Economic burden of recurrent Clostridioides difficile infection in adults admitted to Spanish hospitals. A multicentre retrospective observational study.

OBJECTIVE: Clostridioides difficile infection (CDI) is associated with increased hospital stays and mortality and a high likelihood of rehospitalization, leading to increased health resource use and costs. The objective was to estimate the economic burden of recurrent CDI (rCDI). METHODS: Observational, retrospective study carried out in six hospitals. Adults aged ≥18 years with ≥1 confirmed diagnosis (primary or secondary) of rCDI between January 2010 and May 2018 were included. rCDI-related resource use included days of hospital stay (emergency room, ward, isolation and ICU), tests and treatments. For patients with primary diagnosis of rCDI, the complete hospital stay was attributed to rCDI. When diagnosis of rCDI was secondary, hospital stay attributed to rCDI was estimated using 1:1 propensity score matching as the difference in hospital stay compared to controls. Controls were hospitalizations without CDI recorded in the Spanish National Hospital Discharge Database. The cost was calculated by multiplying the natural resource units by the unit cost. Costs (euros) were updated to 2019. RESULTS: We included 282 rCDI episodes (188 as primary diagnosis): 66.31% of patients were aged ≥65 years and 57.80% were female. The mean hospital stay (SD) was 17.18 (23.27) days: 86.17% of rCDI episodes were isolated for a mean (SD) of 10.30 (9.97) days. The total mean cost (95%-CI) per episode was €10,877 (9,499-12,777), of which the hospital stay accounted for 92.56. CONCLUSIONS: There is high cost and resource use associated with rCDI, highlighting the importance of preventing rCDI to the Spanish National Health System.

Optimization of Free Phytoprostane and Phytofuran Production by Enzymatic Hydrolysis of Pea Extracts Using Esterases.

Given the growing interest in phytoprostanes (PhytoPs) and phytofurans (PhytoFs) in the fields of plant physiology, biotechnology, and biological function, the present study aims to optimize a method of enzymatic hydrolysis that utilizes bacterial and yeast esterases that allow the appropriate quantification of PhytoPs and PhytoFs. To obtain the highest concentration of PhytoPs and PhytoFs, a response surface methodology/Box-Behnken design was used to optimize the hydrolysis conditions. Based on the information available in the literature on the most critical parameters that influence the activity of esterases, the three variables selected for the study were temperature (°C), time (min), and enzyme concentration (%). The optimal hydrolysis conditions retrieved differed between PhytoPs (21.5 °C, 5.7 min, and 0.61 µg of enzyme per reaction) and PhytoFs (20.0 °C, 5.0 min, and 2.17 µg of enzyme per reaction) and provided up to 25.1- and 1.7-fold higher contents relative to nonhydrolyzed extracts. The models were validated by comparing theoretical and experimental values for PhytoP and PhytoF yields (1.01 and 1.06 theoretical/experimental rates, respectively). The optimal conditions were evaluated for their relative influence on the yield of individual nonesterified PhytoPs and PhytoFs to define the limitations of the models for obtaining the highest concentration of most considered compounds. In conclusion, the models developed provided valuable alternatives to the currently applied methods using unspecific alkaline hydrolysis to obtain free nonesterified PhytoPs and PhytoFs, which give rise to more specific hydrolysis of PhytoP and PhytoF esters, reducing the degradation of free compounds by classical chemical procedures.

Impact of pretransplant CMV-specific T-cell immune response in the control of CMV infection after solid organ transplantation: a prospective cohort study.

INTRODUCTION: Although solid organ transplant (SOT) recipients with pretransplant serology for cytomegalovirus (CMV-R+) are considered at intermediate risk for CMV infection post transplantation, CMV infection remains a major cause of morbidity in this population. We prospectively characterized whether having pretransplant CMV-specific cellular immunity is independently associated with controlling infection after transplantation in R + SOT recipients. METHODS: A prospective cohort of consecutive R + SOT recipients that received pre-emptive treatment for CMV infection was monitored after transplantation and variables were recorded during the follow-up. The cytomegalovirus-specific T-cell immune response was characterized by intracellular cytokine staining and viral loads determined using real-time PCR. RESULTS: One hundred and thirty-five R + SOT recipients were included (67 kidney, 64 liver, four liver-kidney). Only one-third of the patients (42; 31.85%) had CMV-specific T-cell immunity (CD8+CD69+INF-γ+ T cells >0.25%) before transplantation. Patients with negative pretransplant immunity had more CMV infection (49, 52.7% vs. 15, 35.7%; p 0.07) and received more antiviral therapy than those with immunity (32, 34.4% vs. 6, 14.3%, p 0.016). Having CMV specific immunity was an independent factor for protection from developing viraemia ≥2000 IU/mL (OR 0.276, 95% CI 0.105-0.725, p < 0.01) and lower administration of treatment (OR 0.398, 95% CI 0.175-0.905, p 0.028). Only patients with no pretransplant CMV-specific T-cell response were diagnosed with CMV-disease (8, 8.6% vs. 0, 0%, p 0.05). DISCUSSION: Our results show that having a pretransplant CMV specific T-cell response may be associated with a lower rate of CMV viraemia and less antiviral treatment after transplantation; however, more prospective studies are needed to confirm these findings.

Typha latifolia as potential phytoremediator of 2,4-dichlorophenol: Analysis of tolerance, uptake and possible transformation processes.

2,4-Dichlorophenol (2,4-DCP) is considered a priority pollutant due to its high toxicity. Therefore, it is urgent to develop technologies for the disposal of this pollutant. Various remediation processes have been proposed for the elimination of 2,4-DCP in contaminated water, however, most of them involve high costs of operation and maintenance. This study aimed to determine the capacity of remediation of 2,4-DCP in water by Typha latifolia L. wild plants. For that, the tolerance, removal, accumulation and biotransformation of 2,4-DCP by T. latifolia were investigated. The plants were exposed to 2,4-DCP solutions with a concentration range from 1.5 to 300 mgL-1 for 10 days. They exhibited a reduction in chlorophyll levels and growth rate when 2,4-DCP solutions were ≥30 mgL-1 and ≥50 mgL-1, respectively. The removal of contaminant was dose-depended, being 99.7% at 1.5-3 mgL-1, 59-70% at 10-70 mgL-1 and 35-42% at 100-300 mgL-1 of 2,4-DCP in the solution. Studies indicated that 2,4-DCP was mainly accumulated in root tissue rather than in shoot tissue. Acid hydrolysis of biomass extracts suggests 2,4-DCP bioconjugates formation in root tissue as a response mechanism. Additionally, an increment in glutathione S-transferase (GST) activity could indicate a 2,4-DCP conjugation with glutathione as a detoxification mechanism of T. latifolia.

The effect of C content on the mechanical properties of Ti-Zr coatings.

In this study, Ti-Zr and Ti-Zr-C coatings were deposited at room temperature via pulsed-DC magnetron sputtering. A 70Ti-30Zr at% target and a 99.99% graphite plate were used to deposit samples. In order to modify C content, coatings were deposited at different target powers such as 50, 75 and 100 W. Changes on the structure, microstructure and mechanical properties due to C addition were studied. Results indicate that the as-deposited coatings were partly crystalline and that an increment on C content stabilized α' phase and inhibited the appearance of ω precipitates. Therefore, Ti-Zr-C alloys with C>1.9 at% showed only α' phase whereas the others alloys exhibited α'+ω structures. Hardness values from 12.94 to 34.31 GPa were obtained, whereas the elastic modulus was found between 181.84 and 298 GPa. Finally, a high elastic recovery ratio (0.69-0.87) was observed as a function of composition. The overall properties of these coatings were improved due to C content increment, martensitic α' phase and nanocrystalline grain size (10-16 nm).

Metallographic preparation of Zn-21Al-2Cu alloy for analysis by electron backscatter diffraction (EBSD).

Samples of Zn-21Al-2Cu alloy (Zinalco) that will be heavily deformed were prepared using five different manual mechanical metallographic methods. Samples were analyzed before tensile testing using the orientation imaging microscopy-electron backscatter diffraction (OIM-EBSD) technique. The effect of type and particle size during the final polishing stages for this material were studied in order to identify a method that produces a flat, damage free surface with a roughness of about 50 nm and clean from oxide layers, thereby producing diffraction patterns with high image quality (IQ) and adequate confidence indexes (CI). Our results show that final polishing with alumina and silica, as was previously suggested by other research groups for alloys that are difficult to prepare or alloys with low melting point, are not suitable for manual metallographic preparation of this alloy. Indexes of IQ and CI can be used to evaluate methods of metallographic preparation of samples studied using the OIM-EBSD technique.

Global impact of an educational antimicrobial stewardship programme on prescribing practice in a tertiary hospital centre.

The misuse of antibiotics has been related to increased morbidity, mortality and bacterial resistance. The development of antimicrobial stewardship programmes (ASPs) has been encouraged by scientific societies as an essential measure. An educational, institutionally supported ASP was developed in our tertiary-care centre. Local guidelines on the management of infectious syndromes were created. Antimicrobial prescriptions were chosen arbitrarily weekly and counselling interviews by expert clinicians were carried out, using a paedagogic, non-restrictive methodology. Satisfaction with the interview was assessed using anonymous questionnaires. The appropriateness of antimicrobial prescriptions as well as consumption was assessed prospectively throughout the year. Feedback regarding the correct use of treatments was communicated to each participating department periodically. The improvement in antimicrobial prescription was included among the annual objectives linked to economic incentives in every department. A total of 1206 counselling interviews were carried out during the first year. Fifty-three per cent of antimicrobial prescriptions (176/332) were inappropriate when the programme started. The rate of inappropriate prescriptions continuously declined to 26.4% (107/405) in the fourth trimester (p <0.001; RR = 0.38; 95% CI, 0.23-0.43). Antimicrobial consumption decreased from 1150 defined daily doses (DDDs) per 1000 occupied bed-days in the first trimester to 852 DDDs in the fourth, reflecting a reduction in antimicrobial expenditures of 42%. A total of 352 satisfaction questionnaires were received and 98% described the advice as positive. In conclusion, the implementation of an education-based ASP achieved a significant improvement in all antimicrobial prescriptions in the centre and a reduction in antimicrobial consumption, even when no restrictive measures were implemented. The programme was highly accepted by all prescribers.

Supercomplex assembly determines electron flux in the mitochondrial electron transport chain.

The textbook description of mitochondrial respiratory complexes (RCs) views them as free-moving entities linked by the mobile carriers coenzyme Q (CoQ) and cytochrome c (cyt c). This model (known as the fluid model) is challenged by the proposal that all RCs except complex II can associate in supercomplexes (SCs). The proposed SCs are the respirasome (complexes I, III, and IV), complexes I and III, and complexes III and IV. The role of SCs is unclear, and their existence is debated. By genetic modulation of interactions between complexes I and III and III and IV, we show that these associations define dedicated CoQ and cyt c pools and that SC assembly is dynamic and organizes electron flux to optimize the use of available substrates.

[Candidemias: multicentre analysis in 16 hospitals in Andalusia (Spain)]. / Candidemias: análisis multicéntrico en 16 hospitales andaluces.

INTRODUCTION: Candidemia is a nosocomial infection with high associated mortality. There have been changes in microbiology, epidemiology and treatment over the last few years, which has led us to analyse our own situation. MATERIAL AND METHODS: Prospective, multicentre and observational study. All episodes of candidemia in adult patients seen in 17 Andalusian hospitals from 1 October 2005 to 30 September 2006 were included. RESULTS: Were detected 220 cases, the incidence was 0.58 cases/1,000 hospital discharges. Candida albicans was the most frecuent species (53% of cases). The majority of isolates (89%) was susceptibility to fluconazole. Sepsis was the most frequent clinical manifestation (65.7%). The treatment was inadequate in 38.7% of cases. Overall mortality was 40%. On univarite analysis death was found to be significantly associated with: aged > 60 years, unknown candidemia focus, Pitt score ≥ 2, APACHE II, shock at onset, persistents positive second blood cultures, non-removal of the central venous catheter and Candida species different of C. parasilopsis, among others. In the multivariate analysis death was found to be significantly associated with: aged > 60 years, Pitt score ≥ 2, Candida species different of C.parasilopsis and inadequate treatment. CONCLUSIONS: The candidemia clinical epidemiology in our region is similar to other areas and receiving inadequate treatment is the only modifiable risk factor associated with higher odds of mortality. Therefore, this modifiable factor needs to be improved to reduce the mortality.

Strongyloides stercoralis hyperinfection transmitted by liver allograft in a transplant recipient.

We describe a case of Strongyloides stercoralis hyperinfection in a liver allograft recipient 2.5 months after transplantation. The patient lives in Spain, which is not considered an endemic country for strongyloidiasis, and denied prior residence or travel to any known endemic area. The initial symptoms were fever and vomiting, and he subsequently developed a severe respiratory disease. An endoscopic biopsy of ulcerative lesions of the duodenum revealed massive mucosa infiltration by larvae and adult worms, which were also found in respiratory samples. The patient was successfully treated with combined therapy with albendazole and ivermectin. The strongyloides infection was transmitted by the liver allograft. The donor was from Ecuador and, retrospectively, his serum tested positive for S. stercoralis IgG antibodies. Additionally, the pancreas-left kidney allograft recipient from the same donor later developed an intestinal strongyloidiasis without hyperinfection syndrome. To our knowledge, this is the first confirmed case of S. stercoralis infection transmission from the same donor to two solid allograft recipients.

Seasonal occurrence and degradation of 2-methylisoborneol in water supply reservoirs.

Methylisoborneol (MIB) and geosmin are cyanobacterial metabolites that occur at nanograms per liter levels in surface water supplies and are responsible for many taste and odor complaints about the aesthetics of drinking water. This study evaluated three water supply reservoirs with bottom-release (hypolimnion) outlet structures in Arizona. MIB concentrations were always higher than geosmin concentrations, but both followed similar seasonal trends. MIB concentrations increased from spring to late summer, and stratified vertically with depth in the water column; the highest concentrations were always in the upper 10 m of the water column. Thermal destratification in the autumn increased MIB concentrations released from the outlet of reservoirs and impacted downstream utilities for several months. By winter of each year MIB concentrations were non-detectable. Mass balance analyses on MIB indicated that in-reservoir reactions were more important in changing MIB concentrations than conservative hydraulic "flushing" of the reservoir. Maximum net loss rates for MIB in the field (R(F,max)) were on the order of 0.23-1.7 ng/L-day, and biodegradation appeared more important than volatilization, photolysis or adsorption. Using lake water in laboratory experiments, bacterial biodegradation rates (R(L)) ranged from 0.5-1 ng/L-day and were comparable to R(F,max) values. Based upon these rates, MIB concentrations in a reservoir would decrease by approximately 30 ng/L over a period of 1 month. This was the magnitude change in MIB concentrations commonly observed after autumn thermal destratification of the reservoirs.

Colistin efficacy in an experimental model of Acinetobacter baumannii endocarditis.

The in-vivo activity of colistin was evaluated in an experimental rabbit model of Acinetobacter baumannii endocarditis with a strain susceptible to colistin and intermediate to imipenem. Compared to a control group, colistin was effective (p < 0.05) in bacterial clearance from blood and in the sterilisation of blood cultures, but was not effective in clearing A. baumannii from vegetations. Thus, although colistin may be effective in treating bacteraemia caused by susceptible strains of A. baumannii, it may not be a suitable treatment for endocarditis, perhaps because of poor penetration into vegetations and a low C(max)/MIC ratio in tissue.

Effect of ham protein substitution on oxidative stress in older adults.

Mediterranean diet has been related to a low risk of coronary hearth disease. In the present study, we have evaluated the effect of substituting 120 g of meat by 120 g of acorn-fed Iberian ham (one of the meat components of the Mediterranean diet) on body weight, blood pressure (MAP), plasma lipids and oxidant-antioxidant equilibrium in 13 males and 8 females with an average age of 71. Study was performed in three periods: basal diet evaluations (BD1), ham diet for 6 weeks (HD), and basal diet again for 6 weeks (BD2). MAP significantly diminished from 96 mmHg in BD1 to 89 mmHg after HD. After BD2, MAP remained in the same value. Plasma total antioxidant substances increased from 0.791 mmol/L in BD1, to 1.525 in HD, and to 1.213 in BD2. Glutathione reductase significantly increased from 49.5 U/L in BD1 to 57 in HD and decreased to 49.2 in BD2. Glutathione peroxidase rose from 33 U/gHb in BD1 to 72 in HD and decreased to 52 in BD2. Superoxide dismutase increased from 401 U/gHb in BD1 to 723 in HD and decreased to 433 in BD2. Plasma thiobarbituric acid reacting substances (TBARS) fall from 1.65 mmol/l in BD1 to 1.38 in HD and to 1.47 in BD2. TBARS in erythrocyte membranes also diminished but only in BD2. It can be concluded that including acorn-fed Iberian ham in the diet increased the antioxidant substances and decrease lipid peroxidation, with its subsequent beneficial effects on the atherogenic risk factors.

[Tonsillectomy and obstructive sleep apnea syndrome]. / Amigdalectomía en el síndrome de apneas obstructivas del sueño.

We presents the case of a patient, 12-year-old, asthmatic, diagnosed by means of polysomnography of obstructive sleep apnea syndrome (OSAS). Improvement take place after tonsillectomy. This case provide evidence for the condition in childhood, headache being the sole annoyance noticed and surgery seems successful.

Aspergillus fumigatus cranial infection after accidental traumatism.

Described here is a case of Aspergillus fumigatus cranial infection secondary to accidental cranial traumatism that occurred in an immunocompetent patient and the questions that arose concerning treatment. No reports of post-traumatic cranial osteomyelitis caused by Aspergillus spp. and the ideal treatment to be followed have yet been described in the literature. In the present case, surgical debridement of the wound followed by treatment with 1 mg/kg/iv/day of amphotericin B for 21 days and then 200 mg/vo/12 h of itraconazole for 6 months obtained good results.

Biochemical studies of patients with Cuban epidemic neuropathy.

In 1992-1994, a disorder known as the epidemic neuropathy afflicted more than 50,000 Cubans. Three different forms of the illness were identified: epidemic optic neuropathy, peripheral neuropathy and mixed optic and peripheral neuropathy. The causes are still unknown. Skeletal muscle biopsy samples were analyzed by standard histological techniques and by biochemical assays. Elevated activities of citrate synthase, a non-respiratory-chain mitochondrial matrix enzyme, suggested possible mitochondrial proliferation in 7 of the 8 patients. Nicotinamide adenine dinucleotide phosphate (NADP(+)) levels were higher in the patients than in the controls (p = 0.04). Levels of nicotinamide adenine dinucleotide (NAD) and the reduced compounds NADH and NADPH were comparable in patients and controls. Elevations of succinate dehydrogenase and citrate synthase activities and high NADP(+) levels suggest that alterations of mitochondrial functions may be associated with this disorder.

Sulbactam efficacy in experimental models caused by susceptible and intermediate Acinetobacter baumannii strains.

Sulbactam and imipenem were compared in an experimental pneumonia model in immunocompetent mice, using a susceptible strain of Acinetobacter baumannii, and in an experimental endocarditis model in rabbits, using an intermediately susceptible strain. In the former, sulbactam was as efficacious as imipenem in terms of survival, sterility of lungs and in the bacterial clearance from lungs and blood, provided that the t > MIC for sulbactam (1.84 h) was similar to that for imipenem (2.01 h). In the endocarditis model, imipenem (t > MIC, 2.12 h) was more efficacious than sulbactam (t > MIC, 1.17 h) in bacterial clearance from vegetations. These results show the efficacy of sulbactam in infections caused by susceptible strains of A. baumannii, with an MIC up to 4 mg/L, provided that doses reach a t > MIC similar to that of imipenem. The activity of sulbactam was time dependent.