Elaine S. Walker

A Decline in Mupirocin Resistance in Methicillin-Resistant Staphylococcus aureus Accompanied Administrative Control of Prescriptions

ABSTRACT Susceptibility to mupirocin was assessed in methicillin-resistant Staphylococcus aureus isolates selected from eras corresponding to differences in usage rate and prescription policies at a Veterans Affairs medical center. The eras studied encompassed from the time of introduction of the drug to its widespread use, through recommended judicious use, and finally to subsequent stringent administrative control. Prescriptions declined from 3.0 to 0.1 per 1,000 patient days. Precipitous declines first in the numbers of isolates with high-level resistance (from 31% to 4%) and then in those with low-level resistance (from 26% to 10%) accompanied prescription control.

GENETIC TRENDS IN A POPULATION EVOLVING ANTIBIOTIC RESISTANCE

Abstract.— The evolution of antibiotic resistance provides a well‐documented, rapid, and recent example of a selection driven process that has occurred in many bacterial species. An exhaustive collection of Moraxella catarrhalis that spans a transition to chromosomally encoded penicillin resistance was used to analyze genetic changes accompanying the transition. The population was characterized by high haplotypic diversity with 148 distinct haplotypes among 372 isolates tested at three genomic regions. The power of a temporally stratified sample from a single population was highlighted by the finding of high genetic diversity throughout the transition to resistance, population numbers that remained high over time, and no evidence of departures from neutrality in the allele frequency spectra throughout the transition. The direct temporal analysis documented the persistence, antibiotic status, and haplotypic identity of strains undergoing apparent clonal expansions. Several haplotypes that were β‐lactamase nonproducers in early samples converted to producers in later years. Maintenance of genetic diversity and haplotype conversions from sensitive to resistant supported the hypothesis that penicillin resistance determinants spread to a diverse array of strains via horizontal exchange. Genetic differentiation between sample years, estimated by FST, was increasing at a rate that could cause complete haplotype turnover in less than 150 years. Widespread linkage disequilibrium among sites within one locus (copB) suggested recent mutation followed by clonal expansion. Nonrandom associations between haplotypes and resistance phenotypes provided further evidence of clonal expansion for some haplotypes. Nevertheless, the population structure was far from clonal as evidenced by a relatively low frequency of disequilibria both within sites at a second locus (M46) as well as between loci. The haplotype‐antibiotic resistance association that was accompanied by gradual haplotype turnover is consistent with a hypothesis of genetic drift at marker loci with directional selection at the resistance locus.

Nosocomial transmission clusters and risk factors in Moraxella catarrhalis.

We report an objective examination of nosocomial transmission events derived from long-term (10-year) data from a single medical centre. Cluster analysis, based on the temporal proximity of genetically identical isolates of the respiratory pathogen Moraxella catarrhalis, identified 40 transmission events involving 33 of the 52 genotypes represented by multiple isolates. There was no evidence of highly transmissible or outbreak-prone genotypes. Although most clusters were small (mean size 3.6 isolates) and of short duration (median duration 25 days), clustering accounted for 38.7% of all isolates. Significant risk factors for clustering were multi-bed wards, and winter and spring season, but bacterial antibiotic resistance, manifested as the ability to produce a beta-lactamase was not a risk factor. The use of cluster analysis to identify transmission events and its application to long-term data demonstrate an approach to pathogen transmission that should find wide application beyond hospital populations.

Bacterial Activation of Mast Cells

Mast cells often are found in a perivascular location but especially in mucosae, where they may response to various stimuli. They typically associate with immediate hypersensitive responses and are likely to play a critical role in host defense. In this chapter, a common airway pathogen, Moraxella catarrhalis, and a commensal bacterium, Neiserria cinerea, are used to illustrate activation of human mast cells. A human mast cell line (HMC-1) derived from a patient with mast cell leukemia was activated with varying concentrations of heat-killed bacteria. Active aggregation of bacteria over mast cell surfaces was detected by scanning electron microscopy. The activation of mast cells was analyzed by nuclear factor-kappaB (NF-kappaB) activation and cytokine production in culture supernatants. Both M. catarrhalis and N. cinerea induce mast cell activation and the secretion of two key inflammatory cytokines, interleukin-6 and MCP-1. This is accompanied by NF-kappaB activation. Direct bacterial contact with mast cells appears to be essential for this activation because neither cell-free bacterial supernatants nor bacterial lipopolysaccharide induce cytokine secretion.

Pattern and Rate of Decline of a Population of Carolina Hemlock (Tsuga caroliniana Engelm.) in North Carolina

Abstract We monitored a population of Carolina Hemlocks in northwestern North Carolina for four years to examine the rate and pattern of decline in response to infestation by Adelges tsugae (Hemlock Woolly Adelgid). Our yearly census of hemlock condition and severity of the adelgid infestation included trees of all sizes. We estimated declines in condition as the portions of the leaf canopy that were lost. Initially, infestation occurred throughout the population but was severe in only a small cluster of individuals. Within 1 year, the area of severe infestation increased in size to encompass 48% of the population. In another region of the population, there was a cluster of relatively healthy individuals comprised largely of seedlings. Of the 4 size-classes of trees, sapling-sized individuals experienced the highest rates of decline in condition. Most trees declined to poor health within 3 years of an observation of moderate to severe infestation.

Comparative activity of telavancin and other antimicrobial agents against methicillin-resistant Staphylococcus aureus isolates collected from 1991 to 2006.

Background: Increasingly frequent reports of vancomycin treatment failures for serious methicillin-resistant Staphylococcus aureus (MRSA) infections provide impetus for comparative in vitro studies to assess the activity of newer antimicrobial agents against a range of MRSA isolates. Methods: A sample of 168 MRSA derived from a long-term MRSA collection was subjected to susceptibility testing to telavancin, daptomycin, linezolid, tigecycline and vancomycin by broth micro-dilution. Data were reviewed for sporadic occurrence of isolates with reduced susceptibility. Analyses were performed to test for temporal trends toward decreasing susceptibility and to compare susceptibility of isolates from different infection sites. Results: No MRSA isolate from any time period was resistant to test antibiotics. For daptomycin, linezolid and tigecycline, there were no susceptibility differences between the pre- and postclinical availability periods. All newer agents were active against MRSA isolates with minimum inhibitory concentrations (MICs) of vancomycin >1 mg/l, but there were significant correlations in susceptibility among several pairs of antibiotics. Conclusions: Telavancin and other newer antistaphylococcal agents were fully active against MRSA from various infection sites including isolates with vancomycin MIC >1 mg/l.

Modeling the spread of infectious disease using genetic information within a marked branching process

Accurate assessment of disease dynamics requires a quantification of many unknown parameters governing disease transmission processes. While infection control strategies within hospital settings are stringent, some disease will be propagated due to human interactions (patient-to-patient or patient-to-caregiver-to-patient). In order to understand infectious transmission rates within the hospital, it is necessary to isolate the amount of disease that is endemic to the outside environment. While discerning the origins of disease is difficult when using ordinary spatio-temporal data (locations and time of disease detection), genotypes that are common to pathogens, with common sources, aid in distinguishing nosocomial infections from independent arrivals of the disease. The purpose of this study was to demonstrate a Bayesian modeling procedure for identifying nosocomial infections, and quantify the rate of these transmissions. We will demonstrate our method using a 10-year history of Morexella catarhallis. Results will show the degree to which pathogen-specific, genotypic information impacts inferences about the nosocomial rate of infection.

Deidamia inscriptum (Lettered Sphinx Moth) Caterpillars Feeding on Oxydendrum arboreum (Sourwood) and Their Predation by Black Bears in Northeast Tennessee

Abstract An outbreak of Deidamia inscriptum (Lettered Sphinx Moth) caterpillars was noted in northeast Tennessee where Oxydendrum arboreum (Sourwood) trees were defoliated. Nearly all published literature and online resources list only plants in the grape family (Vitaceae) as larval food plants. Food-plant preference trials using fresh leaves of 3 woody plant species showed that Deidamia caterpillars from this region had a preference for Sourwood over Parthenocissus quinquefolia (Virginia Creeper), and rejected Acer rubrum (Red Maple), a non-host species. Ursus americanus (Black Bear) were feeding on the caterpillars as evidenced by bent and broken Sourwood saplings bearing claw marks and by abundant sphingid remains in bear scat.

Demographics and Cronartium appalachianum Rust Disease Assessments in Three Tennessee Populations of Buckleya distichophylla (Nutt.) Torr. (Santalaceae)

ABSTRACT  A demographic census and disease assessment was conducted in 2007 and 2015 in three Tennessee populations of the dioecious shrub, Buckleya distichophylla (Santalaceae). Population sizes were relatively stable over time and plant heights and numbers of stems per clump were similar among populations. Seedlings were present in all populations, where they represented 14–19% of individuals. Two populations had an equal male:female sex ratio, but a third population was male-biased. Nonflowering individuals comprised 33–41% of individuals in a population. The majority of plants in all populations had high vigor. Spatial analyses revealed clusters of seedlings in two populations and a cluster of low-vigor plants in one population. Cronartium appalachianum, a rust fungus dependent upon Pinus virginiana and B. distichophylla as primary and alternate hosts, respectively, was present in all populations with prevalences on B. distichophylla of 19–29%, but there was no spatial clustering of disease in populations. The tree species nearest to B. distichophylla varied among populations with Tsuga canadensis predominant in one population, T. caroliniana in another, and P. virginiana in the third. Buckleya distichophylla in proximity to P. virginiana had a higher than expected prevalence of C. appalachianum infection.