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Whole-Genome Sequencing Reveals Diversity of Carbapenem-Resistant Pseudomonas aeruginosa Collected Through the Emerging Infections Program
- Richard Stanton, Jonathan Daniels, Erin Breaker, Davina Campbell, Joseph Lutgring, Maria Karlsson, Kyle Schutz, Jesse Jacob, Lucy Wilson, Elisabeth Vaeth, Linda Li, Ruth Lynfield, Erin C. Phipps, Emily Hancock, Ghinwa Dumyati, Rebecca Tsay, P. Maureen Cassidy, Jacquelyn Mounsey, Julian Grass, Maroya Walters, Alison Halpin
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- Journal:
- Infection Control & Hospital Epidemiology / Volume 41 / Issue S1 / October 2020
- Published online by Cambridge University Press:
- 02 November 2020, pp. s513-s514
- Print publication:
- October 2020
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- Article
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Background: Carbapenem-resistant Pseudomonas aeruginosa (CRPA) is a frequent cause of healthcare-associated infections (HAIs). The CDC Emerging Infections Program (EIP) conducted population and laboratory-based surveillance of CRPA in selected areas in 8 states from August 1, 2016, through July 31, 2018. We aimed to describe the molecular epidemiology and mechanisms of resistance of CRPA isolates collected through this surveillance. Methods: We defined a case as the first isolate of P. aeruginosa resistant to imipenem, meropenem, or doripenem from the lower respiratory tract, urine, wounds, or normally sterile sites identified from a resident of the EIP catchment area in a 30-day period; EIP sites submitted a systematic random sample of isolates to CDC for further characterization. Of 1,021 CRPA clinical isolates submitted, 707 have been sequenced to date using an Illumina MiSeq. Sequenced genomes were classified using the 7-gene multilocus sequence typing (MLST) scheme, and a core genome MLST (cgMLST) scheme was used to determine phylogeny. Antimicrobial resistance genes were identified using publicly available databases, and chromosomal mechanisms of carbapenem resistance were determined using previously validated genetic markers. Results: There were 189 sequence types (STs) among the 707 sequenced genomes (Fig. 1). The most frequently occurring were high-risk clones ST235 (8.5%) and ST298 (4.7%), which were found across all EIP sites. Carbapenemase genes were identified in 5 (<1%) isolates. Overall, 95.6% of the isolates had chromosomal mutations associated with carbapenem resistance: 93.2% had porinD-associated mutations that decrease membrane permeability to the drugs; 24.8% had mutations associated with overexpression of the multidrug efflux pump MexAB-OprM; and 22.9% had mutations associated with overexpression of the endogenous β-lactamase ampC. More than 1 such chromosomal resistance mutation type was present in 37.8% of the isolates. Conclusions: The diversity of the sequence types demonstrates that HAIs caused by CRPA can arise from a variety of strains and that high-risk clones are broadly disseminated across the EIP sites but are a minority of CRPA strains overall. Carbapenem resistance in P. aeruginosa was predominantly driven by chromosomal mutations rather than acquired mechanisms (ie, carbapenemases). The diversity of the CRPA isolates and the lack of carbapenemase genes suggest that this ubiquitous pathogen can readily evolve chromosomal resistance mechanisms, but unlike carbapenemases, these cannot be easily spread through horizontal transfer.
Funding: None
Disclosures: None
8 - Risk Assessment for Intimate Partner Homicide
- Edited by Georges-Franck Pinard, Université de Montréal, Linda Pagani, Université de Montréal
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- Book:
- Clinical Assessment of Dangerousness
- Published online:
- 03 July 2009
- Print publication:
- 13 November 2000, pp 136-157
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Summary
Intimate partner homicide represents a serious health and social problem throughout the world. The majority of research on the topic has been conducted in the United States, Canada, and Australia, with only limited cross-national investigations disaggregating intimate partner homicide from other forms of homicide (Gartner, 1990; LaFree, 1998). Even with the limitations in worldwide databases, it is clear that men are universally most often the perpetrators in intimate partner homicide as with homicide in general. When women kill a husband, boyfriend, or estranged partner, they are far more likely to be acting in self-defense than are men (Wolfgang, 1958; Easteal, 1993; Browne, Williams, & Dutton, 1998). In intimate partner homicide overall, estrangement, jealousy, and prior beating of the female partner represent major risk factors (Browne et al., 1998; Smith, Moracco, & Butts, 1998). Daly and Wilson (1998) conclude that the underlying dynamics of intimate partner homicide are basically “male sexual proprietariness and female attempts to escape male control” with the actual homicide only representing the extreme of the coercive control that characterizes battering. Most data from individual countries′ sources such as Africa, Australia, England, United States, and Canada support that general contention (Crawford & Gartner, 1992; Edwards, 1985; Mushanga, 1978; Easteal, 1993; Campbell, 1992).
Determination of risk of intimate partner homicide needs to be based on this underlying theoretical premise of male coercive control of females.