Multi-drug resistant (MDR), gram-negative Enterobacteriaceae, such as Escherichia coli (E. coli) limit therapeutic options and increase morbidity, mortality, and treatment costs worldwide. They pose a serious burden on healthcare systems, especially in developing countries like Rwanda. Several studies have shown the effects caused by the global spread of extended-spectrum beta-lactamase (ESBL)-producing E. coli. However, limited data is available on transmission dynamics of these pathogens and the mobile elements they carry in the context of clinical and community locations in Sub-Saharan Africa. Here, we examined 120 ESBL-producing E. coli strains from patients hospitalized in the University Teaching Hospital of Butare (Rwanda), their attending caregivers as well as associated community members and livestock. Based on whole-genome analysis, the genetic diversification and phylogenetics were assessed. Moreover, the content of carried plasmids was characterized and investigated for putative transmission among strains, and for their potential role as drivers for the spread of antibiotic resistance. We show that among the 30 different sequence types (ST) detected were the pandemic clonal lineages ST131, ST648 and ST410, which combine high-level antimicrobial resistance with virulence. In addition to the frequently found resistance genes blaCTX–M–15, tet(34), and aph(6)-Id, we identified csg genes, which are required for curli fiber synthesis and thus biofilm formation. Numerous strains harbored multiple virulence-associated genes (VAGs) including pap (P fimbriae adhesion cluster), fim (type I fimbriae) and chu (Chu heme uptake system). Furthermore, we found phylogenetic relationships among strains from patients and their caregivers or related community members and animals, which indicates transmission of pathogens. Also, we demonstrated the presence and potential transfer of identical/similar ESBL-plasmids in different strains from the Rwandan setting and when compared to an external plasmid. This study highlights the circulation of clinically relevant, pathogenic ESBL-producing E. coli among patients, caregivers and the community in Rwanda. Combining antimicrobial resistance with virulence in addition to the putative exchange of mobile genetic elements among bacterial pathogens poses a significant risk around the world.

There are growing concerns that antibiotic pollution impacts environmental microbiota and facilitates the propagation of antibiotic resistance. However, the prediction or analytical determination of bioavailable concentrations of antibiotics in soil is still subject to great uncertainty. Biological assays are increasingly recognized as valuable complementary tools that allow a more direct determination of the residual antibiotic activity. This study assessed the bioavailability of structurally diverse antibiotics at a soil-water interface applying activity-based analyses in conjunction with equilibrium partitioning (EqP) modeling. The activity against Gram-positive and Gram-negative bacteria of nine antibiotics from different classes was determined in the presence and absence of standard soil (LUFA St. 2.2). The addition of soil affected the activity of different antibiotics to highly varying degrees. Moreover, a highly significant correlation ( p < 0.0001) between the experimentally observed and the EqP-derived log EC (half-maximal effective concentration) values was observed. The innovative experimental design of this study provided new insights on the bioavailability of antibiotics at soil-water interfaces. EqP appears to be applicable to a broad range of antibiotics for the purpose of screening-level risk assessment. However, EqP estimates cannot replace soil-specific ecotoxicity testing in higher-tier assessments, since their accuracy is still compromised by a number of factors.

Zusammenfassung. Hintergrund: Die aufgrund der Coronavirus-Pandemie veranlassten Maßnahmen haben weitreichende Folgen für den Alltag von Menschen mit Demenz und ihren pflegenden Angehörigen. Beide Gruppen gehören meist zur Risikogruppe und sollen sich entsprechend stark einschränken. Die Alltagssituation wird dadurch erschwert, dass Betreuungsleistungen und Entlastungsangebote pausieren. Zudem haben Menschen mit Demenz Schwierigkeiten, die Beschränkungen und Hygieneregeln zu verstehen und umzusetzen. Ziel: Die Studie will die aktuelle Lebenssituation aus Sicht der pflegenden Angehörigen und der Menschen mit Demenz beschreiben. Methode: Zu zwei Erhebungszeitpunkten im Frühjahr 2020 wurden Telefoninterviews mit 21 pflegenden Angehörigen und Menschen mit Demenz geführt und inhaltsanalytisch ausgewertet. Ergebnisse: Die Situation wird von den Befragten unterschiedlich erlebt. Besonders die soziale Isolation, der erhöhte Betreuungs- und Pflegeaufwand, die Ungewissheit der Situation und die Zunahme von psychischen Symptomen werden als belastend beschrieben. Bezüglich der Bewältigung der Situation werden die Unterstützung durch das soziale Umfeld, alternative Kommunikationsmöglichkeiten, Erfahrungen mit vergleichbaren Krisen, die Stabilität der Versorgung und der Umgang mit Informationen thematisiert. Schlussfolgerungen: Pflegende Angehörige und Menschen mit Demenz fühlen sich durch die Coronavirus-Pandemie belastet, verfügen häufig jedoch über Bewältigungsstrategien für die besondere Situation. Insbesondere informelle Hilfen sind dabei ein wichtiger Unterstützungsmechanismus.

all at affiliation 2); Miles W. Carroll (at affiliation 7); and Annina Schmid (at affiliation 9). Also, two author names (Rachel Varughes and Gary Mallett) were incorrect; the correct names are 'Rachel Varughese' and 'Garry Mallett' (respectively). The errors have been corrected in the HTML and PDF versions of the article.

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