Monday, November 25, 2024

Detroit health professionals urge the community to act and address the dangers of antimicrobial resistance

Wayne State University - Office of the Vice President for Research

DETROIT — Wayne State University's Center for Emerging and Infectious Diseases (CEID) is launching its participation in World AMR Awareness Week with an urgent message: the growing threat of antimicrobial resistance requires immediate community action, so it is critical to educate, advocate, and act now.

Antimicrobial Resistance (AMR) occurs when bacteria, viruses, fungi, and parasites no longer respond to antimicrobial agents. Because of drug resistance, antibiotics and other antimicrobial agents become ineffective and infections become difficult or impossible to treat, increasing the risk of spreading various diseases that may lead to severe illness or even death.

"Antimicrobial resistance isn't just a future threat—it's a present crisis affecting our Detroit community right now," said Marcus Zervos, M.D., co-director of CEID. "When common infections become resistant to treatment, routine medical procedures become increasingly dangerous. We're seeing this challenge firsthand in our hospitals."

World AMR Awareness Week is a global campaign to raise awareness and understanding of AMR and promote best practices to address it. It goes from Monday, Nov. 18 to Sunday, Nov. 24. CEID will lead initiatives highlighting this year's theme, “Educate, Advocate, Act Now.”

CEID officials say that Detroit has become an important community in the observation and response to AMR, with several new types of resistant microorganisms first being observed in the southeast Michigan area.

"In Detroit's healthcare facilities, we're encountering more cases where standard antibiotics are failing,” said Teena Chopra, M.D., M.P.H., an infectious diseases expert and co-director at CEID. “This puts our most vulnerable populations at heightened risk."

Increased use and misuse of antimicrobials across sectors and other microbial stressors, such as pollution, create favorable conditions for microorganisms to develop resistance. Bacteria in water, soil and air, for example, can become resistant to common antibiotics following contact with resistant microorganisms. Human exposure to AMR in the environment can occur through contact with polluted waters, contaminated food, inhalation of fungal spores, and other pathways that contain antimicrobial resistant microorganisms.

Health experts have several suggestions to help prevent AMR: Only use antibiotics when prescribed by healthcare professionals, complete the full course of prescribed antibiotics, practice regular hand hygiene, keep vaccinations up to date, properly dispose of unused medications, and learn about infection prevention. CEID experts want the public to understand that antibiotics are not just another medication; they're a precious resource that must be protected through informed usage.

"The public needs to be aware of the potential presence of drug-resistant bacteria in our food supply," said Paul Kilgore, M.D., M.P.H., F.A.C.P, a professor and director of research for the Department of Pharmacy Practice in Wayne State University and co-director of CEID. "As antimicrobial resistance increases globally, some bacteria are becoming resistant to multiple antibiotics, creating dangerous 'superbugs' that pose significant risks to public health. It is important that people adopt responsible practices in their daily lives for using antibiotics and other antimicrobial agents. Important steps include using antibiotics only when prescribed, avoid sharing antibiotics or using them for non-infectious conditions, vaccinate to prevent disease, use good hygiene by washing your hands regularly, practice safe food handling, and educate others about the importance of using antibiotics responsibly and the risks of antimicrobial resistance.”

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About Wayne State University

Wayne State University is one of the nation’s pre-eminent public research universities in an urban setting. Through its multidisciplinary approach to research and education, and its ongoing collaboration with government, industry and other institutions, the university seeks to enhance economic growth and improve the quality of life in the city of Detroit, state of Michigan and throughout the world. For more information about research at Wayne State University, visit research.wayne.edu.

Wayne State University’s research efforts are dedicated to a prosperity agenda that betters the lives of our students, supports our faculty in pushing the boundaries of knowledge and innovation further, and strengthens the bonds that interconnect Wayne State and our community. To learn more about Wayne State University’s prosperity agenda, visit president.wayne.edu/prosperity-agenda.

Genomic surveillance studies reveal circulation of multidrug-resistant Enterobacterales in Europe

Two studies indicate warning signs about spread of bacteria resistant to the same group of antibiotics (carbapenems) in both healthcare and community settings across Europe.

European Centre for Disease Prevention and Control (ECDC)

image:
Phylogenetic tree of Escherichia coli ST131 isolates, including its single locus variants included in the genomic relatedness
analysis, EU/EEA and outside, 2005–2024 (n = 691).
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Credit: Eurosurveillance journal

Patients seeking treatment in hospital or other healthcare facilities can be particularly vulnerable for infections they acquire during their stay, especially if the infections are difficult to treat because they are resistant to commonly used drugs. For example, Carbapenem-resistant Enterobacterales (CRE) are known to particularly affect hospitalised patients. [1]

Two studies published in Eurosurveillance marking World AMR Awareness Week from 18 to 22 November 2024, analysed new data on spread of such CRE, namely Escherichia coli sequence type (ST)131 producing various carbapenemases and New Delhi metallo-beta-lactamase-1 (NDM-1)-producing Providencia stuartii to inform potential public health action.

Escherichia coli lineage with emerging resistance pattern spreads in the community

In a rapid communication, Kohlenberg et al. assessed genomic and epidemiological data from 17 EU/EEA countries and observed an emergence of Escherichia coli that produces carbapenemases.

Worldwide, E. coli is the pathogen associated with most deaths attributable to antimicrobial resistance [2] and the specific type of E. coli that the authors investigated in their study (ST 131) has been detected across the world and is frequently associated with multidrug-resistance.

Kohlenberg et al. analysed the sequencing and epidemiological data of almost 600 E. coli ST131 isolates provided by national reference laboratories from Austria, Belgium, Czechia, Denmark, Finland, France, Hungary, Ireland, Germany, Latvia, Lithuania, Luxembourg, the Netherlands, Norway, Portugal, Slovenia and Sweden. [3]

Detection of E. coli ST131 isolates producing carbapenemases increased over time. One group of isolates stood out for potential association with urinary tract infections in the community inferred from the relatively low median age of patients (57 years), a high proportion of female patients and the frequent detection of isolates from urine samples. The authors note that “community-acquired urinary tract infections might only represent the tip of the iceberg in terms of patient colonisation in the community”.

While Kohlenberg et al. acknowledge they did not analyse a random population of E. coli ST131 but pre-selected isolates from the reference laboratories which probably resulted in an isolate collection with a higher likelihood for co-carriage of other resistance markers, they argue that the results of their study across 17 EU/EEA countries “sends another warning about the worsening epidemiological carbapenemase-producing Enterobacterales situation in the EU/EEA. Further spread of E. coli carrying carbapenemase genes would mean that carbapenems could no longer be consistently effective for empiric treatment of severe E. coli infections.”

Sustained transmission of carbapenem-resistant Providencia stuartii in the healthcare system
One type of CRE which has been very rare in Europe thus far – New Delhi metallo-beta-lactamase-1 (NDM-1)-producing Providencia stuartii – has now been detected in several hospitals in Romania.

In their genomic investigation, Linkevicius et al. [4] looked at how NDM-1-producing P. stuartii is spreading in hospitals with the aim to generate timely information to control any further transmission.

In their study, the authors analysed 74 P. stuartii samples they received from six hospitals across Romania. Most (n=72/74) of the retrieved isolates were related to a reported infection among patients, such as lower respiratory tract bloodstream or urinary tract infections. The authors categorised the majority of the infections as healthcare-associated, i.e. the patients acquired them in a hospital or other healthcare setting. [3]

Given their resistance to several antibiotic classes like penicillins, cephalosporins and carbapenems, 90% of the tested isolates in this study were categorised as multidrug-resistant. In their investigation, Linkevicius et al. identified four multi-hospital clusters of such resistant isolates detected over a year. This indicates sustained transmission within the Romanian healthcare system over a longer period.

Putting their study results into international context by comparing with data from other countries, the authors could also connect the specific lineage of P. stuartii detected in Romania to isolates found in other countries, i.e. Bulgaria, France, Germany, Ireland, the Netherlands, Switzerland, the United Kingdom and the United States of America.

They conclude that “sustained transmission in hospitals in Romania and the international spread point to high risk of further transmission of NDM-1-producing P. stuartii in healthcare settings. Enhanced infection prevention and control measures should be put in place as soon as cases are detected in healthcare facilities.”

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References/notes to editors:
[1] Enterobacterales are a group of bacteria (germs) that are a normal part of the human and animal gut but can also cause infections. Carbapenem-resistant Enterobacterales (CRE) are germs resistant to one or several antibiotics called carbapenems. See: https://www.cdc.gov/cre/about/index.html

[2] Kohlenberg Anke, Svartström Olov, Apfalter Petra, Hartl Rainer, Bogaerts Pierre, Huang Te-Din, Chudejova Katerina, Malisova Lucia, Eisfeld Jessica, Sandfort Mirco, Hammerum Anette M, Roer Louise, Räisänen Kati, Dortet Laurent, Bonnin Rémy A, Tóth Ákos, Tóth Kinga, Clarke Christina, Cormican Martin, Griškevičius Algirdas, Khonyongwa Kirstin, Meo Marie, Niedre-Otomere Baiba, Vangravs Reinis, Hendrickx Antoni PA, Notermans Daan W, Samuelsen Ørjan, Caniça Manuela, Manageiro Vera, Müller Vilhelm, Mäkitalo Barbro, Kramar Urška, Pirs Mateja, Palm Daniel, Monnet Dominique L, Alm Erik, Linkevicius Marius. Emergence of Escherichia coli ST131 carrying carbapenemase genes, European Union/European Economic Area, August 2012 to May 2024. Euro Surveill. 2024;29(47)
Available from: https://doi.org/10.2807/1560-7917.ES.2024.29.47.2400727

[3] Murray CJL, Ikuta KS, Sharara F, Swetschinski L, Robles Aguilar G, Gray A, et al. Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet. 2022;399(10325):629-55. Available from: http://dx.doi.org/10.1016/S0140-6736(21)02724-0 PMID:35065702

[4] Linkevicius Marius, Witteveen Sandra, Buzea Mariana, Flonta Mirela, Indreas Marina, Nica Maria, Székely Edit, Tălăpan Daniela, Svartström Olov, Alm Erik, Palm Daniel, Monnet Dominique L, Hendrickx Antoni PA, Kohlenberg Anke, Popescu Gabriel Adrian. Genomic surveillance detects interregional spread of New Delhi metallo-beta-lactamase-1-producing Providencia stuartii in hospitals, Romania, December 2021 to September 2023. Euro Surveill. 2024;29(47):pii=2400587. Available from: https://doi.org/10.2807/1560-7917.ES.2024.29.47.2400587

[5] Healthcare-associated infections are infections acquired by patients during their stay in a hospital or another healthcare setting. Although some of these infections can be treated easily, others may more seriously affect a patient’s health, increasing their stay in the hospital and hospital costs, and causing considerable distress to these patients.

The most frequently reported types of healthcare-associated infections are respiratory tract infections, surgical site infections, urinary tract infections, bloodstream infections and gastro-intestinal infections. See: https://www.ecdc.europa.eu/en/healthcare-associated-infections

Journal

Eurosurveillance

DOI

10.2807/1560-7917.ES.2024.29.47.2400727

Method of Research

Data/statistical analysis

Article Title

Emergence of Escherichia coli ST131 carrying carbapenemase genes, European Union/European Economic Area, August 2012 to May 2024

Article Publication Date

21-Nov-2024

Cary scientists act fast to study spongy moth impacts on disease-carrying ticks

Spongy moth caterpillars defoliated Hudson Valley forests this summer. Is that good or bad news for ticks that carry Lyme disease? With a RAPID grant from the National Science Foundation, Cary scientists aim to find out.

Cary Institute of Ecosystem Studies

Defoliation snapshots, Millbrook, NY — image:
Photos taken at the same location on the Cary Institute's grounds on May 21, 2024 (left) and June 4, 2024 (right).

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Credit: Photo: Mike Fargione/Cary Institute of Ecosystem Studies

(Millbrook, NY) In June, Cary Institute’s hardwood forest — stripped of its foliage by hordes of invasive spongy moth caterpillars — more closely resembled a savanna. Standing in a grassy area doused in sunlight, Kelly Oggenfuss pointed out, “This spot would normally be a lot shadier, and the ground would be covered in leaf litter.”

Oggenfuss has been collecting data at this site for 25 years as part of Cary’s long-term project studying the ecology of tick-borne diseases, and she had never seen it like this before.

Cary’s campus in Millbrook, NY, was hit hard by the invasive spongy moth this spring and summer. Defoliation of oak trees — the pest’s favorite food — reached nearly 100%, and other species, including evergreens, suffered significant damage. Cary was not alone; the caterpillars denuded much of the Mid-Hudson Valley region before they died or retreated into cocoons, allowing the trees to unfold new leaves.

Because Oggenfuss and the tick ecology team — led by Cary disease ecologists Richard Ostfeld and Shannon LaDeau — had already been studying how heat and moisture at the ground level shapes tick survival, the team realized the sudden increase in light due to defoliation might have serious implications for ticks and the diseases they spread to humans. So they applied for, and quickly won, a RAPID grant from the National Science Foundation. RAPID grants are fast-tracked to allow scientists to study unanticipated and fast-changing conditions.

With an award of $179,544, the team sprang into action, scaling up the experiments they had already started. The one-year project is assessing how spongy moth defoliation shapes the survival of blacklegged ticks, the main vectors of the pathogens that cause Lyme disease, babesiosis, and anaplasmosis.

“We know from our previous research that if it's very warm and dry, that's really bad for some life stages of ticks,” said Ostfeld. “So if this defoliation by the spongy moths is changing temperature and humidity conditions on the ground, it could influence their survival, and as a consequence, our risk of getting sick from tick-borne disease.”

To examine the impacts on ticks, the team set up 144 mesh enclosures. The enclosures are bags made of white organza, the same material often used in wedding party favors. However, the contents are definitely not suitable for a party. Each bag contains a small cylinder of the natural layer of soil and leaf litter, two data loggers the size of watch batteries that record temperature and humidity, and a certain number of blacklegged ticks. The crew ties each bag, trapping the ticks inside, then comes back in a few weeks to count how many survived.

Under the RAPID grant, the tick enclosures are evenly deployed in three kinds of conditions: heavily defoliated areas, areas with lower defoliation, and in defoliated locations under a shade cloth to simulate an intact canopy. The team will measure tick survival under each condition, and with each tick life stage. They started with larvae in September. Next they’ll deploy adults in November, and nymphs in May 2025, matching their natural seasonal patterns.

Ostfeld and LaDeau hypothesize that ticks in the most defoliated areas will experience warmer and drier conditions, and therefore higher mortality rates. However, ecological responses to change are notoriously complex and unpredictable, and the team is prepared for nature to throw a curveball. For example, the scientists have already observed that more light coming through to the forest floor has allowed understory plants to thrive in areas where they’re normally not found.

“The crew was blown away by the degree to which grasses and forbs underwent this amazing flush of growth in the understory,” said Ostfeld. “So in terms of the impact on ticks, it could go either way. It could be that the loss of leaves from the trees makes it hotter and drier and kills a lot of ticks. Or it could be that the loss of leaves from the trees makes conditions just lovely for ticks, because of all this flush of greenery.”

In another interesting dynamic, the flush of ground-level plants seems to have welcomed large numbers of meadow voles into the study sites, where they’re not commonly found. This influx could mean that many ticks will feed on voles instead of mice and chipmunks. Voles are less likely to pass pathogens to the ticks, and may be more likely to kill the ticks that bite them, and therefore could influence tick survival and disease risk.

Cary scientists are uniquely poised to keep a finger on the pulse of these dynamics, as they’ve been studying interactions like these for almost 35 years.

The long-term project has revealed connections between acorn production, rodent population size, and ticks that carry Lyme disease bacteria. When oak trees drop a lot of acorns in the fall, for example, the all-you-can-eat acorn buffet can lead to surges in populations of white-footed mice and other rodents the following year. Ticks are then more likely to feed on these rodents, which happen to be very good at sharing the bacteria that cause Lyme disease. Hence, more ticks are then capable of spreading Lyme disease if they bite a human the following year.

Over the years, the team has investigated many other ecological dynamics surrounding these interactions. Predators such as foxes and bobcats can lower Lyme disease risk, they learned, possibly by killing and eating rodents, and/or serving as an alternate food source for ticks. The team also discovered that years with high numbers of mice and chipmunks can be devastating for birds that nest on the ground, as the rodents are more likely to eat their eggs and young.

This isn’t the first time spongy moths have been included in the long-term experiment. Many years ago, the project revealed that when mice are abundant, they have some capacity to regulate spongy moth populations by eating the moth’s cocoons.

“Now we’re coming at it from a new angle,” said Ostfeld. “It’s the same players, but different interactions.”

As part of the long-term project, the team had already deployed soil cores and were tracking microhabitat data when the spongy moth infestation exploded. Those data will no doubt prove useful in understanding how defoliation affects tick survival, but the RAPID grant allowed the team to rapidly scale up their efforts.

“The level of defoliation this summer was a surprise to all of us,” said LaDeau. “It's pretty remarkable that we were able to respond and get funding and start studying it as quickly as we did. And a lot of that wouldn't have happened without the longer-term project in place.”

The new study will clarify how dramatic ecological changes — from spongy moth infestations to the hotter and drier conditions projected in some locations — influence tick survival, and what that means for people. LaDeau and Ostfeld are eager to plug their findings into a custom model they’ve been developing with collaborators to generate real-time forecasts of tick populations and local risk of Lyme disease.

Finding out whether the ticks thrive or “take it on the chin,” in Ostfeld’s words, may turn out to be key to understanding that risk over the next few years.

Project assistant Marie Young uses a paint brush to gently add ticks to a soil core enclosure. She is surrounded by burnweed, a species that never occurred on these forested plots before the spongy moth defoliation.

Credit

Photo: Morgan Lilley/Cary Institute of Ecosystem Studies

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Cary Institute of Ecosystem Studies is an independent nonprofit center for environmental research. Since 1983, our scientists have been investigating the complex interactions that govern the natural world and the impacts of climate change on these systems. Our findings lead to more effective resource management, policy actions, and environmental literacy. Staff are global experts in the ecology of: cities, disease, forests, and freshwater.

Animal characters can boost young children’s psychological development, study suggests

University of Plymouth

Children’s books are full of animal characters whose antics capture the hearts and inspire the imaginations of their young readers.

However, a new study has shown that iconic characters such as Peter Rabbit – or Toad and Ratty from The Wind in the Willows – can also play an important role in children’s psychological development.

The research explored the extent to which different non-human characters influence children’s theory of mind skills, which include the ability to read and predict social changes in the environment through tone of voice, choice of words, or facial expression.

For the study, more than 100 children aged between five and 10 were tested on their theory of mind skills when presented with stories featuring animal characters as opposed to those featuring human ones.

The study found that when faced with human characters, there was a clear age-related progression, with older children consistently outperforming their younger counterparts. In fact, Year 3 children performed better than the researchers had predicted in the tests featuring human characters.

However, in tests that involved animal characters, Year 1 participants were able to match the scores achieved by pupils from Year 3, two years older than them.

Writing in the Journal of Experimental Child Psychology, the researchers say the findings highlight the importance of both human and non-human characters for children’s earliest development.

The research was led by Dr Gray Atherton and Dr Liam Cross, from the University of Plymouth’s School of Psychology.

Dr Atherton, lead author on the new study, said: “Animals play a huge part of children’s stories, whether that is in books and comics or through TV and film. We wanted to test if that is down to more than simply liking the characters, and whether there are actual benefits of children learning through by watching or reading about animals and if this changes over time. Our findings showed that both human and non-human characters are important in helping children interpret the world around them, and that they play differing roles at different stages in their development. Adapting activities and lessons in nurseries and the early school years to take that into account could be hugely effective in helping to support their development.”

The research builds on previous studies by Dr Atherton and Dr Cross exploring factors which can influence the educational and social development of people with autism and learning difficulties.

These have included initiatives showing that playing board and online games can boost the confidence among people with autism, and others highlighting that people with dyslexia and dyscalculia show reduced bias against others based on characteristics such as their disability, race or gender.

Based on the new research, the academics now intend to explore in more detail if their findings could be used specifically to benefit children with such conditions.

Dr Cross added: “We believe this new study could have particular importance for people with autism or other conditions which can impact their learning. Working with teenagers in the past, we have noticed how tasks that involve animal characters can result in autistic people performing just as well as non-autistic children. It would be interesting to replicate our current study with autistic children, to understand if we can find more effective ways to support them at a critical point in their development.”