Testing of In Vitro Susceptibility of Neisseria gonorrhoeae to Azithromycin: Comparison of Disk Diffusion and Reference Agar Dilution Methods.

Azithromycin in combination with ceftriaxone is recommended as the first-line treatment for uncomplicated gonorrhea in many countries. Therefore, monitoring of azithromycin susceptibility of Neisseria gonorrhoeae isolates is essential. In 2019, the Clinical and Laboratory Standards Institute (CLSI) listed the MIC breakpoint for a susceptible-only category to azithromycin, but breakpoints for disk diffusion are not yet available. In this study, we evaluated the usefulness of disk diffusion for testing the susceptibility of N. gonorrhoeae isolates to azithromycin. A total of 189 clinical isolates susceptible and nonsusceptible to azithromycin were used. Agar dilution MICs were correlated with inhibition zone diameters of azithromycin disks (15-µg) manufactured by BBL and Oxoid. In addition, an interlaboratory study involving two clinical microbiology laboratories was conducted. There was a strong correlation between disk diffusion and agar dilution for BBL disks (r = -0.74; P < 0.001) and Oxoid disks (r = -0.75; P < 0.001). Using a zone diameter breakpoint of ≥27 mm (susceptible) and ≤26 mm (nonsusceptible) yielded good separation between susceptible and nonsusceptible isolates and the least number of discrepancies. Compared to agar dilution, disk diffusion showed high agreement and kappa values of 95.2% and 0.899 (P < 0.001) for BBL disks and 96.8% and 0.933 (P < 0.001) for Oxoid disks, respectively. Major and very major discrepancies were observed in isolates with azithromycin MICs (1 and 2 µg/ml, respectively) near to the breakpoint. These data illustrate that disk diffusion could be a reliable method in clinical laboratories to test susceptibility to azithromycin in N. gonorrhoeae isolates.

Genetic and Ecological Relationships of Anastrepha ludens (Diptera: Tephritidae) Populations in Southern Mexico.

Knowledge of the influence of evolutionary factors that promote either the differentiation or cohesion of pest insect populations is critical for the improvement of control strategies. Here, we explore the extent to which genetic differentiation occurs between populations of the Mexican fruit fly, Anastrepha ludens, in association with four plant hosts (Citrus sinensis, C. paradisi, Mangifera indica and Casimiroa edulis) in the Soconusco region of Chiapas (Mexico). Using variants from six enzymatic loci, we obtained measures of genetic diversity for three sample arrangements: (1) by sex per locality, (2) by locality and (3) by host. The extent of genetic differentiation in populations was assessed using the Analyses of Molecular Variance (AMOVA) method for each array of samples, and moderate to high levels of genetic variation were observed between the sexes, as well as among localities and host plants. A Bayesian approach was then used to assess any population structure underlying the genetic data we obtained, but this analysis showed no significant structuring due to locality or host plant. We also considered whether the observed genotypic frequencies in male and females matched those expected under a hypothesis of random mating. Here we found significant deviations from expected genotypic frequencies, suggesting that sexual selection is acting on these populations. Overall, our results indicate that sexual selection, along with the presence of some heterogeneity in environments provided by both geographical factors and availability of host plants, has influenced the evolution of pest populations in this region of Mexico. Implications for area-wide pest management strategies are discussed.

Multiple clones of metallo-ß-lactamase-producing Acinetobacter ursingii in a children hospital from Argentina.

Acinetobacter spp. are opportunistic pathogens being A. baumannii the most frequently identified in nosocomial settings. A. ursingii was mainly described as causing bacteremia and outbreaks in neonatal intensive care units. Ten A. ursingii isolates were recovered from rectal swab screening for carbapenemase-producing bacteria between June 2013 and December 2015 from a children hospital in Argentina. All ten isolates were metallo-ß-lactamase-producing, nine were positive for blaIMP-1 and one for blaNDM-1. IMP-positive isolates were also positive for blaOXA-58 gene. All isolates were susceptible to ciprofloxacin, colistin and minocycline, and nine were susceptible to ampicillin-sulbactam and gentamicin. Two A. ursingii displayed high level of resistance to aztreonam associated with blaCTX-M-15 in one isolate, and blaVEB-1 in the other. Eight SmaI-PFGE patterns were recognized. We evaluated the usefulness of Acinetobacter MLST-Pasteur scheme, to analyse A. ursingii isolates, however the rpoB gene was not amplified. A new set of primers were designed for specific amplification and sequencing, allowing the analysis of rpoB gene for this species. New alleles and the sequence types 748, 749, 750, 751, 993, 1186, 1187, and 1189 were included at the Acinetobacter MLST-Pasteur database. Those isolates showing related PFGE patterns were assigned to the same ST. To the best of our knowledge, this is the first report of MBL-producing A. ursingii in Argentina. The inclusion of A. ursingii species to the Acinetobacter MLST-Pasteur scheme allows deeper molecular characterization and a better understanding about the epidemiology of this germen.

Unidad Nefrológica de Atención Continuada. Experiencia de un Hospital Universitario / Nephrological Unit for Continued Care. Experience of a University Hospital

Introducción: Los hospitales de día suponen una alternativa asistencial a la hospitalización convencional mejorando la eficacia de la asistencia sanitaria. Desde nuestro punto de vista, la nefrología se beneficiaria de esta modalidad de atención, ya que el paciente con enfermedad renal crónica tiene unas necesidades concretas de cuidado que conllevan al profesional de enfermería a generar una atención integral e individualizada. Por este motivo surge en nuestro servicio la creación de la Unidad Nefrológica de Atención Continuada. Objetivo: Presentar nuestra experiencia en la implantación y desarrollo de la Unidad Nefrológica de Atención Continuada en el Hospital Universitario del Henares. Material y Método: Estudio descriptivo retrospectivo de la actividad realizada en la Unidad Nefrológica de Atención Continuada entre enero-junio de 2017. Desarrollo y puesta en marcha de las distintas funciones y competencias profesionales. Resultados: En este periodo se asistieron a un total de 874 pacientes, con una media de 145,6 visitas/mes. De todas estas visitas, se atendieron 474 pacientes en programa de Diálisis Peritoneal (55% del volumen total), 149 pacientes con enfermedad renal crónica (16%), 245 pacientes con enfermedad renal crónica avanzada (18%) y 11 pacientes en tratamiento conservador (1%). Se realizaron diferentes técnicas, bien programadas en la agenda electrónica o a demanda. Conclusiones: La implantación de la Unidad Nefrológica de Atención Continuada, de forma estructurada y planificada, es una alternativa válida y necesaria en nuestro sistema sanitario. Permite aseguramos un abordaje integral de los pacientes renales y alcanzar una continuidad de cuidados con menor coste sanitario

Introduction: The daytime hospitals are an alternative to conventional hospitalization and improve the effectiveness of healthcare. From our point of view, nephrology is a specialty that should be able to benefit from this type of care, because chronic kidney disease (CKD) patients have specific care needs that lead to the nursing professional to generate comprehensive and individualized care. For this reason, the creation of the Nephrological Unit for Continued Care (NUCA) arises in our service. Aim: To present our experience in the implantation and development of a NUCA in the University Hospital of Henares. Material and Method: Retrospective descriptive study of the activity carried out at NUCA between January 1, 2017 and June 30, 2017. Development and implementation of different functions and professional competencies. Results: In this period, a total of 804 patients were attended, with an average of 145.6 visits per month. Of all these visits, 474 patients undergoing Peritoneal Dialysis (55% of total volume), 149 patients with CKD (16%), 245 patients with advanced CKD (18%) and 11 patients in conservative treatment (1%). Different techniques were carried out, either programmed by electronic agenda or by demand. Conclusions: The implantation of the NUCA, in a structured and planned way, is a valid and necessary alternative in our health system. It allows to ensure an integral approach to renal patients and achieve a continuity of care with lower healthcare costs