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The transmission of Staphylococcus aureus and methicillin-resistant S. aureus (MRSA) through food products of animal origin may pose a public health concern. Therefore, the objectives of the present work were to determine the prevalence of S. aureus and MRSA in raw meat samples (beef, chicken, turkey, and duck) at retail level, and to determine the antimicrobial resistance profile of the MRSA isolates. Between September 2018 and January 2019, a total of 325 raw meat samples were collected from retail stores, and analysed for the presence of S. aureus and MRSA using primary enrichment method as well as using secondary selective enrichment methods for MRSA detection. All the suspected S. aureus and MRSA colonies obtained from the samples were confirmed by both phenotypic and genotypic methods. The MRSA isolates were tested against various antimicrobials, and the minimal inhibitory concentration (MIC) of vancomycin was determined. Macrolide-lincosamide-streptogramin B (MLSB) resistance phenotypes were also screened using the double-disk diffusion test. The overall prevalence of S. aureus was 57.2%, whereas the food-specific prevalence in beef, turkey, duck, and chicken samples was 75, 53, 48, and 46%, respectively. The overall prevalence of MRSA was 1.2%, whereas it was 3, 1, 0, and 0% in beef, turkey, chicken, and duck samples, respectively. All MRSA isolates were detected by the secondary selective enrichment method. These MRSA isolates had a variety of MLSB resistance phenotypes (i.e., iMLSB, cMLSB, and MS-MLSB) with vancomycin MIC values ranging between 1 - 2 µg/mL. These findings are important for developing interventions to reduce raw meat contamination with S. aureus and MRSA, and to improve public health. [ABSTRACT FROM AUTHOR]

Bone-in and boneless parts, such as drumsticks, are used in ground chicken production. In addition, neck skin is used as a source of fat in ground products. Contaminated chicken neck skin and bones containing internalized Salmonella are potential sources of this pathogen in ground chicken. This study determined the prevalence of Salmonella and serotype distribution in drumstick bones and neck skin of postchill chicken carcasses. One week prior to slaughter, chicken houses (n = 26) at nine farms were tested for the presence of Salmonella, using the boot sock method. Chicken flocks from these houses originated from Salmonella-positive breeders. Eight Salmonella-positive chicken flocks and one flock with undetermined Salmonella status were monitored through processing. Three hundred postchill drumsticks and 299 neck skin samples were analyzed for Salmonella prevalence. Skin samples were rinsed and stomached prior to analysis. Bones were extracted from the drumsticks, external surfaces were sterilized, and bones were crushed for analysis. One Salmonella isolate from each positive sample was serogrouped. Half of the isolates representing different sample types were serotyped. Overall, Salmonella was found in 0.8, 21.4, and 80.1% of bone marrow, neck skin, and farms, respectively. Prevalence of Salmonella on rinsed skin samples (2.3%) and stomached skin samples (20.7%) differed significantly (P ≤ 0.05). Serogroups B, C2, D, and E were found at 23.4, 31.9, 11.7, and 29.8%, respectively. Six Salmonella serotypes were identified: Liverpool (37.9%), Kentucky (27.6%), and Typhimurium (27.6%) were isolated most frequently from neck skin; the two bone isolates were Kentucky; and more than 50% of the farm isolates were Kentucky and Ouakam. Salmonella-contaminated neck skin might be a more significant source of this contamination in ground chicken than Salmonella internalized in bones. [ABSTRACT FROM AUTHOR]

The objectives of this study were to determine the effect of an essential oil blend (EO; carvacrol, thymol, eucalyptol, lemon) administered in drinking water on the performance, mortality, water consumption, pH of crop and ceca, and Salmonella enterica serovar Heidelberg fecal shedding and colonization in broiler birds following Salmonella Heidelberg challenge and feed withdrawal. Chicks were randomly assigned to water treatments containing 0.05, 0.025, or 0.0125% EO or untreated controls. Treatments were administered in drinking water on 0 to 7 and 35 to 42 d. One-half of the chicks were challenged with Salmonella Heidelberg and placed in pens with unchallenged chicks on d 1. Performance, mortality, water consumption, and pH were determined during the 42-d study. Prevalence of Salmonella Heidelberg was determined on drag swabs (0, 14, and 42 d) and in the ceca and crops (42 d). The 0.05% EO administered in drinking water significantly (P<0.05) reduced Salmonella Heidelberg colonization in crops of challenged birds, significantly lowered the feed conversion ratio, and increased weight gain compared with controls. The 0.025% and 0.015% EO in drinking water significantly lowered the feed conversion ratio and increased weight gain compared with controls, but did not significantly reduce Salmonella Heidelberg colonization in the crops. The EO in drinking water did not significantly reduce Salmonella Heidelberg colonization in ceca or fecal shedding in broilers. The EO used in the study may control Salmonella Heidelberg contamination in crops of broilers when administered in drinking water and therefore may reduce the potential for cross-contamination of the carcass when the birds are processed. [ABSTRACT FROM AUTHOR]

An abstract of the article "Low Dose Versus High Dose Entecavir for Chronic Hepatitis B Virus Infection with Liver" by S. Khan and others is presented.

Data regarding Salmonella on raw poultry are very limited in China. The objective of this study was to determine the prevalence of Salmonel la on raw poultry at the retail level in six provinces and two national cities in China. Whole chicken carcasses (n = 1,152) were collected from three types of retail markets (large, small, and wet). All samples were analyzed for the presence of Salmonel la by using the U.S. Department of Agriculture, Food Safety Inspection Service method. Of 1,152 chicken samples, overall Salmonel la prevalence was 52.2%. The highest prevalence was observed in Guangxi Province (65.3%), next in Guangdong Province (64.6%), and then in Beijing (63.9%), Shaanxi Province (50.7%), Henan Province (47.9%), Shanghai (44.4%), and Fujian Province (42.4%), and lowest prevalence was observed in Sichuan Province (38.9%). Salmonel la prevalence was significantly different among the six provinces and two national cities. Salmonella prevalence was highest in the wet markets (54.4%) compared with the large markets (50.3%) and the small markets (52.1%), but differences were not significant (P > 0.05). Good manufacturing practices, good agricultural practices, and hazard analysis critical control point systems for Salmonel la control in poultry production at the farm, processing, and retail level should be implemented. [ABSTRACT FROM AUTHOR]

We sought to assess pre-vaccination and post-vaccination seroprevalences of anti-SARS-CoV-2 antibodies in Kuwait and to compare antibody levels between vaccine types. In phase 1 (pre-vaccination period, n = 19,363), blood samples were collected before the launch of COVID-19 vaccination in Kuwait between 1 September and 31 December 2020. Blood samples for phase 2 (post-vaccination period, n = 4973) were collected between 1 September and 30 November 2021. We tested subjects for anti-SARS-CoV-2 antibodies using the DiaSorin LIAISON ® SARS-CoV-2 IgM and Trimeric S IgG tests. In the pre-vaccination period, the prevalence of SARS-CoV-2 IgM and IgG was 14.50% (95% CI: 14.01-15.00) and 24.89% (95% CI: 24.29-25.50), respectively. The trend of seropositivity increased with age and was higher for females and non-Kuwaiti participants ( p < 0.0001). Interestingly, seroprevalence was significantly higher for those who had received one dose of BNT162b2 (95.21%) than those who had received one dose of ChAdOx1-nCov-19 (92.86%). In addition, those who reported receiving two doses had higher seroprevalence, 96.25%, 95.86%, and 94.93% for ChA-dOx1-nCov-19/AstraZeneca, mix-and-match, and BNT162b2 recipients, respectively. After the second dose, median spike-specific responses showed no significant difference between ChAdOx1-nCov-19 and BNT162b2. Furthermore, statistical analysis showed no significant difference between median anti-trimeric S antibody levels of vaccinated individuals according to sex, age, or nationality ( p > 0.05). In contrast, a negative correlation between age and anti-trimeric S IgG titers of BNT162b2-vaccinated subjects was observed (r = -0.062, p = 0.0009). Antibody levels decreased with time after vaccination with both vaccines. Our findings indicate that seroprevalence was very low during the pre-vaccination period (25%) in the general population and was greater than 95% in the vaccinated population in Kuwait. Furthermore, ChAdOx1-nCov-19 and BNT162b2 are effective in generating a similar humoral response.

Objectives: An increased frequency of intermittent hypoxemia (IH) is associated with a higher risk for poor developmental outcomes, disability, or death in extremely preterm infants. The objective of the prFesent study is to quantify the effect of hands-on medical and parental interventions on the incidence of IH in extremely preterm infants., Methods: An observational design with intraindividual comparisons was used. Blood oxygen saturation levels (SpO2) and time-lapse video were recorded. Frequency, duration, and time to occurrence of IH (SpO2 <80% for ≥10 s) were compared between nursing and medical care (NMC), health care by parents, skin-to-skin contact (SSC), touch in incubator, physiotherapy, and rest. Each infant was observed for six consecutive 24-h periods. Inclusion criteria were as follows: gestational age ≤28 weeks, birth weight <1500 g, postnatal age 0-6 weeks, gavage feeding, no severe illnesses or invasive procedures, no mechanical ventilation., Results: The highest proportion of time with IH occurred during NMC (2.49%) and incubator touch (1.32%), the lowest during SSC (0.74%) and health care by parents (0.67%). IH frequency per hour was highest during NMC (2.95, IQR 1.19-4.01) and lowest during SSC (0.88, IQR 0.37-2.32, p < 0.001). While an increase in IH during NMC was expected, the high incidence during incubator touch was surprising. Parental touch in the incubator is intended to be soothing, not stressful., Conclusions: Future studies need to clarify how preterm infants process touch, which attributes of touch are fundamental trigger mechanisms of IH, and which handling strategies are most effective in lowering the incidence of IH during hands-on medical care., (© 2022 The Author(s). Published by S. Karger AG, Basel.)

Background: Electronic health record (EHR) has emerged as a backbone health care organization that aims to integrate health care records and automate clinical workflow. With the adoption of the eHealth care system, health information communication technologies and EHRs are offering significant health care advantages in the form of error reduction, improved communication, and patient satisfaction., Objective: This study aimed to (1) investigate factors associated with physicians' EHR adoption status and prevalence of EHRs in Kuwait and (2) identify factors predicting physician satisfaction with EHRs in public hospitals in Kuwait., Methods: This study was conducted at Kuwait's public Al-Jahra hospital from May to September 2019, using quantitative research methods. Primary data were gathered via questionnaires distributed among 295 physicians recruited using convenience sampling. Data were analyzed in SPSS using descriptive, bivariate, and multivariate linear regression, adjusted for demographics., Results: Results of the study revealed that the controlled variable of gender (β=-.197; P=.02) along with explanatory variables, such as training quality (β=.068; P=.005), perception of barriers (β=-.107; P=.04), and effect on physician (β=.521; P<.001) have a significant statistical relationship with physicians' EHR adoption status. Furthermore, findings also suggested that controlled variables of gender (β=-.193; P=.02), education (β=-.164; P=.03), effect on physician (β=.417; P<.001), and level of ease of use (β=.254; P<.001) are significant predictors of the degree of physician satisfaction with the EHR system., Conclusions: The findings of this study had significant managerial and practical implications for creating an inductive environment for the acceptance of EHR systems across a broad spectrum of health care system in Kuwait., (©Jawaher Al-Otaibi, Eleni Tolma, Walid Alali, Dari Alhuwail, Syed Mohamed Aljunid. Originally published in JMIR Medical Informatics (https://medinform.jmir.org), 07.10.2022.)

Abstract: Vibrio cholerae can cause pandemic cholera in humans. The bacterium resides in aquatic environments worldwide. Continuous testing of V. cholerae contamination in water and aquatic products is imperative for food safety control and human health. In this study, a rapid and visualized method was developed for the first time based on loop-mediated isothermal amplification (LAMP) for detection of the important virulence-related genes ace, zot, cri, and nanH for toxins and the infectious process of V. cholerae. Three pairs of molecular probes targeting each of these genes were designed and synthesized. The one-step LAMP reaction was conducted at 65°C for 40 min. Positive results were inspected by the production of a light green color under visible light or green fluorescence under UV light (302 nm). Limit of detection of the LAMP method ranged from 1.85 to 2.06 pg per reaction of genomic DNA or 2.50 × 100 to 4.00 × 102 CFU per reaction for target genes of cell culture of V. cholerae, which was more sensitive than standard PCR. Inclusivity and exclusivity of the LAMP method were 100% for all target genes. The method showed similar high efficiency to a certain extent in rapid testing of spiked or collected specimens of water and aquatic products. Target genes were detected by absence from all water samples from various sources. However, high occurrences of the nanH gene were observed in intestinal samples derived from four species of fish and one species of shellfish, indicating a risk of potentially toxic V. cholerae in commonly consumed aquatic products. The results in this study provide a potential tool for rapid and visualized detection of V. cholerae in water and aquatic products., (Published 2022 by the International Association for Food Protection.)

Background : Coronavirus disease 2019 (COVID-19) pandemic is unprecedented. Health science students are the future frontliners to fight pandemics. Awareness and perception toward COVID-19 among health science students and staff at Kuwait University was assessed. Methods : Between June and July 2020, an online questionnaire was distributed to all students and staff at HCS. The questionnaire was divided into six sections: socio-demography, risk and awareness, preparedness and prevention, source of information, policies, and social stigma. Results : A total of 592 students and 162 staff completed the questionnaire. The prevalence of self-reported chronic condition among students and staff was 14.0% and 19.1%, respectively. Moreover, self-reported COVID-19 prevalence among students and staff was 2.7% and 1.2%, respectively. Interestingly, 54% of students and 38.3% of staff reported that they knew someone within their immediate social environment who have been/are infected with SARS-CoV-2. Among students, 92.4% wore face mask in indoor places (outside of their home) 'often/all the time' compared to wearing it outdoors (69.3%); whereas, for staff, it was more common to wear it outdoor than in indoor places (75.9% vs. 81.5%). Willingness to take COVID-19 vaccine was indicated by 50% of students 'strongly agreed' and an additional 25.8% agreed to taking it. Interest vaccine uptake was lower among staff (28.4% and 34.6% strongly agreed or agreed, respectively). Participants strongly agreed or agreed (72.5% and 19.6% of students as well as 68.5% and 22.2% of staff ) that wearing face mask in public should be obligatory. More than 18% of students and staff indicated that they would avoid contact with COVID-19 infected people. Conclusions : Responses of students and staff were mostly similar and showed that they follow precautionary measures to control spread of COVID-19, understand the viral transmission risk, and willing to raise awareness to reduce social stigma., Competing Interests: No competing interests were disclosed., (Copyright: © 2021 Alali W et al.)

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has emerged as a global pandemic. Seroprevalence surveillance is urgently needed to estimate and monitor the growing burden of coronavirus disease 2019 (COVID-19). The aim of this study is to estimate the seroprevalence of SARS-CoV-2 infection among worker population residing in areas under lockdown in Kuwait and investigated their risk factors associated with a positive status. From April 18 to May 10, 2020 a randomly sampled, worker-based survey was conducted in 7 governorate in Kuwait (Ahmadi, Farwaniya, Hawali, Asma, Jahra, and Mubarak Alkabeer) among 10,256 workers. SARS-CoV-2 IgG and IgM antibodies was assessed using a commercially point-of-care lateral flow immunoassay (Biozek medical COVID-19 IgG/IgM Rapid Test Cassette). We estimated an overall seroprevalence (IgG or IgM positive) of 5.9% (95% CI: 5.4-6.3). Notably, SARS-CoV-2 seropositivity was significantly higher in males (6.2%) than females (1.9%) (  p  < 0.001). Furthermore, the seroprevalence was significantly different by age group, governorate, and nationality of the workers. These results highlighted that the relatively low prevalence of anti-SARS-CoV-2 antibodies in hotspot areas in a specific population. Thus, we emphasize to repeat the serosurvey in the general population to assess the magnitude of viral spread and monitor the growing burden of COVID-19 in Kuwait., Competing Interests: All authors declare that there are no conflicts of interests., (© 2021 The Author(s).)

Aims: Investigate the interactions of organic acids (OAs), acetic, butyric, citric, formic, lactic and propionic acid against 50 Gram-positive vancomycin-resistant Enterococcus faecium (VRE) strains to determine whether pH, undissociated or dissociated acid forms correlate with bacterial inhibition., Methods and Results: Concentrations of undissociated and dissociated OAs at the molar minimum inhibitory concentrations (MIC M s) of the VRE were calculated using the Henderson-Hasselbalch equation. The pH at the MIC M s of all VRE strains against acetic, butyric, formic and propionic acids was similar, 4·66 ± 0·07, but there was a 1·1 pH unit difference for all six OAs. Inhibition of VRE by all six OAs did not appear to be solely dependent on pH or on the undissociated OA species. The inhibition of VRE by all six dissociated acids was within Δ = 3·1 mmol l -1 ., Conclusions: Vancomycin-resistant Enterococcus faecium inhibition correlated with the dissociated OA species. A small decrease in the concentration of the dissociated OAs from optimum may result in allowing VRE strains to escape disinfection., Significance and Impact of the Study: When an OA is used to disinfect VRE strains, the concentration of the dissociated OA should be carefully controlled. A concentration of at least 20 mmol l -1 dissociated OA should be maintained when disinfecting VRE., (© 2018 The Society for Applied Microbiology.)

Introduction: Non-typhoidal Salmonella is considered one of the leading causes of foodborne disease worldwide. This protocol provides methods that will be used to synthesise available epidemiological data on non-typhoidal enteric Salmonella in humans and food in Middle East and North Africa (MENA) region and to characterise the morbidity of human salmonellosis in this region., Methods and Analysis: A systematic review will be conducted based on the Cochrane Collaboration handbook and will be reported following the items outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We will search PubMed, Embase, CAB Direct and Global Health Library (WHO) databases in order to identify relevant reports. Additionally, the literature search will be supplemented by checking references of the included reports and the identified reviews. Furthermore, we will hand-search conference proceedings and Ministry of Health's website of each country of the MENA region. We will use comprehensive search criteria with no time and no language restrictions. We will extract data on report and study characteristics, biological assay characteristics, individuals' demographic characteristics and on primary and secondary outcomes of interest. If appropriate, meta-analysis will be conducted in order to estimate pooled prevalence measures using DerSimonian and Laird random-effects models. We will conduct meta-regression analysis to explore the effect of study-level characteristics as potential sources of heterogeneity., Ethics and Dissemination: The results of the systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences., Trial Registration Number: The trial registration number is CRD42016046360., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

During the past century, the microbiological safety of the US food supply has improved; however, many foodborne illnesses and outbreaks occur annually. Hence, opportunities for the food industry to improve the safety of both domestic and imported food exist through the adoption of risk-based preventive measures. Challenging food safety issues that are on the horizon include demographic changes to a population whose immune system is more susceptible to foodborne and opportunistic pathogens, climate changes that will shift where food is produced, and consumers' preferences for raw and minimally processed foods. Increased environmental and product testing and anonymous data sharing by the food industry with the public health community would aid in identifying system weaknesses and enabling more targeted corrective and preventive actions. Clinicians will continue to play a major role in reducing foodborne illnesses by diagnosing and reporting cases and in helping to educate the consumer about food safety practices., (© 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.)

Bone-in and boneless parts, such as drumsticks, are used in ground chicken production. In addition, neck skin is used as a source of fat in ground products. Contaminated chicken neck skin and bones containing internalized Salmonella are potential sources of this pathogen in ground chicken. This study determined the prevalence of Salmonella and serotype distribution in drumstick bones and neck skin of postchill chicken carcasses. One week prior to slaughter, chicken houses (n = 26) at nine farms were tested for the presence of Salmonella, using the boot sock method. Chicken flocks from these houses originated from Salmonella-positive breeders. Eight Salmonella-positive chicken flocks and one flock with undetermined Salmonella status were monitored through processing. Three hundred postchill drumsticks and 299 neck skin samples were analyzed for Salmonella prevalence. Skin samples were rinsed and stomached prior to analysis. Bones were extracted from the drumsticks, external surfaces were sterilized, and bones were crushed for analysis. One Salmonella isolate from each positive sample was serogrouped. Half of the isolates representing different sample types were serotyped. Overall, Salmonella was found in 0.8, 21.4, and 80.1% of bone marrow, neck skin, and farms, respectively. Prevalence of Salmonella on rinsed skin samples (2.3%) and stomached skin samples (20.7%) differed significantly (P ≤ 0.05). Serogroups B, C2, D, and E were found at 23.4, 31.9, 11.7, and 29.8%, respectively. Six Salmonella serotypes were identified: Liverpool (37.9%), Kentucky (27.6%), and Typhimurium (27.6%) were isolated most frequently from neck skin; the two bone isolates were Kentucky; and more than 50% of the farm isolates were Kentucky and Ouakam. Salmonella-contaminated neck skin might be a more significant source of this contamination in ground chicken than Salmonella internalized in bones.

A cross-sectional study was performed to estimate the prevalence of Salmonella on retail market chicken carcasses in Colombia. A total of 1,003 broiler chicken carcasses from 23 departments (one city per department) were collected via a stratified sampling method. Carcass rinses were tested for the presence of Salmonella by conventional culture methods. Salmonella strains were isolated from 27 % of the carcasses sampled. Logistic regression analysis was used to determine potential risk factors for Salmonella contamination associated with the chicken production system (conventional versus free-range), storage condition (chilled versus frozen), retail store type (supermarket, independent, and wet market), poultry company (integrated company versus nonintegrated company), and socioeconomic stratum. Chickens from a nonintegrated poultry company were associated with a significantly (P < 0.05) greater risk of Salmonella contamination (odds ratio, 2.0) than were chickens from an integrated company. Chilled chickens had a significantly (P < 0.05) higher risk of Salmonella contamination (odds ratio, 4.3) than did frozen chicken carcasses.

The organic meat industry in the United States has grown substantially in the past decade in response to consumer demand for nonconventionally produced products. Consumers are often not aware that the United States Department of Agriculture (USDA) organic standards are based only on the methods used for production and processing of the product and not on the product's safety. Food safety hazards associated with organic meats remain unclear because of the limited research conducted to determine the safety of organic meat from farm-to-fork. The objective of this review is to provide an overview of the published results on the microbiological safety of organic meats. In addition, antimicrobial resistance of microbes in organic food animal production is addressed. Determining the food safety risks associated with organic meat production requires systematic longitudinal studies that quantify the risks of microbial and nonmicrobial hazards from farm-to-fork.

Data regarding Salmonella on raw poultry are very limited in China. The objective of this study was to determine the prevalence of Salmonella on raw poultry at the retail level in six provinces and two national cities in China. Whole chicken carcasses (n = 1,152) were collected from three types of retail markets (large, small, and wet). All samples were analyzed for the presence of Salmonella by using the U.S. Department of Agriculture, Food Safety Inspection Service method. Of 1,152 chicken samples, overall Salmonella prevalence was 52.2%. The highest prevalence was observed in Guangxi Province (65.3%), next in Guangdong Province (64.6%), and then in Beijing (63.9%), Shaanxi Province (50.7%), Henan Province (47.9%), Shanghai (44.4%), and Fujian Province (42.4%), and lowest prevalence was observed in Sichuan Province (38.9%). Salmonella prevalence was significantly different among the six provinces and two national cities. Salmonella prevalence was highest in the wet markets (54.4%) compared with the large markets (50.3%) and the small markets (52.1%), but differences were not significant (P > 0.05). Good manufacturing practices, good agricultural practices, and hazard analysis critical control point systems for Salmonella control in poultry production at the farm, processing, and retail level should be implemented.

Background: Escherichia coli serogroup O157:H7 has emerged as an important zoonotic bacterial pathogen, causing a range of symptoms from self-limiting bloody diarrhea to severe hemorrhagic colitis and hemolytic-uremic syndrome in humans. Beef and dairy cattle are considered the most important animal reservoirs for this pathogen. One of the important virulence characteristics of E. coli O157:H7 is the eaeA gene encoding the 97 kDa surface protein intimin. Intimin is required for attachment and effacement during the interaction of enterohemorrhagic E. coli with human and bovine neonatal enterocytes. The present study was undertaken to test the hypothesis that an adaptive mucosal immune response directed against intimin will reduce or prevent enteric colonization and fecal shedding of E. coli O157:H7 in cattle., Results: Cattle were orally inoculated with either milk (control), milk with live attenuated Salmonella enterica serovar Dublin (vector), or milk with live attenuated recombinant S. Dublin expressing intimin (vaccinated) on days 0, 14 and 28. On day 98, all calves were challenged orally with E. coli O157:H7 to evaluate whether vaccination with the recombinant S. Dublin expressing intimin would reduce the level of E. coli O157:H7 fecal shedding.During the first 28 days, vaccinated calves shed both the vector strain and the intimin-expressing S. Dublin strain at a similar level. The vector strain was shed for a significantly longer period as compared to the level of recombinant vaccine strain. Calves that received the intimin-expressed vaccine ceased shedding S. Dublin from day 28 to day 63. All calves were challenged with E. coli O157:H7 on day 98 to determine the effect on fecal shedding of E. coli O157:H7. The amount of E. coli O157:H7 in feces was measured for 30 days post-challenge. We observed a transient clearance of E. coli O157:H7 from the feces in the vaccinated calves. The magnitude of fecal E. coli O157:H7 shedding did not correlate with the presence of intimin-specific fecal IgA., Conclusion: Oral vaccination with live attenuated recombinant S. Dublin expressing intimin reduced enteric colonization and fecal shedding of E. coli O157:H7. However, the transient clearance of E. coli O157:H7 was not associated with an enhanced IgA-mediated mucosal immune response.

Statistical methods employed to analyze antimicrobial resistance (AR) phenotypic data have largely focused on multiple individual antimicrobial resistance outcomes without considering the pharmacologic and biological dependence among these data. In our 3-year longitudinal study, the relationship between AR phenotype of E. coli isolates from integrated multi-site group cohorts of humans and swine and the following risk factors: host-species (human versus swine) and human vocation (swine-workers versus non-workers) was assessed; first, by using cluster analysis techniques and then multivariate generalized estimating equation (GEE) models. Human sewage wastewater draining from occupation-specific housing and swine fecal E. coli isolates (n=3,113 and 3,428, respectively) were tested for antimicrobial susceptibility to 15 agents on the 2003 NARMS panel using the Sensititre system (Trek Diagnostics, Cleveland, OH). The MIC values for each isolate were interpreted according to standardized breakpoints into resistant or susceptible. The phenotypic data (n=6,541) were cluster-analyzed using Ward's minimum variance with Jaccard's distance measure. The multivariate relationships of E. coli cluster membership with the risk factors in the study were assessed using a multivariate GEE model in a SAS((R)) macro to adjust for the multiple cluster dependencies as well as adjusting for response dependencies within each unit location. The cluster solution that best described our entire dataset and where the multivariate GEE model converged was 14. In general, the adjusted odds-ratios of the multiple clusters (i.e., 14 clusters) for human isolates were significantly (P<0.05) at a higher odds of being in the pansusceptible cluster (OR=12.8), and also in clusters that contained high levels of resistance to amoxicillin/clavulanic acid, ampicillin, cefoxitin, nalidixic acid, sulfisoxazole, and/or trimethoprim/sulfamethoxazole, when compared to swine isolates. The adjusted odds-ratios of the multiple clusters for non-swine worker isolates were at significantly (P<0.05) higher risk of being in the pansusceptible cluster (OR=13.6) compared to swine-worker isolates (OR=12.1) (swine isolates were the referent group). In general, the adjusted odds-ratios of the multiple clusters for swine-worker E. coli isolates were significantly (P<0.05) at higher odds of being in multi-resistant clusters (defined as resistant to >or=3 antimicrobial agents) as compared to non-swine worker isolates. Considering vocation, swine-worker E. coli isolates exhibited increased odds of falling in multi-drug resistance clusters compared to those isolates arising from non-swine-workers.

The objective of this longitudinal controlled trial was to quantitatively compare carriage of a gene encoding for ceftiofur-resistance (bla(CMY-2)), standardized to a reference gene (16SrRNA), among total community DNA extracted from fecal samples collected from cattle treated with three different dose regimens of ceftiofur crystalline-free acid (CCFA) versus those untreated (controls). Sixty-one steers were assigned to three treatment regimens and housed in six pens. In each pen, five steers were treated and five were controls (one of the pens had six controls). CCFA administration was as follows: two-thirds dose treatment (4.4 mg/kg, on day 0), single-dose treatment (6.6 mg/kg, on day 0), and three-dose treatment (6.6 mg/kg, on days 0, 6, and 13). Fecal samples were collected on days 0, 3, 7, 10, 14, 18, 21, and 28. The gene copy numbers/gram of feces for bla(CMY-2) and 16SrRNA were determined in total community DNA samples using quantitative real-time PCR. The relationships between the quantities of standardized bla(CMY-2), nonstandardized bla(CMY-2), and nonstandardized 16SrRNA, and the explanatory variables (treatment, time, and treatment x time) were assessed using repeated measures mixed models. There were significant differences in each of the three models with respect to each explanatory variable. Overall, while steers administered three doses and two-thirds dose of CCFA had significantly higher quantities of nonstandardized bla(CMY-2) than controls, the standardized values were lower. The administration of CCFA in feedlot cattle may provide selection pressure favoring higher levels of bla(CMY-2) carriage, but this may also lead to concurrent reductions in the total bacterial population (as reflected by lowered 16SrRNA) during the treatment period.

The objective of this longitudinal ecological study was to examine the relationship between the prevalence of antibiotic-resistant (AR) commensal Escherichia coli isolates from both monthly human wastewater and composite swine fecal samples and the concurrent aggregated monthly antibiotic use recorded within each host species in multi-site vertically integrated swine and human populations. In addition, human vocation (swine worker versus non-swine worker), swine production group, and season were examined as potential confounding variables. Human and swine E. coli isolates (n=2469 human and 2310 swine, respectively) were tested for antimicrobial susceptibility using a commercial broth microdilution system. In the human population, among swine workers the relative odds of tetracycline resistance were increased significantly for tetracycline (class) drug use at the third quartile and above of mean monthly dosage (MMD) (OR=1.8) as compared to the referent category (non-use). The relative odds of ciprofloxacin resistance were significantly increased for ciprofloxacin use in non-swine workers (OR=5.5) as compared to the referent (non-use). The relative odds of tetracycline resistance were increased significantly for chlortetracycline use in medicated feed for the upper tertile of MMD category (OR=2.9) as compared to the referent category (no use) across all swine production groups. While high variability among seasonal samples over the 3-year period was observed, no common seasonal trends relating to antibiotic use and prevalence of resistance over the 3-year period were apparent. The overall effects of concurrent human and swine antibiotic use on AR E. coli levels were inconsistent and modest in this study.

We examined antimicrobial resistance (AR) phenotypes among commensal Escherichia coli isolated from fecal matter of humans and swine housed in a semi-closed and uniquely integrated multi-site farrow-to-plate operation. Aggregate cohorts of humans consisted of (1) "control" groups of consumers, (2) groups of swine workers, and (3) groups of slaughter-plant workers. Analyses of cross-sectional AR data from 472 human and 376 swine isolates are presented. AR phenotypes among these isolates were compared by (1) host species, (2) facility location, (3) facility type, (4) housing (human) or production (swine) cohort, and (5) sample collection period and time of day. There were significant (p < 0.05) differences in isolates among host-species with swine uniformly at greater risk for (1) AR to four specific antimicrobials (kanamycin, streptomycin, sulfamethoxazole, tetracycline), and (2) multiple resistance phenotypes (p < 0.0001). Facility type and unit location were more often associated with AR differences among swine isolates than among human isolates. Swine production group was significantly associated with AR prevalence (p < 0.05) for nine antimicrobials; in general, purchased boars, suckling piglets, weaned piglets, and lactating sows were at higher risk of AR. There was no significant (p > 0.05) association of human occupational/consumer cohort with AR prevalence. Several unique AR phenotypes were detected in each of the human- and swine-intake groups. These data establish baseline characteristics for an on-going 3-year longitudinal study designed to further characterize AR phenotype and genotype in this population. Host-, facility-, and cohort-specific data demonstrate that sufficient prevalence differences exist to permit the future quantification of AR transmission, should it occur. Based on these cross-sectional data, occupational exposure to either swine-rearing or swine-slaughter facilities does not appear to be associated with the prevalence of phenotypic resistance among the commensal fecal E. coli isolated from this integrated system.