Stenotrophomonas maltophilia Infections in Haematological Malignancies and Hematopoietic Stem Cell Transplantation: A Case Series including Cefiderocol-Based Regimens.

Background and Objectives: Stenotrophomonas maltophilia is a ubiquitous, aerobic, Gram-negative bacillus causing increasing concern in patients affected by haematological malignancies. Materials and Methods: We report a case series from two centres in Northern Italy to describe the characteristics, outcome and microbiological response of S. maltophilia infections in patients with haematological malignancies and/or allogenic hematopoietic stem cell transplantation (aHSCT). Results: Ten patients were included. The median age was 67 years, and seven patients (70%) were males. The median Charlson Comorbidity Index was 6 (IQR: 4-8). The most frequent haematological comorbidities were acute myeloid leukaemia (AML; n = 3; 30%) and non-Hodgkin's lymphoma (n = 3; 30%). Three (30%) patients underwent aHSCT before infection, all for AML. All the patients had undergone a recent antibiotics course and had an indwelling central venous catheter before infection. The main clinical presentations were nosocomial pneumonia, with (2; 20%) or without (4; 40%) secondary bloodstream infection and CRBSI (3; 30%). Four patients were treated with cefiderocol in monotherapy or combinations therapy with cotrimoxazole. The rest of the patients were treated with cotrimoxazole or levofloxacin in monotherapy. Conclusions: Despite a high rate of clinical improvement (90%) after starting antimicrobial therapy, we faced high 30-day mortality (30%) and in-hospital mortality (50%) rates in a highly comorbid population.

Overlapping Infection by Strongyloides spp. and Cytomegalovirus in the Immunocompromised Host: A Comprehensive Review of the Literature.

Strongyloides and cytomegalovirus co-infections are rarely reported, even though they are distinguished by high morbidity and mortality, especially in immunocompromised hosts. We narratively reviewed the literature on reported cases of Strongyloides and CMV co-infections in immunosuppressed patients. Most cases occurred in males with a median age of 47 (IQR, 37-59). Strongyloides/CMV co-infections occurred among immunocompromised hosts, especially in solid organ transplants and hematological or rheumatological diseases. Most of the patients underwent a course of steroid treatment before the diagnosis of co-infections. Other common immunomodulatory agents were tacrolimus and mycophenolate. The first clinical manifestations of co-infections were mainly gastrointestinal, followed by respiratory symptoms. CMV was, in most patients, co-infected with an isolated reactivation, although Strongyloides manifested especially as hyperinfection syndrome. Ganciclovir and ivermectin are the mainstays of CMV and Strongyloides treatment. However, the treatment mortality reported in this narrative review is around 52.4%. Interestingly secondary bacterial infections are common in CMV/Strongyloides-infected patients.

Strongyloides spp. and Cytomegalovirus Co-Infection in Patient Affected by Non-Hodgkin Lymphoma.

To our knowledge, we have described the first case of Strongyloides/Cytomegalovirus (CMV) concomitant infection that occurred in a European country. The patient was a 76-year-old woman affected by relapsed non-Hodgkin lymphoma who presented interstitial pneumonia with a rapidly progressive worsening of respiratory insufficiency, leading to cardiac dysfunction and consequent death. CMV reactivation is a common complication in immunocompromised patients, while hyperinfection/disseminated strongyloidiasis (HS/DS) is rare in low endemic regions, but has been widely described in Southeast Asia and American countries. HS and DS are two consequences of the failure of infection control by the immune system: HS is the uncontrolled replication of the parasite within the host and DS the spreading of the L3 larvae in organs other than the usual replication sites. Only a few cases of HS/CMV infection have been reported in the literature, and only in one patient with lymphoma as an underlying disease. The clinical manifestations of these two infections overlap, usually leading to a delayed diagnosis and a consequent poor outcome.

The Burden of Carbapenem-Resistant Acinetobacter baumannii in ICU COVID-19 Patients: A Regional Experience.

Since the beginning of the COVID-19 pandemic, the impact of superinfections in intensive care units (ICUs) has progressively increased, especially carbapenem-resistant Acinetobacter baumannii (CR-Ab). This observational, multicenter, retrospective study was designed to investigate the characteristics of COVID-19 ICU patients developing CR-Ab colonization/infection during an ICU stay and evaluate mortality risk factors in a regional ICU network. A total of 913 COVID-19 patients were admitted to the participating ICUs; 19% became positive for CR-Ab, either colonization or infection (n = 176). The ICU mortality rate in CR-Ab patients was 64.7%. On average, patients developed colonization or infection within 10 ± 8.4 days from ICU admission. Scores of SAPS II and SOFA were significantly higher in the deceased patients (43.8 ± 13.5, p = 0.006 and 9.5 ± 3.6, p < 0.001, respectively). The mortality rate was significantly higher in patients with extracorporeal membrane oxygenation (12; 7%, p = 0.03), septic shock (61; 35%, p < 0.001), and in elders (66 ± 10, p < 0.001). Among the 176 patients, 129 (73%) had invasive infection with CR-Ab: 105 (60.7%) Ventilator-Associated Pneumonia (VAP), and 46 (26.6%) Bloodstream Infections (BSIs). In 22 cases (6.5%), VAP was associated with concomitant BSI. Colonization was reported in 165 patients (93.7%). Mortality was significantly higher in patients with VAP (p = 0.009). Colonized patients who did not develop invasive infections had a higher survival rate (p < 0.001). Being colonized by CR-Ab was associated with a higher risk of developing invasive infections (p < 0.001). In a multivariate analysis, risk factors significantly associated with mortality were age (OR = 1.070; 95% CI (1.028−1.115) p = 0.001) and CR-Ab colonization (OR = 5.463 IC95% 1.572−18.988, p = 0.008). Constant infection-control measures are necessary to stop the spread of A. baumannii in the hospital environment, especially at this time of the SARS-CoV-2 pandemic, with active surveillance cultures and the efficient performance of a multidisciplinary team.

Out of sight out of mind? A life cycle-based environmental assessment of goods traded by the European Union.

Ensuring responsible production and consumption is one of the United Nations' Sustainable Development Goals (SDGs) to which the European Union (EU) has committed. An increasing body of literature has demonstrated that global trade flows are key contributors to the environmental impacts of consumption. Indeed, very often developed countries import fuels and other resources from developing ones, displacing a large share of environmental burdens related to consumption of goods outside their boundaries. This paper has a triple goal. Firstly, it assesses the environmental impacts of traded goods with a bottom-up approach, adopting life cycle assessment (LCA) and identifying hotspots related to EU consumption. Secondly, it analyses the extent to which the trade of goods is contributing to the environmental impacts of EU apparent consumption. Finally, it compares the contribution of environmental impact of EU traded goods against overall global impacts. Forty representative products imported or exported by the EU were selected based on their relevance in mass and economic value according to official trade statistics. LCA was applied to these products using the EU Environmental Footprint method. The results were then upscaled in order to be representative of the entire impact of traded goods in the EU. Overall, consumption in the EU resulted to cause considerable environmental impacts outside EU boundaries and impacts of imports and exports were mostly associated with few products groups, which either were traded in large quantities (e.g. "Fuels and mineral oils") or had a high impact intensity compared to the others (e.g. "Pulp of wood and other cellulosic material" for land use).

Assessing the environmental impacts of EU consumption at macro-scale.

Sustainable Consumption and Production is one of the leading principle towards reducing environmental impacts globally. This study aims at combining Environmentally-Extended Input-Output Analysis (using EXIOBASE 3) with up-to-date impact assessment models to quantify the environmental impacts induced by final consumption in the EU Member States in 2011. The environmental extensions are characterized in 14 environmental impact categories out of the 16 used in the Environmental Footprint life cycle impact assessment method. A contribution analysis of key products and services as well as emissions and resources, which drive the environmental impacts of EU consumption, is conducted. Environmental impacts are mainly induced along the supply-chain of products and services. Several expenditures relative to services represent large shares both in the total final consumption and in the 14 impacts under study, despite a relatively low impact intensity. Food products, in particular meat and dairy products, are identified as key contributors regarding acidification, eutrophication, land use, and water use, and to a lower extent climate change. Finally, several manufactured products, raw materials and basic products respectively importantly contribute to impacts on human toxicity, freshwater ecotoxicity and resource uses. The total volume of final consumption expenditures per EU Member State appears a key explanatory variable to most of the impacts embodied in their consumption, yet to a lower extent regarding water use and fossils resource use. Finally, the current limitations in using EXIOBASE 3 for environmental impact assessment are discussed, with specific attention to EXIOBASE environmental extensions and to the case study on EU consumption. Since the classification of emissions and resources for impact assessment requires a number of assumptions that may influence the results, a sensitivity analysis is performed to exemplify some of the key issues relative to the characterization of impacts based on EXIOBASE environmental extensions.

Biomolecules and Natural Medicine Preparations: Analysis of New Sources of Bioactive Compounds from Ribes and Rubus spp. Buds.

It is well known that plants are important sources for the preparation of natural remedies as they contain many biologically active compounds. In particular, polyphenols, terpenic compounds, organic acids, and vitamins are the most widely occurring groups of phytochemicals. Some endemic species may be used for the production of herbal preparations containing phytochemicals with significant bioactivity, as antioxidant activity and anti-inflammatory capacities, and health benefits. Blackberry sprouts and blackcurrant buds are known to contain appreciable levels of bioactive compounds, including flavonols, phenolic acids, monoterpenes, vitamin C, and catechins, with several clinical effects. The aim of this research was to perform an analytical study of blackcurrant and blackberry bud-preparations, in order to identify and quantify the main biomarkers, obtaining a specific phytochemical fingerprint to evaluate the single botanical class contribution to total phytocomplex and relative bioactivity, using a High Performance Liquid Chromatograph-Diode Array Detector; the same analyses were performed both on the University laboratory and commercial preparations. Different chromatographic methods were used to determine concentrations of biomolecules in the preparations, allowing for quantification of statistically significant differences in their bioactive compound content both in the case of Ribes nigrum and Rubus cultivated varieties at different harvest stages. In blackcurrant bud-extracts the most important class was organic acids (50.98%) followed by monoterpenes (14.05%), while in blackberry preparations the main bioactive classes were catechins (50.06%) and organic acids (27.34%). Chemical, pharmaceutical and agronomic-environmental knowledge could be important for obtaining label certifications for the valorization of specific genotypes, with high clinical and pharmaceutical value: this study allowed to develop an effective tool for the natural preparation quality control and bioactivity evaluation through the chemical fingerprinting of bud preparations.

Analytical fingerprint and chemometrics as phytochemical composition control tools in food supplement analysis: characterization of raspberry bud preparations of different cultivars.

BACKGROUND: The raspberry, Rubus idaeus L., provides several plant parts (as buds) used for food supplements. The aim of this research was to establish a technique for chemical composition control of R. idaeus herbal preparations, using chromatographic methods. These methods allowed us to identify and quantify the main phytochemicals, obtaining a specific phytochemical fingerprint (phytocomplex). Combined with two different chemometric methods - clustering analysis and principal component analysis - the raspberry bud extracts of the different cultivars were efficiently characterized. RESULTS: Rubus idaeus buds were identified as a rich source of anti-inflammatory and antioxidant compounds: organic acids, vitamins and catechins were found to be the most discriminating variables by chemometric techniques to differentiate raspberry cultivars. In particular, catechins (13.25%) and flavonols (8.71%) were the most important polyphenolic classes, followed by cinnamic and benzoic acids. CONCLUSION: This study developed a useful tool for R. idaeus extract phytochemical characterization that could be applied also for differentiation and composition control of other herbal preparations. © 2015 Society of Chemical Industry.

Life cycle assessment of edible insects for food protein: a review.

Compared to their vertebrate counterparts in traditional husbandry, insects are extremely efficient at converting organic matter into animal protein and dietary energy. For this reason, insects for food and feed show great potential as an environmentally friendly choice in future food systems. However, to obtain a true assessment of this, more information is needed about the production systems. Currently, only six studies applying the life cycle assessment (LCA) method to insect production systems have been published. The studies are heterogenous and thus difficult to compare. The aim of this paper was to establish a versatile reference framework that would allow for the selection of standardized settings for LCA applications in insect production systems, taking both the peculiarity of each system and the latest developments in food LCA into account. It is recommended that future LCAs of insect production systems take the following into account: (1) clear definition of the insect species and life stages included in the LCA, (2) use of at least two of the following types of functional units: nutritional, mass, or economic-based, (3) collection of empirical data in situ (e.g., on farms/production sites), (4) comparative analysis where production systems produce products that are realistic alternatives to the insect species under investigation, (5) inclusion of additional or previously unconsidered unit processes, such as processing and storage and waste management, and (6) use of a wide range of impact categories, especially climate change, resource consumption, nutrient enrichment potential, acidification potential, and impacts on land and water consumption in order to allow for comparison between studies.

A review of studies applying environmental impact assessment methods on fruit production systems.

Although many aspects of environmental accounting methodologies in food production have already been investigated, the application of environmental indicators in the fruit sector is still rare and no consensus can be found on the preferred method. On the contrary, widely diverging approaches have been taken to several aspects of the analyses, such as data collection, handling of scaling issues, and goal and scope definition. This paper reviews studies assessing the sustainability or environmental impacts of fruit production under different conditions and identifies aspects of fruit production that are of environmental importance. Four environmental assessment methods which may be applied to assess fruit production systems are evaluated, namely Life Cycle Assessment, Ecological Footprint Analysis, Emergy Analysis and Energy Balance. In the 22 peer-reviewed journal articles and two conference articles applying one of these methods in the fruit sector that were included in this review, a total of 26 applications of environmental impact assessment methods are described. These applications differ concerning e.g. overall objective, set of environmental issues considered, definition of system boundaries and calculation algorithms. Due to the relatively high variability in study cases and approaches, it was not possible to identify any one method as being better than the others. However, remarks on methodologies and suggestions for standardisation are given and the environmental burdens of fruit systems are highlighted.