We established a modular, rapidly deployable laboratory system that provides diagnostic support in resource-limited, remote areas. Developed as a quick response asset to unusual outbreaks of infectious diseases worldwide, several of these laboratories have been used as part of the World Health Organization response to the Ebola virus outbreaks by teams of the ‘European Mobile Lab’ project in West Africa since March 2014. Within three days from deployment, the first European mobile laboratory became operational at the Ebola Treatment Unit (ETU) in Guéckédou, southern Guinea. Deployment in close proximity to the ETU decreased the turnaround time to an average of 4 h instead of several days in many cases. Between March 2014 and May 2015, more than 5,800 samples were tested in this field laboratory. Further EMLab units were deployed to Nigeria, Liberia and Sierra Leone in the following months of the Ebola outbreak. The technical concept of the EMLab units served as a blueprint for other mobile Ebola laboratories which have been set up in Mali, Côte d’Ivoire, Sierra Leone and other countries in West Africa. Here, we describe design, capabilities and utility of this deployable laboratory system for use in response to disease outbreaks, epidemiological surveillance and patient management.

SummaryBackgroundMatrix-Assisted Laser-Desorption/Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS) has already proven to be a powerful tool for species identification in microbiological laboratories. As adequate and rapid screening methods for antibiotic resistance are crucially needed, the present study investigated the discrimination potential of MALDI-TOF MS among extended-spectrum-beta-lactamase (ESBL) or metallo-beta-lactamases- (MBL) producing and the nonproducing strains of Escherichia coli (n=19), Klebsiella pneumoniae (n=19), and Pseudomonas aeruginosa (n=38), respectively.Material/MethodsWe used a MALDI-TOF MS protocol, usually applied for species identification, in order to integrate a screening method for beta-lactamases into the routine species identification workflow. The acquired spectra were analyzed by visual inspection, statistical similarity analysis and support vector machine (SVM) classification algorithms.ResultsNeither visual inspection nor mathematical similarity analysis allowed discrimination between spectra of beta-lactamase-producing and the nonproducing strains, but classification within a species by SVM-based algorithms could achieve a correct classification rate of up to 70%.ConclusionsThis shows that MALDI-TOF MS has definite potential to discriminate antibiotic-resistant strains due to ESBL and MBL production from nonproducing strains, but this performance is not yet sufficiently reliable for routine microbiological diagnostics.

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Discrimination of Enterobacteriaceae and Non-fermenting Gram Negative Bacilli by MALDI-TOF Mass SpectrometryMatrix assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) has proven to be an effective identification tool in medical microbiology. Discrimination to subspecies or serovar level has been found to be challenging using commercially available identification software. By forming our own reference database and using alternative analysis methods, we could reliably identify all implemented Enterobacteriaceae and non-fermenting gram negative bacilli by MALDI-TOF MS and even succeeded to distinguish Shigella sonnei from Escherichia coli (E. coli) and Salmonella enterica spp. enterica serovar Enteritidis from Salmonella enterica spp. enterica serovar Typhimurium. Furthermore, the method showed the ability to separate Enterohemorrhagic E. coli (EHEC) and Enteropathogenic E. coli (EPEC) from non-enteropathogenic E. coli.

human-to-animal transfer through close contacts. In our study, the OXA-48-positive animal was living in France, where OXA-48 is not endemic in humans. 6 This suggests that OXA-48 producers in animals might be underreported in OXA-48-endemic countries. The origin of the OXA-48 E. coli in this dog could not be traced. No bla CTX-M-15 gene was identified along with bla OXA-48 , a combination that is, on the contrary, rather common in human isolates. Also, carbapenem-susceptible ST372 E. coli isolates have already been associated with human and canine infections. 7 In conclusion, even though resistance to carbapenems is uncommon in animals, carbapenemase genes are associated with a high potential for dissemination and their prevalence in non-human sources may be underestimated, potentially even in countries or continents where CPE are not highly prevalent in humans. CPE in animals should be more thoroughly monitored worldwide in order to clarify the role of non-human settings as possible reservoirs of carbapenemase genes.

Clostridium species cause several local and systemic diseases. Conventional identification of these microorganisms is in part laborious, not always reliable, time consuming or does not always distinguish different species, i.e., C. botulinum and C. sporogenes. All in, there is a high interest to find out a reliable, powerful and rapid method to identify Clostridium spp. not only on genus but also on species level. The aim of the present study was to identify Clostridium spp. strains and also to find differences and metabolic groups of C. botulinum by Matrix-Assisted Laser Desorption/Ionization Time of Flight Mass Spectrometry (MALDI-TOF MS). A total of 123 strains of Clostridium spp. (C. botulinum, n = 40, C. difficile, n = 11, C. tetani, n = 11, C. sordellii, n = 20, C. sporogenes, n = 18, C. innocuum, n = 10, C. perfringens, n = 13) were analyzed by MALDI-TOF MS in combination with methods of multivariate statistical analysis. MALDI-TOF MS analysis in combination with methods of multivariate statistical analysis was able to discriminate between the different tested Clostridium spp., even between species which are closely related and difficult to differentiate by traditional methods, i.e., C. sporogenes and C. botulinum. Furthermore, the method was able to separate the different metabolic groups of C. botulinum. Especially, E gene-positive C. botulinum strains are clearly distinguishable from the other species but also from those producing other toxin types. Thus, MALDI-TOF MS represents a reliable and above all quick method for identification of cultivated Clostridium species.

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This study was designed to investigate the killing activity of levofloxacin, gatifloxacin, moxifloxacin and garenoxacin against 12 Bacteroides fragilis strains by kill kinetics over time. MIC values were determined by Etest and by agar dilution. B. fragilis strains were divided according to their MIC values into two groups: one group with strains with MIC ,8.0 mg ml "1 and one group with strains with MIC ¢8.0 mg ml "1 . For kill kinetics over time, the strains with MIC ,8.0 mg ml "1 were incubated with the antibiotics at 0.5, 1, 2 and 4 times their MIC values. The strains with MIC ¢8.0 mg ml "1 were incubated with 0.5, 1, 2, and 4 times the maximum achievable concentrations of the antibiotics in human plasma (C max ). Among the strains with MIC ,8.0 mg ml "1 levofloxacin and gatifloxacin showed equal efficacy. The growth of the strains with MIC ¢8.0 mg ml "1 was barely affected by levofloxacin, while gatifloxacin had bactericidal action when concentrations of 4¾C max were used. Moxifloxacin was more effective against both groups of strains compared with levofloxacin and gatifloxacin. Garenoxacin was the most active agent against all strains investigated. Due to the varying in vitro activity of the quinolones against obligate anaerobes the treatment with quinolones of patients with intra-abdominal infections needs intensive scrutiny. INTRODUCTIONBacteroides fragilis is the most commonly isolated anaerobic pathogen (Wexler, 2007 2006). However, the problem of increasing resistance rates also applies to quinolones. Golan et al. (2003) found that quinolone resistance has been increasing among Bacteroides since 1994. Recently, Nagy et al. (2011) reported a dramatic increase in resistance to cefoxitin, clindamycin and moxifloxacin, with resistance rates of 17.2 %, 32.4 % and 13.6 %, respectively, throughout Europe, with higher resistance rates for moxifloxacin in Scandinavian countries than in Mediterranean countries (Fille et al., 2006;Hedberg et al., 2003). Thus, the knowledge of resistance patterns is important for adequate prophylaxis and treatment of anaerobic or mixed aerobic and anaerobic infections. As studies employing kill kinetics are expensive in terms of time and cost, they are not likely to be performed in the routine laboratory. Therefore, the aim of the present study was to investigate the in vitro killing activity of four different quinolones against 12 B. fragilis strains evaluated by kill kinetics over time. METHODSBacterial strains. Twelve B. fragilis isolates were selected from the institute's stock. The RMA strains were kindly provided by E. J. C. Goldstein, R. M. Alden Research Lab, Culver City, California, USA.3These authors contributed equally to this work. The WAL strains were collected at the University Hospital of Wales, Cardiff, UK, and are isolates of an international anaerobe study tested