Differences in In Vitro Bacterial Adherence between Ti6Al4V and CoCrMo Alloys.

Prosthetic joint infection is an uncommon entity, but it supposes high costs, both from the economic side to the health systems and from the emotional side of the patient. The evaluation of the bacterial adherence to different materials frequently involved in joint prostheses allows us to better understand the mechanisms underlying this and provide information for the future development of prevention strategies. This study evaluated the bacterial adherence of four different species (Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli and Pseudomonas aeruginosa) on Ti6Al4V and CoCrMo. The topography, surface contact angles, and linear average roughness were measured in the samples from both alloys. The interaction with the surface of both alloys was significantly different, with the CoCrMo showing an aggregating effect on all the species, with additional anti-adherent activity in the case of Pseudomonas aeruginosa. The viability also changes, with a significant decrease (p < 0.05) in the CoCrMo alloy. In the case of S. epidermidis, the viability in the supernatant from the samples was different, too, with a decrease in the colony-forming units in the Ti6Al4V, which could be related to cation release from the surface. Beyond adhesion is a multifactorial and complex process, and considering that topography and wettability were similar, the chemical composition could play a main role in the different properties observed.

Epidemiology and in vitro antimicrobial susceptibility of aerobic Actinomycetales in a clinical setting.

INTRODUCTION: The incidence of infections caused by aerobic actinomycetes is increasing. Recent changes in taxonomy and the variability in susceptibility patterns among species make necessary a proper identification and antibiotic susceptibility testing. MATERIAL AND METHODS: Fifty-three strains of aerobic actinomycetes were identified by MALDI-TOF MS using the VITEK MS Mycobacterium/Nocardia kit (bioMérieux, France) in a tertiary hospital in Spain during a six-year period. Antimicrobial susceptibility testing of the isolates was performed using the Sensititre Rapmycoi microdilution panel (Thermo Fisher Scientific, Massachusetts, USA). RESULTS: Forty strains of Nocardia spp. were identified in the study, being N. farcinica and N. cyriacigeorgica the most prevalent ones. All isolates were susceptible to linezolid and the resistance to amikacin was only observed in one isolate of Gordonia sputi. Resistance to cotrimoxazole was only found in five isolates. CONCLUSIONS: Routine identification and antimicrobial susceptibility testing of aerobic actinomycetes is advisable for an efficient identification of species and effective treatment.

Evaluating bedaquiline as a treatment option for multidrug-resistant tuberculosis.

Introduction: Despite efforts to the contrary, tuberculosis remains one of the leading causes of death in the world. The appearance of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis has increased the need for new therapeutic options against these strains.Areas covered: This review covers the in vitro susceptibility, pharmacokinetics, and pharmacodynamics of bedaquiline, a new drug shown to be active against M. tuberculosis-resistant strains. The authors further review clinical data concerning its use against MDR and XDR strains, discussing recent clinical guidelines from different international societies.Expert opinion: Available data demonstrate the usefulness of bedaquiline against resistant M. tuberculosis. Despite the difficulty in analyzing multidrug therapies, the use of bedaquiline in MDR and XDR tuberculosis increases success rates, allowing shortened treatments and lower drug use than previously recommended regimens. Moreover, the fact that MDR and XDR strains are common in many places creates a need to include this drug in the currently available protocols. It is essential to overcome the substantial barriers that some countries encounter in obtaining bedaquiline, as doing so will make therapeutic regimens including this drug available for all patients.

Cutibacterium spp. isolated from orthopaedic implant-associated infection: A not-so-slowly growing organism.

INTRODUCTION: It has been reported that microbiological diagnosis of Cutibacterium spp. infection requires a prolonged incubation time (up to 14 days). We present our experience with regard to incubation time for detection of Cutibacterium spp. in orthopaedic samples over a 10-year period. METHODS: One hundred and nineteen samples were included in this retrospective study. Fifty-three were implants (having previously undergone sonication), 64 were periprosthetic tissue biopsies and two were synovial fluids. Atkins's criteria were used for interpreting the isolates. Quantification and number of days until a culture became positive for Cutibacterium spp. were evaluated. RESULTS: The median number of days to detection of a clinically significant isolate and a contaminant was 4 days. No clinically significant isolates grew after day eight. CONCLUSION: Most clinically significant isolates of Cutibacterium spp. are detected in the first 7 days of incubation, although a recommendation of prolonged incubation (up to 14 days) appears to be necessary for detecting other organisms.

Epidemiology and in vitro antimicrobial susceptibility of aerobic Actinomycetales in a clinical setting.

INTRODUCTION: The incidence of infections caused by aerobic actinomycetes is increasing. Recent changes in taxonomy and the variability in susceptibility patterns among species make necessary a proper identification and antibiotic susceptibility testing. MATERIAL AND METHODS: Fifty-three strains of aerobic actinomycetes were identified by MALDI-TOF MS using the VITEK MS Mycobacterium/Nocardia kit (bioMérieux, France) in a tertiary hospital in Spain during a six-year period. Antimicrobial susceptibility testing of the isolates was performed using the Sensititre Rapmycoi microdilution panel (Thermo Fisher Scientific, Massachusetts, USA). RESULTS: Forty strains of Nocardia spp. were identified in the study, being N. farcinica and N. cyriacigeorgica the most prevalent ones. All isolates were susceptible to linezolid and the resistance to amikacin was only observed in one isolate of Gordonia sputi. Resistance to cotrimoxazole was only found in five isolates. CONCLUSIONS: Routine identification and antimicrobial susceptibility testing of aerobic actinomycetes is advisable for an efficient identification of species and effective treatment.

Compassionate use of tocilizumab in severe SARS-CoV2 pneumonia.

INTRODUCTION: Tocilizumab (TCZ) is an interleukin-6 receptor antagonist, which has been used for the treatment of severe SARS-CoV-2 pneumonia (SSP), which aims to ameliorate the cytokine release syndrome (CRS) induced acute respiratory distress syndrome (ARDS). However, there are no consistent data about who might benefit most from it. METHODS: We administered TCZ on a compassionate-use basis to patients with SSP who were hospitalized (excluding intensive care and intubated cases) and who required oxygen support to have a saturation >93%. The primary endpoint was intubation or death after 24 h of its administration. Patients received at least one dose of 400 mg intravenous TCZ from March 8, 2020 to April 20, 2020. RESULTS: A total of 207 patients were studied and 186 analyzed. The mean age was 65 years and 68% were male patients. A coexisting condition was present in 68% of cases. Prognostic factors of death were older age, higher IL-6, d-dimer and high-sensitivity C-reactive protein (HSCRP), lower total lymphocytes, and severe disease that requires additional oxygen support. The primary endpoint (intubation or death) was significantly worst (37% vs 13%, p < 0·001) in those receiving the drug when the oxygen support was high (FiO2 >0.5%). CONCLUSIONS: TCZ is well tolerated in patients with SSP, but it has a limited effect on the evolution of cases with high oxygen support needs.