Molecular Characterization by Using Next-Generation Sequencing of Plasmids Containing blaNDM-7 in Enterobacteriaceae from Calgary,Canada

Enterobacteriaceae with bla_NDM-7 are relatively uncommon and had previously been described in Europe, India, the United States, and Japan. This study describes the characteristics of Enterobacteriaceae (Klebsiella pneumoniae [n = 2], Escherichia coli [n = 2], Serratia marcescens [n = 1], and Enterobacter hormaechei [n = 1] isolates) with bla_NDM-7 obtained from 4 patients from Calgary, Canada, from 2013 to 2014. The 46,161-bp IncX3 plasmids with bla_NDM-7 are highly similar to other bla_NDM-harboring IncX3 plasmids and, interestingly, showed identical structures within the different isolates. This finding may indicate horizontal transmission within our health region, or it may indicate contact with individuals from areas of endemicity within the hospital setting. Patients infected or colonized with bacteria containing bla_NDM-7 IncX3 plasmids generate infection control challenges. Epidemiological and molecular studies are required to better understand the dynamics of transmission, the risk factors, and the reservoirs for bacteria harboring bla_NDM-7. To the best of our knowledge, this is the first report of S. marcescens and E. hormaechei with bla_NDM-7.     

Patterns of Self-reported Behaviour Change Associated with Receiving Voluntary Counselling and Testing in a Longitudinal Study from Manicaland, Zimbabwe

Voluntary counselling and testing (VCT) is promoted as a potential HIV prevention measure. We describe trends in uptake of VCT for HIV, and patterns of subsequent behaviour change associated with receiving VCT in a population-based open cohort in Manicaland, Zimbabwe. The relationship between receipt of VCT and subsequent reported behaviour was analysed using generalized linear models with random effects. At the third survey, 8.6% of participants (1,079/12,533), had previously received VCT. Women who received VCT, both those positive and negative, reduced their reported number of new partners. Among those testing positive, this risk reduction was enhanced with time since testing. Among men, no behavioural risk reduction associated with VCT was observed. Significant increases in consistent condom use, with regular or non-regular partners, following VCT, were not observed. This study suggests that, among women, particularly those who are infected, behavioural risk reduction does occur following VCT.     

Obstacles to local-level AIDS competence in rural Zimbabwe: putting HIV prevention in context

We explore the wider social context of an HIV-prevention programme in rural Zimbabwe. We make no comment on the programme itself, rather seeking to examine the wider community dynamics into which it was inserted, to highlight how pre-existing social dynamics may have influenced community "readiness" to derive optimal benefit from the intervention. Using the concept of "the AIDS competent community", we analysed 44 interviews and 11 focus groups with local people. Despite high levels of HIV/AIDS-related knowledge, there were several ways gender, poverty and low literacy may have undermined its perceived relevance to peoples' lives. Lack of opportunities for dialogue in the social milieu beyond the intervention may have limited opportunities for translating factual AIDS knowledge into action plans, or sharing hidden individual experiences of HIV/AIDS-affected family members or friends, given stigma and denial. The initiative of women and young people to respond effectively to AIDS was limited in a context dominated by adult males. People spoke of HIV/AIDS in a passive and fatalistic way, expecting outsiders to solve the problem. This tendency was exacerbated given the community's previous experiences of HIV/AIDS-related NGOs, which had often regarded local people as unpaid volunteer labour rather than building their capacity to make significant decisions and play leadership roles in health programmes. Despite obstacles, however, there were many potential community strengths and resources. There were high levels of HIV/AIDS-related knowledge. Public denial of HIV/AIDS masked huge reservoirs of private support and kindness to AIDS-affected family and friends. There were many strong community organisations and clubs, potentially forming the springboard for more empowered community responses to HIV/AIDS. HIV/AIDS programmers should pay greater attention to community readiness for interventions, especially around: (1) identifying and anticipating pre-existing obstacles to programme success and (2) mobilising the social assets that exist, even in contexts of poverty and gender inequality.     

Population-Based Study of the Epidemiology and the Risk Factors for <Emphasis Type="Italic">Pseudomonas aeruginosa</Emphasis> Bloodstream Infection

Background:   

Detailed population-based data on the epidemiologyof Pseudomonas aeruginosa bloodstream infectionsare sparse. We sought to describe the incidence rate, riskfactors, and outcomes associated with P. aeruginosa bacteremiain a large Canadian health region.     

Periostitis Secondary to Prolonged Voriconazole Therapy in Lung Transplant Recipients

We report five cases of possible drug‐induced periostitis associated with long‐term use of voriconazole therapy after lung transplantation (LT). The diagnosis of periostitis was made by the documentation of bone pain, elevation of serum alkaline phosphatase and characteristic findings on radionuclide bone imaging in the absence of any identifiable rheumatologic disease. This periostitis appears similar to hypertrophic osteoarthopathy (HOA) but does not meet all criteria for HOA. In all patients, the symptoms resolved rapidly after discontinuation of voriconazole therapy. Awareness of this potential syndrome, which manifests as bone pain, elevated serum alkaline phosphatase and a bone scan suggestive of periostitis, is necessary in LT recipients on long‐term voriconazole.     

Critique of early models of the demographic impact of HIV/AIDS in sub-Saharan Africa based on contemporary empirical data from Zimbabwe

Early mathematical models varied in their predictions of the impact of HIV/AIDS on population growth from minimal impact to reductions in growth, in pessimistic scenarios, from positive to negative values over a period of 25 years. Models predicting negative rates of natural increase forecast little effect on the dependency ratio. Twenty years later, HIV prevalence in small towns, estates, and rural villages in eastern Zimbabwe, has peaked within the intermediate range predicted by the early models, but the demographic impact has been more acute than was predicted. Despite concurrent declines in fertility, fueled in part by HIV infections (total fertility is now 8% lower than expected without an epidemic), and a doubling of the crude death rate because of HIV/AIDS, the rate of natural population increase between 1998 and 2005 remained positive in each socioeconomic stratum. In the worst-affected areas (towns with HIV prevalence of 33%), HIV/AIDS reduced growth by two-thirds from 2.9% to 1.0%. The dependency ratio fell from 1.21 at the onset of the HIV epidemic to 0.78, the impact of HIV-associated adult mortality being outweighed by fertility decline. With the benefit of hindsight, the more pessimistic early models overestimated the demographic impact of HIV epidemics by overextrapolating initial HIV growth rates or not allowing for heterogeneity in key parameters such as transmissibility and sexual risk behavior. Data collected since the late 1980s show that there was a mismatch between the observed growth in the HIV epidemic and assumptions made about viral transmission.     

Community-onset Urinary Tract Infections: A Population-based Assessment

Abstract Background: Although multiple studies have investigated community-onset urinary tract infections (UTI), population-based data are lacking. We therefore conducted population-based laboratory surveillance in order to define the incidence, demographic risk factors, etiology, and antimicrobial susceptibilities of community onset UTI in a large Canadian region. Methods: Laboratory surveillance for all community onset UTIs among residents of the Calgary Health Region (population ~1.2 million) was conducted during 2004/2005. Repeated positive samples within a 1-month period and those infections first cultured more than 2 days after admission to a hospital were excluded. Results: A total of 40,618 episodes of community onset UTI occurred among 30,851 residents for an overall annual incidence of 17.5 per 1,000. Seventy-four percent of the cultures were submitted from ambulatory patients, 18% from hospitalized patients within the first 2 days of admission, and 9% from nursing home residents. Females were at significantly increased risk as compared to males (30.0 vs 5.0 per 1,000, RR 5.98; 95% CI, 5.81–6.15; p < 0.0001) as were the very young and very old. The most common infecting organisms were Escherichia coli (70%), Klebsiella pneumoniae (7%) and Enterococcus species (6%). Overall resistance rates among first isolates per patient tested were 14% for trimethoprim/sulfamethoxazole, 8% for cefazolin, 7% for nitrofurantoin, 6% for ciprofloxacin, 4% for gentamicin, and 2% for ceftriaxone although rates differed significantly based on sending location and patient age. Conclusion: This study provides novel information on the epidemiology of community-onset UTIs in a non-selected Canadian population. The occurrence, etiology, and resistance rates of community onset UTI differ significantly among definable population groups.