Tracing of Di-Ethylhexyl Phthalate in the Tequila Production Process.

The purpose of this study was to determine the origin, presence, and fate of the endocrine disruptor di-ethylhexil phthalate (DEHP) during tequila production. For this, three tequila factories (small, medium, and large) were monitored. DEHP concentrations in water, agave, additives, lubricating greases, neoprene seals, and materials of each stage process were analyzed using gas chromatography/mass spectrometry. DEHP mass balances were performed to identify the processes with significant changes in the inputs/outputs. DEHP was detected in agave at up to 0.08 ± 0.03 mg kg-1, water 0.02 ± 0.01 mg kg-1, lubricant greases 131.05 ± 2.80 mg kg-1, and neoprene seals 369.11 ± 22.52 mg kg-1. Whereas, tequila produced in the large, medium, and small factories contained 0.05 ± 0.01, 0.24 ± 0.04, and 1.43 ± 0.48 mg kg-1 DEHP, respectively. Furthermore, in waste materials (vinasses and bagasse) released, 534.26 ± 349.02, 947.18 ± 65.84, and 5222.60 ± 2836.94 mg of DEHP was detected for every 1000 L of tequila produced. The most significant increase in DEHP occurred during the sugar extraction and distillation stages. Results demonstrate that main raw materials, such as agave and water, contain DEHP, but lubricant greases and neoprene seals are the major sources of DEHP contamination. Identification of the contamination sources can help the tequila industry to take actions to reduce it, protect consumer health and the environment, and prevent circular contamination.

Pain sensitivity in patients with schizophrenia: a systematic review and meta-analysis.

BACKGROUND: Alterations in pain perception have been observed in people diagnosed with schizophrenia. Some research suggests the existence of a possible hyposensitivity, while others describe a hypersensitivity to pain in people with schizophrenia. In summary, the studies present contradictory results.

Sensibilidad al dolor en pacientes con esquizofrenia: una revisión sistemática y metaanálisis / Pain sensitivity in patients with schizophrenia: a systematic review and meta-analysis

Introducción: En personas diagnosticadas de esquizofrenia se han observado alteraciones en la percepción del dolor.Algunas investigaciones sugieren la existencia de una posiblehiposensibilidad, mientras que otras describen una hipersensibilidad al dolor en personas con esquizofrenia. En definitiva, los estudios presentan resultados contradictorios.Método. Se ha llevado a cabo una revisión sistemática deestudios experimentales y comparativos en 5 bases de datosdiferentes, incluyendo aquellos estudios que evalúan el dolorinducido de manera experimental mediante métodos físicosy comparando los resultados con un grupo control sano. Posteriormente, se ha llevado a cabo un metaanálisis comparando los pacientes con esquizofrenia con los controles sanos,utilizando un modelo de efectos aleatorios.Resultados. Finalmente fueron seleccionados nueve estudios, con un total de 186 participantes diagnosticados deesquizofrenia y 186 controles sanos. En el metaanálisis no seobservaron diferencias significativas en la comparación deanálisis general entre pacientes con esquizofrenia y controlessanos. No obstante, cuando el tipo de estímulo fue estudiadopor separado (mecánico, térmico o eléctrico), se observarondiferencias significativas a favor de una mayor sensibilidad aldolor en los pacientes con esquizofrenia en los estudios queevaluaron el dolor con presión mecánica o isquemia, perono en aquellos que utilizaron métodos térmicos o eléctricos.Conclusiones. El resultado global de nuestra revisión sistemática no respalda la existencia de una alteración en lasensibilidad al dolor en los sujetos con esquizofrenia, aunque un análisis de subgrupos sugiere que cuando el estímulodel dolor es causado por métodos mecánicos, las personascon esquizofrenia presentan una hipersensibilidad al doloren comparación con los controles sanos. Aunque estos resultados son datos novedosos, se requieren más estudios para replicar los resultados. (AU)

Background: Alterations in pain perception have been observed in people diagnosed with schizophrenia. Some researchsuggests the existence of a possible hyposensitivity, while othersdescribe a hypersensitivity to pain in people with schizophrenia.In summary, the studies present contradictory results.Methods. A systematic review of experimental andcomparative studies has been conducted in 5 differentdatabases, including those studies that measure pain experimentally inducing it with physical methods and thatcompares the results with a healthy control group. Afterwards, a meta-analysis was carried out comparing thepatients with schizophrenia to the healthy controls, usingthe random effects model.Results. Nine studies were finally selected, with a totalof 186 participants diagnosed with schizophrenia and 186healthy controls. In the meta-analysis, no significative differences were observed in the general analysis. But when thetype of stimuli was studied separately (mechanical, thermal, or electrical), significative differences in favor of a highersensitivity in the patients with schizophrenia were observedin the studies that measured pain with mechanical pressure or ischemia, not in those that used thermal or electricalmethods.Conclusions. The global result of our systematic reviewdoes not support the existence of an alteration in pain sensitivity in subjects with schizophrenia, although a subgroup analysissuggests that when pain stimulation is caused by mechanicalmethods, people with schizophrenia present hypersensitivity topain compared to healthy controls. Although these results arenovel data, more studies are required to replicate these results. (AU)

Chitosan-G-Glycidyl Methacrylate/Au Nanocomposites Promote Accelerated Skin Wound Healing.

Herein, we report the synthesis of Au nanoparticles (AuNPs) in chitosan (CTS) solution by chemically reducing HAuCl4. CTS was further functionalized with glycidyl methacrylate (chitosan-g-glycidyl methacrylate/AuNP, CTS-g-GMA/AuNP) to improve the mechanical properties for cellular regeneration requirements of CTS-g-GMA/AuNP. Our nanocomposites promote excellent cellular viability and have a positive effect on cytokine regulation in the inflammatory and anti-inflammatory response of skin cells. After 40 days of nanocomposite exposure to a skin wound, we showed that our films have a greater skin wound healing capacity than a commercial film (TheraForm®), and the presence of the collagen allows better cosmetic ave aspects in skin regeneration in comparison with a nanocomposite with an absence of this protein. Electrical percolation phenomena in such nanocomposites were used as guiding tools for the best nanocomposite performance. Our results suggest that chitosan-based Au nanocomposites show great potential for skin wound repair.

Comparison of performance of MALDI-TOF MS and MLST for biotyping carbapenemase-producing Klebsiella pneumoniae sequence types ST11 and ST101 isolates.

INTRODUCTION: The rapid identification and detection of carbapenemase-producing Klebsiella pneumoniae (CPKP) isolates is crucial to ascertain outbreaks, as well as to limit their spread. The current reference method for this purpose is multilocus sequence typing (MLST), which is laborious and expensive. Consequently, alternative typing methods are gaining attention, such as Matrix-Assisted Laser Desorption Ionization-Time Of Flight Mass Spectrometry (MALDI-TOF MS). METHODS: This study sought to analyze MALDI-TOF MS as a typing method using 44 CPKP isolates that were well characterized by MLST. The most common types of samples from which these pathogens were isolated were skin and soft tissues (32%) and urine (29%). Half of the CPKP isolates were from hospitalized patients. Two approaches were followed for the analysis of the mass peak data obtained by MALDI-TOF MS. The first using all peaks obtained and the second using a selection of 21 characteristic peaks. RESULTS: The selection of 21 characteristic peaks showed greater discrimination power for ST11 and ST101. Principal component analysis (PCA) indicated that this dataset could be efficiently grouped with lineal classifiers. A Support Vector Machine (SVM) was chosen for this purpose after checking its capacity to classify bacterial strains on the basis of MALDI-TOF MS information. CONCLUSION: SVM was able to discriminate between ST11 and ST101 with high accuracy. In conclusion, our results reveal MALDI-TOF MS as a promising alternative technique for typing of CPKP isolates.

Comparison of performance of MALDI-TOF MS and MLST for biotyping carbapenemase-producing Klebsiella pneumoniae sequence types ST11 and ST101 isolates / Estudio comparativo de la utilidad de MALDI-TOF MS y MLST para el biotipado de Klebsiella pneumoniae ST11 y ST101 productoras de carbapenemasas

IntroductionThe rapid identification and detection of carbapenemase-producing Klebsiella pneumoniae (CPKP) isolates is crucial to ascertain outbreaks, as well as to limit their spread. The current reference method for this purpose is multilocus sequence typing (MLST), which is laborious and expensive. Consequently, alternative typing methods are gaining attention, such as Matrix-Assisted Laser Desorption Ionization–Time Of Flight Mass Spectrometry (MALDI-TOF MS).MethodsThis study sought to analyze MALDI-TOF MS as a typing method using 44 CPKP isolates that were well characterized by MLST. The most common types of samples from which these pathogens were isolated were skin and soft tissues (32%) and urine (29%). Half of the CPKP isolates were from hospitalized patients. Two approaches were followed for the analysis of the mass peak data obtained by MALDI-TOF MS. The first using all peaks obtained and the second using a selection of 21 characteristic peaks.ResultsThe selection of 21 characteristic peaks showed greater discrimination power for ST11 and ST101. Principal component analysis (PCA) indicated that this dataset could be efficiently grouped with lineal classifiers. A Support Vector Machine (SVM) was chosen for this purpose after checking its capacity to classify bacterial strains on the basis of MALDI-TOF MS information.ConclusionSVM was able to discriminate between ST11 and ST101 with high accuracy. In conclusion, our results reveal MALDI-TOF MS as a promising alternative technique for typing of CPKP isolates.

IntroducciónLa rápida identificación y detección de los aislados de Klebsiella pneumoniae productores de carbapenemasas (CPKP) es crucial para identificar brotes e impedir la propagación de los aislados resistentes. El método de referencia para este propósito es el multilocus sequencing typing (MLST), que es un técnica laboriosa y cara, por lo que se buscan métodos de tipado alternativos que pueden desempeñar la misma función con menor esfuerzo. Entre las posibles técnicas se encuentra la espectrometría de masas de tiempo de vuelo MALDI-TOF.MétodosEste estudio se han utilizado el sistema MALDI-TOF MS para tipar 44 aislamientos de CPKP previamente caracterizados por MLST. Las muestras clínicas de las que proceden los aislados son principalmente piel y tejidos blandos (32%) y orina (29%). La mitad de los aislamientos de CPKP procedían de pacientes ingresados. El análisis los datos obtenidos por MALDI-TOF MS se realizó con 2 enfoques diferentes, el primero usando todos los picos obtenidos y el segundo usando una selección de picos.ResultadosLa selección de 21 picos característicos ofreció un mayor poder de discriminación entre ST11 y ST101. El análisis de componentes principales (PCA) indicó que este conjunto de datos podría agruparse eficientemente con clasificadores lineales. Para realizar este agrupamiento se escogió el algoritmo support vector machine (SVM, máquinas de vectores de soporte) para este propósito después de verificar su capacidad para clasificar las cepas bacterianas en base a la información de MALDI-TOF MS.ConclusiónSVM pudo discriminar entre ST11 y ST101 con alta precisión. En conclusión, nuestros resultados revelan MALDI-TOF MS puede ser una técnica alternativa para el tipificación de aislamientos de CPKP.

EUROLD: preliminary results of the ecological study on suicide and its associated socioeconomic variables in people over 85 in Europe.

The present study aims to compare the suicide rates in people over 85 years of age in relation to overall suicide rates in different European countries. In addition, the study aims to perform a preliminary analysis of which socioeconomic factors could explain higher suicide rates in this age group in Europe. An analysis of the Eurostat database has been made. In this pilot phase, certain socioeconomic variables representative of people over 85 years of age were chosen based on criteria of suitability, according to the bibliography available for other regions and availability of the information provided. The conditional suicide rate in this age group with respect to the overall suicide rate in each country has been calculated. Furthermore, Spearman correlations between the suicide rates in this age group and the chosen socioeconomic factors were performed. Conditional suicide rates in people over 85 years of age show a marked difference between southern and northern European countries. In the correlational analysis, suicide in this age group was associated with different economic ratios, the old-age dependency ratio, and the self-perceived health ratio. After performing a multivariate regression, the model that best explained the differences between the European countries included the variables "old-age dependency ratio" and "economic impossibility to buy new clothes ratio." Different socioeconomic factors, specifically poverty and economic inequality, added to the old-age dependency ratio, could explain huge differences between the suicide rates in people over 85 years of age in the different European countries.

Comparison of performance of MALDI-TOF MS and MLST for biotyping carbapenemase-producing Klebsiella pneumoniae sequence types ST11 and ST101 isolates.

INTRODUCTION: The rapid identification and detection of carbapenemase-producing Klebsiella pneumoniae (CPKP) isolates is crucial to ascertain outbreaks, as well as to limit their spread. The current reference method for this purpose is multilocus sequence typing (MLST), which is laborious and expensive. Consequently, alternative typing methods are gaining attention, such as Matrix-Assisted Laser Desorption Ionization-Time Of Flight Mass Spectrometry (MALDI-TOF MS). METHODS: This study sought to analyze MALDI-TOF MS as a typing method using 44 CPKP isolates that were well characterized by MLST. The most common types of samples from which these pathogens were isolated were skin and soft tissues (32%) and urine (29%). Half of the CPKP isolates were from hospitalized patients. Two approaches were followed for the analysis of the mass peak data obtained by MALDI-TOF MS. The first using all peaks obtained and the second using a selection of 21 characteristic peaks. RESULTS: The selection of 21 characteristic peaks showed greater discrimination power for ST11 and ST101. Principal component analysis (PCA) indicated that this dataset could be efficiently grouped with lineal classifiers. A Support Vector Machine (SVM) was chosen for this purpose after checking its capacity to classify bacterial strains on the basis of MALDI-TOF MS information. CONCLUSION: SVM was able to discriminate between ST11 and ST101 with high accuracy. In conclusion, our results reveal MALDI-TOF MS as a promising alternative technique for typing of CPKP isolates.

Impact of 13-valent pneumococcal conjugate vaccination on invasive pneumococcal disease in children under 15 years old in Madrid, Spain, 2007 to 2016: The HERACLES clinical surveillance study.

Streptococcus pneumoniae is a major cause of morbidity and mortality worldwide. Using the data from the HERACLES clinical surveillance study (2007-2016), we describe the population impact of the 13-valent pneumococcal conjugate vaccine (PVC13) on invasive pneumococcal disease (IPD) in children <15 years of age in the Community of Madrid, Spain. After six years of the inclusion of PCV13 in the vaccination calendar (2010-2016), and despite changes in the Regional Immunization Programme that limited its availability, the net benefit incidence rate (IR) of IPD fell by 70.1% (IRR 0.3 [95% CI: 0.22-0.4]; p ≤ 0.001), mainly due to a significant reduction (91%) in the PCV13 serotypes (IRR 0.09 [95% CI: 0.05-0.16], p ≤ 0.001). Furthermore, no significant changes were detected in the IR of IPD caused by non-PCV13 serotypes. The IRs of the aggressive, resistant and most prevalent serotype in the analysed population, the 19A serotype, dramatically decreased from the beginning to the end of the study (98%) [IRR 0.03 (95% CI: 0.00-0.19), p ≤ 0.001], to its almost total disappearance. Remarkably, this reduction led to a pronounced decline in the percentage of cefotaxime-resistant isolates and the incidence of meningitis cases. Assessment of the clinical impact revealed a reduction in the number of all clinical presentations of IPD, confirming the effectiveness of the PCV13. Finally, PCV13 detected by PCR is predicted to have a stronger impact than the one based on culture methods, which can overlook more than 20% of cases of IPD, mainly pleural empyemas.

Impact of 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis in children.

OBJECTIVES: To evaluate the impact of 13-valent pneumococcal conjugate vaccine on pneumococcal meningitis in children. METHODS: Children younger than 15years of age attending 27 hospitals in the Region of Madrid with confirmed pneumococcal meningitis were identified in a prospective surveillance study, from 2007 to 2015. Clinical data, neurological sequelae, pneumococcal vaccination status, serotyping and antibiotic susceptibility were recorded. RESULTS: One hundred and four cases of pneumococcal meningitis were identified, 63 during the period of routine 7-valent pneumococcal conjugate vaccine immunisation (May 2007-April 2010) and 41 during the period of 13-valent pneumococcal conjugate vaccine immunisation (May 2010-April 2015). When both periods were compared, a 62% (95% CI: 45-75%) decrease in the incidence of pneumococcal meningitis was observed, from 2.19 cases per 100,000 inhabitants in the PCV7 period to 0.81 per 100,000 inhabitants in the PCV13 period (p=0.0001), mainly due to an 83% (95% CI: 30-96%) reduction in cases caused by serotype 19A. Isolates not susceptible to cefotaxime (MIC>0.5µg/L) decreased from 27% to 8%, (p=0.02). Mean patient ages rose from 28.7months to 38.5months (p<0.05). Case fatality rate across both periods was 5%. An unfavourable outcome (death or neurological sequelae) occurred in 27% of patients, while the rate was similar in both periods. There was no increase in meningitis caused by pneumococcal serotypes not included in 13-valent pneumococcal conjugate vaccine throughout the years of the study. CONCLUSIONS: Immunisation with 13-valent pneumococcal conjugate vaccine has reduced the rate of pneumococcal meningitis in children less than 15years, with a near-elimination of cefotaxime-resistant isolates, but morbidity has remained unchanged. A shift of pneumococcal meningitis towards slightly higher age groups was also observed.

In-vitro activity of several antimicrobial agents against methicillin-resistant Staphylococcus aureus (MRSA) isolates expressing aminoglycoside-modifying enzymes: potency of plazomicin alone and in combination with other agents.

This study investigated the in-vitro activity of clinically relevant aminoglycosides and new antimicrobial agents-plazomicin, ceftobiprole and dalbavancin-against 55 methicillin-resistant Staphylococcus aureus (MRSA) isolates producing aminoglycoside-modifying enzymes (AMEs). The checkerboard method was used to assess synergism between plazomicin and four antibiotics (fosfomycin, ceftobiprole, cefoxitin and meropenem), and time-kill assays were performed for the most active combinations. Among the aminoglycosides tested, plazomicin was the most active agent against MRSA, with >90% of isolates being inhibited at a minimum inhibitory concentration (MIC) of ≤1 mg/L. MIC50 and MIC90 values for ceftobiprole and dalbavancin were 2 and 4 mg/L, and 0.125 and 0.125 mg/L, respectively. The most prevalent AME gene was aac(6')Ie-aph(2″)Ia (87.3%), followed by ant(4')Ia (52.7%) and aph(3')IIIa (52.7%). Plazomicin activity was not affected by the type or number of enzymes detected. In checkerboard and time-kill assays, indifference was the most common result achieved for the antibiotic combinations. Notably, no antagonism was observed with any combination tested. Overall, plazomicin in combination with meropenem had the highest synergistic effect, demonstrating synergy against seven isolates in the checkerboard assay and three isolates in time-kill curves. In conclusion, plazomicin showed potent activity against aminoglycoside-resistant MRSA isolates, regardless of the number and type of AMEs present. These findings indicate the potential utility of plazomicin in combination with meropenem for the treatment of MRSA infections.

Characterization and circulation of seasonal influenza viruses in Madrid, 2010-2016.

Influenza virus infection is a major health care burden and is associated with significant morbidity and mortality. The 2009 influenza pandemic highlighted the importance of influenza surveillance. The objective of this study was to assess the epidemiology and activity of influenza A and B viruses in adults and children in the post-pandemic period with a special focus on the pediatric population. We performed a retrospective descriptive study involving adults and children with influenza-like illness at the Clinico San Carlos Hospital (Madrid, Spain) over six influenza seasons, between August 2010 and April 2016. Respiratory specimens were collected from 3131 patients and routinely processed for influenza diagnosis. Epidemiological analysis was performed in terms of gender, age, and seasonal distribution. Globally, Influenza A and B viruses were detected in the respiratory specimens of 696 (22.2%) of the 3131 studied population. Among all influenza positive specimens, 142 (20.4%) were influenza A(H1N1)pdm09, 61 (8.8%) were influenza A(H3N2), 321 (46.1%) were untypeable influenza A viruses and 166 (23.9%) were influenza B. Co-infection by both influenza A and B viruses was detected in six patients (0.9%). Meanwhile, co-infection with other non-influenza respiratory viruses was identified in 5 children and 20 adults. Influenza A(H1N1)pdm09 virus activity has been significantly high since the 2009 pandemic and has gradually replaced the previously circulating seasonal influenza A(H1N1) virus. Moreover, influenza A(H3N2) virus activity remained at low levels during the last winter season while influenza B virus isolates increased significantly over the past 2 years.

Consenso sobre la vacunación anti-neumocócica en el adulto por riesgo de edad y patología de base. Actualización 2017 / Consensus document on pneumococcal vaccination in adults at risk by age and underlying clinical conditions. 2017 Update

La enfermedad neumocócica invasiva (ENI) y la neumonía neumocócica (NN) suponen un grave problema de salud entre los adultos de mayor edad y aquellos con determinadas condiciones y patologías de base, entre los que destacan los inmunodeprimidos y algunos inmunocompetentes, que les hacen más susceptibles a la infección y favorecen cuadros de mayor gravedad y peor evolución. Entre las estrategias para prevenir la ENI y la NN se encuentra la vacunación, aunque las coberturas vacunales son más bajas de lo deseable. Actualmente, existen 2 vacunas disponibles para el adulto. La vacuna polisacárida (VNP23), que se emplea en mayores de 2 años de edad desde hace décadas, es la que mayor número de serotipos (23) incluye, pero no genera memoria inmunitaria, los niveles de anticuerpos disminuyen con el tiempo, provoca un fenómeno de tolerancia inmunitaria y no actúa sobre la colonización nasofaríngea. La vacuna conjugada (VNC13) puede emplearse a cualquier edad de la vida a partir de las 6 semanas de vida y genera una respuesta inmunitaria más potente que la VNP23 frente a la mayoría de los 13 serotipos en ella incluidos. En el año 2013 las 16 Sociedades Científicas más directamente relacionadas con los grupos de riesgo para padecer ENI publicamos un documento de Consenso con una serie de recomendaciones basadas en las evidencias científicas respecto a la vacunación antineumocócica en el adulto con condiciones especiales y patología de base. Se estableció un compromiso de discusión y actualización ante la aparición de nuevas evidencias. Fruto de este trabajo de revisión, presentamos una actualización del anterior documento junto a otras nuevas Sociedades Científicas donde destaca la recomendación por edad (AU)

Invasive pneumococcal disease (IPD) and pneumococcal pneumonia (PP) represent an important health problem among aging adults and those with certain underlying pathologies and some diseases, especially immunosuppressed and some immunocompetent subjects, who are more susceptible to infections and present greater severity and worse evolution. Among the strategies to prevent IPD and PP, vaccination has its place, although vaccination coverage in this group is lower than desirable. Nowadays, there are 2 vaccines available for adults. Polysacharide vaccine (PPV23), used in patients aged 2 and older since decades ago, includes a greater number of serotypes (23), but it does not generate immune memory, antibody levels decrease with time, causes an immune tolerance phenomenon, and have no effect on nasopharyngeal colonization. PCV13 can be used from children 6 weeks of age to elderly and generates an immune response more powerful than PPV23 against most of the 13 serotypes included in it. In the year 2013 the 16 most directly related to groups of risk of presenting IPD publised a series of vaccine recommendations based on scientific evidence regarding antipneumococcal vaccination in adults with underlying pathologies and special conditions. A commitment was made about updating it if new scientific evidence became available. We present an exhaustive revised document focusing mainly in recommendation by age in which some more Scientific Societies have been involved (AU)

Effect of the different 13-valent pneumococcal conjugate vaccination uptakes on the invasive pneumococcal disease in children: Analysis of a hospital-based and population-based surveillance study in Madrid, Spain, 2007-2015.

In the Community of Madrid, the 13-valent pneumococcal conjugate vaccine (PCV13) replaced the 7-valent (PCV7) in the fully government-funded Regional Immunization Program (RIP) in May, 2010, but was later excluded in May, 2012, and included again in January, 2015. These unique changes allowed us to assess the impact of the different pneumococcal vaccination policies on PCV13 uptake in infants and on the incidence rate (IR) of invasive pneumococcal disease (IPD) in children <15 years old. In this prospective, active, surveillance study, we estimated PCV13 uptakes, IR and incidence rate ratios (IRR) for total IPD and for IPD caused by PCV13- and non-PCV13 serotypes in children <15 years, stratified by age, in four periods with different vaccination policies: fully government-funded PCV7 vaccination, fully government-funded PCV13, mixed public/private funding and only private funding. Vaccine uptakes reached 95% in periods with public-funded pneumococcal vaccination, but fell to 67% in the private funding period. Overall, IR of IPD decreased by 68% (p<0.001) in 2014-15, due to 93% reduction in the IR of PCV13-type IPD (p<0.001) without significant changes in non-PCV13-type IPD. A fully government-funded PCV13 vaccination program lead to high vaccine uptake and dramatic reductions in both overall and PCV13-type IPD IR. When this program was switched to private PCV13 vaccination, there was a fall in vaccine coverage and stagnation in the decline of PCV13-type IPD with data suggesting a weakening of herd immunity.

Epidemiology of Otitis Media with Spontaneous Perforation of the Tympanic Membrane in Young Children and Association with Bacterial Nasopharyngeal Carriage, Recurrences and Pneumococcal Vaccination in Catalonia, Spain - The Prospective HERMES Study.

The Epidemiology of otitis media with spontaneous perforation of the tympanic membrane and associated nasopharyngeal carriage of bacterial otopathogens was analysed in a county in Catalonia (Spain) with pneumococcal conjugate vaccines (PCVs) not included in the immunization programme at study time. A prospective, multicentre study was performed in 10 primary care centres and 2 hospitals (June 2011-June 2014), including all otherwise healthy children ≥2 months ≤8 years with otitis media presenting spontaneous tympanic perforation within 48h. Up to 521 otitis episodes in 487 children were included, showing by culture/PCR in middle ear fluid (MEF): Haemophilus influenzae [24.2%], both Streptococcus pneumoniae and H. influenzae [24.0%], S. pneumoniae [15.9%], Streptococcus pyogenes [13.6%], and Staphylococcus aureus [6.7%]. Culture-negative/PCR-positive otitis accounted for 31.3% (S. pneumoniae), 30.2% (H. influenzae) and 89.6% (mixed S. pneumoniae/H. influenzae infections). Overall, incidence decreased over the 3-year study period, with significant decreases in otitis by S. pneumoniae and by H. influenzae, but no decreases for mixed S. pneumoniae/H. influenzae infections. Concordance between species in nasopharynx and MEF was found in 58.3% of cases, with maximal rates for S. pyogenes (71.8%), and with identical pneumococcal serotype in 40.5% of cases. Most patients (66.6%) had past episodes. PCV13 serotypes were significantly more frequent in first episodes, in otitis by S. pneumoniae as single agent, and among MEF than nasopharyngeal isolates. All non-PCV13 serotypes separately accounted for <5% in MEF. Up to 73.9% children had received ≥1 dose of PCV, with lower carriage of PCV13 serotypes than among non-vaccinated children. Pooling pneumococcal isolates from MEF and nasopharynx, 30% were multidrug resistant, primarily belonging to serotypes 19A [29.8%], 24A [14.3%], 19F [8.3%] and 15A [6.0%]. Our results suggest that increasing PCV13 vaccination would further reduce transmission of PCV13 serotypes with special benefits for youngest children (with none or uncompleted vaccine schedules), preventing first otitis episodes and subsequent recurrences.

Detection of Escherichia coli ST131 clonal complex (ST705) and Klebsiella pneumoniae ST15 among faecal carriage of extended-spectrum ß-lactamase- and carbapenemase-producing Enterobacteriaceae.

PURPOSE: The objective of the present study was to evaluate the prevalence of intestinal colonization with extended-spectrum ß-lactamase (ESBL)-producing Enterobacteriaceae (ESBL-E) and carbapenemase-producing Enterobacteriaceae (CPE) in non-selected hospitalized and non-hospitalized patients from the same geographic area of Madrid. METHODOLOGY: A total of 501 fecal samples were screened. Diluted samples in saline were cultured in MacConkey agar plates with ceftazidime, cefotaxime, imipenem and meropenem disks. Colonies growing within the inhibition zone of either disk were selected. Characterization of ESBLs and CPEs were performed by PCR and sequencing. The Wider system was used for the bacterial identification. In addition, clonal analysis was carried out for species predominant among the fecal carriage. KEY FINDINGS: Among the 501 patients enrolled, 43 (8.6 %) carried ESBL-E and 8 (1.6 %) patients exhibited CPE. The main intestinal colonizer among ESBL-E was CTX-M-producing Escherichia coli isolates in both settings (community and hospital). ST131 clonal complex was the most common among faecal ESBL-producing E. coli. All gut carriers of CPE were hospitalized patients, Klebsiella pneumoniae being the most prevalent species. Two OXA-48-producing K. pneumoniae isolates belonging to ST15 were detected. CONCLUSION: Present study reveals that faecal carriage of ESBL is common among inpatients and outpatients, whereas carbapenemase producers are only present in the hospital setting. Therefore, active surveillance will be useful for reducing transmission of antimicrobial-resistant bacteria and preventing infection.

Plazomicin Activity against 346 Extended-Spectrum-ß-Lactamase/AmpC-Producing Escherichia coli Urinary Isolates in Relation to Aminoglycoside-Modifying Enzymes.

The activity of plazomicin and clinically relevant aminoglycosides was tested against 346 extended-spectrum-ß-lactamase/AmpC-producing Escherichia coli urinary isolates, and the results were correlated with the presence of aminoglycoside-modifying enzymes (AMEs). Data showed that plazomicin was very active against all ESBL/AmpC-producing E. coli urinary isolates. Its activity was not related to the AME genes studied.

Evaluation of the Alere i Influenza A&B assay for rapid identification of influenza A and influenza B viruses.

The Alere i Influenza A&B assay is a novel isothermal nucleic acid amplification assay capable of detecting and differentiating influenza A and B viruses in approximately 15 min with minimal hands-on time. This study was conducted in order to assess the performance of the Alere i Influenza A&B assay compared to molecular techniques, considered to be gold standard methods, to evaluate the results. A total of 119 nasopharyngeal swabs collected from inpatients with influenza-like illness were included in the study using both archived and prospectively collected samples from adults and children. Prospectively collected samples were also compared to the Alere BinaxNOW® Influenza A & B Card. The overall sensitivity for detection of influenza A and B viruses compared to those of molecular techniques were 65.96 % and 53.33 % respectively, while the specificity was 98.51 % and 95.96 %. Compared to the Alere BinaxNOW® Influenza A & B Card, the Alere i assay is considerably more sensitive for detection of influenza A and B viruses, although both tests demonstrated excellent specificity for diagnosis of influenza viruses.

El desarrollo de nuevas vacunas / Development of new vaccines

Recientes e importantes avances en los campos de la inmunología, genómica, genómica funcional, inmunogenética, inmunogenómica, bioinformática, microbiología, ingeniería genética, biología de sistemas, bioquímica sintética, proteómica, metabolómica y nanotecnología, entre otros, facilitan nuevos enfoques en el desarrollo de vacunas. La mejor identificación de epítopos ideales, la potenciación de la respuesta inmunitaria gracias a los nuevos adyuvantes o la búsqueda de nuevas vías de administración son buenos ejemplos de avances que ya son una realidad y que favorecerán el desarrollo de más vacunas, su uso en grupos poblaciones indicados o el abaratamiento de su producción. Actualmente hay en desarrollo más de 130 nuevas vacunas frente a las enfermedades infecciosas más deseadas (malaria y VIH), las que más dificultades están planteando (CMV o VRS), graves infecciones reemergentes (dengue o ebola), enfermedades parasitarias cada vez más presentes en nuestro medio (enfermedad de Chagas o leishmaniasis), o emergentes infecciones bacterianas nosocomiales (Clostridium difficile o Staphylococcus aureus)

Recent and important advances in the fields of immunology, genomics, functional genomics, immunogenetics, immunogenomics, bioinformatics, microbiology, genetic engineering, systems biology, synthetic biochemistry, proteomics, metabolomics and nanotechnology, among others, have led to new approaches in the development of vaccines. The better identification of ideal epitopes, the strengthening of the immune response due to new adjuvants, and the search of new routes of vaccine administration, are good examples of advances that are already a reality and that will favour the development of more vaccines, their use in indicated population groups, or its production at a lower cost. There are currently more than 130 vaccines are under development against the more wished (malaria or HIV), difficult to get (CMV or RSV), severe re-emerging (Dengue or Ebola), increasing importance (Chagas disease or Leishmania), and nosocomial emerging (Clostridium difficile or Staphylococcus aureus) infectious diseases