Transmission Routes Research Articles

Assessment of genetic diversity, tissue tropism, and antigenic properties of Grimsö betacoronavirus in Swedish bank voles (Clethrionomys glareolus)

Zoonotic coronaviruses can transmit over species barriers and infect humans. To understand the zoonotic potential of a betacoronavirus, Grimsö virus (GRIV), we investigated the geographic distribution and tissue tropism of GRIV in Swedish bank voles (Clethrionomys glareolus), and the antigenicity of the nucleocapsid (N) protein. We screened the lung tissues from animals collected in the southern Sweden by RT-PCR with primers targeting the spike gene. Seven out of 74 animals were found to be positive. They are genetically close to GRIV from Grimsö, central Sweden. Positive rodents were studied for the tissue distribution of GRIV and GRIV RNA was mainly found in the respiratory tract. After three attempts of virus isolation were failed, we successfully established a Vero E6 cell line that stably expressed GRIV N protein, which has no cross-reactivity with patient serum containing antibodies against SARS-CoV-2, or with MERS-CoV. However, a low level of cross-reactivity to common cold coronaviruses was found, likely HCoV-OC43 or HCoV-HKU1, probably due to shared linear epitopes. With the high prevalence and the suggested respiratory transmission route, GRIV may have a high potential for spillover and cross-species transmission, and future serological screening of GRIV infections in domestic animals or humans will be needed.

Respiratory Isolation for Tuberculosis: A Historical Perspective.

Although tuberculosis is an ancient disease, recognition of its airborne route of transmission, with implications for respiratory isolation, is only relatively recent. Since the time of Hippocrates, the dogma among health practitioners was that the disease was hereditary or that it could be contracted by inhaling "miasma", or corrupted air. Consequently, isolation of patients was not routine practice, and, in fact, patients with scrofula (morbus regius, or "king's evil) sought to be cured by the "royal touch" throughout the middle ages. The sanatorium, which emerged in the mid-19th century, initially served as a place of healing, where patients could receive the appropriate diet, rest therapy, graduated exercise, and abundant fresh air. Major scientific breakthroughs, including Robert Koch's 1882 discovery of the tubercle bacillus as the disease's etiological agent and early 20th century experimental evidence that the organism could be transmitted via expectorated droplet nuclei, helped to reinforce the important public health role of sanatoria and tuberculosis hospitals in preventing disease transmission through isolation. The advent of highly efficacious and oral antitubercular regimens in the mid-20th century and the concurrent declining incidence of the disease contributed to the closure of tuberculosis sanatoria and hospitals in the US and western Europe. Over the past several decades, tuberculosis treatment in the US has been conducted in the outpatient setting under the supervision of local public health departments. Patients receiving treatment are required to remain in respiratory isolation in the home until they are deemed noninfectious based on multiple sputum samples. This historical review demonstrates that despite changing medical knowledge, drug therapies, and social conditions over time, the role of isolation remains an important topic of debate in the treatment of patients with pulmonary tuberculosis.

RpoS activates formation of Salmonella Typhi biofilms and drives persistence in the gall bladder.

The development of strategies for targeting the asymptomatic carriage of Salmonella Typhi in chronic typhoid patients has suffered owing to our basic lack of understanding of the molecular mechanisms that enable the formation of S. Typhi biofilms. Traditionally, studies have relied on cholesterol-attached biofilms formed by a closely related serovar, Typhimurium, to mimic multicellular Typhi communities formed on human gallstones. In long-term infections, S. Typhi adopts the biofilm lifestyle to persist in vivo and survive in the carrier state, ultimately leading to the spread of infections via the fecal-oral route of transmission. In the present work, we studied S. Typhi biofilms directly, applied targeted as well as genome-wide genetic approaches to uncover unique biofilm components that do not conform to the CsgD-dependent pathway established in S. Typhimurium. We undertook a genome-wide Tn5 mutation screen in H58, a clinically relevant multidrug resistance strain of S. Typhi, in gallstone-mimicking conditions. We generated New Generation Sequencing libraries based on the ClickSeq technology to identify the key regulators, IraP and RpoS, and the matrix components Sth fimbriae, Vi capsule and lipopolysaccharide. We discovered that the starvation sigma factor, RpoS, was required for the transcriptional activation of matrix-encoding genes in vitro, and for S. Typhi colonization in persistent infections in vivo, using a heterologous fish larval model. An rpoS null mutant failed to colonize the gall bladder in chronic zebrafish infections. Overall, our work uncovered a novel RpoS-driven, CsgD-independent paradigm for the formation of cholesterol-attached Typhi biofilms, and emphasized the role(s) of stress signaling pathways for adaptation in chronic infections. Our identification of the biofilm regulators in S. Typhi paves the way for the development of drugs against typhoid carriage, which will ultimately control the increased incidence of gall bladder cancer in typhoid carriers.

A systematic review of case reports on mortality, modes of infection, diagnostic tests, and treatments for Nipah virus infection.

First identified in Malaysia in 1998, the Nipah virus is a paramyxovirus related to the Hendra virus. The clinical manifestation can vary from a silent infection to a life-threatening encephalitis. The World Health Organization (WHO) has documented 25 outbreaks in South Asia, resulting in 429 cases and 307 deaths to date. Currently, there are no approved treatments for the deadly Nipah virus infection, which is a serious threat to public health worldwide. Consequently, a review was conducted to examine the geographic distribution of the Nipah virus, mortality, transmission pathways, and available methods for diagnosis and treatment. PubMed, Scopus, Web of Science, and Google Scholar servers were used to conduct a systematic search in compliance with the PRISMA guidelines. The results were tabulated and analyzed. A total of 12 studies (7 case series and 5 case reports) were included in the final analysis, and 92 cases were analyzed. The most frequent symptoms were fever (80%), myalgia (47%), headache (47%), shortness of breath/acute respiratory distress syndrome (n = 44.1%), altered sensorium (44.1%), and vomiting (42.6%). The most commonly used diagnostic test was RT-PCR (45.5%). The most common route of transmission reported is direct human contact with the infected patients. Treatment modalities include interventional procedures, antiviral drugs, and symptomatic treatment. The most common complications were seizures (39.2%) and altered sensorium (35.7%). The mortality rate was 73.9%. It is crucial to emphasize the importance of early Nipah virus infection diagnosis and treatment to prevent life-threatening consequences.

Course and outcome of pregnancy in a woman with Epstein-Barr virus infection: clinical case

Epstein-Barr virus, due to the variety of clinical forms and transmission routes, is widespread throughout the world. The mechanisms of immunopathogenesis of infection caused by Epstein-Barr virus remain incompletely understood. The management of pregnant women with this infection requires special attention. The clinical case described in the article demonstrates the clear course of Epstein-Barr virus infection and the complications resulting from it.

KNOWLEDGE, PERCEPTION, AND AWARENESS OF MENINGITIS AMONG UNIVERSITY STUDENTS: A CASE STUDY OF YUSUF MAITAMA SULE UNIVERSITY KANO

Meningitis remains a significant global health concern, particularly in developing countries where it can lead to severe consequences, including death. This case study examines the knowledge, perception, and awareness of meningitis among students at Yusuf Maitama Sule University Kano (YUMSUK), an educational institution with a diverse student population. The study utilizes a cross-sectional survey design, gathering data from 200 undergraduate students through structured questionnaires. The research objectives include evaluating students' knowledge of meningitis, exploring their perceptions and attitudes towards individuals with the disease, and assessing their overall awareness of diagnostic tests, treatment options, and vaccination programs. Findings reveal varying levels of understanding, with notable gaps in knowledge about transmission routes, risk factors, and preventive measures. Additionally, some misconceptions and stigma towards those affected by meningitis were identified. The study underscores the need for targeted health education programs to enhance awareness and reduce the disease's burden within the university community. The implications of these findings are discussed, and recommendations are made for future awareness campaigns, curriculum integration, and further research on meningitis among university populations.

Detection of airborne wild waterbird-derived DNA demonstrates potential for transmission of avian influenza virus via air inlets into poultry houses, the Netherlands, 2021 to 2022.

BackgroundOutbreaks of highly pathogenic avian influenza (HPAI) on poultry farms and in wild birds worldwide persists despite intensified control measures. It causes unprecedented mortality in bird populations and is increasingly affecting mammalian species. Better understanding of HPAI introduction pathways into farms are needed for targeted disease prevention and control. The relevance of airborne transmission has been suggested but research involving air sampling is limited and unequivocal evidence on transmission routes is lacking.AimWe aimed to investigate whether HPAI virus from wild birds can enter poultry houses through air inlets by characterising host materials through eukaryote DNA sequencing.MethodsWe collected particulate matter samples in and around three HPAI-affected poultry farms which were cleared and decontaminated before sampling. Indoor measurements (n = 61) were taken directly in the airflow entering through air inlets, while outdoor air samples (n = 60) were collected around the poultry house. Positive controls were obtained from a bird rehabilitation shelter. We performed metabarcoding on environmental DNA by deep sequencing 18S rRNA gene amplicons.ResultsWe detected waterbird DNA in air inside all three, and outside of two, poultry farms. Sequences annotated at species level included swans and tufted ducks. Waterbird DNA was present in all indoor and outdoor air samples from the bird shelter.ConclusionAirborne matter derived from contaminated wild birds can potentially introduce HPAI virus to poultry houses through air inlets. The eDNA metabarcoding could assess breaches in biosecurity for HPAI virus and other pathogens potentially transmitted through air via detection of their hosts.

Identification of JC polyomavirus in upper respiratory samples from Portuguese children

BackgroundJC polyomavirus (JCPyV) is ubiquitous in the human population and the causative agent of a rare, fatal and demyelinating disease of the central nervous system named Progressive Multifocal Leukoencephalopathy (PML). The route of JCPyV transmission remains unclear, but high values of seroprevalence suggest an easy and frequent mode, such as respiratory route. ObjectivesThe present study aims to investigate the presence of JCPyV in upper respiratory samples and contribute to the elucidation of the JCPyV transmission pathway. Study designNasopharyngeal swabs from 587 Portuguese individuals, including 380 children (≤18 years) and 207 adults (>18 years), collected for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) diagnosis between September and November 2021 were evaluated for the presence of JCPyV DNA. ResultsJCPyV DNA was detected in 3.1 % of the nasopharyngeal swabs analysed, with higher frequency of detection in samples from children (4.5 %) than from adults (0.5 %) (p = 0.005). Infection with SARS-CoV-2 does not potentiate the presence of JCPyV in upper respiratory tract, once only one adult of 28 years with confirmed SARS-CoV-2 infection showed detectable JCPyV DNA. JCPyV DNA was more frequently detected in respiratory samples from children without SARS-CoV-2 infection (6.4 %). As for this group, children under six years of age presents the highest frequency of detection (10.3 %). ConclusionsThe present study demonstrates that upper respiratory secretions of children, particularly under the age of six, may be implicated in JCPyV transmission, regardless of SARS-CoV-2 infection.

Coexistence of seven different carbapenemase producers in a single hospital admission screening confirmed by whole-genome sequencing

ObjectiveTo molecularly characterize several extensively drug-resistant isolates from a single hospital admission screening of a war injured patient from the Ukraine. MethodsAdmission screening included swabs from skin, wounds, catheters, nasopharyngeum and rectum. Bacterial identification, antimicrobial susceptibility testing (AST) and rapid multiplex PCR assays targeting resistance genes were performed during routine diagnostics. Isolates positive by PCR had their genomes sequenced using short- and long read-platforms (MiSeq and MinION) to confirm species, identify resistance genes and plasmids and investigate clonality with core genome MLST (cgMLST). ResultsSeven Gram-negative pathogens (Acinetobacter baumannii (n=2; ST78, ST2), Klebsiella pneumoniae (n=2; ST395), Pseudomonas aeruginosa (n=1; ST1047), Escherichia coli (n=1; ST46), Enterobacter cloacae complex (n=1; ST231)) were molecularly confirmed non-identical. AST showed resistance to carbapenems (7/7 isolates) and last resort treatment options such as ceftazidime-avibactam (6/7 isolates) and cefiderocol (4/7 isolates). All isolates were colistin susceptible. Sequencing identified the E. cloacae complex as E. hormaechei subsp. xiangfangensis. Six acquired carbapenemase genes (blaIMP-1, blaNDM-1, blaOXA-48, blaNDM-5, blaOXA-23 and blaOXA-72) were detected. Both A. baumannii isolates differed in sequence type, carbapenemases and cefiderocol susceptibility. Both K. pneumoniae isolates shared sequence type and some resistance genes on an IncR plasmid but were different in cgMLST and carbapenemases (OXA-48 or NDM-1). One vancomycin-resistant Enterococcus faecium was also detected (VanA). ConclusionWar injured patients from Ukraine may carry different clones of multidrug-resistant pathogens with limited treatment options and diverse resistance genes at risk for dissemination. Infection control measures should include early molecular characterization of isolates for detection of routes of transmission.

Genome-scale analysis of Mycobacterium avium complex isolates from Portugal reveals extensive genetic diversity

Opportunist infections caused by nontuberculous mycobacteria (NTM) have emerged as a significant public health problem. Among these, species of the Mycobacterium avium complex (MAC) are the main responsible for the increase in the number of human disease cases. In order to address the current needs in the detection and surveillance of MAC disease cases, we evaluated different species classification methodologies (BLASTn-based marker-gene approach, Kraken v2, rMLST and MLST databases) and their congruence with a core-SNP phylogenetic approach, based on whole genome sequencing (WGS) data. For this purpose, we used a collection of 142 MAC isolates from Portuguese patients diagnosed between 2014 and 2022. The marker-gene approach (based on the rpoB, hsp65 and groEL genes), showed the best results, allowing the identification of the 142 MAC isolates to the species/subspecies level (M. avium subsp. hominissuis, M. intracellulare, M. intracellulare subsp. chimaera, M. intracellulare subsp. yongonense, M. marseillence and M. colombiense). Additionally, we performed drug susceptibility testing that confirmed clarithromycin efficacy as a first-line treatment for MAC disease, as 93 % of the Portuguese isolates were susceptible. Using a core-SNP approach we also performed an in-depth phylogenetic analysis within each identified species group, and despite the high genetic diversity within the MAC species, we were able to clearly distinguish all the species/subspecies and identify genetic clusters with epidemiological potential.We highlight not only the need for the standardization of an appropriate genotyping approach for species identification and management of MAC disease, but also a more robust large-scale WGS data analysis, in a One Health perspective, in order to identify potential routes of transmission.

Spatiotemporal Data Modelling for Epidemiological Research in Hospitals.

Nosocomial infections are a great source of concern for healthcare organizations. The spatial layout of hospitals and the movements of patients play significant roles in the spread of outbreaks. However, the existing models are ad-hoc for a specific hospital and research topic. This work shows the design of a data model to study the spread of infections among hospital patients. Its spatial dimension describes the hospital layout with several levels of detail, and the temporal dimension describes everything that happens to the patients in the form of events, which can relate to the spatial dimension. The model is meant to be sufficiently general to fit any hospital layout and to be used for different epidemiological research topics. We proved the model's suitability by defining six queries based on patients' movements and contacts that could assist in several epidemiological research tasks, such as discovering potential transmission routes. The model was implemented as an RDF* knowledge graph, and the queries were in SPARQL*. Finally, we designed two experiments in which two outbreaks of Clostridium difficile were analyzed using several queries (four in the first experiment and two in the second) on a knowledge graph (105,000 nodes, 185,000 edges) with synthetic data.

Seroprevalence of Rickettsia Spp. and Orientia tsutsugamushi in Indigenous Populations from the Sierra Nevada de Santa Marta, Colombia.

Background: Rickettsia spp. are vector-borne zoonotic pathogens that cause febrile illness in humans. Rickettsioses is not included in the Colombian national surveillance system and is subsequently expected to be underreported. This cross-sectional study aimed to determine the seroprevalence of Rickettsia spp. and the closely related Orientia tsutsugamushi in two indigenous populations residing in the Sierra Nevada de Santa Marta, Colombia. Materials and Methods: Serum samples (n = 539) were collected from the Wiwa and Koguis people between 2021 and 2022. Serum samples were screened for spotted fever group (SFG) and typhus group (TG) Rickettsia spp. using the Fuller laboratories Rickettsia IgG IFA kit and for O. tsutsugamushi with the Scrub Typhus Detect™ IgG ELISA. Results: We observed an overall seroprevalence of 26.2% (95% confidence interval [CI] 22.5-30.1] for Rickettsia spp. of the SFG, 5.4% (95% CI 3.6-7.6) for Rickettsia spp. of the TG and 4.3% (95% CI 2.7-6.3) for O. tsutsugamushi. Common risk factors for zoonotic disease infections were assessed for 147 of the Wiwa participants. Increased odds of seropositivity for SFG Rickettsia spp. were observed for Wiwa participants who cared for livestock, including assisting with the birth of cattle (odds ratio [OR] = 8.85; 95% CI 1.54-50.90; p = 0.015) and goats (OR = 7.60; 95% CI 1.70-33.90; p = 0.008). Conclusions: These results highlight a notable exposure to Rickettsia spp., especially the SFG, in rural Colombia. Together with recent reports of high mortality for Rocky Mountain Spotted Fever in nearby regions of South America, more detailed investigations focusing on improving knowledge and awareness as well as "One Health" and "causes-of-fever" studies are needed. The characterization of Rickettsia spp. infections in humans, livestock, and tick vectors with their potential transmission routes could make a high impact on these easily treatable diseases.

MHealth interventions to improve public knowledge of HPV-associated oropharyngeal cancer in the UK

In the United Kingdom (UK), the current prevalence rates of oropharyngeal cancer linked to human papillomavirus (HPV) are 6.29% and 2.04% in men and women, respectively. Over the years, the burden of this disease has increased in the UK, and this is mainly due to the rising prevalence of HPV infection in the UK. Research evidence has shown that over 70% of oropharyngeal cancers in the UK are linked to HPV. Oral sex is the major route of transmission of HPV, and over 63% of UK young adults are found to have a positive history of oral sex practice. However, only a minority of the UK population are aware of HPV-associated oropharyngeal cancer; this therefore calls for more public health efforts to increase awareness and knowledge on HPV-associated oropharyngeal cancer in the UK. While the use of technology-based, clinic-based, and community-based interventions have been employed to improve public awareness and knowledge on the role of HPV-associated oropharyngeal cancer, mobile health (mhealth) interventions have not been seriously explored despite existing robust evidence on the effective roles of mhealth in improving awareness and knowledge in diverse diseases. This article therefore calls for the adoption and use of mhealth interventions in educating the UK’s population on HPV-associated oropharyngeal cancer. The use of mhealth interventions in this regard is highly viable as its implementation closely aligns with the country’s National Health Service (NHS) commitment towards the digital transformation of the UK’s healthcare system.

Evaluation of polymer combinations in vaginal mucoadhesive tablets for the extended release of acyclovir

Genital herpes, caused by herpes simplex virus type 2 (HSV-2), affects nearly 500 million people, mostly women. Since the main route of transmission is sexual contact, the development of an acyclovir extended-release vaginal microbicide would be a suitable tool for the prevention of virus transmission. In this work, we evaluated the potential of three polymers with different characteristics (chitosan, xanthan gum and ethyl cellulose) for obtaining acyclovir extended-release vaginal tablets. By combining the polymers, certain useful synergies were observed to modify their mucoadhesive capacity and control drug release. In the swelling studies, it observed that a polyelectrolyte complex with more moderate swelling and sustained gelation was formed between chitosan and xanthan gum exclusively in acidic medium (simulated vaginal fluid). This complex allowed prolonging the mucoadhesion of the tablets in ex vivo studies performed with vaginal mucosa, which would translate into better retention in the vagina after administration. In addition, the combination of chitosan and xanthan gum allowed obtaining a controlled release of acyclovir for 5 days, regardless of the pH of the medium, which would guarantee that drug release continues even in the presence of seminal fluid.

Microevolution of Bartonella grahamii driven by geographic and host factors.

Bartonella grahamii has been reported worldwide and shown to infect humans. Up to now, an effective transmission route of B. grahamii to humans has not been confirmed. The genetic evolution of B. grahamii and the relationship between B. grahamii and its host need to be further studied. The factors driving the genetic diversity of B. grahamii are still controversial. The results showed that the European isolates shared a common ancestor with the Chinese isolates. Host factors were shown to play an important role in driving the genetic diversity of B. grahamii. When host factors were fixed, geographic barriers drove B. grahamii microevolution. Our study emphasizes the importance of characterizing isolate genomes derived from hosts and geographical locations and provides a new reference for the origin of B. grahamii.

Hepatitis C Virus Infection in Europe.

The Hepatitis C Virus (HCV) is a significant public health challenge in European countries. Historically, healthcare-related procedures were the primary source of HCV infection in Europe. However, with the implementation of blood safety programs, injection drug use has become the main transmission route. The infection's distribution and genotype prevalence vary widely across the continent. Even with the availability of highly effective direct-acting antiviral (DAA) therapies, HCV infection is far from being controlled. A significant proportion of patients remain undiagnosed, contributing to the ongoing transmission of the virus. Additionally, several barriers hinder the widespread use of DAAs, including high treatment costs, stigma, poor linkage to care, and considerable geographical variations in prevalence and transmission routes. The World Health Organization has set ambitious targets to reduce liver-related deaths, decrease new viral hepatitis infections, and ensure that 90% of infected individuals are diagnosed by 2030. However, most European countries face challenges, highlighting the need for screening programs, funding mechanisms, and public health strategies to effectively control HCV infection in Europe.

Assessment of porcine reproductive and respiratory syndrome virus (PRRSV) farm surface contamination through environmental sampling

BackgroundDuring the fall of 2020, the porcine reproductive and respiratory syndrome virus (PRRSV) L1C.5 variant emerged and rapidly spread throughout southern Minnesota generating questions regarding possible transmission routes. This study aimed to investigate whether PRRSV could be detected on surfaces inside and outside pig barns housing L1C.5 variant PRRSV-positive pigs to illustrate the potential for indirect transmission of PRRSV. Seven Midwestern U.S. PPRS-positive breeding or growing pig farms and one PRRS-negative farm were conveniently selected. Internal and external barn surfaces were wiped using a PBS moistened cloth and the resulting liquid was submitted to the University of Minnesota Veterinary Diagnostic Laboratory for PRRSV RT-PCR testing and virus isolation.ResultsAll (n = 26) samples from PRRSV-negative farm tested negative. Nineteen (13%) out of 143 samples from positive farms yielded positive RT-PCR results. Positive samples originated primarily from exhaust fan cones and doorknobs, followed by anteroom floor and mortality carts/sleds. Virus isolation attempted on two samples did not yield positive results.ConclusionsPRRSV contamination can occur on surfaces inside and outside pig barns that are in frequent contact with farm personnel. Although virus isolation attempts were negative, our results illustrate the potential for PRRSV to be transmitted indirectly through contaminated materials or farm personnel. The study supports the implementation of biosecurity practices by farm personnel to prevent the introduction of PRRSV into farms and the prevention of PRRSV transmission between farms.

Describing the Accumulation, Concentration, and Amplification Effects of MPs Through the Food Chain

Microplastics (MP) are new pollutants that threaten the ecological environment and, therefore, human and animal health. Given the extensive utilization of plastics across various domains, MPs are commonly detected in the atmosphere, water bodies, terrestrial regions, and living organisms. Important accumulation points of MPs are air, soil, and water ecosystems. This study aims to summarize how animals are exposed to environmental MPs, identify the specific organs where these MPs accumulate, and assess the risks associated with different foods. The urrent research on MP pollution in ecosystems generally focuses on organisms living in water and soil, but unfortunately, there are significant deficiencies in the transmission routes of MPs in the food chain from soil to table. MPs build up in animals across the food chain, and their presence in animal- derived food products intensifies during processing and packaging. The transfer of MPs to food-producing animals has been understudied, particularly with regard to the important role of livestock in converting plant nutrients into proteins required for human consumption. It is understood that more research is needed, especially for contamination in animal foods. Conducting comprehensive risk assessments of MPs throughout the entire food chain is extremely important for food safety.

Prevalence of Antimicrobial Resistant Escherichia coli from Sinking Creek in Northeast Tennessee.

Antibiotic resistance (AR) is a critical global health threat exacerbated by complex human-animal-environment interactions. Aquatic environments, particularly surface water systems, can serve as reservoirs and transmission routes for AR bacteria. This study investigated the prevalence of AR E. coli in Sinking Creek, a pathogen-impacted creek in Northeast Tennessee. Water samples were collected monthly from four sites along the creek over a 6-month period. E. coli isolates were cultured, identified, and tested for susceptibility to eight antibiotics using the Kirby-Bauer disk diffusion method and broth disk elution method for colistin. Data were analyzed to determine the prevalence of AR and multidrug resistance (MDR) among isolates. Of the 122 water samples, 89.3% contained E. coli. Among the 177 isolates tested, resistance was highest to ciprofloxacin (64.2%) and nitrofurantoin (62.7%), and lowest to fosfomycin (14.1%) and colistin (6.0%). Significant differences in resistance to ceftriaxone and amoxicillin/clavulanic acid were observed between sampling sites. MDR was prevalent in 47.5% of isolates, with 5.1% resistant to seven antibiotics. The most frequent MDR patterns (6.8%) included three antibiotics: ceftriaxone, ciprofloxacin, and nitrofurantoin. The high prevalence of AR E. coli in Sinking Creek poses a significant public health risk, highlighting the need for ongoing surveillance and intervention strategies to prevent the spread of AR bacteria.

Advancing Hybrid Vehicle Technology: A Systematic Review of Power Transmission Routes in Leading Hybrid Systems

Advancing Hybrid Vehicle Technology: A Systematic Review of Power Transmission Routes in Leading Hybrid Systems