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Panton-Valentine leukocidin (PVL)-positive methicillin-resistant Staphylococcus aureus (MRSA) that are multi-locus sequence type clonal complex 22 (CC22) comprise a significant public health problem in the UK. In the present study we sought to determine the genetic diversity, and the respective patient demographics, among 47 PVL-MRSA with a CC22 pulsotype that occurred sporadically or in clusters in community and healthcare settings in eight of nine geographic regions in England and Wales between January 2005 and September 2007. Patient demographics and disease presentations were typical for PVL-S. aureus infections (mostly skin and soft tissue infections in individuals <40 years old); one patient with community-acquired pneumonia died. Although the isolates were closely genotypically related by spa typing and pulsed field gel electrophoresis, at least two variant groups were suggested. PCR detections demonstrated that the majority of the CC22 PVL-MRSA identified (n = 42; 89%) harboured SCCmecIVc, three had SCCmecIVd, one had SCCmecIV but was non-subtypeable, and one isolate harboured SCCmecV. At least three different PVL-encoding phages were detected: ΦPVL, Φ108PVL and an unidentified icosahedral phage. Agar dilution MIC determinations showed that the CC22 PVL-MRSA identified were typically resistant to gentamicin and trimethoprim (43 of 47 isolates) and ciprofloxacin resistance was also noted in six isolates. In conclusion, the CC22 PVL-MRSA tested were geographically disseminated but highly genetically related. The observed variances in acquired elements (most notably SCCmec and PVL-encoding phages) suggested that CC22 PVL-MRSA in England and Wales have evolved on multiple occasions [ABSTRACT FROM AUTHOR]

Objectives: To evaluate the potential for a national innovation fund, in the context of devolved health policy, to stimulate local action to deliver national priorities, using as a case study the conception, design and implementation of the £30m Welsh Assembly Government's (WAG) Inequalities in Health Fund (IiHF) 2001-08., Methods: Multi-method evaluation of the national and local conception, design and implementation of the Fund, using analysis of documentary evidence, interviews and focus groups with national (Wales) officials and more than 170 local managers and professionals. The field work was carried out between October 2004 and June 2007., Results: Different approaches at the three stages (concept, design, implementation) can reduce or enhance the effectiveness of funds like this one as a tool for achieving national objectives, and these are described., Conclusions: National funds can be a useful lever for change, if appropriately conceived, designed and implemented. However, in the context of competing healthcare and other policy priorities, 'good practice' is often difficult to achieve, and somewhat simplistic incentives are often subverted locally, diluting the original purpose of the initiative., (Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.)

We aimed to enhance our case ascertainment of meticillin-resistant Staphylococcus aureus encoding Panton-Valentine leucocidin (PVL-MRSA), determine the patient demographic, risk factor and disease associations, and define the clonal diversity amongst isolates referred to the UK Health Protection Agency's Staphylococcus Reference Unit. PVL-MRSA collected during 2005-6 from community-based and hospitalised patients located across England and Wales were identified by polymerase chain reaction (PCR). Representative geographically and temporally unrelated isolates were characterised via toxin gene profiling, SCCmec, spa and agr typing, multilocus sequence typing (MLST) and minimum inhibitory concentration (MIC) determinations. PVL-MRSA were identified from 275 patients. Affected individuals were <1 to 95 years of age (mean 30, median 27 years). Forty-five isolates were from 18 household or community-based clusters and 23 isolates were from outbreaks in healthcare settings. Overall, 58% (n = 161) had skin and soft tissue infections and 9% (n = 25) presented with or developed more serious disease, including eight patients (3%) with necrotising pneumonia, five of whom subsequently died. PVL-MRSA were genetically diverse and harboured SCCmecIV or V(T)/VII. Representatives of MLST clonal complexes (CCs) 8, 30 and 80 were identified the most often. The 275 PVL-MRSA included internationally disseminated community-associated MRSA (CA-MRSA) strains, as well as other minor lineages, and were associated with typical risk factors and disease presentations.

--A study assessed whether more older people would avoid institutional care if current home care technologies were utilised fully. --A number of people were found to benefit from different technology bundles and at a lower cost than institutional care. --For this approach to succeed, high application of comprehensive geriatric assessment would be needed.

Group B streptococci (GBS) are a major cause of invasive disease in infants, with enhanced surveillance in England and Wales showing an incidence of 0.74 cases per 1000 live births and a mortality rate of 8%. Among 353 isolates obtained during enhanced surveillance, the predominant serotypes were III (48%), Ia (27%), and V (10%), and the remainder comprised Ib, II, IV, VI, and VII; 3% were not typable. Isolates from patients with early-onset disease had serotypes III (38%), Ia (32%), and V (13%), with late-onset disease having a higher incidence of type III (67%) strains. Patients infected with serotype III strains had a higher rate of meningitis, and those with type V strains had a higher mortality rate. Isolates were susceptible to penicillin and ampicillin, but 4% were resistant to erythromycin, and 91% were resistant to tetracycline. A trivalent vaccine containing capsular polysaccharides III, Ia, and V could theoretically provide coverage against 85% of the cases of GBS disease among infants in England and Wales.

During 2000, the UK witnessed a sudden increase in severe infections and related deaths in injecting drug users (IDUs), sparking off a UK-wide investigation. A worrying upward trend in severe group A streptococcal (GAS) infections has recently been observed in IDUs based upon isolate referrals to the PHLS Respiratory and Systemic Infection Laboratory. Most cases were young male adults who presented with skin sepsis and bacteraemia. Serotyping revealed a diverse range of M types, with higher types predominating in some geographical areas. The data suggest that GAS invasive soft-tissue infections may present in an epidemic fashion among IDUs in the absence of a common source.

Objective: To assess the prevalence of antibiotic resistance and serotype distribution among pneumococci in England and Wales in 1990 and 1995., Design: Observational surveys in March 1990 and March 1995. During two weeks in each survey period all pneumococci isolated in public health laboratories in England and Wales were collected and assessed for sensitivity to antibiotics and the distribution of serogroups or serotypes., Setting: The network of public health laboratories throughout England and Wales., Subjects: 1127 individual patient isolates of Streptococcus pneumoniae obtained during the two surveys., Main Outcome Measures: Sensitivity or resistance to a range of antibiotics; serogroup or serotype., Results: The prevalence of intermediate or full resistance to penicillin increased from 1.5% in 1990 to 3.9% in 1995 and resistance to erythromycin increased from 2.8% to 8.6%. About 92% of isolates belonged to serogroups or serotypes included in the currently available pneumococcal vaccine., Conclusion: Resistance to penicillin and erythromycin has increased among pneumococci in England and Wales. Continued surveillance to assess further increases in the prevalence of pneumococcal resistance to antibiotics is essential.

The National Health Services in Wales has adopted a strategic approach based on health gain. Five approaches to meeting this problem are considered (i) eliminating basic inefficiencies; (ii) eliminating unnecessary clinical activity; (iii) doing what is done now but differently; (iv) investing now to save later and (v) withdrawing from a particular area of activity, because it is less important than other competing claims. Each of these is briefly considered with particular reference to the Welsh situation. Three particular lines of advance are identified to achieve the above: creating new sources of information; working more effectively across organisational boundaries; and making the cultural changes to make it all possible.

Nearly half of all deaths in Wales are from cardiovascular disease. Christopher Riley and colleagues set out how health planners aim to change all that with protocols for health gain.