Decreased mortality among patients with catheter-related bloodstream infections at Catalan hospitals (2010-2019).

BACKGROUND: The incidence of catheter-related bloodstream infections (CRBSIs) has fallen over the last decade, especially in intensive care units (ICUs). AIM: To assess the existence of concomitant trends in outcomes and to analyse the current risk factors for mortality. METHODS: A multicentre retrospective cohort study was conducted at 24 Catalan hospitals participating in the Surveillance of healthcare-associated infections in Catalonia (VINCat). All hospital-acquired CRBSI episodes diagnosed from January 2010 to December 2019 were included. A common protocol including epidemiological, clinical, and microbiological data was prospectively completed. Mortality at 30 days after bacteraemia onset was analysed using the Cox regression model. FINDINGS: Over the study period, 4795 episodes of CRBSI were diagnosed. Among them, 75% were acquired in conventional wards and central venous catheters were the most frequently involved (61%). The 30-day mortality rate was 13.8%, presenting a significant downward trend over the study period: from 17.9% in 2010 to 10.6% in 2019 (hazard ratio (HR): 0.95; 95% confidence interval (CI): 0.92-0.98). The multivariate analysis identified age (HR: 1.03; 95% CI: 1.02-1.04), femoral catheter (1.78; 1.33-2.38), medical ward acquisition (2.07; 1.62-2.65), ICU acquisition (3.45; 2.7-4.41), S. aureus (1.59; 1.27-1.99) and Candida sp. (2.19; 1.64-2.94) as risk factors for mortality, whereas the mortality rate associated with episodes originating in peripheral catheters was significantly lower (0.69; 0.54-0.88). CONCLUSION: Mortality associated with CRBSI has fallen in recent years but remains high. Intervention programmes should focus especially on ICUs and medical wards, where incidence and mortality rates are highest.

Lung ultrasound in hypoxic patient with veno-arterial ECMO / Ecografía pulmonar en el paciente con ECMO venoarterial hipóxico

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Life history of the bird cherry-oat aphid, Rhopalosiphum padi (Homoptera: Aphididae), on transgenic and untransformed wheat challenged with barley yellow dwarf virus.

The life history of Rhopalosiphum padi (L.) was monitored on transgenic and untransformed (soft white winter wheat plants that were infected with Barley yellow dwarf virus (BLDV), noninfected, or challenged with virus-free aphids under laboratory conditions. Two transgenic soft white winter wheat genotypes (103.1J and 126.02) derived from the parental variety Lambert and expressing the barley yellow dwarf virus coat protein gene, and two untransformed varieties, virus-susceptible Lambert and virus-tolerant Caldwell, were tested. B. padi nymphal development was significantly longer on the transgenic genotypes infected with BYDV, compared with noninfected transgenic plants. In contrast, nymphal development on Lambert was significantly shorter on BYDV-infected than on noninfected plants. Nymphal development on noninfected Lambert was significantly longer than on noninfected transgenics. No significant difference in nymphal development period was detected between virus-infected and noninfected Caldwell. Aphid total fecundity, length of reproductive period, and intrinsic rate of increase were significantly reduced on BYDV-infected transgenic plants compared with BYDV-infected Lambert. In contrast, reproductive period, total adult fecundity, and intrinsic rate of increase on noninfected Lambert were significantly reduced compared with noninfected transgenics. Transgenic plants infected with BYDV were inferior hosts for R. padi compared with infected Lambert. However, noninfected transgenics were superior hosts for aphids than noninfected Lambert. Moderate resistance to BYDV, as indicated by a significantly lower virus titer, was detected in the transgenic genotypes compared with the untransformed ones. Results show for the first time that transgenic virus resistance in wheat can indirectly influence R. padi life history.

Variation in barley yellow dwarf virus transmission efficiency by Rhopalosiphum padi (Homoptera: Aphididae) after acquisition from transgenic and nontransformed wheat genotypes.

The effects of different acquisition access periods (AAPs) and inoculation access periods (IAPs) on the transmission efficiency of barley yellow dwarf luteovirus (BYDV) by Rhopalosiphum padi (L.) (Homoptera: Aphididae) after feeding on transgenic or nontransformed wheat, Triticum aestivum L., genotypes were studied. Three wheat genotypes were tested as virus sources: virus-susceptible 'Lambert' and 'Lambert'-derived transgenic lines 103.1J and 126.02, which express the BYDV-PAV coat protein gene. Lower virus titers were measured in BYDV-infected transgenic plants compared with Lambert. No significant differences in transmission efficiency were detected for R. padi after varying IAPs, regardless of genotype. Transmission efficiency increased with an increase in AAP in all genotypes tested. However, AAPs ranging from 6 to 48 h on Lambert resulted in significantly greater transmission efficiency than similar periods on transgenic 103.1J. Maximum transmission efficiency (70%) was observed after a 48-h AAP on Lambert, whereas the same AAP on 103.1J and 126.02 resulted in a significantly lower transmission efficiency (57%). Contrasts were used to compare the rates of transmission and the theoretical maximum transmission percentage among the different wheat genotypes serving as virus sources. Both parameters were significantly different among genotypes, indicating that viral acquisition from each genotype resulted in a unique pattern of virus transmission by R. padi. The lowest rate of virus transmission after an AAP was observed on 103.1J compared with 126.02 or Lambert. This is likely associated with a lower virus titer in 103.1J. This is the first report of transgenic virus resistance in wheat affecting the transmission efficiency of a virus vector.

Problemas bucodentales en pacientes con diabetes mellitus (I): Indice de placa y caries dental / Bucco-dental problems in patients with Diabetes Mellitus (I) : Index of plaque and dental caries

La diabetes mellitus es considerada, hoy día, como una de las enfermedades crónicas más frecuentes; por ello, es importante conocer cuáles son sus alteraciones más relevantes a nivel bucal. Objetivos: Estudiar los distintos signos y síntomas que presentan los pacientes diabéticos en la cavidad oral. Valorar el estado de higiene oral y la prevalencia de caries dental en una población diabética con respecto a una población control. Diseño del estudio: Hemos realizado el trabajo sobre 70 pacientes diabéticos (30 varones y 40 mujeres) con edades comprendidas entre 11 y 81 años, y una población control de 74 pacientes no diabéticos (29 varones y 45 mujeres) con edades comprendidas entre 11 y 75 años. Dentro de la población diabética se valoró el tipo de diabetes, el grado de control de su enfermedad mediante la hemoglobina glicosilada, el tiempo de evolución de la diabetes y la existencia o no de complicaciones tardías. La higiene oral se midió mediante el índice placa de O´Leary. La prevalencia de caries se estudió mediante el índice CAOD. Resultados: El estado de higiene oral fue significativamente peor en los pacientes diabéticos respecto a los controles a partir de los 56 años de edad. No hemos encontrado diferencias significativas en la prevalencia de caries ni en el índice CAOD, si bien, éste fue ligeramente más elevado en los pacientes diabéticos. El estudio de los pacientes diabéticos evidenció que sólo el tipo y la evolución de su enfermedad fueron parámetros significativos en relación al número de caries, mientras que para el índice de placa no se halló significación para ninguno de los parámetros analizados. Conclusiones: En el presente estudio hemos observado un mayor número de ausencias dentarias en la población diabética con respecto a una población sana. No hemos encontrado diferencias en el número de caries, ausencias y obturaciones en función del control metabólico, tiempo de evolución y existencia o no de complicaciones tardías de la diabetes (AU)

Visceral leishmaniasis (kala-azar) in solid organ transplantation: report of five cases and review.

Visceral leishmaniasis is an infectious disease that occurs only rarely in recipients of solid organ grafts but is associated with an elevated mortality rate despite proper treatment. We report five cases diagnosed in our hospital. All the patients were men aged 30 to 60 years who had undergone kidney transplantation (3 patients), heart transplantation (1), or liver transplantation (1). Three of the patients died, one had multiple recurrences, and one developed post-kala-azar cutaneous leishmaniasis. We review the clinical features, treatments, and outcomes of 26 previously reported cases, pointing out the lower cure rate associated with human immunodeficiency virus infection.