Area of technical uncertainty for susceptibility testing of amoxicillin/clavulanate against Escherichia coli: analysis of automated system, Etest and disk diffusion methods compared to the broth microdilution reference.

OBJECTIVES: The European Committee on Antimicrobial Susceptibility Testing (EUCAST) recently warned about an area of technical uncertainty (ATU) of amoxicillin/clavulanate (AMX/C) disk susceptibility testing against members of the Enterobacterales. Thus, we aimed to compare the reliability of three routine methods and to evaluate the impact of the ATU. METHODS: 286 Escherichia coli strains (including 159 AMX-resistant strains) were categorized for the two EUCAST AMX/C breakpoints by disk diffusion (Bio-Rad), the Phoenix automated system (Becton Dickinson) and the Etest (AES) compared to the broth microdilution reference method. RESULTS: By microdilution, 84.2% of strains were AMX/C-susceptible using the urinary breakpoint (MIC ≤32 mg/L) and 62.2% using the systemic breakpoint (MIC ≤8 mg/L), with 63.6% of MICs between 4 and 16 mg/L. For the systemic breakpoint, category agreement (CA) and very major error (VME) were unacceptable for the Etest (71.7% and 27.3%), disk (73.1% and 23.4% at 19-mm cut-off) and to a lesser extent for the Phoenix system (83.6% and 10.5%). For disks, an unacceptable VME rate was observed for diameters up to 22 mm, probably due to overcharged disks. For the Etest, VMEs were high at 6 mg/L (46/63) and 8 mg/L (22/29). For the urinary breakpoint, CA was more acceptable for disk (88.9%) and Etest (84.3%) but was unevaluable for Phoenix. CONCLUSION: AMX/C susceptibility testing of E. coli for systemic breakpoint was unreliable with the three routine methods, explained mainly by the high prevalence (~60%) of strains with microdilution MICs around the breakpoint (8 mg/L). Our data confirmed the EUCAST 19-20-mm ATU for disk and suggest introducing ATU for Etest MIC values of 6 and 8 mg/L.

Immunosenescence patterns differ between populations but not between sexes in a long-lived mammal.

In animals, physiological mechanisms underlying reproductive and actuarial senescence remain poorly understood. Immunosenescence, the decline in the ability to display an efficient immune response with increasing age, is likely to influence both reproductive and actuarial senescence through increased risk of disease. Evidence for such a link has been reported from laboratory animal models but has been poorly investigated in the wild, where variation in resource acquisitions usually drives life-history trade-offs. We investigated immunosenescence patterns over 7 years in both sexes of two contrasting roe deer populations (Capreolus capreolus). We first measured twelve immune markers to obtain a thorough identification of innate and adaptive components of immunity and assessed, from the same individuals, the age-dependent variation observed in parasitic infections. Although the level of innate traits was maintained at old age, the functional innate immune traits declined with increasing age in one of two populations. In both populations, the production of inflammatory markers increased with advancing age. Finally, the adaptive response declined in late adulthood. The increasing parasite burden with age we reported suggests the effective existence of immunosenescence. Age-specific patterns differed between populations but not between sexes, which indicate that habitat quality could shape age-dependent immune phenotype in the wild.

Haematological parameters do senesce in the wild: evidence from different populations of a long-lived mammal.

Increasing evidence of senescence has been reported from long-term studies of wild populations. However, most studies have focused on life-history traits like survival, reproduction or body mass, generally from a single intensively monitored population. However, variation in the intensity of senescence across populations, and to a lesser extent between sexes, is still poorly understood. In addition, the pattern of age-specific changes in haematological parameters remains virtually unknown to date for any population of vertebrate living in the wild. Using repeated blood samples collected from known-aged (2-15 years of age) roe deer (Capreolus capreolus) from two populations facing highly different environmental conditions, we filled the gap. In particular, we investigated age-specific changes in haematocrit, albumin and creatinine. We reported clear evidence of senescence in all haematological parameters. Moreover, senescence patterns differed between sexes and populations. The rate of senescence was higher in males than in females for haematocrit with no site difference. On the other hand, the rate of senescence in creatinine was higher at Trois Fontaines than at Chizé with no sex difference. Our findings provide a first demonstration of age-specific declines in haematological parameters in wild populations of large herbivores and show that the process of senescence in vertebrates is not restricted to body mass or fitness components. We also demonstrate that the senescence pattern of haematological parameters is context dependent and varies both between sexes and according to environmental conditions.

A comparison of the physiological status in parasitized roe deer (Capreolus capreolus) from two different populations.

Studies of the impact of parasites on host performance have mainly focused on body mass, a phenotypic trait that responds relatively slowly to the presence of parasites, and the expectedly faster response of physiological parameters has been mostly overlooked. We filled the gap by measuring the impact of endoparasites on four hematological/biochemical parameters (hematocrit, albumin, creatinine and fructosamine) in two contrasting free-living populations of roe deer. We generally found negative relationships between parasites and physiological parameters. Our findings also indicate little role of host sex on parasite impact and strongest parasite effects on young and senescent hosts.

Factors influencing the duration of breastfeeding in the Sudbury region.

OBJECTIVE: To determine the duration of breastfeeding in the Sudbury Region and to identify the reasons why mothers wean before the Canadian Paediatric Society's recommended six month period. METHODS: Questionnaires addressing factors that influence the duration of breastfeeding were mailed to 350 breastfeeding mothers at one/two weeks, three months and six months after their postpartum discharge from hospital. RESULTS: Forty percent of mothers breastfed for the recommended six month period. Reported factors positively influencing longer durations of breastfeeding were higher education, higher family income, parity, previous breastfeeding experience, decision to breastfeed before the child was born and late introduction to solids. Reasons for weaning included perceived insufficient milk supply, fatigue, breast problems and return to work. Mothers' top three choices of services were home visits, telephone hot line and television programs. CONCLUSIONS: The duration of breastfeeding in the Sudbury Region is lower than the provincial average. Several modifiable factors associated with duration of breastfeeding were identified.