This document is a dissertation proposal investigating antibiotic-resistant Staphylococcus aureus in poultry. The study aims to characterize the ecology and epidemiology of antibiotic-resistant S. aureus in poultry farms and processing facilities. The proposal outlines collecting samples from poultry, workers, and environments to establish prevalence and risk factors. Molecular typing and antibiotic resistance testing will characterize strains. The results could provide recommendations to prevent the spread of S. aureus in poultry production.
Smith TC, Male MJ, Harper AL, Kroeger J, Tinkler G, Moritz-Korolev E, Herwaldt L, Diekema D. High prevalence of MRSA found in Midwestern US Swine and Swine workers. PLoS ONE, 4(1):e4258, 2009.
Smith TC, Male MJ, Harper AL, Kroeger J, Tinkler G, Moritz-Korolev E, Herwaldt L, Diekema D. High prevalence of MRSA found in Midwestern US Swine and Swine workers. PLoS ONE, 4(1):e4258, 2009.
Prevalence and Characterisation of Beta Lactamases in Multi Drug Resistant Gr...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Urine samples collected from hospitalized
male and female patients belonging to different age groups
suffering from urinary tract infections were used in the present
study. The samples were subjected to isolate the strains of E.coli.
The isolates were found to be capable of producing biofilm and
Extended Spectrum β –Lactamases (ESBLs) especially of CTX –
M - type. Both male and female affected individuals exhibited
high incidence of E.coli in the urine samples. The overall results
indicated that the biofilm producing E.coli strains with β –
lactamase activity had highest antibiotic resistance
The influence of reduced oxygen availability on gene expression in laboratory...Santhi Devasundaram
Virtually all dormant
models against tuberculosis tested in animals used laboratory strain H37Rv or Erdman strain. But major
outbreaks of tuberculosis (TB) occur with the strains that have widely different genotypes and phenotypes
compared to H37Rv. In this study, we used a custom oligonucleotide microarray to determine the overall
transcriptional response of laboratory strain (H37Rv) and most prevalent clinical strains (S7 and S10) of
M. tuberculosis from South India to hypoxia.
Incidence rate of multidrug-resistant organisms in a tertiary care hospital, ...Apollo Hospitals
Antimicrobial resistance to microorganisms is a growing public health concern globally, especially in developing countries. This study was conducted to study the incidence rate of multidrug-resistant organisms with their antibiotic sensitivity pattern.
Methicillin-resistant Staphylococcus aureus (MRSA) infections have been recognized for decades as hospital acquired MRSA (HA-MRSA). Nowadays, MRSA is also recognized as a worldwide emerging community-associated pathogen. Community associated- MRSA (CA-MRSA) has been shown to be more virulent with a high degree of severity of disease when compared to HA-MRSA.
PLEASE DO NOT COPY PASTE 100% OF MY ALL PRESENTATIONS. IF YOU NEED THIS FOR YOUR PRESENTATION IN SCHOOL YOU MAY PERMIT ME BY VIA EMAIL : tyvaniars06@gmail.com
IG : @tyvaniaRsashi
Created by :
Elfadea Satiti
Intan C.M.
Falya A.D.
Rena P.W.
Tyvania R.S.
SMAN 1 Tegal
@tyvaniaRsashi
Please like and comment for more presentations
or send me tyvaniars06@gmail.com
Prevalence and Characterisation of Beta Lactamases in Multi Drug Resistant Gr...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
Urine samples collected from hospitalized
male and female patients belonging to different age groups
suffering from urinary tract infections were used in the present
study. The samples were subjected to isolate the strains of E.coli.
The isolates were found to be capable of producing biofilm and
Extended Spectrum β –Lactamases (ESBLs) especially of CTX –
M - type. Both male and female affected individuals exhibited
high incidence of E.coli in the urine samples. The overall results
indicated that the biofilm producing E.coli strains with β –
lactamase activity had highest antibiotic resistance
The influence of reduced oxygen availability on gene expression in laboratory...Santhi Devasundaram
Virtually all dormant
models against tuberculosis tested in animals used laboratory strain H37Rv or Erdman strain. But major
outbreaks of tuberculosis (TB) occur with the strains that have widely different genotypes and phenotypes
compared to H37Rv. In this study, we used a custom oligonucleotide microarray to determine the overall
transcriptional response of laboratory strain (H37Rv) and most prevalent clinical strains (S7 and S10) of
M. tuberculosis from South India to hypoxia.
Incidence rate of multidrug-resistant organisms in a tertiary care hospital, ...Apollo Hospitals
Antimicrobial resistance to microorganisms is a growing public health concern globally, especially in developing countries. This study was conducted to study the incidence rate of multidrug-resistant organisms with their antibiotic sensitivity pattern.
Methicillin-resistant Staphylococcus aureus (MRSA) infections have been recognized for decades as hospital acquired MRSA (HA-MRSA). Nowadays, MRSA is also recognized as a worldwide emerging community-associated pathogen. Community associated- MRSA (CA-MRSA) has been shown to be more virulent with a high degree of severity of disease when compared to HA-MRSA.
PLEASE DO NOT COPY PASTE 100% OF MY ALL PRESENTATIONS. IF YOU NEED THIS FOR YOUR PRESENTATION IN SCHOOL YOU MAY PERMIT ME BY VIA EMAIL : tyvaniars06@gmail.com
IG : @tyvaniaRsashi
Created by :
Elfadea Satiti
Intan C.M.
Falya A.D.
Rena P.W.
Tyvania R.S.
SMAN 1 Tegal
@tyvaniaRsashi
Please like and comment for more presentations
or send me tyvaniars06@gmail.com
Aspek klinis dan penyebaran pada pengendalian penyakit ternak - triakosoNusdianto Triakoso
Penjelasan tentang aspek-aspek klinis dan penyebaran penyakit dalam upaya pengendalian penyakit-penyakit pada ternak. Pernah disampaikan pada penyegaran paramedik petugas kesehatan hewan kabupaten/kota di Jawa Timur, di Dinas Peternakan Tk I Jawa Timur tahun 2009
Makanan Jajanan Anak Sekolah merupakan contoh dimana sekolah memiliki peran penting dalam pencapaian kesehatan masyarakat, terutama kesehatan siswa sekolah. Peran penting ini telah diakui dan didorong oleh WHO pada tahun 2008 melalui pencanangan Konsep Sekolah Sehat, atau sekolah yang mempromosikan kesehatan (health promoting school).
Hal serupa telah diatur dalam Undang-Undang No. 36 Tahun 2009 tentang Kesehatan pasal 79 tentang Kesehatan Sekolah. Sekolah merupakan institusi yang dapat menciptakan pembelajaran, pertumbuhan, dan perkembangan harmonis peserta didik untuk menjadi sumber daya manusia yang berkualitas. Oleh karenanya, kemampuan hidup sehat peserta didik, dan lingkungan pendidikan yang sehat, perlu diwujudkan dan menjadi tujuan penyelenggaraan Kesehatan Sekolah. Dalam konteks lingkungan pendidikan yang sehat, maka makanan jajanan anak sekolah yang aman, bermutu dan bergizi menjadi suatu keharusan.
Prevalence of malnutrition among under five children of RukaminiNagar, BelgaumSawan Kumar
synopsis of prevalence of malnutrition among under five years children in Rukmini Nagar, Belgaum
Reaserche:- Mr. Sawan Kumar Yadav
Guide:- Dr. Mubashir Angolkar,
Coordinator and Assistant Professor
Department of Public Health,
J.N. Medical college, Belgaum, Karnataka, India
Dr. Sid Thakur - Antimicrobial Resistance: Do We Know Everything?John Blue
Antimicrobial Resistance: Do We Know Everything? - Dr. Sid Thakur, Assistant Professor, North Carolina State University, from the 2013 NIAA Merging Values and Technology conference, April 15-17, 2013, Louisville, KY, USA.
More presentations at http://www.trufflemedia.com/agmedia/conference/2013-niaa-merging-values-and-technology
Emergence of antibiotic resistance in captive wildlifeBhoj Raj Singh
In this presentation antimicrobial drug resistance (AMR) in captive wildlife has been compared with AMR in bacteria isolated from veterinary clinical cases. In captive wildlife bacteria resistant to carbapenems, all generations of cephalosporins, producing ESBL, MBL, and NDM were prevalent. In this study 36.7% bacterial isolates from captive wildlife were ESBL producers and about 45% were MDR type. In recent past not much increase in AMR in bacteria of captive wildlife was observed. Carvacrol was found to be the most effective herbal antimicrobial. About 67.5% bacteria from birds kept in zoo and >71% those from zoo carnivores had MDR. This was much more than in strains of wild herbivore origin (<30%). Herbal drugs resistance was more common in bacteria from herbivore captive wildlife in contrast to AMR for conventional antimicrobials in bacteria from carnivores. Bacteria from carnivores had higher levels of multidrug resistance than those from omnivores or herbivores. No such difference was evident in bacterial isolates from domesticated or pet herbivores and carnivores. Omnivore animals (pigs) and human isolates had almost similar levels of AMR but much higher than herbivores. Position in food chain and Food of the host play an important role in occurrence of AMR bacteria. The study revealed that members of Enterobacteriaceae are the major players in the propagation of AMR. And for maintenance or propagation of AMR Enterobacteriaceae members, wild carnivores are the major abode. The study indicated that AMR was common in bacteria of captive wildlife too as in other biotic and abiotic components of the environment. However, the level of AMR was much more aggravated than in domestic animals. It can be concluded that if we need to monitor the AMR in any locality it will be more informative to look for the AMR strains in wildlife and aquatic environment than in livestock. This might be due to the concentration of the AMR strains in wild carnivores having a specific niche in food chain. More long term studies on large number of isolates from wide variety of captive wildlife living in different geographical and climatological conditions are required for better understanding of AMR trends.
Investigate archaea with the Eurofins Genomics Microbiome Profiling 3.0 service! In addition to profiling bacteria and fungi, we now offer profiling of the archaea community in your samples. Why did we include archaea? It has been found that archaea are associated with conditions such as irritable bowel disease, obesity, anorexia nervosa, but also with infectious diseases like brain abscesses. Methanogenic archaea in the digestive tract of ruminants are the main producers of the greenhouse gas methane. Archaea also play roles in the microbiomes of the human skin and mouth, they show growth- and health-promoting effects on plants, and are present in the microbiome of corals, intracellular niches in amoebae, protozoa, and termites. The option to profile archaea provides a tool for researchers to broaden the knowledge about the effects and impact of archaea.
Study of virulence genes in vancomycin resistant Enterococci (vre) from anima...Innspub Net
With Enterococcus species in the leading cause of nosocomial infections and resistance to an array of antibiotics, this study focused to determine the frequency and distribution of vancomycin-resistant Enterococci, the presence of virulence genes and to determine the relative nucleotide sequence relatedness among isolates using 16S rRNA sequence. A random sampling of 120 fecal samples of cattle, poultry, and piggery, and human clinical isolates was analyzed. Standard bacteriological methods were employed in the isolation and characterization of isolates and the disk diffusion method was used in determining their antibiotic resistance profiles. Results showed Enterococcus species in cattle at 100%, followed by clinical isolates at 80%. Vancomycin resistance was observed at high rates in Enterococcus species from human clinical isolates and cattle isolates at 90% and 80% respectively. Multiple antibiotic-resistant isolates yielded twelve resistance profiles and 16S rDNA sequences identified E. faecalis, E. durans, E. mundtii, and Enterococcus sp. Isolates from cattle samples were the most probable source of clinical isolates at 78% homology of conserved regions with the clinical isolates. Virulence determinant genes Asa1 was recorded at66.6%, Cyl at 16.6% and GelE at 8.3% among the isolates. This study established farm animals as possible reservoirs of VRE isolates to man. Hence, healthy and professional practices among animal farmers with antibiotic usage, as well as hygienic and preventive measures among hospital workers are here recommended.
If antibiotics quit working we would see deaths from otherwise treatable infections rise rapidly. This presentation from Genome Alberta President & CEO Dr. David Bailey looks at the rising problem of antibiotic resistant microbes, or AMR. It was part of the Beef Value Chain Roundtable held in Ottawa, Ontario.
Study of virulence genes in vancomycin resistant Enterococci (vre) from anima...Innspub Net
With Enterococcus species in the leading cause of nosocomial infections and resistance to an array of antibiotics, this study focused to determine the frequency and distribution of vancomycin-resistant Enterococci, the presence of virulence genes and to determine the relative nucleotide sequence relatedness among isolates using 16S rRNA sequence. A random sampling of 120 fecal samples of cattle, poultry, and piggery, and human clinical isolates was analyzed. Standard bacteriological methods were employed in the isolation and characterization of isolates and the disk diffusion method was used in determining their antibiotic resistance profiles. Results showed Enterococcus species in cattle at 100%, followed by clinical isolates at 80%. Vancomycin resistance was observed at high rates in Enterococcus species from human clinical isolates and cattle isolates at 90% and 80% respectively. Multiple antibiotic-resistant isolates yielded twelve resistance profiles and 16S rDNA sequences identified E. faecalis, E. durans, E. mundtii, and Enterococcus sp. Isolates from cattle samples were the most probable source of clinical isolates at 78% homology of conserved regions with the clinical isolates. Virulence determinant genes Asa1 was recorded at66.6%, Cyl at 16.6% and GelE at 8.3% among the isolates. This study established farm animals as possible reservoirs of VRE isolates to man. Hence, healthy and professional practices among animal farmers with antibiotic usage, as well as hygienic and preventive measures among hospital workers are here recommended.
Antibiotic Resistance form food of animal origint- Debatable issueAsima Zehra
Contribution to the development of antibiotic resistance is multifactorial wherein human medicine plays a major role and food of animal origin are least to bother.
Dr. Peter Davies - An Update From The Food Safety SymposiumJohn Blue
An Update From The Food Safety Symposium - Dr. Peter Davies, from the 2015 Allen D. Leman Swine Conference, September 19-22, 2015, St. Paul, Minnesota, USA.
More presentations at http://www.swinecast.com/2015-leman-swine-conference-material
Dr. Mary Torrence - Progress Report on Nationally Funded Antimicrobial Resist...John Blue
Progress Report on Nationally Funded Antimicrobial Resistance Research Projects - Dr. Mary Torrence, USDA, ARS, from the 2012 NIAA One Health Approach to Antimicrobial Resistance and Use Symposium, October 26-27, 2012, Columbus, OH, USA.
More presentations at:
http://www.trufflemedia.com/agmedia/conference/2012-one-health-to-approach-antimicrobial-resistance-and-use
Similar to Antibiotic-resistant Staphylococcus aureus: Investigation of a poultry reservoir (20)
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Antibiotic-resistant Staphylococcus aureus: Investigation of a poultry reservoir
1. DISSERTATION
PROPOSAL:
Antibiotic-resistant Staphylococcus
aureus: Investigation of a poultry
reservoir
Department of Occupational & Environmental
Health
Sept.10, 2010 Abby L. H. Maples, MPH
2. Introduction
Background
Significance
Goals
Specific Aims
Limitations of Current Literature & Research
Research Design & Methods
Strengths & Limitations
3. Background
Staphylococcus aureus
Signs & symptoms
Methicillin-resistant S. aureus (MRSA)
Hospital
94,000 infections (Klevens, 2007)
18,000 deaths (Klevens, 2007)
Community
1% of US population colonized
(Graham, 2006; Kuehnert, 2006;
Shorr, 2007)
Livestock
http://www.medicinenet.com/mrsa_infection/page2.
4. Antibiotic-resistant S. aureus &
Animals
S. aureus can cause infection in animals
(Baptiste, 2005; De Neeling, 2007; Juhasz-
Kaszanyitzky, 2007; Khanna, 2008; Smith,
2009; Van Loo, 2007; Weese, 2005; Weese,
2006)
Role of humans
Transient carriers or reservoirs?
Role of animals
Endemic?
Swine herds studied
Livestock-associated MRSA increasing
5. Antibiotic-resistant S. aureus in
Environmental Samples
Airborne transmission
Colonization role?
Previous airborne transmission studies
(Gibbs, 2004; Gibbs, 2006)
Surface contamination
Meat contamination
(De Boer, 2009;
Hanson, in press)
http://www.takepart.com/news/tag/anti-factory-
farming
6. Goals
Long-term goal
Understand ecology & epidemiology of antibiotic-
resistant (AbR)S. aureus
Objective
Characterize ecology & epidemiology of AbR S.
aureus
Central hypothesis
Workers in close proximity to poultry are at risk of
occupational exposure to AbR S. aureus
Farmers in contact with poultry will be colonized
with MRSA
7. Specific Aims
1. Establish the prevalence & molecular
characteristics of AbR S. aureus on poultry
farms
2. Establish the prevalence & molecular
characteristics of AbR S. aureus in poultry
processing facilities
3. Determine risk factors for presence of AbR S.
aureus on farms or processing facilities
8. Limitations of Current Literature
S. aureus is rapidly changing
Previous studies in chickens did not include
workers
Epidemiologic studies in poultry have not
been conducted in U.S.
http://www.sciencedaily.com/releases/2009/03/090316120846.htm
9. Preliminary Studies
Prevalence of MRSA in Iowa & Illinois swine
18 swine farms in Iowa & Illinois (Smith, 2009)
9 each – confined animal feeding operations
(CAFOs) & antibiotic-free systems
5/18 (27.7%) farms positive for MRSA
All CAFOs (55.5%, 5/9)
Prevalence in swine 43/428 (10.0%)
Prevalence in humans 29/89 (32.6%)
Humans working at CAFOs (45.3%, 29/64)
10. Research Design & Methods
Farm Description
Broilers,
layers, and turkeys
Estimate 40% (± 5.0%) prevalence in poultry
95% confidence interval, 80% power = 600 animals
20 animals from 30 farms (10 each)
Convenience Sample
Estimate 1-2 employees per farm
Goal to enroll 60 humans
http://newshopper.sulekha.com/turkey-farm_photo_1063248.
15. Research Design & Methods
Continued
Molecular Typing
Spa typing
PVL PCR
Multilocus sequence typing (MLST)
Pulsed-Field Gel Electrophoresis (PFGE)
Antibiotic Resistance Testing
Brothdilution (CLSI standards)
Tested for susceptibility
16. Research Design & Methods
Continued
Data and Statistical Analysis
Double-entry into databases
Excel, Access, and Teleform Verifier
Unique specimen numbers
Multivariate modeling of risk factors (SAS)
Logistic
regression
Cochran-Armitage trend test
17. Strengths & Limitations
Strengths Limitations
First study of S. aureus Convenience, single-
in live poultry & workers time samples (not
in US representative)
Well qualified & Pilot study
experienced team Limited geography
Collaboration with ISU Limited farmer
Iowa is a national leader enrollment
in eggs and turkey
production
18. Impact & Benefit to Field
Assess infectious disease risks
Provide recommendations for preventative
measures
Establish prevalence and dominant molecular
types of S. aureus in poultry
Create potential implementations to prevent
spread of S. aureus in rural Iowa
19. Three Publishable Paper Topics
Literature review of poultry diseases
Antibiotic resistant Staphylococcus aureus:
Investigation into a poultry reservoir
Staphylococcus aureus in environmental
samples and humans: Two poultry production
facilities in Iowa(?)
Airborne Staphylococcus aureus in (10)
poultry barns (?)
**Open for discussion
21. Questions, Comments, or
Concerns?
http://ehsmanager.blogspot.com/2009/05/bacteria-create-aquatic-superbugs-
Editor's Notes
Staph aureus is a common bacterium that can cause superficial as well as deep and systemic infections. MRSA infection may begin as a reddish rash with lesion(s) that looks like a pimple or small boil. Often it progresses to an open, inflamed area of skin (as pictured in the lower right) that may weep pus or drain other similar fluid. It can manifest into more a severe infection with symptoms of: endocarditis, necrotizing fasciitis, osteomyelitis, and sepsis. Some cases become life threatening. While the earliest history of infections with methicillin-resistant S. aureus (MRSA) typically occurred in a hospital setting in the 1970s, more current information reveals additional risk groups outside of hospitals within the broader community [a.k.a. community-acquired MRSA (1990s)]. MRSA may be found on human skin and in the nasopharynx, where they can be carried asymptomatically. MRSA is a major public health concern because infections are more difficult to treat and lead to higher mortality rates than infections with methicillin-susceptible S. aureus (MSSA). CA-MRSA also has been reported to cause infections in groups which typically are not at risk of MRSA infections, including athletes, young children, and those in the military and in correctional institutions. Community-acquired infections are becoming more common in individuals relative to HA-MRSA. It is estimated that roughly 1% of the population (~2.3 million Americans) are colonized with some type of MRSA, and that HA-MRSA was responsible for over 94,000 infections and 18,000 deaths in the U.S. in 2005. Further, a newly found MRSA type within the community is livestock-associated MRSA, making livestock producers a newly identified risk group. A 2009 study (Graham – US) indicated antibiotic-resistant S. aureus was found on flies collected near confined poultry operations, indicating another avenue of spread into the community. Further, there have been several anecdotal cases and peer-reviewed articles suggesting that farmers and hatchery workers have contracted antibiotic-resistant S. aureus in the workplace setting.
Antibiotic-resistant S. aureus can cause infections in a variety of animals. The bacterium has been isolated from horses, cattle, dogs and cats, and most recently, in swine. Swine have been the most heavily studied animals. It is not currently known whether humans are transient carriers or reservoirs transferring antibiotic-resistant S. aureus to animals, or whether strains of antibiotic-resistant S. aureus have entered the animal populations and may be endemic there as well (or whether both routes of transmission may have occurred, or still be occurring). Studies in swine herds have shown that isolates obtained from swine and their human caretakers are frequently indistinguishable, suggesting transmission can occur between human and animal species. The occurrence of secondary LA-MRSA infections, as exemplified by the finding of LA-MRSA infected individuals who have no known exposure to live animals, suggests transmission via human carriers or by exposure to contaminated environments. Investigations in the Netherlands have shown that a strain of MRSA that was first found in swine and cattle (referred to by its molecular type, ST398) now accounts for 20% of human MRSA cases in that country. Thishighlightsthe importance of considering livestock and other animals in antibiotic-resistant S. aureus epidemiology. Currently the prevalence of antibiotic-resistant S. aureus in poultry or their caretakers is unknown in the U.S. I am proposing to carry out the first examination of the prevalence of S. aureus in live poultry and poultry workers in the U.S. LA-MRSA has been documented in an increasing number of countries across Europe, Asia, and North America. However, most of these studies have focused on pigs and cattle, and livestock veterinarians, with very few studies carried out in poultry, and none in live turkeys. In a rural state such as Iowa – which is the nation’s leader in egg production and produces 8.2 million turkeys per year – antibiotic-resistant S. aureus on poultry farms could complicate efforts to reduce transmission statewide.
In most environments, transmission of antibiotic-resistant S. aureus takes place either through direct person-to-person contact (for example, during skin contact) or via contaminated fomites such as doorknobs. However, in an environment with several thousand antibiotic-resistant S. aureus-colonized animals concentrated into a relatively limited space, a greater proportion of the bacteria have the potential to dry on environmental surfaces and become aerosolized due to animal movement and the high-powered ventilation systems. Therefore, airborne transmission is likely to play a large role in colonization of both animals and humans inside the barns. Previous studies have examined the presence of antibiotic resistant bacteria within and outside of animal barns. One study examined airborne bacteria within and downwind of two confined animal feeding operations (CAFOs), but did not test for the presence of antibiotic-resistant S. aureus. Other environmental samples were not tested, and bacterial loads were only measured up to 25 m outside of the barns. A 2006 study repeated this, sampling up to a distance of 150 m downwind, but still did not examine MRSA. Additionally, both studies used two-stage Andersen samplers rather than six-stage samplers (six stage samplers provide a better definition of the source of the particles that contain MRSA). Although our group has identified LA-MSSA in approximately 25% of retail turkey meat samples in Iowa, and LA-MRSA was found in over 35% of retail turkey meat samples and 16% of chicken samples in the Netherlands, and in broiler chickens in Belgium, a study of LA-MRSA in live poultry has not been conducted in the United States. Several studies have suggested the occurrence of secondary spread of LA-MRSA as exemplified by the finding LA-MRSA infected individuals who have no known exposure to live animals, suggesting transmission via human carriers or by exposure to contaminated environments or food products. Greater knowledge of the ecology and epidemiology would is invaluable in assessing infectious disease risks and providing recommendations for preventative measures.
Our long-term goalis to better understand the ecology and epidemiology of antibiotic-resistant S. aureus, including MRSA, in the community environment, specifically in the agricultural environment. Our objective in this application is to characterize the ecology and epidemiology of S. aureus associated with poultry farming. Our central hypothesisis that individuals working in close proximity to poultry are at risk of occupational exposure to antibiotic-resistant S. aureus. Further, we hypothesize that farmers in contact with poultry will be colonized with livestock-associated S. aureus strains previously found in live chickens and retail meat samples.The proposed research is innovative because it is designed to examine the epidemiology of S. aureus in an agricultural/rural setting, rather than in the health care setting where most research has been carried out to date. Additionally, we are proposing the first study of S. aureus in live turkeys and turkey workers, and the first study of this in chickens in the United States.
We will test our central hypothesis and accomplish the objective of this application by pursuing the following specific aims: Establish the prevalence and molecular characteristics of antibiotic-resistant S. aureus on poultry farms. Our working hypothesis is that poultry will be colonized with antibiotic-resistant S. aureus; and that individuals working with live animals will be colonized with identical strains of this bacterium. We will collect nasal and pharyngeal swabs of workers and poultry on selected poultry farms. We will culture the samples on selective media, and carry out molecular typing of S. aureus isolated from these samples. Establish the prevalence and molecular characteristics of antibiotic-resistant S. aureus in poultry processing facilities. Our working hypothesis is that poultry will be colonized with antibiotic-resistant S. aureus; and that areas where animals are slaughtered and processed will be contaminated with identical strains of this bacterium. We will collect surface swabs of processing facilities, poultry, feed, litter, and eggs at selected poultry processing facilities. We will also collect air samples throughout the processing facility. We will culture the samples on selective media, and carry out molecular typing of S. aureus isolated from these samples. Determine risk factors for presence of antibiotic-resistant S. aureus on farms or processing facilities.Our working hypothesisis that the presence of antibiotic-resistant S. aureus on farms will be associated with use of antibiotics during animal husbandry. After aim 1 is completed, questionnaire data will be analyzed using statistical software.
Livestock-associated MRSA (LA-MRSA) has been documented in an increasing number of countries across Europe, Asia, and North America, although most studies have examined a relatively small number of farm workers in cross-sectional studies and have frequently been conducted on the farm site. However, such epidemiologic studies in poultry have not yet been conducted in the United States. A cross-sectional study examining carriage and transmission of antibiotic-resistant S. aureus of poultry, poultry workers, and poultry farms is of vital importance, as the epidemiology of MRSA appears to be rapidly changing to a more apparent public health issue. For example, community-associated MRSA strain USA300, first reported in 1998 in North Dakota, was recently found in 29% of invasive MRSA isolates collected from US metropolitan areas, demonstrating how quickly new strains can become established in the population. Therefore, there is a critical need to better understand the epidemiology of novel S. aureus isolates associated with farming exposures. Such knowledge would be invaluable in assessing infectious disease risks and providing recommendations for preventative measures.While several studies have been conducted on antibiotic-resistant S. aureus in swine and cattle, there have been few studies pertaining to poultry. Two studies have examined antibiotic-resistant S. aureus in chickens from Belgium. However, the studies did not include workers. Furthermore, no studies have investigated antibiotic-resistant S. aureus in turkeys or turkey farmers.
In 2008 and 2009, we sampled a total of 18 swine farming systems in Iowa and Illinois. Nine of these were confined animal feeding operations (CAFOs), which typically have large numbers of animals (hundreds to thousands of animals per barn) and administer antibiotics throughout the lifespan of the animal. An additional 9 organic/antibiotic-free swine farms were also sampled, but MRSA was not detected on these farms. Five of 18 (27.7%) of farms were found to be positive for MRSA; 55.5% of confinement operations tested were positive (5/9). Overall prevalence in swine was 10% (43/428 animals). Overall, the prevalence of MRSA in humans was 32.6%. However, in humans that worked in confinement operations, the prevalence was higher at 45.3% (29/64).
We will be collaborating with the Iowa State University to examine multiple poultry production systems, including broiler, layer chickens, and turkeys. All farms examined will be in the state of Iowa. Given numbers from previous research in live chickens, we estimate a 40% (± 5.0%) prevalence of S. aureus in live birds. Using a 95% confidence interval and 80% power, we calculated the sample size of live animals to be 600. To reach sufficient sample size, we will be conducting convenience sampling of 20 animals from 30 different farms (10 turkey farms, 10 layer farms and 10 broiler farms). At each farm, all consenting caretakers will also be sampled (estimating 1-2 employees per farm, totaling 30-60 humans). We are looking for zoonotic transmission and therefore identical strains between the humans and live poultry.
We have gained IRB-01 approval for this study. Humans are typically colonized with S. aureus in the anterior nares, and nasal swabs are commonly used for detection of MRSA carriers. However, nasal swabs alone miss approximately 13% percent of MRSA carriers; therefore, we will employ both nasal and throat swabs for this study in order to maximize sensitivity of detection. A study subject will be considered to have occupational exposure to livestock/poultry when his or her employment duties involve entering buildings where live animals are housed. Such building entry must occur on average one or more times a week over the previous year. Slaughterhouse workers may have such exposures if their worksite is located prior to the kill room. Further, a comparison group has been established from an ongoing pilot study of the prevalence of S. aureus in rural Iowa (SIRI). The comparison group, recruited in rural Iowa, has no exposure to livestock or poultry. Human subjects will be sampled once over the course of the research.ICAUC approval has been obtained. Poultry will be swabbed in a similar manner. Samples will be collected from the choanal (palatine) cleft and from the cloaca of the selected animal. Sterile swabs will be inserted approximately 1 cm into the choanal cleft and rotated against the anterior mucosa. The swab will then be returned to the tube for transportation. Sterile swabs will also be inserted approximately 2 cm into the cloaca of the selected animal and returned to the tube for transportation. Samples will be collected by the production system’s veterinarians, caretakers, and trained laboratory staff. Animals will be sampled once over the course of the research.The six-stage Andersen viable cascade impactor was developed to allow simultaneous sizing and counting of viable microorganisms in air samples. It has the advantage of collection directly onto culture media for incubation and analysis with no dilution or plating of organisms. Air will be sampled internally in barns and processing facilities described. Samplers will be placed at breathing zone level approximately in the center of the work area when possible.
Given numbers from previous research in chicken and turkey meat, we estimate a 25% prevalence of S. aureus in poultry processing facilities. Samples will be collected from participating poultry processing facilities in Iowa. We will collect surface swabs of processing facilities, poultry, feed, litter, and eggs at selected poultry processing facilitiesA questionnaire will be administered, focused upon capturing animal exposure data in the previous year, as well as capturing demographic and some behavioral data. The enrollment questionnaire covers areas including general demographic data such as age and race, as well as study-specific questions such as the number of animals the subjects are in contact with, what type of work they perform with live animals, contact hours/years with animals, use of gloves or other personal protective equipment while working, smoking (whether at during work hours or not), presence of any cuts or abrasions on the skin in the prior nine months, and additional risk factors that we hypothesize may predispose to infection with antibiotic-resistant S. aureus (including use of antibiotics in the past three months; participation in team sports; or exposure to correctional facilities. In addition, the questionnaire will ask whether participants or their family members work in healthcare facilities including hospitals and long-term care facilities, or whether they have been hospitalized in the previous 12 months, and whether they have had any skin or soft tissue infections or antibiotic-resistant S. aureus infections in the previous 12 months). A questionnaire will be administered to the present administrator or manager and will focus upon capturing farm-specific data. The farm questionnaire covers study-specific questions including the numbers of animals, the source of poultry (eggs or chicks), feed source, litter type and how often it is changed, if the eggs are washed or unwashed, type of poultry (breed and origin), how long the farm has been populated, and what, if any, antibiotics are used. In addition, the questionnaire will ask general questions including how many employees work on the farm, what the turnover rate is like, whether farm workers are offered ammonia-filtered masks, if the masks are fit-tested, and the approximate compliance rate among workers.
Samples will be collected using sterile swabs and inserted into liquid Stuart’s medium for transportation to the Emerging Pathogens Laboratory at the Center for Emerging Infectious Diseases. Samples collected by investigators will be stored on ice until transport and processing (within 48 hours). Swab samples will be inoculated into 5mL enrichment broth. Cultures will be incubated for 24h at 35°C, then 5 µL of broth will be inoculated onto selective MRSA agar plates and onto Columbia CNA agar plates (CNA). Isolates will be confirmed as S. aureus by examining their appearance on Gram stain, and by doing the catalase test, the coagulase test and the S. aureus latex agglutination assay. Methicillin resistance will be confirmed by testing for the presence of penicillin binding protein (PBP2). Antibiotic-resistant S. aureus isolates will be stored at -80°C. Positive and negative controls will be used for all tests.
All isolates will be analyzed by spa typing (a PCR/sequencing method which distinguishes between closely related isolates); pvl PCR (which detects the presence of the Panton-Valentine Leukocydin toxin, a potential virulence factor), multilocus sequence typing (MLST), pulsed-field gel electrophoresis (PFGE) and antibiotic resistance testing as described below. Isolates representing distinct spa patterns on each farm will be subjected to further typing. If all isolates on an individual farm show identical spa patterns, 5 isolates will be randomly selected for further analysis. This will allow us to minimize duplicative testing of closely related isolates that are unlikely to significantly increase our knowledge of the epidemiology of this organism. However, all isolates will be retained and frozen down for potential future studies. Isolates chosen for further analysis will be subjected to MLST typing. A subset of unique S. aureus isolates will be tested in the hospital laboratory for antimicrobial susceptibility by the broth dilution method described by the Clinical and Laboratory Standards Institute. Isolates will be tested for susceptibility to tetracycline, erythromycin, clindamycin, trimethoprim-sulfamethoxazole, gentamicin, levofloxacin, moxifloxacin, linezolid, daptomycin, vancomycin, and rifampin.
All data from prevalence and molecular tests will be independently double-entered into databases and checked to ensure accuracy. Questionnaire and laboratory data will be linked by a unique specimen number. Multivariate modeling of risk factors will be performed using logistic regression. A trend in prevalence of antibiotic-resistant S. aureus in poultry by type will be tested with the Cochran-Armitage trend test. A significance level of 0.05 will be used in the analyses. Analyses will be performed using SAS software version 9.1 (SAS Institute Inc., Cary, NC).
The proposed study has several strengths, including being the first study of S. aureus in live turkeys and turkey workers, and the first study of this in chickens and chicken workers in the United States. We have a well-qualified, interdisciplinary research team consisting of investigators with expertise in microbiology, environmental health, occupational and rural medicine, veterinary medicine, and epidemiology. Further, the state of Iowa is a national leader in eggs and turkey production.Limitations also exist in the study. Because farms are convenience, single-time samples, they may not be representative of all farms. Additionally, the proposed research is a pilot study, indicating a potential need for further research. Also, the limited geography of the study area many not be representative of the United States in general.
Greater knowledge of the ecology and epidemiology of these organisms is invaluable in assessing infectious disease risks and providing recommendations for preventative measures. At the completion of this research, it is our expectation that we will have established the prevalence and dominant molecular types of S. aureus in poultry and poultry workers, all of which provide novel routes of transmission for this bacterium. Such results will have an important positiveimpact on the field, because they will provide insight into the maintenance and spread of S. aureus in the rural environment, as well as potential mechanisms that could be implemented to prevent such emergence and spread.