scholarly journals Increased usage of antiseptics is associated with reduced susceptibility in clinical isolates of S. aureus

2017 ◽  
Author(s):  
Katherine Hardy ◽  
Katie Sunnucks ◽  
Hannah Gil ◽  
Sahida Shabir ◽  
Eleftheria Trampari ◽  
...  
Keyword(s):  
Efflux Pump ◽  
Sequence Data ◽  
Hospital Medicine ◽  
Cross Resistance ◽  
Resistant Bacteria ◽  
Single Strain ◽  
Biocide Resistance ◽  
The Face ◽  
The Uk ◽  
The Impact

AbstractHospital acquired infection is a major cause of morbidity and mortality and regimes to prevent infection are crucial in infection control. These include decolonisation of at-risk patients of carriage of MRSA which is commonly achieved by protocols that include the use of chlorhexidine, or octenidine as biocidal agents. There is however no standardised single decolonisation regime agreed upon in the UK or other countries and protocols include a variety of active agents. Antibiotic resistant bacteria cause major problems in hospital medicine and concern has been raised regarding the development of biocide resistance which would cause decolonisation regimes to become unreliable. In this study, we assembled a panel of isolates of S. aureus including isolates collected before the development of chlorhexidine and octenidine through to a contemporaneous panel of isolates from a major hospital trust in the UK during a period when the decolonisation regime was altered. We observed significant increases in the MIC and MBC of chlorhexidine in isolates collected from periods of high usage of chlorhexidine. No isolates had a significantly altered MIC or MBC of octenidine apart from those collected after octenidine was introduced into the trust where isolates with four-fold decreases in susceptibility emerged. There was no suggestion of cross-resistance between the two biocidal agents. A combination of VNTR, PCR for qac genes and whole genome sequencing was used to type isolates and examine possible mechanisms of resistance. The typing data showed no expansion of a single strain was associated with decreased biocide tolerance and isolates with increased chlorhexidine MIC and MBCs were found from different clonal complexes; CC8, CC22 and CC30. Biocide susceptibility did not correlate with carriage of qac efflux pump genes – carriage of qacA and qacB was detected but, with one exception was restricted to isolates of CC8. Analysis of genome sequence data for closely related pairs of strains with differential biocide susceptibility revealed no common mutations or carriage of accessory elements that correlated with biocide tolerance. Mutations with the NorA or NorB efflux pumps, previously associated with chlorhexidine export were identified suggesting this may be an important mechanism of biocide tolerance. The clinical relevance of decreased biocide tolerance in terms of efficacy of decolonisation therapies remains to be established but we present evidence here that isolates are evolving in the face of biocide challenge in patients and that changes to decolonisation regimes are reflected in changes in susceptibility of isolates. More work is needed to assess the impact of these changes to ensure effective and robust decolonisation protocols remain in place.

scholarly journals Increased Usage of Antiseptics Is Associated with Reduced Susceptibility in Clinical Isolates of Staphylococcus aureus

mBio ◽  
2018 ◽  
Vol 9 (3) ◽  
Author(s):  
Katherine Hardy ◽  
Katie Sunnucks ◽  
Hannah Gil ◽  
Sahida Shabir ◽  
Eleftheria Trampari ◽  
...  
Keyword(s):  
Staphylococcus Aureus ◽  
Efflux Pump ◽  
Variable Number Tandem Repeat ◽  
Variable Number ◽  
Cross Resistance ◽  
Single Strain ◽  
Content Type ◽  
Biocide Resistance ◽  
The Face ◽  
The Impact

ABSTRACT Hospital-acquired infection is a major cause of morbidity and mortality, and regimes to prevent infection are crucial in infection control. These include the decolonization of vulnerable patients with methicillin-resistant Staphylococcus aureus (MRSA) carriage using antiseptics, including chlorhexidine and octenidine. Concern has been raised, however, regarding the possible development of biocide resistance. In this study, we assembled a panel of S. aureus isolates, including isolates collected before the development of chlorhexidine and octenidine and isolates, from a major hospital trust in the United Kingdom during a period when the decolonization regimes were altered. We observed significant increases in the MIC and minimum bactericidal concentration (MBC) of chlorhexidine in isolates from periods of high usage of chlorhexidine. Isolates with increased MICs and MBCs of octenidine rapidly emerged after octenidine was introduced in the trust. There was no apparent cross-resistance between the two biocidal agents. A combination of variable-number tandem repeat (VNTR) analysis, PCR for qac genes, and whole-genome sequencing was used to type isolates and examine possible mechanisms of resistance. There was no expansion of a single strain associated with decreased biocide tolerance, and biocide susceptibility did not correlate with carriage of qac efflux pump genes. Mutations within the NorA or NorB efflux pumps, previously associated with chlorhexidine export, were identified, however, suggesting that this may be an important mechanism of biocide tolerance. We present evidence that isolates are evolving in the face of biocide challenge in patients and that changes in decolonization regimes are reflected in changes in susceptibility of isolates. IMPORTANCE Infection in hospitals remains a major cause of death and disease. One way in which we combat this is by decolonizing at-risk patients from carriage of bacteria which can cause disease such as MRSA. This is done with antiseptics, including chlorhexidine and octenidine. There is concern, however, that bacteria may be able to become resistant to these antiseptics. In this study, we looked at isolates of MRSA and found that there was a correlation between the use of antiseptics and increased resistance in the isolates. We also suggest that the mechanism by which these more tolerant isolates may become resistant to antiseptics is that of changing a transport pump that exports these agents. This information suggests that we need to study the impact of antiseptics on clinically important bacteria more closely.

scholarly journals The Impact of the Covid-19 Pandemic on Uptake of Influenza Vaccine: A UK-Wide Observational Study (Preprint)

2020 ◽  
Author(s):  
Patrik Bachtiger ◽  
Alexander Adamson ◽  
Ji-Jian Chow ◽  
Rupa Sisodia ◽  
Jennifer K Quint ◽  
...  
Keyword(s):  
Influenza Vaccine ◽  
National Health ◽  
Personal Health Record ◽  
Resource Planning ◽  
Flu Vaccination ◽  
The Face ◽  
Uk National Health Service ◽  
The Uk ◽  
The Impact ◽  
To Receive

BACKGROUND In the face of the Covid-19 pandemic, the UK National Health Service (NHS) flu vaccination eligibility is extended this year to ~32.4 million (48.8%) of the population. Knowing intended uptake will inform supply and public health messaging to maximise vaccination. OBJECTIVE The objective of this study was to measure how the Covid-19 pandemic will impact uptake of the UK National Health Service's (NHS) expanded flu vaccination programme, and to inform reasons for or against vaccination. METHODS Intention to receive influenza vaccine in 2020-21 was asked of all registrants of the NHS’s largest electronic personal health record. Of those who were either newly or previously eligible but had not previously received influenza vaccination, multivariable logistic regression, and network analysis were used to examine reasons to have or decline vaccination. RESULTS Among 6,641 respondents, 945 (14.2%) were previously eligible but not vaccinated of whom 536 (56.7%) intend to receive flu vaccination in 2020/21, as do 466 (68.6%) of the newly eligible, increasing nationwide vaccination demand by ~50%. Intention to receive the flu vaccine was associated with increased age, index of multiple deprivation (IMD) quintile, and considering oneself at high risk from Covid-19. Among those eligible but intending not to be vaccinated in 2020/21, 164 (30.2%) gave misinformed reasons. 47 (49.9%) of previously unvaccinated healthcare workers will decline vaccination in 2020/21. CONCLUSIONS In this sample, Covid-19 has increased acceptance of flu vaccination from 79.6% to 91.2% in those previously eligible, and 69% in the newly eligible. Meeting this demand for flu vaccination of ~26 million of the UK population is 50% higher than last year. This study is essential for informing resource planning and the need for effective messaging campaigns to address negative misconceptions, a strategy also necessary for Covid-19 vaccination programmes.

scholarly journals ‘I decided not to go into surgery due to dress code’: a cross-sectional study within the UK investigating experiences of female Muslim medical health professionals on bare below the elbows (BBE) policy and wearing headscarves (hijabs) in theatre

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e019954 ◽  
Author(s):  
Abida Malik ◽  
Hafsah Qureshi ◽  
Humayra Abdul-Razakq ◽  
Zahra Yaqoob ◽  
Fatima Zahra Javaid ◽  
...  
Keyword(s):  
Hospital Medicine ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Dress Code ◽  
Cross Sectional Survey ◽  
Cross Sectional ◽  
Operating Theatres ◽  
Uniform Policy ◽  
The Uk ◽  
The Impact

ObjectivesThe objective of this study is to explore the impact of workplace dress code policies and guidance that may influence inclusivity and opportunities in the workplace.DesignQuantitative, self-completion cross-sectional survey.SettingBritish Islamic Medical Association conference.ParticipantsEighty-four female medical healthcare professionals with a range of ethnicities and wide geographical coverage.Primary and secondary outcome measuresThe study reports on the experiences of female Muslim healthcare professions wearing the headscarf in theatre and their views of the bare below the elbows (BBE) policy. Percentage of positive answers and their respective 95% CIs are calculated.ResultsThe majority of participants agreed that wearing the headscarf was important for themselves and their religious beliefs (94.1%), yet over half (51.5%) experienced problems trying to wear a headscarf in theatre; some women felt embarrassed (23.4%), anxious (37.1%) and bullied (36.5%). A variety of different methods in head covering in operating theatres were identified. The majority of respondents (56.3%) felt their religious requirement to cover their arms was not respected by their trust, with nearly three-quarters (74.1%) of respondents not happy with their trust’s BBE uniform policy alternative. Dissatisfaction with the current practice of headscarves in theatre and BBE policy was highlighted, with some respondents preferring to specialise as GPs rather than in hospital medicine because of dress code matters. The hijab prototype proposed by the research team also received a positive response (98.7%).ConclusionsOur study suggests that female Muslims working in the National Health Service (NHS) reported experiencing challenges when wearing the headscarf in theatre and with BBE policy. The NHS needs to make its position clear to avoid variations in individual trust interpretation of dress code policies. This illustrates a wider issue of how policies can be at odds with personal beliefs which may contribute to a reduction in workforce diversity.

scholarly journals Triclosan resistant bacteria in sewage effluent and cross-resistance to antibiotics

2017 ◽  
Vol 76 (6) ◽  
pp. 1500-1509 ◽  
Author(s):  
I. Coetzee ◽  
C. C. Bezuidenhout ◽  
J. J. Bezuidenhout
Keyword(s):  
High Performance ◽  
Treatment Plant ◽  
16S Rrna Gene Sequencing ◽  
Plate Count ◽  
Cross Resistance ◽  
Resistant Bacteria ◽  
Rrna Gene ◽  
Sewage Effluent ◽  
Resistance To Antibiotics ◽  
The Impact

The purpose of this study was to identify triclosan tolerant heterotrophic plate count (HPC) bacteria from sewage effluent and to determine cross-resistance to antibiotics. R2 agar supplemented with triclosan was utilised to isolate triclosan resistant bacteria and 16S rRNA gene sequencing was conducted to identify the isolates. Minimum inhibitory concentrations (MICs) of organisms were determined at selected concentrations of triclosan and cross-resistance to various antibiotics was performed. High-performance liquid chromatography was conducted to quantify levels of triclosan in sewage water. Forty-four HPC were isolated and identified as the five main genera, namely, Bacillus, Pseudomonas, Enterococcus, Brevibacillus and Paenibacillus. MIC values of these isolates ranged from 0.125 mg/L to >1 mg/L of triclosan, while combination of antimicrobials indicated synergism or antagonism. Levels of triclosan within the wastewater treatment plant (WWTP) ranged between 0.026 and 1.488 ppb. Triclosan concentrations were reduced by the WWTP, but small concentrations enter receiving freshwater bodies. Results presented indicate that these levels are sufficient to maintain triclosan resistant bacteria under controlled conditions. Further studies are thus needed into the impact of this scenario on such natural receiving water bodies.

scholarly journals Resistance determinants and their genetic context in enterobacteria from a longitudinal study of pigs reared under various husbandry conditions

2021 ◽  
Author(s):  
Dominic Poulin-Laprade ◽  
Jean-Simon Brouard ◽  
Nathalie Gagnon ◽  
Annie Turcotte ◽  
Alexandra Langlois ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Efflux Pump ◽  
Multidrug Resistant ◽  
Resistant Bacteria ◽  
Production Cycle ◽  
Antimicrobial Use ◽  
Resistance Determinants ◽  
Extended Spectrum ◽  
Antimicrobial Resistance Genes ◽  
The Impact

Pigs are major reservoirs of resistant Enterobacteriaceae that can reach humans through consumption of contaminated meat or vegetables grown in manure-fertilized soil. Samples were collected from sows during lactation and their piglets at five time points spanning the production cycle. Cefotaxime-resistant bacteria were quantified and isolated from feed, feces, manures and carcasses of pigs reared with penicillin-using or antibiotic-free husbandries. The isolates were characterized by antibiotic susceptibility testing, whole genome sequencing and conjugation assays. The extended spectrum β-lactamase (ESBL) phenotype was more frequent in isolates originating from antibiotic-free animals, while the bacteria isolated from penicillin-using animals were on average resistant to a greater number of antibiotics. The ESBL-encoding genes identified were blaCTX-M-1, blaCTX-M-15 and blaCMY-2 and they co-localised on plasmids with various genes encoding resistance to ß-lactams, co-trimoxazole, phenicols and tetracycline, all antibiotics used in pig production. Groups of genes conferring the observed resistance and the mobile elements disseminating multidrug resistance were determined. The observed resistance to ß-lactams was mainly due to the complementary actions of penicillin-binding proteins, an efflux pump and ß-lactamases. Most resistance determinants were shared by animals raised with or without antimicrobials. This suggests a key contribution of indigenous enterobacteria maternally transmitted along the sow lineage, regardless of antimicrobial use. It is unclear if the antimicrobial resistance observed in the enterobacteria populations of the commercial pig herds studied were present before the use of antibiotics, or the extent to which historical antimicrobial use exerted a selective pressure defining the resistant bacterial populations in farms using penicillin prophylaxis. Importance: Antimicrobial resistance is a global threat that needs to be fought on numerous fronts along the One Health continuum. Vast quantities of antimicrobials are used in agriculture to ensure animal welfare and productivity, and are arguably a driving force for the persistence of environmental and food-borne resistant bacteria. This study evaluated the impact of conventional, organic and other antibiotic-free husbandry practices on the frequency and nature of antimicrobial resistance genes and multidrug resistant enterobacteria. It provides knowledge about the relative contribution of specific resistance determinants to observed antibiotic resistance. It also showed the clear co-selection of genes coding for extended-spectrum beta-lactamases and genes coding for the resistance to antibiotics commonly used for prophylaxis or in curative treatments in pig operations.

scholarly journals External Explanations

2020 ◽  
pp. 185-211
Author(s):  
Leonardo Morlino ◽  
Daniela Piana ◽  
Cecilia E. Sottilotta
Keyword(s):  
European Union ◽  
Social Protection ◽  
Welfare System ◽  
International Terrorism ◽  
The European Union ◽  
Trade Off ◽  
The Face ◽  
The Uk ◽  
Institutional Architecture ◽  
The Impact

When checking the influence of European Union empirically, as for inequalities, first, the amount of resources which are devoted to cohesion policy is still negligible. Second, looking at the effects of the crisis and the impact of austerity measures, compounded by significant reforms of the EMU institutional architecture, the six countries under examination were affected to different degrees. Germany was mostly immune to the crisis, and Poland even experienced sustained growth during the crisis years. As a non-member of the Eurozone, the UK was affected by the crisis but retained its monetary sovereignty, and its commitment to austerity with a decline in social protection, healthcare and education cannot be directly traced to EU-level commitments. France avoided a significant overhaul of its welfare system, while Spain and Italy experienced a contraction, especially in the sectors of healthcare and education. As for freedoms, in the case of the possible ‘trade-off’ between the need to guarantee security in the face of domestic and international terrorism and citizens’ right to privacy, the middle ground established by the current EU ‘Privacy Shield’ paradigm leaves several problems unsolved. Moreover, it is essential to mention that the mechanism put in place by Article 7 of the Treaty on the European Union to sanction possible violations of those values and principles, has not been sufficient to stop the current democratic backslides in some member states, notably Poland and Hungary. To sum up, the new scenario seems to depict a more nuanced predominance of the transnational provisions in terms of European freedoms and a reshaping of the domestic-European balance.

scholarly journals Systematic single-variant and gene-based association testing of 3,700 phenotypes in 281,850 UK Biobank exomes

2021 ◽  
Author(s):  
Konrad Karczewski ◽  
Matthew Solomonson ◽  
Katherine R Chao ◽  
Julia K Goodrich ◽  
Grace Tiao ◽  
...  
Keyword(s):  
Sequence Data ◽  
Association Studies ◽  
Genome Wide Association Studies ◽  
Uk Biobank ◽  
Genetic Associations ◽  
Allelic Series ◽  
Association Analyses ◽  
Wide Range ◽  
The Uk ◽  
The Impact

Genome-wide association studies have successfully discovered thousands of common variants associated with human diseases and traits, but the landscape of rare variation in human disease has not been explored at scale. Exome sequencing studies of population biobanks provide an opportunity to systematically evaluate the impact of rare coding variation across a wide range of phenotypes to discover genes and allelic series relevant to human health and disease. Here, we present results from systematic association analyses of 3,700 phenotypes using single-variant and gene tests of 281,850 individuals in the UK Biobank with exome sequence data. We find that the discovery of genetic associations is tightly linked to frequency as well as correlated with metrics of deleteriousness and natural selection. We highlight biological findings elucidated by these data and release the dataset as a public resource alongside a browser framework for rapidly exploring rare variant association results.

scholarly journals Culture, consent and confidentiality in workplace autoethnography

2018 ◽  
Vol 7 (3) ◽  
pp. 302-319
Author(s):  
Catherine Lee
Keyword(s):  
Role Models ◽  
Critical Incident ◽  
School Teacher ◽  
Well Being ◽  
Professional Identities ◽  
Content Type ◽  
Ethical Implications ◽  
The Face ◽  
The Uk ◽  
The Impact

Purpose The purpose of this paper is to examine the author’s experiences as a school teacher and a lesbian. It considers the culture and discourses of power in the school and the ethical implications of telling the author’s story. Utilizing autoethnography as a method of inquiry, it draws on a critical incident to explore the incompatibility of the author’s private and professional identities, and reflect on the impact of homophobic and heteronormative discursive practices in the workplace, on health, well-being and identity. Design/methodology/approach This research is grounded in an interpretivist philosophy. It utilizes writing about the self as a method of inquiry. Findings This research examines the incompatibility of the author’s private and professional identities and offers insight into the steps that those in positions of power will take to protect and perpetuate the heteronormative discourse of rural life. Research limitations/implications This research presents the perspective of only one lesbian teacher in a rural context. Consequently, generalizations are inappropriate and recommendations are difficult. Whilst the absence of clear ethical regulation presents an infinite number of possibilities for autoethnographers, the silence that surrounds the prescription of the ethics of autoethnography leaves those of us at the beginnings of our research careers without clear guidance. Originality/value This research specifically addresses a dearth of research examining the experiences of the rural lesbian (or gay) teacher in the UK. Headteachers of rural schools must ensure that their schools are inclusive and welcoming environments for teachers, and their equalities policies are living documents that are not simply cast aside in the face of rural parent power. Young people in the countryside deserve access to the full pool of teaching talent and should have access to the diverse role models that their urban and suburban counterparts are beginning to enjoy.

scholarly journals Hepatozoon canis in three imported dogs: a new tickborne disease reaching the United Kingdom

2018 ◽  
Vol 183 (23) ◽  
pp. 716-716 ◽  
Author(s):  
Charalampos Attipa ◽  
David Maguire ◽  
Laia Solano-Gallego ◽  
Balazs Szladovits ◽  
Emily N Barker ◽  
...  
Keyword(s):  
Rhipicephalus Sanguineus ◽  
Hepatozoon Canis ◽  
Canine Babesiosis ◽  
The Past ◽  
The United Kingdom ◽  
Canine Population ◽  
The Face ◽  
South East England ◽  
The Uk ◽  
The Impact

An increasing number of non-endemic vectorborne pathogens have been described in dogs imported to the UK in the past two decades. Recently, an outbreak of canine babesiosis in south-east England has raised veterinary awareness with regard to the impact of such diseases on the UK canine population. Canine hepatozoonosis, caused by Hepatozoon canis and transmitted by the ingestion of Rhipicephalus sanguineus ticks, is widespread in the Mediterranean basin. Herein we describe the first three molecularly confirmed clinical cases of canine hepatozoonosis in dogs imported into the UK. Veterinarians in the UK should be aware of H canis as a potential infection in imported dogs, especially in the face of the expanding distribution of R sanguineus ticks in Europe.

scholarly journals Covid19, Charitable Giving and Collectivism: a data-harvesting approach

2021 ◽  
pp. 1-22
Author(s):  
PETER TAYLOR-GOOBY ◽  
TOMAS PETRICEK ◽  
JACK CUNLIFFE
Keyword(s):  
Social Cohesion ◽  
Charitable Giving ◽  
Social Inclusion ◽  
Policy Research ◽  
Common Humanity ◽  
Social Divisions ◽  
Working Age ◽  
The Face ◽  
The Uk ◽  
The Impact

Abstract This paper charts responses to urgent appeals by welfare charities through crowd funding websites in order to examine the impact of the Covid19 pandemic on public generosity and social cohesion in the UK. It uses a relatively new method in social policy research, data-harvesting. Online public giving to local charities for vulnerable people sky-rocketed during the crisis, despite the long-established stigmatic treatment of the able-bodied poor of working age, a decade of benefit cuts, the increased stringency of Universal Credit and the long-term downward trend in charity incomes. Welfare policy and the rhetoric that surrounds it is increasingly divisive, although most welfare spending addresses needs or risks that confront all of us. The Covid19 lockdown can be seen as a natural experiment in social inclusion. This paper shows how policy discourse that stresses common humanity in the face of a collective challenge, rather than social divisions, can help build social cohesion.

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