The Impact of Culturing the Organ Preservation Fluid on Solid Organ Transplantation: A Prospective Multicenter Cohort Study.

BACKGROUND: We analyzed the prevalence, etiology, and risk factors of culture-positive preservation fluid and their impact on the management of solid organ transplant recipients. METHODS: From July 2015 to March 2017, 622 episodes of adult solid organ transplants at 7 university hospitals in Spain were prospectively included in the study. RESULTS: The prevalence of culture-positive preservation fluid was 62.5% (389/622). Nevertheless, in only 25.2% (98/389) of the cases were the isolates considered "high risk" for pathogenicity. After applying a multivariate regression analysis, advanced donor age was the main associated factor for having culture-positive preservation fluid for high-risk microorganisms. Preemptive antibiotic therapy was given to 19.8% (77/389) of the cases. The incidence rate of preservation fluid-related infection was 1.3% (5 recipients); none of these patients had received preemptive therapy. Solid organ transplant (SOT) recipients with high-risk culture-positive preservation fluid receiving preemptive antibiotic therapy presented both a lower cumulative incidence of infection and a lower rate of acute rejection and graft loss compared with those who did not have high-risk culture-positive preservation fluid. After adjusting for age, sex, type of transplant, and prior graft rejection, preemptive antibiotic therapy remained a significant protective factor for 90-day infection. CONCLUSIONS: The routine culture of preservation fluid may be considered a tool that provides information about the contamination of the transplanted organ. Preemptive therapy for SOT recipients with high-risk culture-positive preservation fluid may be useful to avoid preservation fluid-related infections and improve the outcomes of infection, graft loss, and graft rejection in transplant patients.

Biotransformations catalyzed by multimeric enzymes: stabilization of tetrameric ampicillin acylase permits the optimization of ampicillin synthesis under dissociation conditions.

The importance of the stabilization of the quaternary structure of multimeric enzymes has been illustrated using a model reaction with great industrial relevance: the enzymatic synthesis of ampicillin from 6-amino penicillanic acid (6APA) and phenylglycine methyl ester (PGM) catalyzed by the tetrameric enzyme alpha-amino acid ester hydrolase from Acetobacter turbidans. The stabilization of the multimeric structure of the enzyme was achieved by multi-subunit immobilization of the enzyme followed by its further solid-phase chemical intersubunit cross-linking with polyfunctional macromolecules (dextran-aldehyde). This stabilized derivative has permitted the study of the reaction under conditions where nonstabilized enzyme molecules tended to dissociate (e.g., absence of phosphate ions). Synthetic yields improved from around 65%, under conditions where the nonstabilized derivative was stable, to around 85% in conditions where only the stabilized derivative could be utilized (40% methanol and absence of phosphate ions). When using high concentrations of PGM, a significant worsening of the reaction performance was detected with a significant decrease in the yields (below 55%, using 50 mM 6APA and PGM). This problem has been sorted out by using a fed-batch reaction system. By addition of PGM continuously to the reaction mixture (to maintain the concentration between 0.5 and 3 mM), 95% of 6-APA could be transformed to antibiotic (47.5 mM) by only using a 20% excess of acylating ester.

Ifosfamide and irinotecan in solid tumors: a phase I dose-finding trial.

The combination of ifosfamide and irinotecan was tested in a dose-finding study. The preliminary results of the combination in this phase I study did not show any major toxicity that could help to define the dose-limiting toxicity. The escalation continues even after nine levels; the study is therefore ongoing. The main toxicity is gastrointestinal, with mild nausea, vomiting, and diarrhea. There was some other irrelevant toxicity, which was easily manageable with the usual supportive therapy. When responses were evaluated, stable disease was found in some cases, suggesting some activity for the combination.

[Pancreatic vipoma with bizarre characteristics]. / Vipoma pancreático con características atípicas.

Pancreatic vipoma is an unusual endocrine tumour, with only 5 cases reported in our country. We report a new case in a 41 year-old-male; the diagnosis was made on the basis of increased plasma levels of vasoactive intestinal peptide (VIP) and positive immunohistochemistry for VIP in the tumour. The peculiarities of this case were a strong steatorrhea which was managed with oral pancreatic enzymes and the findings of peritoneal carcinomatosis at the time of diagnosis.

[Activity of trovafloxacin and ten other antimicrobials against gram negative anaerobic bacilli]. / Actividad de trovafloxacino y otros diez antimicrobianos frente a bacilos gramnegativos anaerobios.

As an increase in anaerobes resistant to a great variety of antimicrobials have been seen in the last few years, a search for new agents with activity against these microorganisms is needed. One of these agents is trovafloxacin. In our study, all strains were susceptible to imipenem, metronidazole, chloramphenicol and piperacillin/tazobactam. A total of 97% of the strains were inhibited with 2 mg/ml of trovafloxacin. The microorganisms Bacteroides fragilis and B. uniformis showed the least susceptibility against the antimicrobials studied, with a MIC90 for trovafloxacin of 1 and 2 mg/ml, respectively. Fusobacterium spp. were the most susceptible, with an MIC90 for trovafloxacin of 0.5 mg/ml. Trovafloxacin showed good activity against Gram-negative anaerobe rods, and could therefore be considered as an alternative in the treatment of the infections produced by these microorganisms.

Susceptibilities of 55 strains of Neisseria meningitidis isolated in Spain in 1993 and 1994.

The in vitro susceptibility of 55 strains of Neisseria meningitidis isolated in 1993 and 1994 at the Valme and Macarena Hospitals, Sevilla, Spain to penicillin, ampicillin, cefotaxime, cefpodoxime, imipenem, rifampin, ciprofloxacin, chloramphenicol, tetracycline, erythromycin and trimethoprim-sulfamethoxazole were determined by a microdilution method in Mueller-Hinton broth. Among our N. meningitidis isolates, 36.4% were found to be moderately resistant to penicillin, 43.6% were resistant to trimethoprim/sulfamethoxazole. All the strains were susceptible to tetracycline, ciprofloxacin, cefotaxime and rifampin.

[Nosocomial urinary tract infections in patients with prolonged bladder catheterization: un unsolved problem]. / Infecciones urinarias nosocomiales en pacientes con sondaje vesical prolongado: un problema sin resolver.

Urinary tract infection (UTI) is the primary cause of hospitalary infection. We have prospectively studied during a 8-month period, 94 episodes of UTI in 61 patients with a mean age of 77 years and with a high percentage of vesical sounding (70.5%). The most frequent cause of sounding was urinary incontinence (74%) and in just 15% of all cases, there was a strict urological indication. The association fever/sounding was statistically significant (p < 0.05) and, when analyzing the prognosis factors, we observed that patients who had a significantly higher risk were those with vesical sounding (p < 0.05), fever equal to or higher than 38 degrees C and/or Pseudomonas aeruginosa isolated in their uroculture (p < 0.01). Among the microorganisms isolated, P. aeruginosa ranked in first place, followed by E. Coli. The most sensitive antibiotics in these patients were the aminoglycosides (tobramycin or gentamycin), cephtacidime and aztreonan. Finally, the percentage of coincidence between the microorganisms isolated in the uroculture and in the infections of other patients sharing the same room is significantly higher (p < 0.01) in patients with vesical sounding than in patients without it, suggesting a transmission role of the health staff.

Cloning and expression of the major allergen from yellow mustard seeds, Sin a I.

The cloning and bacterial expression of the major allergen from yellow mustard (Sin a I) is reported. Cloning has been carried out by means of the polymerase chain reaction using non-degenerate oligo primers encoding the N- and C-terminal regions of the mature protein. Two nucleotide sequences (SA2S1 and SA2S2) have been found and analysed. The observed polymorphism suggests the existence of multiple isoforms for Sin a I allergen. SA2S2 has been expressed as a fusion protein, linked to the choline-binding domain of the Streptococcus pneumoniae murein hydrolase. The resulted fusion protein is recognized by Sin-a-I-specific antibodies.

[Antimicrobial sensitivity of 402 strains of Neisseria gonorrhoeae isolated in 7 Spanish cities]. / Sensibilidad a antimicrobianos de 402 cepas de Neisseria gonorrhoeae aisladas en 7 ciudades de España.

To study N. gonorrhoeae resistance in Spain. We evaluate 402 strains consecutively isolated in 7 Spanish cities (Barcelona, Bilbao, Madrid, Murcia, Seville, Valencia and Valladolid). The MIC to 9 antimicrobial agents was determined by agar-dilution (DST) method. We found a high incidence (15.7%) of penicillinase producer strains (NGPP). Most (53.3%) of all non-NGPP strains showed reduced sensitivity to penicillin and 1.5% of the strains had chromosomally mediated resistance. All NGPP strains and 90% of non-NGPP strains showed reduced sensitivity to tetracycline (MIC greater than 0.23 mg/l). We did not found any strain with high-level tetracycline resistance. MIC90 for the other drugs tested were: erythromycin, 0.125 mg/l; spectinomycin, 16 mg/l; cefoxitin, 2 mg/l; cefuroxime 0.06 mg/l; ceftriaxone 0.0037 mg/l; ofloxacin 0.06 mg/l and ciprofloxacin, 0.0018 mg/l. NGPP are very prevalent in Spain. Most of these strains had chromosomally mediated resistance to penicillin and tetracycline. We did not found resistance to other antimicrobial agents.

[Incidence of diarrhea among groups of children in the city of Seville]. / Incidencia de diarreas en una cohorte de niños en la ciudad de Sevilla.

We studied prospectively the cases of diarrhoea that were produced during one year of follow-up in three groups of children (31 newborn, 62 of 1 year and 51 of 2 years) selected randomly from the Civil Register of Sevilla. The incidence of diarrhoea was 47 episodes for every 100 children per year, with a peak of higher incidence detected in July and August. Diarrhoea was more frequent in children of low socioeconomic level. The most common producers of diarrhoea were rotavirus (30%) and enteropathogenic E. coli (12%). The most frequent accompanying symptoms of diarrhoea were anorexia (68%), fever (35%), abdominal pain (32%) and vomiting (30%).

[Detection of anti-Azotobacter antibodies in sera from tumor patients]. / Detección de anticuerpos anti-azotobacter en sueros humanos procedentes de enfermos tumorales.

Employing the agar-gel double immunodiffusion technique, the authors describe the presence of antibodies to a protein fraction existing in the supernatant of Azotobacter chroococcum cultures in a high percentage of blood sera from cancer patients. The small number of false positive results makes them think of the convenience of increasing the sensitivity of the procedure to valorate its usefulness for the early diagnosis of malignant tumors.