Infected dog and cat bites have a complex microbiologic mix that usually includes pasteurella species but may also include many other organisms not routinely identified by clinical microbiology laboratories and not previously recognized as bite-wound pathogens.

While foot infections in persons with diabetes are initially treated empirically, therapy directed at known causative organisms may improve the outcome. Many studies have reported on the bacteriology of diabetic foot infections (DFIs) over the past 25 years, but the results have varied and have often been contradictory. A number of studies have found that Staphylococcus aureus is the main causative pathogen (12,34,35), but two recent investigations reported a predominance of gram-negative aerobes (20, 47). The role of anaerobes is particularly unclear, because in many studies specimens were not collected or cultured properly to recover these organisms. Among those that did use appropriate methods, some report that anaerobes play a minimal role (2,7,15,21,46), while others suggest that Bacteroides fragilis is the predominant anaerobe isolated (1,3,17,57).These discrepancies could be partly due to differences in the causative organisms occurring over time, geographical variations, or the types and severity of infection included in the studies (1,20,47,51). In addition, some studies used a relatively small number of specimens, failed to report recent or concomitant antibiotic therapy, did not ensure that the specimen collection techniques would exclude superficial or colonizing organisms, or even make clear whether or not the wound was clinically infected. Also, laboratory processing of the samples may have been inadequate to grow anaerobes or fastidious organisms, and protocols that classify potential pathogens (e.g., coagulase-negative staphylococci [CoNS] or Corynebacterium species) as colonizers may have been used (4,46,49).While S. aureus and beta-hemolytic streptococci are widely recognized as pathogens in early DFIs, the role of other frequently isolated organisms is less clear to both the clinician and the microbiology laboratory. Previous studies have shown that when optimal specimen collection, transport, and culture techniques are used, multiple organisms are usually recovered from DFIs (6,14,23,29,30,45,55). Furthermore, some studies suggest that the interactions of organisms within these polymicrobial mixtures lead to the production of virulence factors, such as hemolysins, proteases, and collagenases, as well as short-chain fatty acids, that cause inflammation, impede wound healing, and contribute to the chronicity of the infection (5,52,53,56). In such mixtures, biofilms that impede the penetration of antimicrobial agents into the infected site may also form (25). Thus, the presence of multiple species can have important clinical implications that should not be overlooked (5, 23).

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SummaryBackgroundThe control of Clostridium difficile infections is an international clinical challenge. The incidence of C difficile in England declined by roughly 80% after 2006, following the implementation of national control policies; we tested two hypotheses to investigate their role in this decline. First, if C difficile infection declines in England were driven by reductions in use of particular antibiotics, then incidence of C difficile infections caused by resistant isolates should decline faster than that caused by susceptible isolates across multiple genotypes. Second, if C difficile infection declines were driven by improvements in hospital infection control, then transmitted (secondary) cases should decline regardless of susceptibility.MethodsRegional (Oxfordshire and Leeds, UK) and national data for the incidence of C difficile infections and antimicrobial prescribing data (1998–2014) were combined with whole genome sequences from 4045 national and international C difficile isolates. Genotype (multilocus sequence type) and fluoroquinolone susceptibility were determined from whole genome sequences. The incidence of C difficile infections caused by fluoroquinolone-resistant and fluoroquinolone-susceptible isolates was estimated with negative-binomial regression, overall and per genotype. Selection and transmission were investigated with phylogenetic analyses.FindingsNational fluoroquinolone and cephalosporin prescribing correlated highly with incidence of C difficile infections (cross-correlations >0·88), by contrast with total antibiotic prescribing (cross-correlations <0·59). Regionally, C difficile decline was driven by elimination of fluoroquinolone-resistant isolates (approximately 67% of Oxfordshire infections in September, 2006, falling to approximately 3% in February, 2013; annual incidence rate ratio 0·52, 95% CI 0·48–0·56 vs fluoroquinolone-susceptible isolates: 1·02, 0·97–1·08). C difficile infections caused by fluoroquinolone-resistant isolates declined in four distinct genotypes (p<0·01). The regions of phylogenies containing fluoroquinolone-resistant isolates were short-branched and geographically structured, consistent with selection and rapid transmission. The importance of fluoroquinolone restriction over infection control was shown by significant declines in inferred secondary (transmitted) cases caused by fluoroquinolone-resistant isolates with or without hospital contact (p<0·0001) versus no change in either group of cases caused by fluoroquinolone-susceptible isolates (p>0·2).InterpretationRestricting fluoroquinolone prescribing appears to explain the decline in incidence of C difficile infections, above other measures, in Oxfordshire and Leeds, England. Antimicrobial stewardship should be a central component of C difficile infection control programmes.FundingUK Clinical Research Collaboration (Medical Research Council, Wellcome Trust, National Institute for Health Research); NIHR Oxford Biomedical Research Centre; NIHR Health Protection Research Unit on Healthcare Associated Inf...

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The genus Lactobacillus is a taxonomically complex and is composed of over 170 species that cannot be easily differentiated phenotypically and often require molecular identification. Although they are part of the normal human gastrointestinal and vaginal flora, they can also be occasional human pathogens. They are extensively used in a variety of commercial products including probiotics. Their antimicrobial susceptibilities are poorly defined in part because of their taxonomic complexity and are compounded by the different methods recommended by Clinical Laboratory Standards Institute and International Dairy Foundation. Their use as probiotics for prevention of Clostridium difficile infection is prevalent among consumers worldwide but raises the question of will the use of any concurrent antibiotic effect their ability to survive. Lactobacillus species are generally acid resistant and are able to survive ingestion. They are generally resistant to metronidazole, aminoglycosides and ciprofloxacin with L. acidophilus being susceptible to penicillin and vancomycin, whereas L. rhamnosus and L. casei are resistant to metronidazole and vancomycin.

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The predatory ecology of Varanus komodoensis (Komodo Dragon) has been a subject of long-standing interest and considerable conjecture. Here, we investigate the roles and potential interplay between cranial mechanics, toxic bacteria, and venom. Our analyses point to the presence of a sophisticated combined-arsenal killing apparatus. We find that the lightweight skull is relatively poorly adapted to generate high bite forces but better adapted to resist high pulling loads. We reject the popular notion regarding toxic bacteria utilization. Instead, we demonstrate that the effects of deep wounds inflicted are potentiated through venom with toxic activities including anticoagulation and shock induction. Anatomical comparisons of V. komodoensis with V. (Megalania) priscus fossils suggest that the closely related extinct giant was the largest venomous animal to have ever lived. evolution ͉ phylogeny ͉ squamate ͉ protein ͉ toxin P redation by Varanus komodoensis, the world's largest extant lizard, has been an area of great controversy (cf. ref. 1). Three-dimensional finite element (FE) modeling has suggested that the skull and bite force of V. komodoensis are weak (2). However, the relevance of bite force and cranial mechanics to interpretations of feeding behavior cannot be fully evaluated in the absence of comparative data. Moreover, this previous analysis did not account for gape angle, which can significantly influence results (3). Irrespective of evidence for or against a powerful bite, V. komodoensis is clearly capable of opening wounds that can lead to death through blood loss (4). Controversially, the proposition that utilization of pathogenic bacteria facilitates the prey capture (4, 5) has been widely accepted despite a conspicuous lack of supporting evidence for a role in predation. In contrast, recent evidence has revealed that venom is a basal characteristic of the Toxicofera reptile clade (6), which includes the varanid lizards (7), suggesting a potential role of venom in prey capture by V. komodoensis that has remained unexplored. This is consistent with prey animals reported as being unusually quiet after being bitten and rapidly going into shock (4) and the anecdotal reports of persistent bleeding in human victims after bites (including B.G.F.'s personal observations). Shock-inducing and prolonged bleeding pathophysiological effects are also characteristic of helodermatid lizard envenomations (cf. ref . 8), consistent with the similarity between helodermatid and varanid venoms (6).Here, we examine the feeding ecology of V. komodoensis in detail. We compare the skull architecture and dentition with the related extinct giant V. priscus (Megalania). In this 3D finite element modeling of reptilian cranial mechanics that applies a comparative approach, we also compare the bite force and skull stress performance with that of Crocodylus porosus (Australian Saltwater Crocodile), including the identification of optimal gape angle (an aspect not considered in previous nonreptilian comparative FE analyses). We als...