Establishment and Persistence of Glycopeptide-Resistant Enterococcus faecium ST80 and ST117 Clones Within a Health Care Facility Located in a Low-Prevalence Geographical Region.

Vancomycin-resistant Enterococcus faecium (VREfm) is one of the most important nosocomial pathogens with limited therapeutic alternatives. In this study, we followed the trends of VREfm and E. faecium causing bloodstream infections (BSIs) in a Spanish hospital, from 2011 to 2020. During this period, 832 E. faecium strains were isolated and 121 (14.5%) were vancomycin resistant. Nineteen of 101 BSIs (18.8%) caused by E. faecium were due to VREfm. The number of BSI-producing E. faecium isolates increased significantly over the past 5 years, with the percentage of invasive VREfm isolates being substantially higher than the average values in Europe and especially in Spain (<3%). VREfm isolates recovered in 2018 (28) and BSI-producing isolates from 2019 (3) and 2020 (2) were molecularly characterized. All were positive for vanA and belonged to sequence type (ST) 80 (28) or ST117 (5), within clonal complex 17. The isolates were only susceptible to linezolid, although most of them were also susceptible (dose dependent) to daptomycin. We report for the first time the establishment and persistence of the VREfm ST80 and ST117 clones in a Spanish hospital. The spread and establishment of hospital-adapted, multidrug-resistant VREfm clones in health care settings are cause for concern and may precede an increment in the BSIs caused by them.

Case Report: High Doses of Intravenous Immunoglobulins as a Successful Treatment for Late Onset Immune Agranulocytosis After Rituximab Plus Bendamustine.

Late onset neutropenia (LON) related to rituximab or rituximab plus chemotherapy is defined as an unexplained absolute neutrophil count of ≤1.5 × 109/L starting at least four weeks after the last rituximab administration. LON is infrequent and its pathophysiology remains unknown. There are no guidelines or consensus strategies for the optimal management of patients developing LON. The majority of the patients recover promptly with no specific treatment and only some cases need to be managed with granulocytic colony stimulating factor (G-CSF), usually with a rapid response. Here, we describe a 69-year-old patient with Waldenström's macroglobulinemia who presented a septic event in the context of severe LON after rituximab plus bendamustine. The diagnosed of agranulocytosis was established by bone marrow examination. Interestingly, anti-neutrophil antibodies bound to the patient's granulocytes were found suggesting an autoimmune mechanism. The patient did not respond to G-CSF but achieved a rapid response after high doses of intravenous immunoglobulins with full white blood cell recovery.

Bioactivation of biomorphous silicon carbide bone implants.

Wood-derived silicon carbide (SiC) offers a specific biomorphous microstructure similar to the cellular pore microstructure of bone. Compared with bioactive ceramics such as calcium phosphate, however, silicon carbide is considered not to induce spontaneous interface bonding to living bone. Bioactivation by chemical treatment of biomorphous silicon carbide was investigated in order to accelerate osseointegration and improve bone bonding ability. Biomorphous SiC was processed from sipo (Entrandrophragma utile) wood by heating in an inert atmosphere and infiltrating the resulting carbon replica with liquid silicon melt at 1450°C. After removing excess silicon by leaching in HF/HNO3 the biomorphous preform consisted of ß-SiC with a small amount (approximately 6wt.%) of unreacted carbon. The preform was again leached in HCl/HNO3 and finally exposed to CaCl2 solution. X-ray photoelectron spectroscopy (XPS) and Fourier transform infrared analyses proved that oxidation of the residual carbon at the surface induced formation of carboxyl [COO⁻] groups, which triggered adsorption of Ca(2+), as confirmed by XPS and inductively coupled plasma optical emission spectroscopy measurements. A local increase in Ca(2+) concentration stimulated in vitro precipitation of Ca5(PO4)3OH (HAP) on the silicon carbide preform surface during exposure to simulated body fluid, which indicates a significantly increased bone bonding activity compared with SiC.

Colonization process of olive tissues by Verticillium dahliae and its in planta interaction with the biocontrol root endophyte Pseudomonas fluorescens PICF7.

The colonization process of Olea europaea by the defoliating pathotype of Verticillium dahliae, and the in planta interaction with the endophytic, biocontrol strain Pseudomonas fluorescens PICF7 were determined. Differential fluorescent protein tagging was used for the simultaneous visualization of P. fluorescens PICF7 and V. dahliae in olive tissues. Olive plants were bacterized with PICF7 and then transferred to V. dahliae-infested soil. Monitoring olive colonization events by V. dahliae and its interaction with PICF7 was conducted using a non-gnotobiotic system, confocal laser scanner microscopy and tissue vibratoming sections. A yellow fluorescently tagged V. dahliae derivative (VDAT-36I) was obtained by Agrobacterium tumefaciens-mediated transformation. Isolate VDAT-36I quickly colonized olive root surface, successfully invaded root cortex and vascular tissues via macro- and micro-breakages, and progressed to the aerial parts of the plant through xylem vessel cells. Strain PICF7 used root hairs as preferred penetration site, and once established on/in root tissues, hindered pathogen colonization. For the first time using this approach, the entire colonization process of a woody plant by V. dahliae is reported. Early and localized root surface and root endophytic colonization by P. fluorescens PICF7 is needed to impair full progress of verticillium wilt epidemics in olive.

Assessment of adherence to triple antiretroviral treatment including indinavir: role of the determination of plasma levels of indinavir.

OBJECTIVE: To assess the contribution of the determination of concentrations of indinavir (IND) in plasma to the assessment of self-reported adherence and keeping of appointments to withdraw drugs from the hospital pharmacy. PATIENTS AND METHODS: Adherence was assessed using three criteria: questionnaires, punctuality at appointments to withdraw drugs, and plasma concentrations of IND. Blood samples were obtained from 106 HIV-infected patients who had been receiving IND in combination with two nucleoside reverse transcriptase inhibitors for longer than 6 months. Logistic regression analysis was carried out, and receiver operating characteristic curves were drawn. RESULTS: The kappa index showed a low concordance for the three measures. When pharmacy appointments and self-report are used together, the nondetection of drug levels is more reliably predicted (AUC = 0.75). With the viral load as the gold standard, plasma levels contribute nothing to the information given by the other two measures combined (AUC = 0.63, AUC = 0.64). CONCLUSION: Measurement of adherence to highly active antiretroviral therapy is complex. Because there is no gold standard for it, we demonstrated that each of three common adherence measures has shortcomings that can be minimized in a combined measurement system. Indinavir plasma levels appear to provide no additional information, so further studies are undoubtedly necessary.

Factores asociados con el uso y adecuación de la hospitalización en personas mayores de 64 años / Factors associated with hospitalization use and appropriateness for patients over 64 years of age

Fundamento: Algunas características sociales, médicas o funcionales se asocian a mayor consumo de recursos sanitarios, sin que esto signifique un uso inapropiado de éstos. El objetivo de este trabajo es conocer la influencia del estado de salud y otros factores sobre las estancias hospitalarias y las estancias inapropiadas en la población mayor de 64 años.Método: Una cohorte representativa de la población mayor de 64 años del Partido Judicial de Toledo (n=3.214) en la que se había valorado el estado de salud, fue seguida durante 18 meses, identificando sus ingresos y estancias hospitalarias, cuya adecuación fue evaluada con el Appropiateness Evaluation Protocol. Se analizaron las asociaciones entre las características socio-demográficas, de estado de salud y morbilidad de la cohorte con las tasas de frecuentación y hospitalización y con la proporción de estancias e ingresos inadecuados. Resultados: Durante los 18 meses de seguimiento fueron hospitalizados 410 individuos (12,8 por ciento), que generaron 546 ingresos (tasa de frecuentación=17,0 ingresos/100 habitantes) y 7.015 días de estancia (tasa de hospitalización = 218,3 estancias/100 habitantes). El 18,9 por ciento de los ingresos y el 49,9 por ciento de las estancias fueron evaluadas como inadecuados. La hospitalización se asoció al peor estado de salud, institucionalización, género masculino, determinadas patologías y a la utilización previa de servicios sanitarios. No se hallaron asociaciones entre características de los pacientes y proporción de estancias inadecuadas. El 97,5 por ciento de las estancias innecesarias fue atribuido a problemas de programación hospitalaria y estilo de practica de los médicos. Conclusiones: Los factores socio-demográficos, de morbilidad, estado de salud y utilización previa de servicios se muestran como buenos predictores de hospitalización en las personas mayores, pero no se relacionan con el uso inadecuado de la hospitalización (AU)

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