Effectiveness of ceftazidime/avibactam as salvage therapy for treatment of infections due to OXA-48 carbapenemase-producing Enterobacteriaceae.

Background: Experience in real clinical practice with ceftazidime/avibactam is limited, and there are even fewer data on infections due to OXA-48-producing Enterobacteriaceae. Methods: We designed an observational study of a prospectively collected cohort of adult patients receiving ceftazidime/avibactam in our centre. Only the first treatment course of each patient was analysed. Efficacy and safety were evaluated as 14 and 30 day mortality, recurrence rate at 90 days, resistance development and occurrence of adverse effects. Results: Fifty-seven patients were treated with ceftazidime/avibactam. The median age was 64 years (range 26-86), 77% were male and the median Charlson index was 3. The most frequent sources of infection were intra-abdominal (28%), followed by respiratory (26%) and urinary (25%). Thirty-one (54%) patients had a severe infection (defined as presence of sepsis or septic shock). Most patients received ceftazidime/avibactam as monotherapy (81%) and the median duration of treatment was 13 days. Mortality at 14 days was 14%. In multivariate analysis, the only mortality risk factor was INCREMENT-CPE score >7 (HR 11.7, 95% CI 4.2-20.6). There was no association between mortality and monotherapy with ceftazidime/avibactam. The recurrence rate at 90 days was 10%. Ceftazidime/avibactam resistance was not detected in any case and only two patients developed adverse events related to treatment. Conclusions: Ceftazidime/avibactam shows promising results, even in monotherapy, for the treatment of patients with severe infections due to OXA-48-producing Enterobacteriaceae and limited therapeutic options. The emergence of resistance to ceftazidime/avibactam was not observed.

Is the Queen conch Strombus gigas (Mesogastropoda: Strombidae) a species with Allee effect? / Es el caracol marino Strombus gigas (Mesogastropoda: Strombidae) una especie con efecto Allee?

The marine park of Xel-Há has a population of Strombus gigas which breeds in the area. We determined the relationship between reproductive activity, conch density and environmental parameters. Samples were collected from February to December 2012, using the transect method, at four sites of Marine Park Xel-Ha, Quintana Roo, Mexico. Sediment samples were analyzed and classified using Folk & Ward’s method. Temperature, salinity and dissolved oxygen were also recorded. Density had a small correlation with sediment (Pearson r=0.29 with very coarse and r=0.26 with coarse sand), while mating and spawning had a correlation of r=0.54 and 0.62 with medium sand, respectively. Density was high in the four sites and was not associated with mating and spawning (r=0.08 and 0.03, respectively). For reproduction, S. gigas requires specific substrate conditions (sandy effect) and not just a density of 56 Conch Ha-1 (Allee effect).

El parque marino de Xel -Há tiene una población de Strombus gigas que se cría en la zona. Determinamos la relación entre la actividad reproductiva, la densidad de la concha de S. gigas y los parámetros ambientales. Las muestras fueron recolectadas de febrero a diciembre de 2012, utilizando el método de transecto, en cuatro sitios del Parque Marino de Xel -Ha, Quintana Roo, México. Fueron analizados y clasificados utilizando la metodología de Folk & Ward. También se registraron temperaturas, salinidad y oxígeno disuelto. La densidad de concha mostró una baja correlación en la categoría de sedimentos (r = 0.29 , con muy gruesos y r = 0.26 con arena gruesa ), mientras que el apareamiento y desove con arena media mostraron una correlación de r = 0.54 y 0.62, respectivamente. Las densidades en cuatro sitios fueron altas y no se asociaron con el número de apareamientos y desove (r = 0.08 y 0.03, respectivamente). Para la reproducción, S. gigas requiere condiciones específicas de sustrato (efecto arenoso) y no sólo una densidad de 56 Conch Ha-1 (efecto Allee ).

Tackling perinatal loss, a participatory action research approach: research protocol.

AIM: The aim of this study was to promote changes to improve the care provided to parents who have experienced a perinatal loss through participatory action research. BACKGROUND: The birth of a child is a joyful event for most families, however, unfortunately some pregnancies end in loss. Perinatal loss creates a heavy emotional impact not only on parents but also on health professionals, where in most cases there is an evident lack of skills, strategies and resources to cope with these kinds of situations. DESIGN: Participatory action research is the methodology proposed to achieve the purpose of this study. METHODS: Participatory action research consists of five stages: outreach and awareness, induction, interaction, implementation and systematization. The working group will include professionals from the Mother and Child Unit for patients at a tertiary level public hospital in Spain. The duration of the study will be 3 years since the approval of the protocol in January 2011. The qualitative techniques used will include group dynamics such as the SWOT analysis the nominal group technique, focus groups and brainstorming, among others that will be recorded and transcribed, generating reports throughout the evolution of the group sessions and about the consensus reached. Content analysis will be conducted on the field diaries kept by the participants and researchers. This project has been funded by the Andalusian Regional Ministry of Health. DISCUSSION: Participatory action research is a methodological strategy that allows changes in clinical practice to conduct a comprehensive transformative action in the care process for perinatal loss.

Efficacy of ampicillin combined with ceftriaxone and gentamicin in the treatment of experimental endocarditis due to Enterococcus faecalis with no high-level resistance to aminoglycosides.

OBJECTIVE: This study tests the usefulness of ceftriaxone combined with ampicillin as an alternative to ampicillin plus gentamicin for the treatment of experimental endocarditis due to Enterococcus faecalis without high-level resistance to aminoglycosides. It also determines whether adding ceftriaxone to ampicillin and gentamicin increases the effectiveness against experimental enterococcal endocarditis resulting from E. faecalis. METHODS: Animals with catheter-induced endocarditis were infected intravenously with 108 cfu of the EF91 strain of E. faecalis and were treated for 3 days with ampicillin 2 g every 4 h administered as 'human-like' (H-L) pharmacokinetics, plus gentamicin 1 mg/kg every 8 h H-L, or ceftriaxone 2 g every 12 h H-L alone or combined with gentamicin 6 mg/kg every 24 h administered subcutaneously. RESULTS: The results of therapy for experimental endocarditis resulting from EF91 showed that the combination of ampicillin plus ceftriaxone was as effective as ampicillin plus gentamicin. The triple combination did not improve on the overall efficacies of the two-drug combinations. CONCLUSIONS: Because of its lower nephrotoxicity, ampicillin plus ceftriaxone may be a useful alternative therapy for E. faecalis endocarditis in selected patients.