Synergy Disc Research Articles

Occurrence of extended-spectrum beta-lactamaseand AmpC-type cephalosporinase-producing Escherichia coli in mastitic cow’s milk

The aim of the study was to evaluate the occurrence of Escherichia coli producing extended-spectrum betalactamases (ESBL and/or AmpC) in the milk of cows with mastitis. A total 2,500 milk samples from mastitic cows were tested in 2014-2018. The investigations included the culture of bacteria on MacConkey agar with cefotaxime, identification with the API Rapid 32 E test, synergy disc test D68C, assessment of antimicrobial resistance by the microdilution method and confirmation of the occurrence of genes encoding ESBL and AmpC. Out of 133 isolates identified as E. coli, 87 were recognized as ESBL producers and 46 as chromosomally encoded cephalosporinase AmpC producers. The blaTEM was predominant in the ESBL producers. All 46 AmpC-positive strains had the blaCMY gene. The results confirmed the occurrence of extended-spectrum betalactamase- producing E. coli in inflammatory secretions from mastitic

Extended Spectrum Beta-Lactamase and Metallo Beta-Lactamase Producing Pseudomonas Species Isolated From Fish Pond Water in Ibadan, Nigeria

ABSTRACT Gram-negative bacteria that produce Extended-spectrum beta-lactamase (ESBL) and metallo beta-lactamase (MBL) show resistance to beta-lactam antibiotics. This study was to determine Beta-lactamases-producing Pseudomonas species in fish ponds. Pseudomonas species isolated from aquaculture water samples using Pseudomonas base agar were characterised biochemically. The detection of ESBL and MBL was made by double disc synergy and imipenem-EDTA combined disc methods, respectively. Antimicrobial susceptibility was by disc diffusion method. The 94 Pseudomonas species isolated comprised P. aeruginosa (62.8%), P. stutzeri (14.9%), P. putida (9.8%) and P. fluorescens (12.8%). P. aeruginosa 16 (16.3%) and P. stutzeri 4 (4.3%) produced ESBL, but 2 (10%) P. aeruginosa and 1 (5%) P. stutzeri produced MBL. Resistance of ESBL producers to trimethoprim was 55.5% and 7 (35.0%) were multidrug resistant. Detection of ESBL and MBL in Pseudomonas spp. from this study implies environmental health risk. Antibiotics misuse in aquaculture and discharge of untreated aquaculture wastewater into the environment should be discouraged.

Changes in Sagittal Alignment After Cervical Disc Arthroplasty: Results of 24 Month Pilot Study

Background Context: For cervical disc replacements to be comparable to the gold standard of cervical discectomy and fusion (ACDF), disc replacements they must be able to provide normal range of motion as well as predictable and reliable correction of cervical alignment. The Synergy Disc was designed to provide correction of alignment in the sagittal plane while restoring physiologic range of motion. Purpose: This study evaluated whether the Synergy Disc provided preservation and/or restoration of sagittal alignment while normalizing kinematics and providing acceptable clinical outcomes. The alignment provided by the Synergy Disc was compared with a retrospective cohort of 30 single- level ACDF patients. Study Design/Setting: The pilot trial was a multi-center, prospective, consecutive patient enrollment study using the Synergy Disc for the treatment of single and two-level degenerative disc disease of the cervical spine. Patient Sample: The procedure was performed on 43 patients (45 implants) with follow-up on 40 patients (42 implants). For the historical cohort ACDF arm, 30 patients with similar follow-up with single level anterior discectomy, fusion and plating were used for segmental lordosis measurements. Outcome Measures: For the Synergy Disc group, the kinematic outcome parameters included: range of motion (ROM), shell angle (SA), disc height (DH), sagittal plane translation and center of rotation (COR) in the X and Y direction. Standard assessments of clinical outcomes were also measured (Neck Disability Index, Visual Analog Scale). For the fusion arm, only functional spinal unit (FSU) angle was recorded using a single preoperative and postoperative standing lateral cervical radiograph. Methods: In the Synergy Disc group, static and dynamic radiological assessments were performed in 43 consecutive patients prior to the placement of the Synergy Disc. Forty patients were studied for the course of the study protocol (3 patients lost to follow-up). For the Synergy Disc group, lateral cervical radiographs were evaluated for range of motion, translation, center of rotation, disc height and shell angle before and at the longest postoperativr follow-up. Neck Disability Index and Visual Analog Scale for arm and neck pain were collected and analyzed. For the fusion group, standing lateral radiographs were reviewed. Results: In all the patients (40 patients, 42 implants), followed up for at least 24 months at an average of 28 months the average SA of the Synergy Disc was maintained at 6±2.7° of lordosis. Preoperative ROM, translation and center of rotation on X axis did not change significantly following surgery. There was a significant upward shift in the center of rotation on Y axis. There was significant improvement in all clinical outcome measures. In the fusion group, with a similar follow-up period, there was a 4° increase in lordosis at the FSU. Conclusions: The Synergy Disc provided lordosis at the surgical level, while maintaining preoperative range of motion, translation and COR X. The lordosis of 6±2.7° provided by the Synergy Disc at 2 years following surgery was comparable to the lordotic correction provided by an anterior cervical discectomy with interbody fusion and plating.

Can Cervical Arthroplasty Impact Alignment? A Comparison of the Synergy Disc with Cervical Fusion

Background context: Synergy disc is a new cervical disc prosthesis that incorporates alignment restoration while providing full intervertebral disc kinematics.Purpose: This follow-up study with 40 Synergy Disc patients with 24-month follow-up compared cervical alignment changes with a retrospective cohort of 30 single level anterior cervical discectomy and fusion (ACDF) patients.Study design/setting: The pilot trial was a multi-center, prospective, consecutive patient enrollment study using the Synergy Disc for the treatment of single and two-level degenerative disc disease of the cervical spine.Patient sample: The procedure was performed on 43 patients (45 implants) with follow-up on 40 patients (42 implants). For the historical cohort ACDF arm, 30 patients with similar follow-up with single level anterior discectomy, fusion and plating were used for segmental lordosis measurements.Outcome measures: For the Synergy Disc group, the kinematic parameters included: range of motion (ROM), shell angle (SA), disc height (DH), sagittal plane translation and center of rotation (COR) in the X and Y direction. Standard assessments of clinical outcomes were also measured (Neck Disability Index, Visual Analog Scale). For the fusion arm, only functional spinal unit (FSU) angle was recorded using a single pre-operative and post-operative standing lateral cervical radiograph.Methods: In the Synergy Disc group, static and dynamic radiological assessments were performed in 43 consecutive patients prior to the placement of the Synergy Disc. Forty patients were studied for the course of the study protocol (3 patients lost to follow-up). For the Synergy Disc group, all kinematic parameters were examined at a minimum of 24 months follow-up. Neck Disability Index and Visual Analog Scale for arm and neck pain were collected and analyzed. For the fusion group, standing lateral radiographs were reviewed.Results: At a mean of 28 months with all patients having a minimum of 24-month follow-up (40 patients, 42 implants), the average SA of the Synergy Disc was maintained at 6 ± 2.7˚ of lordosis. There was significant improvement in all clinical outcome measures. In the fusion group, with a similar follow-up period, there was a 4˚ increase in lordosis of the FSU.Conclusion: The Synergy Disc had an endplate angle of 6 ± 2.7˚ at 2 years following surgery. This was comparable to the lordotic correction provided by an anterior cervical discectomy with interbody fusion and plating.

Changes in Sagittal Alignment after Cervical Disc Arthroplasty: Results of a Pilot Study

Background context: For cervical disc replacements to be comparable to the gold standard of cervical discectomy and fusion (ACDF), proper cervical alignment after disc replacement is imperative in preventing accelerated facet degeneration, excessive wear debris and axial neck pain. Purpose: This study evaluated whether the Synergy Disc (artificial cervical disc replacement) could provide preservation and/or restoration of cervical alignment while normalizing kinematics and providing acceptable clinical outcomes. Study design/setting: Prospective clinical study for an alignment correcting cervical disc replacement. Patient sample: The Synergy group was comprised of 37 consecutive patients (42 implants) with a minimum follow-up of 1 year (range 12-26 months) on 34 patients (39 implants). Outcome measures: Quantitative motion analysis (QMA) software was used for kinematic outcome parameters: range of motion (ROM), horizontal translation, center of rotation (COR-X, Y), disc height (DH), disc and shell angle (DA and SA, respectively). Neck Disability Index (NDI) and Visual Analog Scale (VAS) were also assessed. Methods: The Synergy Disc patients underwent 204 lateral cervical radiographs (34 patients – 39 implants). Static and dynamic radiological assessments were performed prior to surgery and at last follow-up (mean 18 months, range 12-26 months). Results: At 18 months post-surgery, the average SA of the Synergy Disc was 6 ± 3° of lordosis. Pre-operative ROM, translation and COR X did not change significantly post-surgery. Conclusions: The Synergy Disc provided segmental lordosis at the surgical level, while maintaining pre-operative ROM, translation and COR X. There was a superior shift of COR Y following insertion of the device. The lordosis of 6 ± 3° provided by the Synergy Disc was comparable to the lordotic correction provided by an ACDF

Prevalence of Extended Spectrum β-Lactamase and Antimicrobial Susceptibility Pattern of Clinical Isolates of Pseudomonas from Patients of Khyber Pakhtunkhwa, Pakistan.

Majority of gram negative pathogenic bacteria are responsible for extended spectrum β-lactamases (ESBLs) production, which show resistance to some newer generation of antibiotics. The study was aimed at evaluating the prevalence of ESBL and antibiotic susceptibility pattern of Pseudomonas isolates collected during 2010 to 2014 from tertiary care hospitals of Peshawar, Pakistan. Out of 3450 samples, 334 Pseudomonas spp. isolates comprised of 232 indoor and 102 outdoor patients were obtained from different specimens and their susceptibility pattern was determined against 20 antibiotics. Antimicrobial susceptibility testing was carried out using the Kirby-Bauer agar diffusion method and ESBL production was detected by Synergy Disc Diffusion technique. The mean age group of the patients was 29.9 + 9.15 years. Meronem showed best activity (91.02%) from class carbapenem, β-lactam and β-lactamase inhibitors exhibited 69.16% activity, and doxycycline had a diminished activity (10.18%) to Pseudomonas spp. Outdoor isolates were more resistant than the indoor and during the course of the study the sensitivity rate of antibiotics was gradually reducing. ESBL production was observed in 44.32% while the remaining was non-ESBL. The moderate active antibiotics were amikacin (50.7%), SCF (51.4%), TZP (52.7%), and MXF (54.1%) among ESBL producing isolates. Lack of antibiotic policy, irrational uses (3GCs particularly), and the emergence of antibiotic resistant organisms in hospitals may be causes of high antibiotic resistance.

Fecal carriage of extended-spectrum β-lactamases and AmpC-producing Escherichia coli in a Libyan community.

BackgroundExtended-spectrum β-lactamases (ESBLs), including the AmpC type, are important mechanisms of resistance among Enterobacteriaeceae. CTX-M type extended-spectrum β- lactamases, of which there are now over 90 variants, are distributed globally, yet appear to vary in regional distribution. AmpC β-lactamases hydrolyze third generation cephalosporins, but are resistant to inhibition by clavulanate or other β-lactamase inhibitors in vitro. Fecal carriage and rates of colonization by bacteria harboring these resistance mechanisms have been reported in patients with community-acquired infections and in healthy members of their households. Expression of these ESBLs compromises the efficacy of current antibacterial therapies, potentially increasing the seriousness of hospital- and community-acquired Escherichia coli (E. coli) infections.To investigate the occurrence of ESBL-producing E. coli in human fecal flora isolated from two pediatric populations residing in the Libyan cities Zleiten and Abou El Khoms. Isolates were further studied to characterize genes encoding β-lactam resistance, and establish genetic relationships.MethodsAntibiotic resistance profiles of phenotypically characterized E. coli isolates recovered from the stools of 243 Libyan children during two surveillance periods in 2001 and 2007 were determined by the disk diffusion method. ESBL-screening was performed using the cephalosporin/clavulanate double synergy disc method, and the AmpC-phenotype was confirmed by the aminophenyl-boronic acid test. ESBL genes were molecularly characterized. Phylogenetic group and multilocus sequence typing (MLST) were determined for ESBL-producing isolates and PFGE was performed to compare banding profiles of some dominant strains.ResultsESBLs were identified in 13.4% (18/134) of E. coli isolates, and nine isolates (6.7%) demonstrated AmpC activity; all 18 isolates contained a CTX-M gene. Three CTX-M gene families (CTX-M-1, n = 9; CTX-M-15, n = 8 and CTX-M-3, n = 1) were distributed in diverse E. coli backgrounds (phylogenetic group D, 39%; B2, 28%; B1, 22% and A, 11%). MLST analysis revealed 14 sequence type (ST) with six new sequence types. The gene encoding the CMY-2 enzyme was detected in five AmpC-positive E. coli.ConclusionsThese results identified heterogeneous clones of CTX-M-producing E. coli in the fecal isolates, indicating that the intestinal tract acts as a reservoir for ESBL-producing organisms, and a trafficker of antibiotic resistance genes.

Phenotype detection of metallo-β-lactamase among the imipenem resistant Psudomonas and Acinetobacter in the tertiary care hospitals of Dhaka city

Metallo beta lactamases (MBL) are enzymes that have wide spread of activity and they confer a high level of resistance to all b-lactams including carbapenem, except aztreonam [1]. MBLs require divalent zinc ion for their enzymatic activity which is not diminished by serine b lactamase inhibitors like salbactam, tazobactam, clavulinic acid etc but is inhibited by metal chelators like EDTA and thiol based compounds such as 2-mercaptopropionic acid (2-MPA), 10-phenanthroline, calcium dipicholinate etc [2]. They have constant and efficient carbapenemase activity. This MBL production is typically associated with resistance to aminoglycosides and fluoroquinolones further compromising therapeutic options [3]. There are no standard methods for the detection of MBL production in gram negative organism in routine Microbiology practice. The present study was undertaken to evaluate the screening tests like double disk synergy test (DDST) and disk potentiation test (DPT) using ceftazidime (CAZ) and imipenem (IPM) disks with chelating agents like EDTA and 2-MPA. A total of 132 Pseudomonas and 76 Acinetobacter isolates were obtained from Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh Institute of Research and Rehabilitation for Diabetes, and Endocrine and Metabolic disorders (BIRDEM) hospitals of Dhaka city. A total of 53 and 29 IPM resistant Pseudomonas and Acinetobacter isolates respectively were selected. EDTAIPM micro dilution minimum inhibitory concentration (EDTA-IPM micro dilution MIC) method detected MBL in 44 (83%) IPM resistant Pseudomonas and 19(65.5%) Acinetobacter isolates. DDST with CAZ-0.1M EDTA and CAZ-2-MPA detected MBL in 73.6% and 67.9% of IPM resistant Pseudomonas and 55.2% and 48.3% of Acinetobacter isolates respectively. The detection rate was 67.9% and 66.1% in Pseudomonas and 51.7% and 44.8% in Acinetobacter isolates by EDTA-IPM and IPM-2MPA methods respectively. In comparison to DDST, DPT with 0.1M EDTA showed higher sensitivity (89.7%) and specificity (100%) for detection of MBL in Pseudomonas and Acinetobacter. Isolates were also tested for AmpC b lactamase by DPT using chelating agent aminophenyl boronic acid (APB) and it detected AmpC b lactamase in 6.9% and 21.1% MBL positive Pseudomonas and Acinetobacter respectively. MBL producing Pseudomonas and Acinetobacter are emerging in our country. Rapid detection of these MBLs is necessary to institute appropriate treatment and effective infection control measures. Simple screening test like DPT using CAZ/IPM with 0.1M EDTA can be introduced into the routine clinical laboratories for their early detection.

Effect of arthroplasty design on cervical spine kinematics: analysis of the Bryan Disc, ProDisc-C, and Synergy Disc

Cervical total disc replacement has emerged as a surgical option to preserve motion and potentially avoid adjacent-segment disease after anterior cervical discectomy and fusion. Recently, much attention has been directed at the ability of a given device to maintain and/or restore normal segmental alignment. Nonphysiological disc and segmental angulation could result in increased stresses transmitted to the facet joints and posterior elements, conflicting with the essence of arthroplasty and potentially leading to adjacent-segment disease. The goal of this study was to contrast device alignment and segmental kinematics provided by 3 different cervical disc prostheses. Sixty patients were retrospectively analyzed and divided into 3 groups receiving the Bryan, ProDisc-C, or Synergy disc. Only single-level arthroplasty cases were included in the study. Lateral dynamic radiographs of the cervical spine were analyzed using quantitative motion analysis software (Medical Metrics, Inc.) to analyze the kinematics at the index level both preoperatively and postoperatively. Several parameters were noted, including range of motion, disc angles, shell angles, anterior and posterior disc heights, translation, and center of rotation. Preoperative and postoperative data were compared using the Student t-test with a significance level of p < 0.05. Postoperatively, all 3 disc groups maintained adequate range of motion at the implanted level. With respect to the shell angles, the Synergy disc demonstrated the least variability, maintaining 6 degrees lordotic configuration between the device endplates. In the Bryan disc group, significant shell kyphosis developed postoperatively (p < 0.0001). Both ProDisc-C and Synergy discs significantly increased anterior and posterior disc heights (p < 0.0001). The Bryan and Synergy discs maintained the natural center of rotation, whereas significant anterior shift occurred with ProDisc-C. The goal for motion preservation at the implanted level was achieved using all 3 devices. The Synergy disc was unique in its ability to alter device angulation by 6 degrees. The Bryan disc demonstrated device endplate kyphosis. Both the Synergy disc and ProDisc-C increased disc space height.