More isn't always better: antibiotic duration after surgical decortication in pleural empyema.

Background: While ample high-level evidence supports the limited use of antibiotics post-source control in intraabdominal infections, there is a paucity of available data in guiding antibiotic duration for intrathoracic infections. This study aims to analyze patient outcomes among those who have undergone surgical decortication for parapneumonic pleural empyema, comparing cases managed with infectious disease (ID) specialists against those without, and to identify predictive factors influencing antibiotic duration post-source control. We hypothesized that antibiotic duration would vary depending on the involvement of ID specialists. Methods: A retrospective chart review was completed on patients with parapneumonic pleural empyemas who underwent surgical decortication at a single tertiary center from January 2011 to March 2021. Differences in patient characteristics and outcomes for those whose antibiotics were managed by ID or not were compared with Wilcoxon two-sample tests and Fisher's exact tests. Linear regression was used to evaluate for significant factors predictive of antibiotic duration. Results: A total of 116 patients underwent surgical decortication for pleural empyema of parapneumonic etiology. ID specialists were involved with antibiotic management in 62 (53.4%) cases, while the remaining cases were not managed by ID. Demographics and patient comorbidities were similar between both groups. Growth of preoperative fluid cultures was higher in patients managed by ID (40.3% vs. 20.4%, P=0.03). Postoperatively, patients managed by ID had longer durations of antibiotics (28.7 vs. 20.9 days, P<0.001) and were more likely to be on IV antibiotics than patients not managed by ID (59.7% vs. 38.9%, P=0.04). However, postoperative outcomes were similar, including rates of disease recurrence, readmission, and 30-day mortality. Linear regression revealed length of antibiotics was significantly dependent on preoperative ventilator status [estimate: 16.346; 95% confidence interval (CI): 6.365-26.326; P=0.002], growth of preoperative pleural fluid cultures (estimate: 10.203; 95% CI: 2.502-17.904; P=0.01), and ID involvement (estimate: 8.097; 95% CI: 1.003-15.191; P=0.03). Conclusions: Antibiotic duration for pleural empyema managed with surgical decortication is significantly dependent on ID involvement, preoperative growth of cultures, and preoperative ventilator status. However, outcomes, including disease recurrence and 30-day mortality, were similar between patients regardless of ID involvement and longer length of antibiotics, raising the question of what the adequate duration of antibiotics is for patients who receive appropriate source control for pleural empyema. Further study with randomized control trials should be conducted to provide high-level evidence regarding length of antibiotics in this patient population.

Emergent Esophagectomy in Patients with Esophageal Malignancy Is Associated with Higher Rates of Perioperative Complications but No Independent Impact on Short-Term Mortality.

Background: Data on perioperative outcomes of emergent versus elective resection in esophageal cancer patients requiring esophagectomy are lacking. We investigated whether emergent resection was associated with increased risks of morbidity and mortality. Methods: Data on patients with esophageal malignancy who underwent esophagectomy from 2005 to 2020 were retrospectively analyzed from the American College of Surgeons National Surgical Quality Improvement Program database. Thirty-day complication and mortality rates were compared between emergent esophagectomy (EE) and non-emergent esophagectomy. Logistic regression assessed factors associated with complications and mortality. Results: Of 10,067 patients with malignancy who underwent esophagectomy, 181 (1.8%) had EE, 64% had preoperative systemic inflammatory response syndrome, sepsis, or septic shock, and 44% had bleeding requiring transfusion. The EE group had higher American Society of Anesthesiologists (ASA) class and functional dependency. More transhiatal esophagectomies and diversions were performed in the EE group. After EE, the rates of 30-day mortality (6.1% vs. 2.8%), overall complications (65.2% vs. 44.2%), bleeding, pneumonia, prolonged intubation, and positive margin (17.7% vs. 7.4%) were higher, while that of anastomotic leak was similar. On adjusted logistic regression, older age, lower albumin, higher ASA class, and fragility were associated with increased complications and mortality. McKeown esophagectomy and esophageal diversion were associated with a higher risk of postoperative complications. EE was associated with 30-day postoperative complications (odds ratio, 2.39; 95% confidence interval, 1.66-3.43; p<0.0001). Conclusion: EE was associated with a more than 2-fold increase in complications compared to elective procedures, but no independent increase in short-term mortality. These findings may help guide data-driven critical decision-making for surgery in select cases of complicated esophageal malignancy.

Efficacy and safety of a structured de-escalation from antipseudomonal ß-lactams in bloodstream infections due to Enterobacterales (SIMPLIFY): an open-label, multicentre, randomised trial.

BACKGROUND: De-escalation from broad-spectrum to narrow-spectrum antibiotics is considered an important measure to reduce the selective pressure of antibiotics, but a scarcity of adequate evidence is a barrier to its implementation. We aimed to determine whether de-escalation from an antipseudomonal ß-lactam to a narrower-spectrum drug was non-inferior to continuing the antipseudomonal drug in patients with Enterobacterales bacteraemia. METHODS: An open-label, pragmatic, randomised trial was performed in 21 Spanish hospitals. Patients with bacteraemia caused by Enterobacterales susceptible to one of the de-escalation options and treated empirically with an antipseudomonal ß-lactam were eligible. Patients were randomly assigned (1:1; stratified by urinary source) to de-escalate to ampicillin, trimethoprim-sulfamethoxazole (urinary tract infections only), cefuroxime, cefotaxime or ceftriaxone, amoxicillin-clavulanic acid, ciprofloxacin, or ertapenem in that order according to susceptibility (de-escalation group), or to continue with the empiric antipseudomonal ß-lactam (control group). Oral switching was allowed in both groups. The primary outcome was clinical cure 3-5 days after end of treatment in the modified intention-to-treat (mITT) population, formed of patients who received at least one dose of study drug. Safety was assessed in all participants. Non-inferiority was declared when the lower bound of the 95% CI of the absolute difference in cure rate was above the -10% non-inferiority margin. This trial is registered with EudraCT (2015-004219-19) and ClinicalTrials.gov (NCT02795949) and is complete. FINDINGS: 2030 patients were screened between Oct 5, 2016, and Jan 23, 2020, of whom 171 were randomly assigned to the de-escalation group and 173 to the control group. 164 (50%) patients in the de-escalation group and 167 (50%) in the control group were included in the mITT population. 148 (90%) patients in the de-escalation group and 148 (89%) in the control group had clinical cure (risk difference 1·6 percentage points, 95% CI -5·0 to 8·2). The number of adverse events reported was 219 in the de-escalation group and 175 in the control group, of these, 53 (24%) in the de-escalation group and 56 (32%) in the control group were considered severe. Seven (5%) of 164 patients in the de-escalation group and nine (6%) of 167 patients in the control group died during the 60-day follow-up. There were no treatment-related deaths. INTERPRETATION: De-escalation from an antipseudomonal ß-lactam in Enterobacterales bacteraemia following a predefined rule was non-inferior to continuing the empiric antipseudomonal drug. These results support de-escalation in this setting. FUNDING: Plan Nacional de I+D+i 2013-2016 and Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases; Spanish Clinical Research and Clinical Trials Platform, co-financed by the EU; European Development Regional Fund "A way to achieve Europe", Operative Program Intelligence Growth 2014-2020.

Are intracystic chromogranin A and neuron-specific enolase useful in the diagnosis of cystic pancreatic neuroendocrine tumors?

Value of Choromogranin A and neuron-specific enolase intracystic (EUS-FNB) in the preoperatory diagnosis of cystic pancreatic neuroendocrine tumors.

Identification and antifungal susceptibility testing of Candida haemulonii complex isolated from clinical samples.

Candida haemulonii complex (Candida haemulonii [I], Candida duobushaemulonii [II], and Candida haemulonii var. vulnera [III]) has become relevant in recent times, not so much because of a high incidence in human clinical sample cultures but because of its remarkable antifungal resistance. The objective of this study was to evaluate several methods for the identification of this uncommon species of Candida. Ten isolates of C. haemulonii were identified by biochemical and proteomic methods, and their antifungal susceptibility testing was performed by both commercial and reference methods. MALDI-TOF MS (Vitek MS and Vitek MS PRIME) and Vitek2 correctly identified these genera but API method did not. There was a good correlation between the commercial methods and the reference methods for the AST. In conclusion Vitek MS, Vitek MS PRIME, and Vitek2 systems, but not API32C, are reliable for identification of C. haemulonii complex. Furthermore, MALDI-TOF MS systems could identify to the subspecies level. Commercial methods for antifungal susceptibility testing are valid for the study of this species and confirm amphotericin B and to azole resistance.

Chronic Diarrhea Due to Aeromonas hydrophila in an Immunosuppressed Patient with a Pancreas-Kidney Transplant.

The genus Aeromonas belongs to the Aeromonadaceae family. A patient with a pancreas-kidney transplant had multiple episodes of abdominal sepsis after surgery. Aeromonas hydrophila was isolated in the ascitic and biliary fluid drains. After discharge, the patient had several diarrhea episodes, and A. hydrophila was isolated in four stool samples. We decided to test whether the one strain that we initially isolated in ascitic fluid was the same that appeared in the successive stool samples. Five isolates of A. hydrophila were found in the patient. Identification was performed using the MALDI-TOF system and confirmed via multiplex PCR. The analysis of the REP-PCR fingerprint patterns showed one cluster and confirmed that all isolates were related. We also demonstrated the virulent character of this species associated with genes encoding different toxins (act, alt, ast, hlyA, and aerA). The virulence of this species is associated with the expression of genes that encode different toxins, structural proteins, and metal-associated proteins. This case report highlights the severity of this disease, especially in immunocompromised patients, and its adequate treatment.

Chest vs. neck anastomotic leak post esophagectomy for malignancy: rate, predictors, and outcomes.

Background: Anastomotic leak is a major contributor to comorbidity and mortality following esophagectomy. We sought to assess rate and predictors of leak after esophagectomy and compare outcomes of chest versus neck anastomotic leaks. Methods: A retrospective review was performed utilizing National-Surgical-Quality-Improvement-Program data from 2016-2019 for patients undergoing esophagectomy for malignancy. Preoperative characteristics and postoperative outcomes were compared. Patients were classified into two groups: Ivor Lewis esophagectomy [ILE, chest leak (CL)] and transhiatal esophagectomy (THE)/McKeown esophagectomy [ME, neck leak (NL)]. Multivariable regression models were constructed to determine predictors of each type of leak and postoperative complications. Results: A total of 1,665 patients underwent esophagectomy with 14.1% reported post-operative leak, 61% of patients underwent ILE while 39% underwent THE or ME. Of patients who underwent ILE, 13.8% had CL with complications including significantly higher length of stay and mortality compared to patients without leak. Independent predictors of CL included: diabetes, hypertension, advanced disease stage, chronic steroid use, and operative time. Ninety-five patients (14.6%) who underwent either THE or ME had NL with similar complications. Diabetes, pre-operative white blood cell (WBC), and operative time were independent predictors for NL. On multivariable regression, CL was associated with greater odds of requiring intervention compared with NL. Conclusions: Post-esophagectomy CL and NL are associated with higher morbidity and mortality. Diabetes and operative time were independent predictors for both leaks while steroid use, hypertension, and advanced disease stage predicted CL. CL was associated with greater odds of needing an intervention, but contrary to conventional wisdom, was not associated with higher morbidity or mortality.

Epidemiology of Campylobacter spp. isolated from stool in a tertiary hospital in Cantabria, Northern Spain, from 2016 to 2020 / Epidemiología de Campylobacter spp. aislado de heces en un hospital terciario de Cantabria, norte de España, de 2016 a 2020

Background: The incidence of Campylobacter coli has increased and with greater resistance to antibiotics than Campylobacter jejuni. Objectives: To determine the epidemiology distribution of Campylobacter spp. in our health area, and the sensitivity to commonly tested antibiotics. Methods: Retrospective descriptive study of cases of campylobacteriosis (2016–2020) recovered from stool cultures as laboratory routine protocol. Sensitivity was tested following EUCAST recommendations. Results: Of 1319 campylobacteriosis (C. jejuni 87.7%, C. coli 12.3%) we found a decrease in C. jejuni cases in 2019, and an increase in C. coli. Statistically significant differences were seen in age and gender distribution. The resistance percentages have generally decreased, with higher percentages of resistance in C. coli than in C. jejuni, being significant for erythromycin. Conclusions: There is not an increase of C. jejuni and its resistance but there is a not alarming increase of incidence of C. coli and its resistance in our health area.(AU)

Introducción: La incidencia de Campylobacter coli ha aumentado y con mayor resistencia a los antibióticos que Campylobacter jejuni. Objetivos: Determinar la distribución epidemiológica de Campylobacter spp. en nuestra área de salud y la sensibilidad a los antibióticos comúnmente probados. Métodos: Estudio descriptivo retrospectivo de casos de campilobacteriosis (2016-2020) recuperados de coprocultivos con el protocolo de rutina del laboratorio. La sensibilidad se probó siguiendo las recomendaciones de EUCAST. Resultados: De 1.319 campilobacteriosis (C. jejuni 87,7%, C. coli 12,3%) se encontró una disminución en los casos de C. jejuni en 2019, y un aumento en C. coli. Se observaron diferencias estadísticamente significativas en la distribución de edad y género. Los porcentajes de resistencia han disminuido en general, con porcentajes más altos de resistencia en C. coli que en C. jejuni, siendo significativos para la eritromicina. Conclusiones: No hay un aumento de C. jejuni ni de su resistencia, pero sí un aumento no alarmante de la incidencia de C. coli y su resistencia en nuestra área de salud.(AU)

Epidemiology of Aeromonas spp. isolated from stool in a tertiary hospital in Cantabria, Northern Spain, in the last five years / Epidemiología de Aeromonas spp. aisladas de heces en un hospital terciario en Cantabria, norte de España, en los últimos 5 años

Introduction: The role of Aeromonas species in gastrointestinal disease is controversial. The aim of this study was to know the epidemiological distribution of Aeromonas spp. isolated from stool in our health area, determine the existence of diarrhea as a significant symptom, identification of existing species in our environment and association as co-pathogen. Methods: It was a retrospective descriptive study of isolates of Aeromonas spp. in feces (2016–2020). The protocol for these isolates included coproculture, identification by MALDI-TOF (Vitek-MS®, BioMerieux) and confirmation by multiplex PCR. Results: A total of 366 Aeromonas spp. isolates were analyzed being Aeromonas caviae the most prevalent species (289, 78.7%). A total of 58 (15.8%) co-infections were identified, being more frequent in pediatric age (49;84.5%) (p=0.01) and mostly associated with Campylobacter spp. Discussion: Aeromonas spp. prove to be a gastrointestinal pathogen more frequently associated with co-infections in pediatric age, evidencing its appearance especially with Campylobacter spp.(AU)

Introducción: El papel de las especies de Aeromonas en la enfermedad gastrointestinal es muy controvertido. El objetivo de este estudio fue conocer la distribución epidemiológica de Aeromonas spp. aislada de heces en nuestra área de salud, determinar la existencia de diarrea como síntoma significativo, la identificación de especies existentes en nuestro entorno y la asociación como copatógeno. Métodos: Se trata de un estudio descriptivo retrospectivo de aislados de Aeromonas spp. en heces (2016-2020). El protocolo para estos aislamientos incluía coprocultivo, la identificación por MALDI-TOF (VITEK®MS, bioMérieux) y la confirmación por PCR multiplex. Resultados: Se analizaron un total de 366 aislados de Aeromonas spp., siendo Aeromonas caviae la especie más prevalente (289; 78,7%). Se identificaron un total de 58 (15,8%) coinfecciones, siendo significativamente más frecuentes en edades pediátricas (49; 84,5%) (p=0,01) y asociadas principalmente con Campylobacter spp. Discusión: Aeromonas spp. resulta ser un patógeno gastrointestinal que se asocia con mayor frecuencia a coinfecciones en la edad pediátrica, evidenciando su aparición especialmente con Campylobacter spp.(AU)

Outbreak of Arcobacter butzleri? An emerging enteropathogen.

BACKGROUND: Arcobacter butzleri is a gram-negative rod, with microaerobic growth at an optimal temperature of 37°C. It was reported to be the fourth most common Campylobacter-like organism isolated from patients with diarrhoea. OBJECTIVE: Characterise a potential outbreak of A. butzleri detected in a short period of time in the University Hospital Marqués de Valdecilla. METHODS: Eight strains of A. butzleri were detected in our hospital in only two months. Isolates were identified by MALDI-TOF MS system and 16S rDNA sequencing. Enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) and Pulsed Field Gel Electrophoresis (PFGE) were carried out to assess clonal relationship. Gradient strips (Etest) were used to determine susceptibility by agar diffusion. RESULTS: ERIC-PCR and PFGE confirmed the lack of clonal relationship between strains. Erythromycin or ciprofloxacin might be appropriate for antibiotic treatment of infections. CONCLUSIONS: A. butzleri is an emerging pathogen with increasing incidence, and may be underestimated.

Evaluation of the EUROIMMUN Aspergillus antigen immunoenzyme assay in serum and bronchoalveolar lavage fluid samples.

INTRODUCTION: The most widely used marker for the diagnosis of invasive aspergillosis (IA) is the detection of galactomannan by ELISA. This study describes the evaluation of the results obtained by Euroimmun Aspergillus antigen ELISA (EIA-GM-E) in serum samples and bronchoalveolar lavage fluid (BAL) from patients at risk of IA, and compares these results with those obtained by Bio-Rad Galactomannan EIA (EIA-GM-BR). METHODS: Anonymous retrospective case-control comparative study in 64 serum samples and 28 BAL from 51 patients. RESULTS: Overall agreement of the results of the two assays was observed in 72 of 92 samples (78.3%). The sensitivity of EIA-GM-BR and EIA-GM-E in serum samples was 88.9% and 43.2%, respectively, and 100% and 88.9% for BAL. The specificity of EIA-GM-BR and EIA-GM-E in serum samples was 91.9% for both assays, and 68.4% and 84.2% in BAL. There were no statistically significant differences in the results of both assays. CONCLUSIONS: Both methods show good results for the discrimination of patients with IA when BAL is tested, or serum in case of EIA-GM-BR.

Outbreak of Arcobacter butzleri? An emerging enteropathogen / Brote de Arcobacter butzleri? Un enteropatógeno emergente

Background: Arcobacter butzleri is a gram-negative rod, with microaerobic growth at an optimal temperature of 37°C. It was reported to be the fourth most common Campylobacter-like organism isolated from patients with diarrhoea. Objective: Characterise a potential outbreak of A. butzleri detected in a short period of time in the University Hospital Marqués de Valdecilla. Methods: Eight strains of A. butzleri were detected in our hospital in only two months. Isolates were identified by MALDI-TOF MS system and 16S rDNA sequencing. Enterobacterial repetitive intergenic consensus-PCR (ERIC-PCR) and Pulsed Field Gel Electrophoresis (PFGE) were carried out to assess clonal relationship. Gradient strips (Etest) were used to determine susceptibility by agar diffusion. Results: ERIC-PCR and PFGE confirmed the lack of clonal relationship between strains. Erythromycin or ciprofloxacin might be appropriate for antibiotic treatment of infections. Conclusions: A. butzleri is an emerging pathogen with increasing incidence, and may be underestimated.(AU)

Antecedentes: Arcobacter butzleri es un bacilo gramnegativo, con crecimiento microaerófilo a una temperatura óptima de 37°C. Ha sido descrito como el cuarto organismo asociado a Campylobacter más frecuentemente aislado de pacientes con diarrea. Objetivo: Caracterizar un potencial brote de A. butzleri detectado en el Hospital Universitario Marqués de Valdecilla. Métodos: Se detectaron 8 cepas de A. butzleri en nuestro hospital en solo 2 meses. Los aislamientos fueron identificados con MALDI-TOF MS y secuenciación del ARNr 16S. Se llevó a cabo la PCR basada en secuencia de consenso intergénica repetitiva de enterobacterias(ERIC-PCR) y electroforesis en campo pulsado (PFGE) para asegurar la relación clonal. Para determinar la sensibilidad se usaron tiras de gradiente (Etest®) por difusión en agar. Resultados: ERIC-PCR y PFGE confirmaron la falta de relación clonal entre las cepas. Eritromicina o ciprofloxacino podrían ser apropiados para el tratamiento antibiótico de estas infecciones. Conclusiones: A. butzleri es un patógeno emergente con un aumento en la incidencia, y podría estar subestimado.(AU)

Evaluation of the EUROIMMUN Aspergillus antigen immunoenzyme assay in serum and bronchoalveolar lavage fluid samples / Evaluación del EUROIMMUN Aspergillus antigen immunoenzyme assay en muestras de suero y lavado broncoalveolar

Introduction: The most widely used marker for the diagnosis of invasive aspergillosis (IA) is the detection of galactomannan by ELISA. This study describes the evaluation of the results obtained by Euroimmun Aspergillus antigen ELISA (EIA-GM-E) in serum samples and bronchoalveolar lavage fluid (BAL) from patients at risk of IA, and compares these results with those obtained by Bio-Rad Galactomannan EIA (EIA-GM-BR). Methods: Anonymous retrospective case–control comparative study in 64 serum samples and 28 BAL from 51 patients. Results: Overall agreement of the results of the two assays was observed in 72 of 92 samples (78.3%). The sensitivity of EIA-GM-BR and EIA-GM-E in serum samples was 88.9% and 43.2%, respectively, and 100% and 88.9% for BAL. The specificity of EIA-GM-BR and EIA-GM-E in serum samples was 91.9% for both assays, and 68.4% and 84.2% in BAL. There were no statistically significant differences in the results of both assays. Conclusions: Both methods show good results for the discrimination of patients with IA when BAL is tested, or serum in case of EIA-GM-BR.(AU)

Introducción: El marcador más utilizado para el diagnóstico de aspergilosis invasora (AI) es la detección de galactomanano mediante la técnica de ELISA. Este estudio describe la evaluación de los resultados obtenidos por Euroimmun Aspergillus antigen ELISA (EIA-GM-E) en muestras de suero y lavado broncoalveolar (LBA) de pacientes con factores de riesgo de AI, y compara sus resultados con los obtenidos por Bio-Rad Galactomannan EIA (EIA-GM-BR). Métodos: Estudio comparativo caso-control retrospectivo anónimo en 64 muestras de suero y 28 de LBA de 51 pacientes. Resultados: Se observó una concordancia global de resultados de los dos ensayos en 72 de las 92 muestras (78,3%). Los valores de sensibilidad de EIA-GM-BR y EIA-GM-E en suero fueron 88,9% y 43,2%, respectivamente, y para LBA 100% y 88,9%. La especificidad en suero de EIA-GM-BR y EIA-GM-E fue del 91,9% en ambos ensayos y para LBA 68,4% y 84,2%. No se observaron diferencias estadísticamente significativas en los resultados de ambos ensayos. Conclusiones: Ambos métodos demuestran buenos resultados para la discriminación de pacientes con AI cuando se emplea como muestra el LBA, o el suero en caso de EIA-GM-BR.(AU)

Virulence genes of Aeromonas spp. isolates from stool in Spain.

INTRODUCTION: The role of Aeromonas species in gastrointestinal disease is controversial. The aim was to analyze not only the virulence genes between different species of Aeromonas isolated from feces, but the distribution of these virulence genes between enterotoxigenic strains and co-pathogen strains. METHODS: Retrospective study of isolates of Aeromonas spp. in feces (2016-2021). The protocol included coproculture, identification by MALDI-TOF and confirmation by multiplex PCR. SPSS Statistics program was used. RESULTS: A total of 288 strains were studied for the virulence genes between different species of Aeromonas. To compare virulence genes between Aeromonas as co-pathogen and those isolated alone, 218 strains of the global set were used; 52 as co-pathogens compared with 166 Aeromonas without associated pathogen as controls. CONCLUSIONS: We found no significant differences in the distribution of virulence genes versus co-existence of co-pathogens or not. A. hydrophila is the potentially most virulent species of our set.

Characterization, antifungal susceptibility and virulence of Candida parapsilosis complex isolates in a tertiary hospital in Cantabria, Northern Spain.

INTRODUCTION: The correct identification of the species within the Candida parapsilosis complex has become relevant due to the resistance of Candida metapsilosis to antifungals. We describe the characteristics of the Candida parapsilosis complex isolates, with respect to antifungal resistance and biofilm formation. METHODS: We perform a descriptive cross-sectional study in 30 strains, collected in a tertiary hospital. All strains, were identified by Vitek2, Vitek-MS™ systems and by ITS sequencing. The antifungal susceptibility profile was obtained with Sensititre™ panels, while biomass production and metabolic activity were quantified by means of crystal violet and XTT reduction assay, respectively. RESULTS: There was a 100% correlation between Vitek-MS™ and ITS sequencing. All isolates were susceptible to the nine antifungals tested. The metabolic activity and biomass production tests did not show any difference among the subtypes. CONCLUSIONS: The Vitek-MS™ system provides acceptable identification. We did not find significant differences neither in azole resistance nor in biofilm formation.

Characterization, antifungal susceptibility and virulence of Candida parapsilosis complex isolates in a tertiary hospital in Cantabria, Northern Spain / Caracterización, sensibilidad antifúngica y virulencia de aislamientos del complejo Candida parapsilosis en un hospital terciario en Cantabria, norte de España

Introduction: The correct identification of the species within the Candida parapsilosis complex has become relevant due to the resistance of Candida metapsilosis to antifungals. We describe the characteristics of the Candida parapsilosis complex isolates, with respect to antifungal resistance and biofilm formation. Methods: We perform a descriptive cross-sectional study in 30 strains, collected in a tertiary hospital. All strains, were identified by Vitek2, Vitek-MS™ systems and by ITS sequencing. The antifungal susceptibility profile was obtained with Sensititre™ panels, while biomass production and metabolic activity were quantified by means of crystal violet and XTT reduction assay, respectively. Results: There was a 100% correlation between Vitek-MS™ and ITS sequencing. All isolates were susceptible to the nine antifungals tested. The metabolic activity and biomass production tests did not show any difference among the subtypes. Conclusions: The Vitek-MS™ system provides acceptable identification. We did not find significant differences neither in azole resistance nor in biofilm formation.(AU)

Introducción: La correcta identificación del complejo Candida parasilopsis es relevante debido a la resistencia antifúngica de Candida metasilopsis. Describimos las características de aislados del complejo Candida parapsilosis respecto a la resistencia antifúngica y formación de biopelícula. Métodos: Se realiza un estudio descriptivo transversal de 30 cepas recolectadas en un hospital terciario. Todas se identificaron por los sistemas Vitek2, MALDI-TOF MS Vitek-MSTM y por secuenciación de las regiones ITS. La sensibilidad antifúngica se realizó con paneles SensititreTM. Para la producción de biomasa y la actividad metabólica se emplearon la medición de cristal violeta y el ensayo de reducción de XTT, respectivamente. Resultados: Hubo una correlación del 100% entre Vitek-MSTM y la secuencia de ITS. Todos los aislados fueron sensibles a los 9 antifúngicos evaluados. Los ensayos de actividad metabólica y producción de biomasa no arrojaron diferencias entre los subtipos. Conclusiones: El sistema Vitek-MSTM proporciona una identificación aceptable. No encontramos diferencias significativas ni en la resistencia a azoles ni en la formación de biopelículas.(AU)

Epidemiology of Aeromonas spp. isolated from stool in a tertiary hospital in Cantabria, Northern Spain, in the last five years.

INTRODUCTION: The role of Aeromonas species in gastrointestinal disease is controversial. The aim of this study was to know the epidemiological distribution of Aeromonas spp. isolated from stool in our health area, determine the existence of diarrhea as a significant symptom, identification of existing species in our environment and association as co-pathogen. METHODS: It was a retrospective descriptive study of isolates of Aeromonas spp. in feces (2016-2020). The protocol for these isolates included coproculture, identification by MALDI-TOF (Vitek-MS®, BioMerieux) and confirmation by multiplex PCR. RESULTS: A total of 366 Aeromonas spp. isolates were analyzed being Aeromonas caviae the most prevalent species (289, 78.7%). A total of 58 (15.8%) co-infections were identified, being more frequent in pediatric age (49;84.5%) (p=0.01) and mostly associated with Campylobacter spp. DISCUSSION: Aeromonas spp. prove to be a gastrointestinal pathogen more frequently associated with co-infections in pediatric age, evidencing its appearance especially with Campylobacter spp.

Epidemiology of Campylobacter spp. isolated from stool in a tertiary hospital in Cantabria, Northern Spain, from 2016 to 2020.

BACKGROUND: The incidence of Campylobacter coli has increased and with greater resistance to antibiotics than Campylobacter jejuni. OBJECTIVES: To determine the epidemiology distribution of Campylobacter spp. in our health area, and the sensitivity to commonly tested antibiotics. METHODS: Retrospective descriptive study of cases of campylobacteriosis (2016-2020) recovered from stool cultures as laboratory routine protocol. Sensitivity was tested following EUCAST recommendations. RESULTS: Of 1319 campylobacteriosis (C. jejuni 87.7%, C. coli 12.3%) we found a decrease in C. jejuni cases in 2019, and an increase in C. coli. Statistically significant differences were seen in age and gender distribution. The resistance percentages have generally decreased, with higher percentages of resistance in C. coli than in C. jejuni, being significant for erythromycin. CONCLUSIONS: There is not an increase of C. jejuni and its resistance but there is a not alarming increase of incidence of C. coli and its resistance in our health area.

Automatic classification of Candida species using Raman spectroscopy and machine learning.

One of the problems that most affect hospitals is infections by pathogenic microorganisms. Rapid identification and adequate, timely treatment can avoid fatal consequences and the development of antibiotic resistance, so it is crucial to use fast, reliable, and not too laborious techniques to obtain quick results. Raman spectroscopy has proven to be a powerful tool for molecular analysis, meeting these requirements better than traditional techniques. In this work, we have used Raman spectroscopy combined with machine learning algorithms to explore the automatic identification of eleven species of the genus Candida, the most common cause of fungal infections worldwide. The Raman spectra were obtained from more than 220 different measurements of dried drops from pure cultures of each Candida species using a Raman Confocal Microscope with a 532 nm laser excitation source. After developing a spectral preprocessing methodology, a study of the quality and variability of the measured spectra at the isolate and species level, and the spectral features contributing to inter-class variations, showed the potential to discriminate between those pathogenic yeasts. Several machine learning and deep learning algorithms were trained using hyperparameter optimization techniques to find the best possible classifier for this spectral data, in terms of accuracy and lowest possible overfitting. We found that a one-dimensional Convolutional Neural Network (1-D CNN) could achieve above 80 % overall accuracy for the eleven classes spectral dataset, with good generalization capabilities.

Pharmacological characterization of a novel peptide inhibitor of the Keap1-Nrf2 protein-protein interaction.

LAS200813 is a novel bicyclic lipopeptide that activates Nrf2 by binding to Keap1, thereby antagonising the Keap1-Nrf2 protein-protein interaction. In this work we report the pharmacological characterization of LAS200813 in Nrf2-dependent translational preclinical models. LAS200813 binds to Keap1 with high affinity (IC50: 0.73 nM) and is able to induce the translocation of Nrf2 to the nucleus. Furthermore, LAS200813 increases the expression of Nrf2 target genes in human bronchial epithelial cells (EC50 of 96 and 70 nM for srxn1 and nqo1, respectively). Similarly, the intratracheal administration of LAS200813 to rats increases the expression of Nrf2-dependent genes in lung tissue, an effect that lasts for a few hours. Moreover, in cells exposed to cigarette smoke, LAS200813 shows an antioxidant effect by increasing the production of glutathione and prevents cellular apoptosis. In conclusion, the results described herein demonstrate that LAS200813 is a potent non-electrophilic Nrf2-activating peptide designed to be administered by inhaled route which may be a potential therapeutic strategy for respiratory diseases driven by oxidative stress.