samples revealed a musty and odor compo-nent in 33 % of the samples after 1 week and in 100 % after 2 weeks of cold storage. According to sensory examinations 67 % of the samples were eventually classified as spoilt after 2 weeks. Only 33 % of the deep frozen samples were judged as musty and dull while none of those samples was spoilt after 6 weeks storage. Such sensory defects as a slimy and rope forming consistency were observed in 33 % of the samples after 2 and 6 weeks of storage, while 67 % of the frozen samples showed separation of fat within the marinades. The sensory examination of the marinated venison samples revealed that 17 % had a musty and dull odor after 1 week, increasing to 50 % after 2 weeks of cold storage. In 33 % of the samples frozen for 6 weeks a musty and dull odor was observed. Putrid smell and spoilage could be detected in 33% of the samples after 1 week, in 67% after 2 weeks cold storage and in none of the samples after deep freezing. 33 % of the samples were slimy and rope forming after 1 as well as 2 weeks of cold storage. Separation of fat occurred only in the frozen samples (67 % of the samples). No significant differences could be observed between samples subjected to an interruption of the cold chain and samples held at constant temperature. The microbiological survey of the marinades revealed no occurrence of pathogenic bacteria in critical amounts, with the exception of the detection of B. cereus and C. perfringens in small quantities. Both species of bacteria are to be considered innocuous, because the marinades are subjected to heat treatment together with the meat thereby destroying the toxins. Only the emetic toxin produced by B. cereus is heat resistant and could be a threat to the consumer. In general, the total viable count in marinade samples obtained from containers used in the production process of self-service-products was higher than that of the samples taken directly out of the marinade producers’ original packing. In marinated pork the number of microbes was relatively high in comparison to the untreated meat. The increase in microbes can be attributed to suboptimal conditions in manual processing of the meat preparation. In industrial processing under optimal hygiene circumstances an expiration date of 1 week to 10 days can be justifiable. The microbiological results of deep freezing suggest that this method can be regarded as a viable alternative for ensuring longer storage life and better quality. The examination of raw venison already yielded critical results with regard to its suitability for meat preparations used for barbecuing. The examination of marinated venison further strengthened those results. Only as frozen product a suitable quality could be guaranteed for a longer period because most microbes do not survive a deep freezing process. The pH measurements did not provide any indication of the grade of spoilage. Only after 2 weeks of cold storage a slight decrease in pH was observed, which might indicate progressive spoilage. Generally, the increase in microbiological counts correlated with sensory defects and the duration of storage. Yet the number of microbes showed a slightly earlier and more noticable rise than was to be expected based on the sensory examinations carried out in the same time period.