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Background: While methicillin-resistant Staphylococcus aureus (MRSA) originally was associated with healthcare, distinct strains later emerged in patients with no prior hospital contact. The epidemiology of MRSA continues to evolve. Methods: To characterize the current epidemiology of MRSA-colonized patients entering a hospital serving both rural and urban communities, we interviewed patients with MRSA-positive admission nasal swabs between August 2009 and March 2010. We applied hospitalization risk factor, antimicrobial resistance phenotype, and multi-locus sequence genotype (MLST) classification schemes to 94 case-patients. Results: By MLST analysis, we identified 15 strains with two dominant clonal complexes (CCs)-CC5 (51 isolates), historically associated with hospitals, and CC8 (27 isolates), historically of community origin. Among patients with CC5 isolates, 43% reported no history of hospitalization within the past six months; for CC8, 67% reported the same. Classification by hospitalization risk factor did not correlate strongly with genotypic classification. Sensitivity of isolates to ciprofloxacin, clindamycin, or amikacin was associated with the CC8 genotype; however, among CC8 strains, 59% were resistant to ciprofloxacin, 15% to clindamycin, and 15% to amikacin. Conclusions: Hospitalization history was not a strong surrogate for the CC5 genotype. Conversely, patients with a history of hospitalization were identified with the CC8 genotype. Although ciprofloxacin, clindamycin, and amikacin susceptibility distinguished CC8 strains, the high prevalence of ciprofloxacin resistance limited its predictive value. As CC8 strains become established in healthcare settings and CC5 strains disseminate into the community, community-associated MRSA definitions based on case-patient hospitalization history may prove less valuable in tracking community MRSA strains. [ABSTRACT FROM AUTHOR]

BACKGROUND: Industrial food animal production employs many of the same antibiotics or classes of antibiotics that are used in human medicine. These drugs can be administered to food animals in the form of free-choice medicated feeds (FCMF), where animals choose how much feed to consume. Routine administration of these drugs to livestock selects for microorganisms that are resistant to medications critical to the treatment of clinical infections in humans. OBJECTIVES: In this commentary, we discuss the history of medicated feeds, the nature of FCMF use with regard to dose delivery, and U.S. policies that address antimicrobial drug use in food animals. DISCUSSION: FCMF makes delivering a predictable, accurate, and intended dose difficult. Overdosing can lead to animal toxicity; underdosing or inconsistent dosing can result in a failure to resolve animal diseases and in the development of antimicrobial-resistant microorganisms. CONCLUSIONS: The delivery of antibiotics to food animals for reasons other than the treatment of clinically diagnosed disease, especially via free-choice feeding methods, should be reconsidered. [ABSTRACT FROM AUTHOR]

The article focuses on American Veterinary Medical Association Virtual Convention 2020 will focus on continuing education opportunities to improve antimicrobial resistance (AMR) knowledge and antimicrobial stewardship practices among veterinarians. Topics include continuing education can contribute to improving stewardship efforts, and the ability to ingrain good stewardship behaviors prior to graduation and before students develop their own prescribing habits.

Methods: Following a grounded theory approach, we conducted semi-structured interviews with watermen and related workers who fish and harvest shellfish in the Chesapeake Bay, USA, to investigate risk perceptions and understanding, and compliance with regulations intended to reduce worker and consumer illnesses and injuries from pathogen exposures., Results: Worker and consumer illnesses and injuries, and threat of fishery closures-with regulatory and organizational factors-influence this workforce., Conclusions: Our findings support interventions that promote monitoring, surveillance, and awareness of Vibrio-related risk among watermen, regulatory officials, medical professionals, and the public., Competing Interests: Conflicts of Interest: Author Gould is associate faculty at the Johns Hopkins Bloomberg School of Public Health (BSPH) and also is a full-time employee of the United States Environmental Protection Agency. She conducted this research and wrote this paper entirely on her own time, not during work hours, and not as a part of her official duties but rather via her BSPH affiliation. That said, she discloses that, the views expressed in this document are those of the authors and do not necessarily reflect those of their affiliated institutions, including the U.S. Environmental Protection Agency., (Copyright © 2024 American College of Occupational and Environmental Medicine.)

Background: Certain environmental allergen exposures are more common in disadvantaged communities and may contribute to differences in susceptibility to upper respiratory infections (URIs)., Objectives: We examined associations between indoor allergens and: (1) URI; (2) URI + cold symptoms; (3) URI + cold symptoms + pulmonary eosinophilic inflammation (fraction of exhaled nitric oxide ≥20 ppb); and (4) URI + cold symptoms + reduced lung function (percent predicted forced expiratory volume in 1 second of <80%)., Methods: We used data from the Environmental Control as Add-on Therapy for Childhood Asthma (ECATCh) study. Allergen concentrations were measured in air (mouse) and settled dust (mouse, cockroach, dog, and cat). URI was determined by testing nasal mucus for upper respiratory viruses. We evaluated associations between allergen concentrations and URI-associated outcomes accounting for age, sex, study month, season, health insurance, and household size., Results: Ninety participants (92% Black, 92% public insurance) with 192 observations were included; 52 (27%) of observations were positive for URI. A doubling in cockroach allergen concentration increased the odds of a URI with cold symptoms by 18% (odds ratio [OR] = 1.18, 95% confidence interval [CI], 0.99-1.40), the odds of a URI + cold symptoms + pulmonary eosinophilic inflammation by 31% (OR = 1.31, 95% CI, 1.10-1.57), and the odds of a URI + cold symptoms + reduced lung function by 45% (OR = 1.45, 95% CI, 1.13-1.85). Mouse allergen concentrations were positively associated with all outcomes. Associations were suggestively stronger among children sensitized to pest allergens., Conclusions: Cockroach and mouse, but not dog or cat, allergen exposure may predispose children with asthma to URIs with colds and lower respiratory outcomes., Competing Interests: Disclosure statement Supported by core funds of the Dell Medical School at the University of Texas at Austin (to D.B. and P.J.R.) and the US Environmental Protection Agency (assistance agreement 83615201 to M.C.M.). Research was also supported by the National Institutes of Health (NIH) (grants K24AI114769, R01ES023447, and R01ES026170 to E.C.M., grant P50ES018176 to M.C.M., grant U01AI125290 to C.A.K., grant K01OD019918 to M.F.D., and grant KL2 TR002646 to D.B.). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH. Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest., (Copyright © 2024 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.)

Objective: To spotlight the challenges, gaps, and opportunities to improve workforce mental health and well-being in higher education institutions (HEIs)., Methods: We convened a full-day summit of subject matter experts from academia, business, government, and practice to share research and best practices on workplace mental health., Results: Highlights from the summit are presented in this paper covering the importance of leadership and culture; the mental health costs associated with being a Black STEM scholar; the role of the environment; case studies of three university mental health and well-being programs; and the future of work., Conclusions: Establishing a culture of caring requires leadership commitment; strategic planning; accountability and shared responsibility; and measurement and evaluation. HEI leaders are called to lead by example; foster community partnerships; adopt a Total Worker Health framework; and regularly evaluate progress., Competing Interests: Conflict of Interest for ALL Authors -- NONE DECLARED, (Copyright © 2024 American College of Occupational and Environmental Medicine.)

Background: Animal-assisted intervention (AAI) programs, used widely for patient benefit, have increasingly been used for healthcare workers (HCW) to reduce occupational stress. However, there are barriers to these programs which limit their utilization, for both patients and HCW, specifically infectious disease concerns. The aim of the research project is to identify barriers and facilitators to AAI program use for healthcare worker benefit, and determine knowledge, beliefs, and practices regarding infectious disease risk and control policies, in order to understand the contextual parameters of program implementation., Methods: We collected perceptions of key stakeholders involved with hospital AAI programs (HCW and AAI workers) through semi-structured in-depth interviews. We used framework analysis to guide thematic coding, completed independently by three researchers., Results: We interviewed 37 participants in this study. We divided our themes into two topic areas: program use for HCW and perceived infectious disease risk. Use for healthcare workers included perspectives on the benefits for HCW and program barriers and facilitators (specifically collaboration and leadership). Perceived risk included opinions on infection concerns with AAI, thoughts on control measures to reduce this risk, and responsibility for safety during these programs., Conclusions: While significant benefits were reported for HCW, they were limited by administrative barriers and hazard concerns. Facilitators to surmount these barriers are best implemented with collaboration across the hospital and appropriate leadership roles to direct safe program implementation. By addressing these barriers through targeted facilitators in the form of evidence-backed guidelines, AAI programs can be used to benefit both patients and HCW.

Introduction: There is evidence that obesity, a risk factor for asthma severity and morbidity, has a unique asthma phenotype which is less atopic and less responsive to inhaled corticosteroids (ICS). Peripheral blood mononuclear cells (PBMC) are important to the immunologic pathways of obese asthma and steroid resistance. However, the cellular source associated with steroid resistance has remained elusive. We compared the lymphocyte landscape among obese children with asthma to matched normal weight children with asthma and assessed relationship to asthma control., Methods: High-dimensional flow cytometry of PBMC at baseline and after dexamethasone stimulation was performed to characterize lymphocyte subpopulations, T-lymphocyte polarization, proliferation (Ki-67+), and expression of the steroid-responsive protein FK506-binding protein 51 (FKBP51). T-lymphocyte populations were compared between obese and normal-weight participants, and an unbiased, unsupervised clustering analysis was performed. Differentially expressed clusters were compared with asthma control, adjusted for ICS and exhaled nitric oxide., Results: In the obese population, there was an increased cluster of CD4 + T-lymphocytes expressing Ki-67 and FKBP51 at baseline and CD4 + T-lymphocytes expressing FKBP51 after dexamethasone stimulation. CD4 + Ki-67 and FKBP51 expression at baseline showed no association with asthma control. Dexamethasone-induced CD4 + FKBP51 expression was associated with worse asthma control in obese participants with asthma. FKBP51 expression in CD8 + T cells and CD19 + B cells did not differ among groups, nor did polarization profiles for Th1, Th2, Th9, or Th17 percentage., Discussion: Dexamethasone-induced CD4 + FKBP51 expression is uniquely associated with worse asthma control in obese children with asthma and may underlie the corticosteroid resistance observed in this population., Competing Interests: MM reports royalties from Uptodate, consulting fees from Glaxo Smith Kline and Celgene, outside the submitted work. NH reports grants from COPD Foundation, grants and personal fees from AstraZeneca, grants and personal fees from GSK, grants from Boehringer Ingelheim, and personal fees from Mylan during the conduct of the study, outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2021 Tejwani, McCormack, Suresh, Woo, Xu, Davis, Brigham, Hansel, McCormack and D’Alessio.)

Background: Pseudomonas aeruginosa is an opportunistic pathogen of the canine ear canal and occupies aquatic habitats in the environment. Nosocomial and zoonotic transmission of P. aeruginosa have been documented, including clonal outbreaks., Hypothesis/objectives: The primary objective of this study was to assess various environmental exposures as potential risk factors for canine Pseudomonas otitis. It was hypothesized that isolates derived from infected ears would be clonal to isolates derived from household water sources and the mouths of human and animal companions of the study subjects., Animals: Seventy seven privately owned dogs with otitis were enrolled, along with their human and animal household companions, in a case-control design., Methods: Data on potential risk factors for Pseudomonas otitis were collected. Oral cavities of all study subjects, their human and animal companions, and household water sources were sampled. Pulsed field gel electrophoresis was used to estimate clonal relatedness of P. aeruginosa isolates., Results: In a multivariate model, visiting a dog park was associated with 77% increased odds of case status (P = 0.048). Strains clonal to the infection isolates were obtained from subjects' mouths (n = 18), companion pets' mouths (n = 5), pet owners' mouths (n = 2), water bowls (n = 7) and water taps (n = 2). Clonally related P. aeruginosa isolates were obtained from dogs that had no clear epidemiological link., Conclusions and Clinical Importance: Genetic homology between otic and environmental isolates is consistent with a waterborne source for some dogs, and cross-contamination with other human and animal members within some households., (© 2016 ESVD and ACVD.)

Diabetes is a disease with wide-ranging personal and societal impacts that has been managed medicinally for over half a century. Since the discovery of stem cells, pancreatic islet regeneration has become a central target for clinical application that has the potential to decrease or eliminate the need for insulin administration and adjunctive medications. The discovery of alternative routes to pluripotency that bypass the ethical implications of embryonic stem cells has significantly expanded the horizons of stem cell based therapy. Engraftment of mature insulin producing cells derived from induced pluripotent stem cells may represent the most promising treatment strategy for diabetic patients with impaired β-cell function. These cells are easily accessible and have been shown to closely mimic endogenous β-cell function in vivo . While the risks of oncogenesis and transplant rejection are still of great concern, large strides have been made on both fronts with the application of integration free induction strategies and the ongoing development of microcapsules that cloak implanted cells from an autoimmune response. This review will focus on the progress and remaining obstacles in diabetes related stem cell research, and will specifically discuss approaches using embryonic, induced pluripotent, germline and mesenchymal derived stem cells.

Infections with Staphylococcus aureus are a continuing and growing problem in community and hospital settings. Preclinical animal modeling of S. aureus relies on experimental infection, which carries some limitations. We describe here a novel, spontaneous model of oral staphylococcal infection in double knockout mice, deficient in the receptors for IL-17 (IL-17RA) and interferon (IFN)-γ (IFNγRI), beginning at 6 to 8 weeks of age. IFNγRI(-/-)IL17RA(-/-) (GRAKO) mice developed progressive oral abscesses. Cytometric methods revealed extensive neutrophilic infiltration of oral tissues in GRAKO mice; further investigation evidenced that IL-17 predominated neutrophil defects in these mice. To investigate the contribution of IFN-γ signaling to this native host defense to S. aureus, we observed perturbations of monocyte recruitment and macrophage differentiation in the oral tissues of GRAKO mice, and CXCL9/chemokine ligand receptor (CXCR)3-driven recruitment of T-cell oral tissues and draining lymph nodes. To address the former finding, we depleted macrophages and monocytes in vivo from IL17RA(-/-) mice using liposomes loaded with clodronate. This treatment elicited oral abscesses, recapitulating the phenotype of GRAKO mice. From these findings, we propose novel collaborative functions of IL-17 and IFN-γ, acting through neutrophils and macrophages, respectively, in native mucocutaneous host defenses to S. aureus., (Copyright © 2016 American Society for Investigative Pathology. Published by Elsevier Inc. All rights reserved.)

Background: The duration of colonization and factors associated with clearance of methicillin-resistant Staphylococcus aureus (MRSA) after community-onset MRSA skin and soft-tissue infection (SSTI) remain unclear., Methods: We conducted a prospective cohort study of patients with acute MRSA SSTI presenting to 5 adult and pediatric academic hospitals from 1 January 2010 through 31 December 2012. Index patients and household members performed self-sampling for MRSA colonization every 2 weeks for 6 months. Clearance of colonization was defined as negative MRSA surveillance cultures during 2 consecutive sampling periods. A Cox proportional hazards regression model was developed to identify determinants of clearance of colonization., Results: Two hundred forty-three index patients were included. The median duration of MRSA colonization after SSTI diagnosis was 21 days (95% confidence interval [CI], 19-24), and 19.8% never cleared colonization. Treatment of the SSTI with clindamycin was associated with earlier clearance (hazard ratio [HR], 1.72; 95% CI, 1.28-2.30; P < .001). Older age (HR, 0.99; 95% CI, .98-1.00; P = .01) was associated with longer duration of colonization. There was a borderline significant association between increased number of household members colonized with MRSA and later clearance of colonization in the index patient (HR, 0.85; 95% CI, .71-1.01; P = .06)., Conclusions: With a systematic, regular sampling protocol, duration of MRSA colonization was noted to be shorter than previously reported, although 19.8% of patients remained colonized at 6 months. The association between clindamycin and shorter duration of colonization after MRSA SSTI suggests a possible role for the antibiotic selected for treatment of MRSA infection., (© The Author 2015. Published by Oxford University Press on behalf of the Infectious Diseases Society of America. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.)

Objective: Infection with Campylobacter jejuni, a bacterium carried by poultry and livestock, is the most frequently identified antecedent to the autoimmune neurologic condition Guillain-Barré Syndrome. We used Agricultural Health Study data to assess whether cattle farming was associated with prevalence of neurologic symptoms., Methods: Prevalence of self-reported symptoms in cattle farmers (n = 8878) was compared with farmers who did not work with animals (n = 7462), using multivariate regression., Results: Prevalence of numbness and weakness were increased for beef and dairy farmers compared with the reference group (P < 0.0001). Of cattle farmers, 48% did not report raising other animal species, and prevalence of numbness and weakness were also increased in this subgroup compared with the reference group (P < 0.02)., Conclusions: Occupational exposure to cattle was associated with increased prevalence of self-reported symptoms associated with peripheral neuropathy.