Management of Patients with Suspected or Confirmed Antibiotic Allergy: Executive Summary of Guidelines from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC).

Suspected or confirmed antibiotic allergy is a frequent clinical circumstance that influences antimicrobial prescription and often leads to the avoidable use of less efficacious and/or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs in several countries. These guidelines aim to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. An expert panel (11 members of various scientific societies) formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence, and formulated graded recommendations when possible. The answers to all the questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy was recommended to improve antibiotic selection and, consequently, clinical outcomes. A clinically oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed ß-lactam allergy were formulated, as were recommendations on the implementation and monitoring of the impact of the guidelines. Antimicrobial stewardship programs and allergists should design and implement activities that facilitate the most appropriate use of antibiotics in these patients.

Management of Patients with Suspected or Confirmed Antibiotic Allergy: Executive Summary of Guidelines from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), the Spanish Society of Allergy and Clinical Immunology (SEAIC), the Spanish Society of Hospital Pharmacy (SEFH) and the Spanish Society of Intensive Medicine and Coronary Care Units (SEMICYUC)

Suspected or confirmed antibiotic allergy is a frequent clinical circumstance that influences antimicrobial prescription and often leads to the avoidable use of less efficacious and/or more toxic or costly drugs than first-line antimicrobials. Optimizing antimicrobial therapy in patients with antibiotic allergy labels has become one of the priorities of antimicrobial stewardship programs in several countries. These guidelines aim to make recommendations for the systematic approach to patients with suspected or confirmed antibiotic allergy based on current evidence. An expert panel (11 members of various scientific societies) formulated questions about the management of patients with suspected or confirmed antibiotic allergy. A systematic literature review was performed by a medical librarian. The questions were distributed among panel members who selected the most relevant references, summarized the evidence, and formulated graded recommendations when possible. The answers to all the questions were finally reviewed by all panel members. A systematic approach to patients with suspected or confirmed antibiotic allergy was recommended to improve antibiotic selection and, consequently, clinical outcomes. A clinically oriented, 3-category risk-stratification strategy was recommended for patients with suspected antibiotic allergy. Complementary assessments should consider both clinical risk category and preferred antibiotic agent. Empirical therapy recommendations for the most relevant clinical syndromes in patients with suspected or confirmed ß-lactam allergy were formulated, as were recommendations on the implementation and monitoring of the impact of the guidelines. Antimicrobial stewardship programs and allergists should design and implement activities that facilitate the most appropriate use of antibiotics in these patients (AU)

En la práctica clínica, un antecedente de alergia a los antibióticos, confirmada o sospechada, es frecuente y condiciona la selección de antibióticos, requiriendo con frecuencia el uso de fármacos menos eficaces, más tóxicos o más caros que los antibióticos de primera línea. La optimización del uso de antibióticos en pacientes con este antecedente es una de las prioridades de los programas de optimización de uso de antibióticos (PROA) en varios países. Estas guías pretenden formular recomendaciones para evaluar de una manera sistemática a estos pacientes mediante una aproximación basada en la evidencia. Un panel multidisciplinar constituido por alergólogos, infectólogos, farmacéuticos hospitalarios e intensivistas formularon una serie de preguntas sobre el manejo de estos pacientes; una documentalista realizó la revisión bibliográfica. Las preguntas se distribuyeron entre los miembros del grupo de trabajo, quienes seleccionaron las referencias más relevantes y formularon las correspondientes recomendaciones, que fueron revisadas y aprobadas por todos los miembros del grupo. Es necesaria una aproximación sistemática a los pacientes con antecedentes de alergia a antibióticos para optimizar la selección del tratamiento antibiótico y mejorar los resultados clínicos de estos pacientes cuando precisan antibioterapia. El presente documento recomienda una estrategia de estratificación clínica del riesgo en 3 categorías. La recomendación de realizar evaluaciones complementarias se basa en el riesgo clínico y el antibiótico de primera línea necesario. Además, se formulan recomendaciones de tratamiento antibiótico empírico para los principales síndromes infecciosos en pacientes con alergia confirmada o sospechada. Finalmente, se formulan recomendaciones sobre la implementación y monitorización del impacto de las recomendaciones de la guía (AU)

The sulphur saga in TMC-1: Discovery of HCSCN and HCSCCH.

We report the detection, for the first time in space, of cyano thioformaldehyde (HCSCN) and propynethial (HCSCCH) towards the starless core TMC-1. Cyano thioformaldehyde presents a series of prominent a- and b-type lines, which are the strongest previously unassigned features in our Q-band line survey of TMC-1. Remarkably, HCSCN is four times more abundant than cyano formaldehyde (HCOCN). On the other hand, HCSCCH is five times less abundant than propynal (HCOCCH). Surprisingly, we find an abundance ratio HCSCCH/HCSCN of ∼ 0.25, in contrast with most other ethynyl-cyanide pairs of molecules for which the CCH-bearing species is more abundant than the CN-bearing one. We discuss the formation of these molecules in terms of neutral-neutral reactions of S atoms with CH2CCH and CH2CN radicals as well as of CCH and CN radicals with H2CS. The calculated abundances for the sulphur-bearing species are, however, significantly below the observed values, which points to an underestimation of the abundance of atomic sulphur in the model or to missing formation reactions, such as ion-neutral reactions.

Cumulene carbenes in TMC-1: Astronomical discovery of l-H2C5 ☠.

We report the first detection in space of the cumulene carbon chain l-H2C5. A total of eleven rotational transitions, with Jup = 7-10 and Ka = 0 and 1, were detected in TMC-1 in the 31.0-50.4 GHz range using the Yebes 40m radio telescope. We derive a column density of (1.8±0.5)×1010 cm-2. In addition, we report observations of other cumulene carbenes detected previously in TMC-1, to compare their abundances with the newly detected cumulene carbene chain. We find that l-H2C5 is ~4.0 times less abundant than the larger cumulene carbene l-H2C6, while it is ~300 and ~500 times less abundant than the shorter chains l-H2C3 and l-H2C4. We discuss the most likely gas-phase chemical routes to these cumulenes in TMC-1 and stress that chemical kinetics studies able to distinguish between different isomers are needed to shed light on the chemistry of C n H2 isomers with n > 3.

Pure hydrocarbon cycles in TMC-1: Discovery of ethynyl cyclopropenylidene, cyclopentadiene and indene.

We report the detection for the first time in space of three new pure hydrocarbon cycles in TMC-1: c-C3HCCH (ethynyl cyclopropenylidene), c-C5H6 (cyclopentadiene) and c-C9H8 (indene). We derive a column density of 3.1 × 1011 cm-2 for the former cycle and similar values, in the range (1-2) × 1013 cm-2, for the two latter molecules. This means that cyclopentadiene and indene, in spite of their large size, are exceptionally abundant, only a factor of five less abundant than the ubiquitous cyclic hydrocarbon c-C3H2. The high abundance found for these two hydrocarbon cycles, together with the high abundance previously found for the propargyl radical (CH2CCH) and other hydrocarbons like vinyl and allenyl acetylene (Agúndez et al. 2021; Cernicharo et al. 2021a,b), start to allow us to quantify the abundant content of hydrocarbon rings in cold dark clouds and to identify the intermediate species that are probably behind the in situ bottom-up synthesis of aromatic cycles in these environments. While c-C3HCCH is most likely formed through the reaction between the radical CCH and c-C3H2, the high observed abundances of cyclopentadiene and indene are difficult to explain through currently proposed chemical mechanisms. Further studies are needed to identify how are five- and six-membered rings formed under the cold conditions of clouds like TMC-1.

Discovery of allenyl acetylene, H2CCCHCCH, in TMC-1. A study of the isomers of C5H4.

We present the discovery in TMC-1 of allenyl acetylene, H2CCCHCCH, through the observation of nineteen lines with a signal-to-noise ratio ~4-15. For this species, we derived a rotational temperature of 7±1K and a column density of 1.2±0.2×1013 cm-2. The other well known isomer of this molecule, methyl diacetylene (CH3C4H), has also been observed and we derived a similar rotational temperature, Tr=7.0±0.3 K, and a column density for its two states (A and E) of 6.5±0.3×1012 cm-2. Hence, allenyl acetylene and methyl diacetylene have a similar abundance. Remarkably, their abundances are close to that of vinyl acetylene (CH2CHCCH). We also searched for the other isomer of C5H4, HCCCH2CCH (1.4-Pentadiyne), but only a3σ upper limit of 2.5×1012 cm-2 to the column density can be established. These results have been compared to state-of-the-art chemical models for TMC-1, indicating the important role of these hydrocarbons in its chemistry. The rotational parameters of allenyl acetylene have been improved by fitting the existing laboratory data together with the frequencies of the transitions observed in TMC-1.

TMC-1, the starless core sulfur factory: Discovery of NCS, HCCS, H2CCS, H2CCCS, and C4S and detection of C5S.

We report the detection of the sulfur-bearing species NCS, HCCS, H2CCS, H2CCCS, and C4S for the first time in space. These molecules were found towards TMC-1 through the observation of several lines for each species. We also report the detection of C5S for the first time in a cold cloud through the observation of five lines in the 31-50 GHz range. The derived column densities are N(NCS) = (7.8±0.6)×1011 cm-2, N(HCCS) = (6.8±0.6)×1011 cm-2, N(H2CCS) = (7.8±0.8)×1011 cm-2, N(H2CCCS) = (3.7±0.4)×1011 cm-2, N(C4S) = (3.8±0.4)×1010 cm-2, and N(C5S) = (5.0±1.0)×1010 cm-2. The observed abundance ratio between C3S and C4S is 340, that is to say a factor of approximately one hundred larger than the corresponding value for CCS and C3S. The observational results are compared with a state-of-the-art chemical model, which is only partially successful in reproducing the observed abundances. These detections underline the need to improve chemical networks dealing with S-bearing species.

Discovery of CH2CHCCH and detection of HCCN, HC4N, CH3CH2CN, and, tentatively, CH3CH2CCH in TMC-1.

We present the discovery in TMC-1 of vinyl acetylene, CH2CHCCH, and the detection, for the first time in a cold dark cloud, of HCCN, HC4N, and CH3CH2CN. A tentative detection of CH3CH2CCH is also reported. The column density of vinyl acetylene is (1.2±0.2)×1013 cm-2, which makes it one of the most abundant closed-shell hydrocarbons detected in TMC-1. Its abundance is only three times lower than that of propylene, CH3CHCH2. The column densities derived for HCCN and HC4N are (4.4±0.4)×1011 cm-2 and (3.7±0.4)×1011 cm-2, respectively. Hence, the HCCN/HC4N abundance ratio is 1.2±0.3. For ethyl cyanide we derive a column density of (1.1 ±0.3)×1011 cm-2. These results are compared with a state-of-the-art chemical model of TMC-1, which is able to account for the observed abundances of these molecules through gas-phase chemical routes.

Yebes 40 m radio telescope and the broad band NANOCOSMOS receivers at 7 mm and 3 mm for line surveys.

CONTEXT: Yebes 40m radio telescope is the main and largest observing instrument at Yebes Observatory and it is devoted to Very Long Baseline Interferometry (VLBI) and single dish observations since 2010. It has been covering frequency bands between 2 GHz and 90 GHz in discontinuous and narrow windows in most of the cases, to match the current needs of the European VLBI Network (EVN) and the Global Millimeter VLBI Array (GMVA). AIMS: Nanocosmos project, a European Union funded synergy grant, opened the possibility to increase the instantaneous frequency coverage to observe many molecular transitions with single tunnings in single dish mode. This reduces the observing time and maximises the output from the telescope. METHODS: We present the technical specifications of the recently installed 31.5 - 50GHz (Q band) and 72 - 90.5 GHz (W band) receivers along with the main characteristics of the telescope at these frequency ranges. We have observed IRC+10216, CRL 2688 and CRL 618, which harbour a rich molecular chemistry, to demonstrate the capabilities of the new instrumentation for spectral observations in single dish mode. RESULTS: The results show the high sensitivity of the telescope in the Q band. The spectrum of IRC+10126 offers a signal to noise ratio never seen before for this source in this band. On the other hand, the spectrum normalised by the continuum flux towards CRL 618 in the W band demonstrates that the 40 m radio telescope produces comparable results to those from the IRAM 30 m radio telescope, although with a smaller sensitivity. The new receivers fulfil one of the main goals of Nanocosmos and open the possibility to study the spectrum of different astrophysical media with unprecedented sensitivity.

Discovery of HC4NC in TMC-1: A study of the isomers of HC3N, HC5N, and HC7N.

We present a study of the isocyano isomers of the cyanopolyynes HC3N, HC5N, and HC7N in TMC-1 and IRC+10216 carried out with the Yebes 40m radio telescope. This study has enabled us to report the detection, for the first time in space, of HCCCCNC in TMC-1 and to give upper limits for HC6NC in the same source. In addition, the deuterated isotopologues of HCCNC and HNCCC were detected, along with all 13C substitutions of HCCNC, also for the first time in space. The abundance ratios of HC3N and HC5N, with their isomers, are very different in TMC-1 and IRC+10216, namely, N(HC5N)/N(HC4NC) is ~300 and ≥2100, respectively. We discuss the chemistry of the metastable isomers of cyanopolyynes in terms of the most likely formation pathways and by comparing observational abundance ratios between different sources.

Detection of vibrationally excited HC7N and HC9N in IRC+10216 ⋆.

Observations of IRC +10216 with the Yebes 40m telescope between 31 and 50 GHz have revealed more than 150 unidentified lines. Some of them can be grouped into a new series of 26 doublets, harmonically related with integer quantum numbers ranging from J up=54 to 80. The separation of the doublets increases systematically with J, i.e., as expected for a linear species in one of its bending modes. The rotational parameters resulting from the fit to these data are B = 290.8844 ± 0.0004 MHz, D = 0.88 ± 0.04 Hz, q = 0.1463 ± 0.0001 MHz. The rotational constant is very close to that of the ground state of HC9N. Ab initio calculations show an excellent agreement between these parameters and those predicted for the lowest energy vibrationally excited state, ν 19=1, of HC9N. This is the first detection, and complete characterization in space, of vibrationally excited HC9N. An energy of 41.5 cm-1 is estimated for the ν 19 state. In addition, 17 doublets of HC7N in the ν 15=1 state, for which laboratory spectroscopy is available, have been detected for the first time in IRC+10216. Several doublets of HC5N in its ν 11=1 state have been also observed. The column density ratio between the ground and the lowest excited vibrational states are ≈127, 9.5, and 1.5 for HC5N, HC7N, and HC9N, respectively. We find that these lowest-lying vibrational states are most probably populated via infrared pumping to vibrationally excited states lying at ≈600 cm-1. The lowest vibrationally excited states thus need to be taken into account to precisely determine absolute abundances and abundanceratios for long carbon chains. The abundance ratios N(HC5N)/N(HC7N) and N(HC7N)/N(HC9N) are 2.4 and 7.7 respectively.

Interstellar nitrile anions: Detection of C3N- and C5N- in TMC-1.

We report on the first detection of C3N- and C5N- towards the cold dark core TMC-1 in the Taurus region, using the Yebes 40 m telescope. The observed C3N/C3N- and C5N/C5N- abundance ratios are ~140 and ~2, respectively; that is similar to those found in the circumstellar envelope of the carbon-rich star IRC +10216. Although the formation mechanisms for the neutrals are different in interstellar (ion-neutral reactions) and circumstellar clouds (photodissociation and radical-neutral reactions), the similarity of the C3N/C3N- and C5N/C5N- abundance ratios strongly suggests a common chemical path for the formation of these anions in interstellar and circumstellar clouds. We discuss the role of radiative electronic attachment, reactions between N atoms and carbon chain anions C n -, and that of H- reactions with HC3N and HC5N as possible routes to form C n N-. The detection of C5N- in TMC-1 gives strong support for assigning to this anion the lines found in IRC +10216, as it excludes the possibility of a metal-bearing species, or a vibrationally excited state. New sets of rotational parameters have been derived from the observed frequencies in TMC-1 and IRC +10216 for C5N- and the neutral radical C5N.

Discovery of two new magnesium-bearing species in IRC+10216: MgC3N and MgC4H.

We report on the detection of two series of harmonically related doublets in IRC +10216. From the observed frequencies, the rotational constant of the first series is B = 1380.888 MHz and that of the second series is B = 1381.512 MHz. The two series correspond to two species with a 2Σ electronic ground state. After considering all possible candidates, and based on quantum chemical calculations, the first series is assigned to MgC3N and the second to MgC4H. For the latter species, optical spectroscopy measurements support its identification. Unlike diatomic metal-containing molecules, the line profiles of the two new molecules indicate that they are formed in the outer layers of the envelope, as occurs for MgNC and other polyatomic metal-cyanides. We also confirm the detection of MgCCH that was previously reported from the observation of two doublets. The relative abundance of MgC3N with respect to MgNC is close to one while that of MgC4H relative to MgCCH is about ten. The synthesis of these magnesium cyanides and acetylides in IRC +10216 can be explained in terms of a two-step process initiated by the radiative association of Mg+ with large cyanopolyynes and polyynes followed by the dissociative recombination of the ionic complexes.

Discovery of the first Ca-bearing molecule in space: CaNC.

We report on the detection of calcium isocyanide, CaNC, in the carbon-rich evolved star IRC+10216. We derived a column density for this species of (2±0.5)×1011 cm-2. Based on the observed line profiles and the modelling of its emission through the envelope, the molecule has to be produced in the intermediate and outer layers of the circumstellar envelope where other metal-isocyanides have previously been found in this source. The abundance ratio of CaNC relative to MgNC and FeCN is ≃1/60 and ≃1, respectively. We searched for the species CaF, CaCl, CaC, CaCCH, and CaCH3 for which accurate frequency predictions are available. Only upper limits have been obtained for these molecules.

Broad band high resolution rotational spectroscopy for Laboratory Astrophysics.

We present a new experimental setup devoted to the study of gas phase molecules and processes using broad band high spectral resolution rotational spectroscopy. A reactor chamber has been equipped with radio receivers similar to those used by radio astronomers to search for molecular emission in space. The whole Q (31.5-50 GHz) and W bands (72-116.5 GHz) are available for rotational spectroscopy observations. The receivers are equipped with 16×2.5 GHz Fast Fourier Transform spectrometers with a spectral resolution of 38.14 kHz allowing the simultaneous observation of the complete Q band and one third of the W band. The whole W band can be observed in three settings in which the Q band is always observed. Species such as CH3CN, OCS, and SO2 are detected, together with many of their isotopologues and vibrationally excited states, in very short observing times. The system permits automatic overnight observations and integration times as long as 2.4×105 seconds have been reached. The chamber is equipped with a radiofrequency source to produce cold plasmas and with four ultraviolet lamps to study photochemical processes. Plasmas of CH4, N2, CH3CN, NH3, O2, and H2, among other species, have been generated and the molecular products easily identified by their rotational spectrum, and mass spectrometry and optical spectroscopy. Finally, the rotational spectrum of the lowest energy conformer of CH3CH2NHCHO (N-Ethylformamide), a molecule previously characterized in microwave rotational spectroscopy, has been measured up to 116.5 GHz allowing the accurate determination of its rotational and distortion constants and its search in space.

Intestinal persistence of a plasmid harbouring the OXA-48 carbapenemase gene after hospital discharge.

To study intestinal colonization by OXA-48-producing Klebsiella pneumoniae (KpO48) after hospital discharge, stool samples from 22 previously colonized subjects were collected. Time from discharge was 33-611 days, without readmissions. Eight subjects (36%) were identified as blaOXA-48 gene carriers. In all of them the hospital-acquired strain of KpO48 had been lost, and the gene was harboured by other strains of K. pneumoniae, Klebsiella oxytoca and/or Escherichia coli. Our findings show intestinal persistence for several months of a plasmid harbouring the OXA-48 carbapenemase gene in a significant proportion of individuals in the absence of antibiotic treatment.

IRC +10216 as a spectroscopic laboratory: improved rotational constants for SiC2, its isotopologues, and Si2C.

This work presents a detailed analysis of the laboratory and astrophysical spectral data available for 28SiC2, 29SiC2,30SiC2, Si13CC, and Si2C. New data on the rotational lines of these species between 70 and 350 GHz have been obtained with high spectral resolution (195 kHz) with the IRAM 30m telescope in the direction of the circumstellar envelope IRC +10216. Frequency measurements can reach an accuracy of 50 kHz for features observed with a good signal to noise ratio. From the observed astrophysical lines and the available laboratory data new rotational and centrifugal distortion constants have been derived for all the isotopologues of SiC2, allowing to predict their spectrum with high accuracy in the millimeter and submillimeter domains. Improved rotational and centrifugal distortion constants have also been obtained for disilicon carbide, Si2C. This work shows that observations of IRC +10216 taken with the IRAM 30m telescope, with a spectral resolution of 195 kHz, can be used for any molecular species detected in this source to derive, or improve, its rotational constants. Hence, IRC +10216 in addition to be one the richest sources in molecular species in the sky, can also be used as a state-of-the-art spectroscopy laboratory in the millimeter and submillimeter domains.

Time-dependent molecular emission in IRC+10216.

CONTEXT: The variability in IRC+10216, the envelope of the asymptotic giant branch (AGB) star CW Leo, has attracted increasing attention in recent years. Studying the details of this variability in the molecular emission required a systematic observation program. AIMS: We aim to reveal and characterize the periodical variability of the rotational lines from several molecules and radicals in IRC+10216, and to compare it with previously reported IR variability. METHODS: We carried out systematic monitoring within the ~80 to 116 GHz frequency range with the IRAM 30m telescope. RESULTS: We report on the periodical variability in IRC+10216 of several rotational lines from the following molecules and radicals: HC3N, HC5N, CCH, C4H, C5H, and CN. The analysis of the variable molecular lines provides periods that are consistent with previously reported IR variability, and interesting phase lags are revealed that point toward radiative transfer and pumping, rather than chemical effects. CONCLUSIONS: This study indicates that observations of several lines of a given molecule have to be performed simultaneously or at least at the same phase in order to avoid erroneous interpretation of the data. In particular, merging ALMA data from different epochs may prove to be difficult, as shown by the example of the variability we studied here. Moreover, radiative transfer codes have to incorporate the effect of population variability in the rotational levels in CW Leo.

The Maser Emitting Structure and Time Variability of the SIS Lines J = 14 - 13 and 15 - 14 in IRC+10216.

We present new high angular resolution interferometer observations of the υ = 0 J = 14 - 13 and 15 - 14 SiS lines towards IRC+10216, carried out with CARMA and ALMA. The maps, with angular resolutions of ≃0⋅″25and0⋅″55, reveal (1) an extended, roughly uniform, and weak emission with a size of ≃0⋅″5, (2) a component elongated approximately along the East-West direction peaking at ≃0⋅″13and0⋅″17 at both sides of the central star, and (3) two blue- and red-shifted compact components peaking around 0⋅″07 to the NW of the star. We have modeled the emission with a 3D radiation transfer code finding that the observations cannot be explained only by thermal emission. Several maser clumps and one arc-shaped maser feature arranged from 5 to 20R⋆ from the central star, in addition to a thin shell-like maser structure at ≃ 13R⋆ are required to explain the observations. This maser emitting set of structures accounts for 75% of the total emission while the other 25% is produced by thermally excited molecules. About 60% of the maser emission comes from the extended emission and the rest from the set of clumps and the arc. The analysis of a time monitoring of these and other SiS and 29SiS lines carried out with the IRAM 30 m telescope from 2015 to present suggests that the intensity of some spectral components of the maser emission strongly depends on the stellar pulsation while other components show a mild variability. This monitoring evidences a significant phase lag of ≃ 0.2 between the maser and NIR light-curves.