Low incidence of severe bacterial infections in hospitalised patients with COVID-19: A population-based registry study.

BACKGROUND: Bacterial infections complicating COVID-19 are rare but present a challenging clinical entity. The aim of this study was to evaluate the incidence, aetiology and outcome of severe laboratory-verified bacterial infections in hospitalised patients with COVID-19. METHODS: All laboratory-confirmed patients with COVID-19 admitted to specialised healthcare hospitals in the Capital Province of Finland during the first wave of COVID-19 between 27 February and 21 June 2020 were retrospectively studied. We gathered the blood and respiratory tract culture reports of these patients and analysed their association with 90-day case-fatality using multivariable regression analysis. RESULTS: A severe bacterial infection was diagnosed in 40/585 (6.8%) patients with COVID-19. The range of bacteria was diverse, and the most common bacterial findings in respiratory samples were gram-negative, and in blood cultures gram-positive bacteria. Patients with severe bacterial infection had longer hospital stay (mean 31; SD 20 days) compared to patients without (mean 9; SD 9 days; p < 0.001). Case-fatality was higher with bacterial infection (15% vs 11%), but the difference was not statistically significant (OR 1.38 CI95% 0.56-3.41). CONCLUSIONS: Severe bacterial infection complicating COVID-19 was a rare occurrence in our cohort. Our results are in line with the current understanding that antibiotic treatment for hospitalised COVID-19 patients should only be reserved for situations where a bacterial infection is strongly suspected. The ever-evolving landscape of the pandemic and recent advances in immunomodulatory treatment of COVID-19 patients underline the need for continuous vigilance concerning the possibility and frequency of nosocomial bacterial infections.

The Tarland Catchment Initiative and its effect on stream water quality and macroinvertebrate indices.

The Tarland Catchment Initiative is a partnership venture between researchers, land managers, regulators, and the local community. Its aims are to improve water quality, promote biodiversity, and increase awareness of catchment management. In this study, the effects of buffer strip installations and remediation of a large septic tank effluent were appraised by water physico-chemistry (suspended solids, NO, NH, soluble reactive P) and stream macroinvertebrate indices used by the Scottish Environmental Protection Agency. It was done during before and after interventions over an 8-yr period using a paired catchment approach. Because macroinvertebrate indices were previously shown to respond negatively to suspended solid concentrations in the study area, the installation of buffer strips along the headwaters was expected to improve macroinvertebrate scores. Although water quality (soluble reactive P, NH) improved downstream of the septic tank effluent after remediation, there was no detectable change in macroinvertebrate scores. Buffer strip installations in the headwaters had no measurable effects (beyond possible weak trends) on water quality or macroinvertebrate scores. Either the buffer strips have so far been ineffective or ineffectiveness of assessment methods and sampling frequency and time lags in recovery prevent us detecting reliable effects. To explain and appreciate these constraints on measuring stream recovery, continuous capacity building with land managers and other stakeholders is essential; otherwise, the feasibility of undertaking sufficient management interventions is likely to be compromised and projects deemed unsuccessful.

Differential degeneration of the locus coeruleus in dementia subtypes.

OBJECTIVE: Neuronal loss in the locus coeruleus (LC) is common in Alzheimer's disease (AD), dementia with Lewy bodies (DLB) and Parkinson's disease dementia (PDD). The aims of the present study were to investigate LC degeneration in different dementia disorders including vascular dementia (VaD) and frontotemporal lobar degeneration (FTLD), to compare LC degeneration with severity of pathology in AD and DLB/PDD, to further evaluate the usefulness of a previously presented scoring system and to examine the predictive value of macroscopic assessment of the LC. METHODS: A horizontal mid-level section of the pons was examined in 200 neuropathologically examined cases with clinical dementia. A previous macroscopic assessment of the LC was performed in 149 of the cases. RESULTS: Cases with DLB/ PDD and AD presented with the highest microscopic LC degeneration scores, with significant differences compared to combined AD + VaD, in turn with a higher score than VaD, FTLD and other dementia disorders. Interrater agreement (weighted kappa;) for LC degeneration scoring was 0.83 - 0.91. DLB/ PDD, AD and AD + VaD were the diagnoses for 85% of the cases with macroscopic LC depigmentation. CONCLUSION: LC degeneration, which may be macroscopically noted, often indicates synuclein and/or Alzheimer pathology among demented. When clinical information is scarce or inconsistent, a macroscopic assessment of the LC may facilitate focusing of the subsequent neuropathological investigation. Also, the semiquantitative scoring system is a reliable tool for histological assessment of LC degeneration.

How to interpret MICs of antifungal compounds according to the revised clinical breakpoints v. 10.0 European committee on antimicrobial susceptibility testing (EUCAST).

BACKGROUND: EUCAST has revised the definition of the susceptibility category I from 'Intermediate' to 'Susceptible, Increased exposure'. This implies that I can be used where the drug concentration at the site of infection is high, either because of dose escalation or through other means to ensure efficacy. Consequently, I is no longer used as a buffer zone to prevent technical factors from causing misclassifications and discrepancies in interpretations. Instead, an Area of Technical Uncertainty (ATU) has been introduced for MICs that cannot be categorized without additional information as a warning to the laboratory that decision on how to act has to be made. To implement these changes, the EUCAST-AFST (Subcommittee on Antifungal Susceptibility Testing) reviewed all, and revised some, clinical antifungal breakpoints. OBJECTIVES: The aim was to present an overview of the current antifungal breakpoints and supporting evidence behind the changes. SOURCES: This document is based on the ten recently updated EUCAST rationale documents, clinical breakpoint and breakpoint ECOFF documents. CONTENT: The following breakpoints (in mg/L) have been revised or established for Candida species: micafungin against C. albicans (ATU = 0.03); amphotericin B (S ≤/> R = 1/1), fluconazole (S ≤/> R = 2/4), itraconazole (S ≤/> R = 0.06/0.06), posaconazole (S ≤/> R = 0.06/0.06) and voriconazole (S ≤/> R = 0.06/0.25) against C. dubliniensis; fluconazole against C. glabrata (S ≤/> R = 0.001/16); and anidulafungin (S ≤/> R = 4/4) and micafungin (S ≤/> R = 2/2) against C. parapsilosis. For Aspergillus, new or revised breakpoints include itraconazole (ATU = 2) and isavuconazole against A. flavus (S ≤/> R = 1/2, ATU = 2); amphotericin B (S ≤/> R = 1/1), isavuconazole (S ≤ /> R = 1/2, ATU = 2), itraconazole (S ≤/> R = 1/1, ATU = 2), posaconazole (ATU = 0.25) and voriconazole (S ≤/> R = 1/1, ATU = 2) against A. fumigatus; itraconazole (S ≤/> R = 1/1, ATU = 2) and voriconazole (S ≤/> R = 1/1, ATU = 2) against A. nidulans; amphotericin B against A. niger (S ≤/> R = 1/1); and itraconazole (S ≤/> R = 1/1, ATU = 2) and posaconazole (ATU = 0.25) against A. terreus. IMPLICATIONS: EUCAST-AFST has released ten new documents summarizing existing and new breakpoints and MIC ranges for control strains. A failure to adopt the breakpoint changes may lead to misclassifications and suboptimal or inappropriate therapy of patients with fungal infections.

Subsurface tile drainage loss of modern pesticides: field experiment results.

The concentration and loss of two herbicides (bentazone and MCPA), two fungicides (fenpropimorph and propiconazole) and two insecticides (dimethoate and pirimicarb) were measured in tile drainage water from a 2,813 m2 experimental grass field from May to August 2001. Three different pesticides were applied to the field and subsequently a rainfall of 10 mm was simulated during the first experiment and 16 mm during the second experiment. Bromide was applied as a conservative tracer in the first experiment and the concentration of bromide and suspended sediment was also measured in tile drainage water. In the first experiment, maximum concentrations of bentazone, fenpropimorph and dimethoate in drainage water were 5.8 microg l(-1), 0.33 microg l(-1) and 2.29 microg l(-1), respectively. In the second experiment, maximum concentrations for MCPA, propiconazole and pirimicarb were 3.6 microg l(-1), 0.065 microg l(-1), 2.3 microg l(-1), respectively. The loss:applied ratio was highest for bentazone (0.088%) and declined in the order of dimethoate (0.057%), pirimicarb (0.050%), propiconazole (0.0031%) and fenpropimorph (0.00042%). Exposure of the macroinvertebrate species Gammarus pulex to pesticides in the drainage water during the second experiment (exposure time: 7 hours) showed significant mortality/inactivity as compared to an upstream and downstream control.