Assessment of control measures against livestock-associated methicillin-resistant Staphylococcus aureus in a farrow-to-finish pig herd using infectious disease modelling.

Pigs are considered to be the main reservoir for livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA), which is a zoonotic opportunistic pathogen. As LA-MRSA is an occupational hazard, there is an incentive to control its spread in pig herds. Currently, knowledge about effective control measures which do not require culling the whole herd are limited, and the control strategies against LA-MRSA vary between countries. This study uses a stochastic compartment model to simulate possible control measures for LA-MRSA in a farrow-to-finish pig herd. The aims of the study were to (1) extend a previously published disease spread model with additional management and control measures; (2) use the extended model to study the effect of the individual LA-MRSA control measures on the within-herd LA-MRSA prevalence; (3) evaluate the effect of control measures when they are implemented in combinations. From the individual control measures tested in the study, thorough cleaning was found to be most effective in reducing the LA-MRSA prevalence in the herd. When the different control measures were combined, cleaning together with disease surveillance had the largest impact on reducing the LA-MRSA and a higher chance of causing disease elimination. The results of the study showed that achieving disease elimination once LA-MRSA had been introduced in the herd was challenging but was more likely when control measures were introduced early during the outbreak. This emphasises the importance of early detection of the pathogen and subsequent rapid implementation of LA-MRSA control measures.

Modelling environmentally mediated spread of livestock-associated methicillin-resistant Staphylococcus aureus in a pig herd.

Infectious disease models are a useful tool to support within-herd disease control strategies. This study presents a stochastic compartment model with environmentally mediated transmission to represent the spread of livestock-associated methicillin-resistant Staphylococcus aureus (LA-MRSA) in a farrow-to-finish pig herd. The aims of the study were to (1) construct a model of the spread of LA-MRSA that included spread of LA-MRSA through the environment; (2) parameterise the model to fit previously published observational data in order to obtain realistic LA-MRSA transmission rates; (3) and to investigate how changes in the mixing of animals in the farrowing and finishing units may affect the prevalence of LA-MRSA in a herd. The results showed that indirect transmission allowed LA-MRSA to persist in the herd without the assumption of persistently shedding individuals. Reducing the mixing of pigs upon entry to the finishing unit was also shown to lower the LA-MRSA prevalence in the unit if the initial LA-MRSA level in the unit was low, but at high prevalence, no effect of mixing was identified. In the farrowing unit, changing the proportion of piglets that were cross-fostered did not affect the within-herd LA-MRSA prevalence. The study demonstrates that there are several important knowledge gaps regarding the shedding and transmission of LA-MRSA in different animal age groups and further experimental studies are needed. This work also provides a new, robust and flexible model framework for the investigation of control and mitigation strategies for LA-MRSA and other infections in a pig herd.

Association Between PRRSV ORF5 Genetic Distance and Differences in Space, Time, Ownership and Animal Sources Among Commercial Pig Herds.

The objective of this study was to investigate associations between genetic distance of porcine reproductive and respiratory syndrome virus (PRRSV) detected in Ontario swine herds, and the distance between the herds with respect to space, time, ownership and animal sources. PRRSV sequence data between September 2004 and August 2007 were obtained from the Animal Health Laboratory of the University of Guelph. Geographical coordinates were obtained from the Ontario Pork marketing board, and network information about ownership and animal suppliers was obtained using a telephone interview. The matrices of sequence, spatial, temporal and network distances were generated and were analysed using the Mantel test, and using linear-mixed models with P-values based on random permutations. A total of 438 PRRSV isolates from 329 premises and 232 ownerships were originally included; 57 of the isolates were considered vaccine type. The Mantel correlation test indicated that there was positive correlation between sequence distance and geographic distance (r = 0.11, P = 0.001), as well as sequence distance and temporal distance (r = 0.03, P = 0.03), with similar results reported after adjusting for the ownership distance. Mantel correlogram suggested existence of spatial correlation up to ~30 km distance. Multivariable linear-mixed model for association between genetic distance and space-time distance was characterized by the three-way interaction among space, time and ownership (P < 0.001). It suggested that positive association between sequence similarity and spatial proximity exists in herds under different ownerships, but its magnitude is very small. In contrast, for pairs of herds under identical ownership, the spatial association was more complex. This could be a consequence of interactions within ownerships, or alternatively decisions made about sampling of herds for diagnostic purposes. Of the networks evaluated, ownership (P < 0.001) and gilt supplier (P < 0.001) showed the highest magnitude of association with genetic distance and should be investigated further for their impact on disease spread.

Longitudinal investigation of methicillin-resistant Staphylococcus aureus in piglets.

Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as an important public health concern and pigs have been implicated in human infections. Cross-sectional studies have demonstrated that MRSA can be commonly found in pigs internationally, but little is known about age-related changes in MRSA colonization. This study evaluated MRSA colonization in piglets in a longitudinal manner. Serial nasal swabs were collected from piglets born to 10 healthy sows. The prevalence of MRSA colonization on days 1, 3, 7, 14 and 21 was 1% (1/100), 6.2% (3/97), 8.5% (8/94), 4.4% (4/91) and 20% (18/91) respectively, with an overall pre-weaning prevalence of 34.5%. The prevalence on days 28, 42, 56 and 70 was 34% (31/91), 65% (57/88), 50% (44/88) and 42% (36/87) respectively, with an overall post-weaning prevalence of 85%. Eighty-four percent of piglets from negative sows and 100% of piglets from positive sows that survived at least until the time of weaning were colonized with MRSA at one or more times during the study. There was a significant association between sow and piglet colonization. The age of the piglet was significantly associated with the probability of colonization. No piglets or sows received antimicrobials during the study period. These results indicate that age must be considered when designing surveillance programmes and interpreting results of different studies on MRSA.

Prevalence of Yersinia enterocolitica shedding and bioserotype distribution in Ontario finisher pig herds in 2001, 2002, and 2004.

We investigated characteristics of Yersinia enterocolitica infection in Ontario finisher pig herds. Our specific objectives were to estimate or test: prevalence of Y. enterocolitica shedding in finisher pigs, bioserotype distribution, agreement between the herd-level tests based on sampling pig and pooled fecal samples, whether bioserotypes cluster by farms, and whether Y. enterocolitica-positive herds cluster spatially. In total, 3747 fecal samples were collected from 100 farms over the years 2001, 2002, and 2004 (250 total herd visits). Fecal samples were tested by culture and positive isolates were biotyped and serotyped. Apparent pig-level prevalence of Y. enterocolitica was 1.8%, 3.2%, and 12.5% in 2001, 2002, and 2004, respectively. Estimated true pig-level prevalence of Y. enterocolitica was 5.1%, 9.1%, and 35.1% in 2001, 2002, and 2004, respectively. Herd-level prevalence was 16.3%, 17.9%, and 37.5% in 2001, 2002, and 2004, respectively. In all years, the most common bioserotype was 4, O:3, followed by bioserotype 2, O:5,27. Kappa between herd-level status based on pig and pooled samples ranged between 0.51 and 0.68 for biotype 1A and bioserotype 4, O:3, respectively. For 4, O:3, a significant bias in discordant pairs was detected, indicating that pig samples were more sensitive than pooled samples in declaring a herd as positive. Farms tended to be repeatedly positive with the same bioserotype, but positive study farms did not cluster spatially (suggesting lack of between herd transmission and lack of a common geographic risk factor).

External ventricular drainage in the new-born. Technical note.

A new method for external ventricular drainage using an introducer and a plastic-covered catheter is described. The advantages of the system are discussed.

[Local reactions following intravenous injection of Valium mixed micelles and Diazemuls]. / Lokale reaktioner efter intravenøs injektion af Valium mixed micelles og Diazemuls.

The frequency of local venous reactions after intravenous injection of Diazemuls and Valium Mixed Micelles was studied. A material of 224 patients undergoing surgery for prolapsed lumbar disc was allocated into two groups, receiving either 10 mg of Diazemuls or Valium Mixed Micelles. The incidences of thrombophlebitis in the two groups were 1 and 2%, respectively.

Carbon dioxide tensions in manually ventilated, prone patients.

The distribution of arterial carbon dioxide tensions (PaCO2) in 288 anaesthetized, healthy patients in the prone position was investigated during non-monitored manual ventilation. Four equal groups of 72 patients were compared employing a conventional anaesthetic system with and without CO2-absorption and a modified Mapleson D rebreathing system using high and low fresh gas flows. No fundamental difference between the Mapleson D system and the circle system without CO2-absorption could be demonstrated. With the Mapleson D system a high fresh gas flow resulted in a loss of rebreathing characteristics, the scatter of PaCO2-values then approaching that of a conventional circle system with CO2-absorption. The results demonstrate that during manual ventilation a CO2-absorption results in unpredictable levels of PaCO2 with unacceptably wide ranges. On the other hand, prevention of hypocapnia could be obtained with the rebreathing systems using a low fresh gas flow. Hypercapnia was modest and similar in all groups, PaCO2 never exceeding 7.3 kPa. In terms of PaCO2-levels it seems, compared to recent literature, of no importance whether the patient is prone or supine or whether or not ventilation is monitored, performed by hand or by means of anaesthetic ventilators. Accurate levels of PaCO2 can probably only be obtained by frequent analyses of PaCO2, or monitoring of the end-tidal CO2 concentration.

Influence of general anaesthesia on portal pressure in liver cirrhosis and portal hypertension.

In 19 patients with cirrhosis of the liver and portal hypertension, a catheter was inserted into the portal vein using a percutaneous transhepatic technique. The portal pressure was measured during general anaesthesia with and without halothane, and in the awake state. Addition of halothane to the N2O:O2 anaesthesia did not change portal venous pressure, in spite of a significant fall in arterial blood pressure. Portal venous pressure under general anaesthesia with complete muscle relaxation did not differ from the pressure in the resting, awake patient.

Malignant hyperpyrexia. A case report of successful treatment and subsequent uneventful general anaesthesia.

A case of successfully treated fulminant malignant hyperpyrexia induced by halothane is reported. The patient underwent uneventful general anaesthesia with Althesin, nitrous oxide, fentanyl and pancuronium 1 week later. The treatment of the established MH-syndrome and its prevention in MH-susceptible patients are discussed.

Althesin in neurosurgical patients: effects on cerebral hemodynamics and metabolism.

The effect of althesin 0.5 ml/10 kg on arterial blood pressure, intracranial pressure, cerebral blood flow and oxygen uptake was studied on 19 occasions in 16 patients with varied cerebral pathology. Cerebral blood flow (CBF) was measured using the intracarotid 133xenon method and a 35-channel scintillation detector after cannulation of the internal carotid artery, the internal jugular bulb and the lateral cerebral ventricle. Arterial and intracranial pressures were recorded continuously. Blood gas tensions were measured in simultaneously drawn samples from the internal carotid artery and the jugular bulb. Cerebral oxygen uptake was calculated from the product of CBF and arteriovenous oxygen content difference. Control values were obtained with the patients under a basic general anesthesia, consisting of N2O/O2 pancuronium. The effect of a bolus injection of althesin was then studied 1 and 20 min after the injection. A significant reduction in intracranial pressure, cerebral blood flow and metabolism at 1 min was found to have essentially subsided 20 min after the injection. In patients with focal brain damage, regional flow analysis revealed a paradoxical increase in flow after althesin in the areas corresponding to the focus.