Bloodstream infections: trends and evolution of incidence and etiology in a 12-year period (2010-2021).

INTRODUCTION: The epidemiological evolution of bloodstream infections (BSIs) in the last decade is not clearly defined. Our aim was to analyze the changes in the workload in our institution and to describe the evolution of the incidence and etiology of BSIs in a 12-year period, including the COVID-19 pandemic. METHODS: All blood cultures received in the laboratory of a tertiary general hospital between 2010 and 2021 were analyzed. Bloodstream infection episodes refer to each episode of bacteremia or fungemia in each patient. Incidence rates per 1000 admissions and per 100,000 population were calculated. RESULTS: No significant changes in the incidence of BSI episodes/1000 admissions were observed (mean, 31.1), while estimated population-based incidences showed declining trends (mean, 182.8/100,000 inhabitants). There was a slight increase in BSI episodes per 1000 admissions caused by Gram-negatives (mean, 16.6/1000 admissions) and E. coli was the most frequent pathogen (mean, 8.5/1000 admissions). There was no significant rise in episodes caused by ESBL- and carbapenemase-producing E. coli or K. pneumoniae, with a decline in those caused by methicillin-resistant S. aureus. A spike in BSI episodes, fungal BSIs and catheter-related infections was detected in 2020, during the COVID-19 outbreak. CONCLUSIONS: No clear increase in the incidence of BSI episodes was detected in our center over this period. Gram-negatives are the most frequent etiology, with no clear rise in antimicrobial resistance phenotypes. The COVID-19 pandemic accounted for a small increase in BSI episodes in 2020, probably related to the increase of catheter-related infections.

Characterization of an outbreak caused by Elizabethkingia miricola using Fourier-transform infrared (FTIR) spectroscopy.

Fourier-transform infrared (FTIR) spectroscopy has the potential to be used for bacterial typing and outbreak characterization. We evaluated FTIR for the characterization of an outbreak caused by Elizabethkingia miricola. During the 2020-2021 period, 26 isolates (23 clinical and 3 environmental) were collected and analyzed by FTIR (IR Biotyper) and core-genome MLST (cgMLST), in addition to antimicrobial susceptibility testing. FTIR spectroscopy and cgMLST showed that 22 of the isolates were related to the outbreak, including the environmental samples, with only one discordance between both methods. Then, FTIR is useful for E. miricola typing and can be easily implemented in the laboratory.

Gradient diffusion strips for detecting azole resistance in Aspergillus fumigatus sensu lato.

BACKGROUND: Studies comparing gradient diffusion strips (GDSs) and the EUCAST E.Def 9.4 microdilution method are scarce, thwarted by a low number of isolates, and restricted to selected antifungal agents. OBJECTIVES: We evaluated the performance of GDSs to detect azole resistance in A. fumigatus, including cryptic species. PATIENTS/METHODS: A. fumigatus sensu stricto (n = 89) and cryptic species (n = 52) were classified as susceptible or resistant to itraconazole, voriconazole, posaconazole and isavuconazole (EUCAST E.Def 9.4; clinical breakpoints v10). A. fumigatus sensu stricto azole-resistant isolates had the following cyp51A gene mutations: TR34 -L98H (n = 24), G54R (n = 5), TR46 -Y121F-T289A (n = 1), F46Y-M172V-N248T-D255E-E427K (n = 1), F165L (n = 1) and cyp51A gene wild type (n = 3). GDSs (ETEST®, bioMèrieux, Marcy-l'Etoile, France and Liofilchem®, Roseto degli Abruzzi, Italy) MICs were obtained by following the manufacturer's guidelines. RESULTS: For A. fumigatus sensu stricto, itraconazole MICs >1.5 mg/L, voriconazole >0.38 mg/L, posaconazole >0.75 mg/L, and isavuconazole >0.5 mg/L correctly separated resistant from susceptible isolates with two exceptions. Considering the aforementioned cut-off MICs, sensitivity/specificity values of GDSs to detect azole resistance were: itraconazole (97%/100%), voriconazole (97%/100%), posaconazole (97%/100%) and isavuconazole (93.3%/100%). For cryptic species isolates, voriconazole MICs >1 mg/L and isavuconazole >0.75 mg/L separated resistant isolates from susceptible isolates with 15 and 27 exceptions, respectively. Considering the aforementioned cut-off MICs, sensitivity/specificity values were as follows: voriconazole (68.1%/100%) and isavuconazole (25%/100%). For itraconazole and posaconazole, it was not possible to establish cut-off values. CONCLUSIONS: We set tentative cut-off MIC values to correctly spot resistant Aspergillus fumigatus sensu stricto isolates using GDSs. The performance against cryptic species was poor.

Screening of azole resistance in Aspergillus fumigatus using the EUCAST E.Def 10.2 azole-containing agar method: a single study suggests that filtration of conidial suspensions prior to inoculum preparation may not be needed.

BACKGROUND: Azole resistance screening in A. fumigatus isolates can be routinely carried out by using azole-containing plates (E.Def 10.2 method), that requires filtering conidial suspensions prior inoculum adjustment. OBJECTIVES: We evaluated whether skipping the filtration step of conidial suspensions negatively influences the performance of the E.Def 10.2. Patients/Methods A. fumigatus sensu stricto isolates (n=92), classified as azole-susceptible or azole-resistant according to the EUCAST microdilution E.Def 9.4 method, were studied. Azole-resistant isolates had either wild type cyp51A gene sequence (n = 3) or the TR34 -L98H (n = 26), G54R (n = 5), TR46 -Y121F-T289A (n = 1), F46Y-M172V-N248T-D255E-E427K (n = 1), F165L (n=1), or G448S (n=1) cyp51A gene substitutions. In-house azole-containing agar plates were prepared according to the EUCAST E.Def 10.2 procedure. Conidial suspensions were obtained by adding distilled water (Tween 20 0.1%). Subsequently, the suspensions were either filtered or left unfiltered prior to inoculum adjustment to 0.5 McFarland. Using microdilution as the gold standard, agreement, sensitivity, and specificity of the agar plates inoculated with two inoculums were assessed. RESULTS: Agreements for the agar screening method with either unfiltered or filtered conidial suspensions were high for itraconazole (100%), voriconazole (100%), and posaconazole (97.8%). Sensitivity (100%) and specificity (98.2%) of the procedure to rule in or out resistance when unfiltered suspensions were used were also high. Isolates harbouring the TR34 -L98H, G54R, and TR46 -Y121F-T289A substitutions were detected with the modified method. CONCLUSIONS: Unfiltered conidial suspensions does not negatively influence the performance of the E.Def 10.2 method when screening for A. fumigatus sensu stricto.

Estado da Arte sobre Violência e Escola: Análises e Problematizações Ético-Políticas / State-of-the-Art Research on Violence and School: Ethical-Political Analysis and Problematizations / Estado del Arte sobre Violencia y Escuela: Análisis y Problematizaciones Ético-Políticas

Esta revisão de literatura mapeia e discute a produção acadêmica sobre violência e escola em artigos publicados entre 2003 e 2017 por autores(as) da área da psicologia. Adentraram o estado da arte 101 artigos, os quais foram analisados desde uma perspectiva crítica e interseccional, buscando compreender quais concepções sobre violência e escola orientam os estudos. A maioria decorre de pesquisas de campo, sendo a escola pública e os estudantes dos anos finais do ensino fundamental e médio, respectivamente, o contexto e os sujeitos mais investigados. Há uma escassez de pesquisas sobre racismo, sexismo, homofobia e capacitismo, violências presentes nas relações escolares e estruturais em nossa sociedade. Essa lacuna, atrelada a invisibilização dos marcadores sociais que constituem os sujeitos pesquisados, denota uma aderência à concepção de um suposto sujeito universal na psicologia e sinaliza a necessária problematização sobre as posições epistemológicas que permeiam esse campo de estudo. Consideramos fundamental que pesquisadores(as) da área da psicologia trabalhem com métodos de pesquisa alternativos e com a analítica interseccional, visando à escuta das narrativas de docentes, estudantes, famílias e comunidade sobre suas experiências de opressão e violências, e com a participação destes na elaboração de estratégias educativas e políticas de enfrentamento nas escolas.

This literature review maps and discusses academic production on violence and school in articles published between 2003 and 2017 by authors in the psychology field. 101 articles entered this state-of-the-art research, which were analyzed from a critical and intersectional perspective, seeking to understand which conceptions about violence and school guide the studies. Most of them result from field research, being the public school and the students in the final years of elementary and high school, respectively, the most investigated context and subjects. There is a shortage of research on racism, sexism, homophobia and ableism, violence present in school relations and in our society. This gap, linked to the invisibility of social markers that the researched subject has, denotes an adherence to the conception of a supposedly universal subject in psychology and signals the necessary problematization of the epistemological positions that permeate this field of study. We consider it essential that researchers in the field of psychology work with alternative research methods and intersectional analytics, aiming at listening to the narratives of teachers, students, families and the community about their experiences of oppression and violence, and with their participation in the elaboration of educational strategies and coping policies in schools.

Esta revisión de literatura, del tipo estado del arte, mapea y analiza la producción académica acerca de violencia y escuela en artículos publicados entre 2003 y 2017 por autores en el campo de la psicología. 101 artículos ingresaron al estado del arte, los cuales fueron analizados desde una perspectiva crítica e interseccional, con el objetivo de comprender quales concepciones acerca de violencia y escuela orientan tales estudios. La mayoría proviene de investigaciones de campo, siendo la escuela pública y los estudiantes de los últimos años de la escuela primaria y secundaria, respectivamente, el contexto y los sujetos más investigados. Hay escasez de investigaciones acerca de racismo, sexismo, homofobia y capacitismo, violencias presentes en las relaciones escolares y estructurales en nuestra sociedad. Este vacío, juntamente con la invisibilidad de los marcadores sociales que constituyen los sujetos investigados, denota una adhesión a la concepción de un supuesto sujeto universal en psicología y señala la necesaria problematización acerca de las posiciones epistemológicas que permean este campo de estudio. Consideramos fundamental que los investigadores del campo de la psicología trabajen con métodos de investigación alternativos y con el análisis interseccional, con el objetivo de escuchar las narrativas de professores, estudiantes, familias y comunidad sobre sus experiencias de opresión y violencia, y con su participación en la elaboración de estrategias educativas y políticas de afrontamiento en las escuelas.

Spectrophotometric azole and amphotericin B MIC readings against Aspergillus fumigatus sensu lato using the EUCAST 9.3.2 methodology. Are ≥90 and ≥95% fungal growth inhibition endpoints equally suitable?

We recently reported high essential (97.1%) and categorical (99.6%) agreements between azole and amphotericin B MICs against Aspergillus fumigatus sensu lato obtained by visual and spectrophotometric readings using a ≥ 95% fungal growth endpoint and following the EUCAST methodology (doi: 10.1128/AAC.01693-20). Here, we compared the aforementioned MICs against spectrophotometric MIC readings obtained using a ≥ 90% inhibition endpoint. Spectrophotometric readings using either ≥ 90% or ≥ 95% fungal growth inhibition resulted in high categorical (>99.9%) agreements with visual MIC readings against A. fumigatus sensu stricto. In contrast, agreements with visual MICs against cryptic species were higher with the use of a ≥ 95% fungal growth inhibition endpoint. LAY SUMMARY: Spectrophotometrically obtained MIC readings using either ≥ 90% or ≥ 95% fungal growth inhibition endpoints and following the EUCAST methodology are suitable against A. fumigatus sensu stricto. However, the ≥ 95% fungal growth inhibition endpoint is preferred against cryptic species.

Azole-Resistant Aspergillus fumigatus Clinical Isolate Screening in Azole-Containing Agar Plates (EUCAST E.Def 10.1): Low Impact of Plastic Trays Used and Poor Performance in Cryptic Species.

Azole-containing agar is used in routine Aspergillus fumigatus azole resistance screening. We evaluated the impact of the type of plastic used to prepare in-house agar plates on the procedure's performance against A. fumigatus sensu stricto and cryptic species. A. fumigatus sensu stricto (n = 91) and cryptic species (n = 52) were classified as susceptible or resistant (EUCAST E.Def 9.3.2; clinical breakpoints v10). In-house azole-containing agar plates were prepared following EUCAST E.Def 10.1 on three types of multidish plates. We assessed the sensitivity, specificity, and agreement values of the agar plates to screen for azole resistance. Overall, sensitivity and specificity values of the agar screening method were 100% and 93.3%, respectively. The type of tray used did not affect these values. All isolates harboring TR34-L98H substitutions were classified as resistant to itraconazole and voriconazole by the agar method; however, false susceptibility (very major error) to posaconazole was not uncommon and happened in isolates with posaconazole MICs of 0.25 mg/liter. Isolates harboring G54R and TR46-Y121F-T289A substitutions were correctly classified by the agar method as itraconazole/posaconazole resistant and voriconazole resistant, respectively. False resistance (major error) occurred in isolates showing tiny fungal growth. Finally, agreements between both procedures against cryptic species were much lower. Azole-containing agar plates are a convenient and reliable tool to screen for resistance in A. fumigatus sensu stricto; the type of plastic tray used minimally affects the method. On the contrary, the performance against cryptic species is rather poor.

The gut microbiota regulates hypothalamic inflammation and leptin sensitivity in Western diet-fed mice via a GLP-1R-dependent mechanism.

Mice lacking a microbiota are protected from diet-induced obesity. Previous studies have shown that feeding a Western diet causes hypothalamic inflammation, which in turn can lead to leptin resistance and weight gain. Here, we show that wild-type (WT) mice with depleted gut microbiota, i.e., germ-free (GF) and antibiotic-treated mice, have elevated levels of glucagon-like peptide-1 (GLP-1), are protected against diet-induced hypothalamic inflammation, and have enhanced leptin sensitivity when fed a Western diet. Using GLP-1 receptor (GLP-1R)-deficient mice and pharmacological inhibition of the GLP-1R in WT mice, we demonstrate that intact GLP-1R signaling is required for preventing hypothalamic inflammation and enhancing leptin sensitivity. Furthermore, we show that astrocytes express the GLP-1R, and deletion of the receptor in glial fibrillary acidic protein (GFAP)-expressing cells diminished the antibiotic-induced protection against diet-induced hypothalamic inflammation. Collectively, our results suggest that depletion of the gut microbiota attenuates diet-induced hypothalamic inflammation and enhances leptin sensitivity via GLP-1R-dependent mechanisms.

Absceso hepático por Arcanobacterium haemolyticum

No disponible

Liver abscess caused by Arcanobacterium haemolyticum.

We report the case of a 90-year-old female who was admitted to our hospital due to a three-day history of right abdominal pain and fever of 39 °C (102 °F). The patient's blood pressure was low, with good blood perfusion and no jaundice, and her abdomen was soft and tender in the right hypochondriac and lateral region, with no guarding. Laboratory tests showed: blood glucose level of 201 mg/dl, 362 U/l AST, 237 U/l ALT, 2.5 mg/dl bilirubin, 237 U/l alkaline phosphatase and leukocytosis associated with a left shift. An abdominal ultrasound scan showed a collection of echogenic material and a shadow suggestive of air in hepatic segment 3. Meropenem and metronidazole treatment was started after taking blood cultures, which were negative. A computed tomography (CT) scan confirmed the presence of a liver abscess in segment 3, containing a high-density linear image.

Azole and Amphotericin B MIC Values against Aspergillus fumigatus: High Agreement between Spectrophotometric and Visual Readings Using the EUCAST EDef 9.3.2 Procedure.

The EUCAST EDef 9.3.2 procedure recommends visual readings of azole and amphotericin B MICs against Aspergillus spp. Visual determination of MICs may be challenging. In this work, we aim to obtain and compare visual and spectrophotometric MIC readings of azoles and amphotericin B against Aspergillus fumigatussensu lato isolates. A total of 847 A. fumigatussensu lato isolates (A. fumigatus sensu stricto [n = 828] and cryptic species [n = 19]) were tested against amphotericin B, itraconazole, voriconazole, posaconazole, and isavuconazole using the EUCAST EDef 9.3.2 procedure. Isolates were classified as susceptible or resistant/non-wild type according to the 2020 updated breakpoints. The area of technical uncertainty for the azoles was defined in the updated breakpoints. Visual and spectrophotometric (fungal growth reduction of >95% compared to the control, read at 540 nm) MICs were compared. Essential (±1 2-fold dilution) and categorical agreements were calculated. Overall, high essential (97.1%) and categorical (99.6%) agreements were found. We obtained 100% categorical agreements for amphotericin B, itraconazole, and posaconazole, and consequently, no errors were found. Categorical agreements were 98.7 and 99.3% for voriconazole and isavuconazole, respectively. Most of the misclassifications for voriconazole and isavuconazole were found to be associated with MIC results falling either in the area of technical uncertainty or within one 2-fold dilution above the breakpoint. The resistance rate was slightly lower when the MICs were obtained by spectrophotometric readings. However, all relevant cyp51A mutants were correctly classified as resistant. Spectrophotometric determination of azole and amphotericin B MICs against A. fumigatussensu lato isolates may be a convenient alternative to visual endpoint readings.

Comprometimento e consentimento organizacional: um estudo da validade discriminante dos construtos / Organizational commitment and compliance: a study on the discriminant validity between constructs / Compromiso y consentimiento organizacional: un estudio de validez discriminante de los constructos

O comprometimento organizacional é um dos tópicos de pesquisa mais investigados no campo do comportamento organizacional e a gênese da sua importância reside no reconhecimento do amplo poder explicativo do construto. Tendo em vista a aparente sobreposição reportada na literatura entre a dimensão afetiva e a dimensão normativa do comprometimento, foi proposto o construto de consentimento para diferenciar trabalhadores comprometidos (vínculo ativo) de obedientes (vínculo passivo). O presente artigo busca contribuir para estabelecer os limites entre os construtos do comprometimento e consentimento organizacionais. O estudo consistiu em um survey de corte transversal entre 994 trabalhadores de diferentes organizações e segmentos produtivos. A análise sugere indícios de validade discriminante entre os construtos como se pode perceber, por exemplo, em relação às diferenças na magnitude do efeito das variáveis sociodemográficas na explicação das duas bases do comprometimento e do consentimento e pela baixa correlação entre o consentimento a base normativa (r=0,240).(AU)

The organizational commitment is one of the most investigated topics of research in the field of organizational behavior and the genesis of its importance lies in recognizing the broad explanatory power of the construct. Given the apparent overlap reported in the literature between the affective and the normative dimensions of commitment, it has been proposed the construct of organizational compliance to differentiate committed workers from obedient ones. This article aims to establish the boundaries between the constructs of organizational commitment and consent. The study consisted of a cross-sectional survey with 994 workers from different organizations and production segments. The analysis suggests evidence of discriminant validity between consent, affective commitment and normative commitment. This can be observed in the different effect size of socio demographic variables on commitment and consent and the low correlation between consent and normative base of commitment (r=240).(AU)

El compromiso organizacional es uno de los temas más investigados en el campo del comportamiento organizacional y su importancia radica en el reconocimiento del amplio poder explicativo del constructo. Dada la aparente superposición entre la dimensión afectiva y la dimensión normativa del compromiso registrada en la literatura, fue propuesto el constructo del consentimiento para diferenciar los trabajadores comprometidos (vínculo activo) de los obedientes (vínculo pasivo). Este artículo busca contribuir para establecer los límites entre los constructos del compromiso y el consentimiento organizacional. El estudio consistió en un survey transversal con 994 trabajadores de diferentes organizaciones y segmentos productivos. El análisis señala indicios de validez discriminante entre los constructos, como puede verse por ejemplo, en relación a las diferencias en la magnitud del efecto de las variables socio-demográficas, en la explicación de las dos bases del compromiso y el consentimiento y por la baja correlación entre la base normativa y el consentimiento (r=0,240).(AU)

Comprometimento e consentimento organizacional: um estudo da validade discriminante dos construtos / Organizational commitment and compliance: a study on the discriminant validity between constructs / Compromiso y consentimiento organizacional: un estudio de validez discriminante de los constructos

O comprometimento organizacional é um dos tópicos de pesquisa mais investigados no campo do comportamento organizacional e a gênese da sua importância reside no reconhecimento do amplo poder explicativo do construto. Tendo em vista a aparente sobreposição reportada na literatura entre a dimensão afetiva e a dimensão normativa do comprometimento, foi proposto o construto de consentimento para diferenciar trabalhadores comprometidos (vínculo ativo) de obedientes (vínculo passivo). O presente artigo busca contribuir para estabelecer os limites entre os construtos do comprometimento e consentimento organizacionais. O estudo consistiu em um survey de corte transversal entre 994 trabalhadores de diferentes organizações e segmentos produtivos. A análise sugere indícios de validade discriminante entre os construtos como se pode perceber, por exemplo, em relação às diferenças na magnitude do efeito das variáveis sociodemográficas na explicação das duas bases do comprometimento e do consentimento e pela baixa correlação entre o consentimento a base normativa (r=0,240)...

The organizational commitment is one of the most investigated topics of research in the field of organizational behavior and the genesis of its importance lies in recognizing the broad explanatory power of the construct. Given the apparent overlap reported in the literature between the affective and the normative dimensions of commitment, it has been proposed the construct of organizational compliance to differentiate committed workers from obedient ones. This article aims to establish the boundaries between the constructs of organizational commitment and consent. The study consisted of a cross-sectional survey with 994 workers from different organizations and production segments. The analysis suggests evidence of discriminant validity between consent, affective commitment and normative commitment. This can be observed in the different effect size of socio demographic variables on commitment and consent and the low correlation between consent and normative base of commitment (r=240)...

El compromiso organizacional es uno de los temas más investigados en el campo del comportamiento organizacional y su importancia radica en el reconocimiento del amplio poder explicativo del constructo. Dada la aparente superposición entre la dimensión afectiva y la dimensión normativa del compromiso registrada en la literatura, fue propuesto el constructo del consentimiento para diferenciar los trabajadores comprometidos (vínculo activo) de los obedientes (vínculo pasivo). Este artículo busca contribuir para establecer los límites entre los constructos del compromiso y el consentimiento organizacional. El estudio consistió en un survey transversal con 994 trabajadores de diferentes organizaciones y segmentos productivos. El análisis señala indicios de validez discriminante entre los constructos, como puede verse por ejemplo, en relación a las diferencias en la magnitud del efecto de las variables socio-demográficas, en la explicación de las dos bases del compromiso y el consentimiento y por la baja correlación entre la base normativa y el consentimiento (r=0,240)...

Informatización de la biberonería de un hospital materno-infantil con una producción diaria de 700 biberones / No disponible

Introducción: Con motivo de la remodelación de la biberonería del Hospital Materno-Infantil, se diseñó una aplicación destinada a optimizar la petición, preparación, distribución y control de consumos, de todas las fórmulas elaboradas en dicha biberonería. Material y métodos: El programa desarrollado en Microsoft Access 971 contiene información sobre pacientes hospitalizados y las dietas que se le asignen junto con clasificaciones de fórmulas, marcas comerciales, concentraciones de elaboración, proveedores, material fungible que intervienen en la preparación de dichas dietas. Para la cumplimentación de los datos, se han prepararon diversos formularios que son utilizados tanto por el personal de enfermería de las plantas de hospitalización como por el implicado en la elaboración de los biberones. El acceso a cada una de las funciones es restringido en función del grupo funcional (planta, elaboración y administración) al que pertenece cada usuario. Resultados: El programa está implantado con utilización progresiva de las diversas plantas desde mayo de 1999. Hasta el día de hoy ha controlado la petición y elaboración de 44.281 biberones para 419 neonatos y lactantes. Conclusión: Se ha observado una disminución del número de peticiones fuera de los horarios establecidos y tiempo de elaboración, así como un ahorro en las cantidades de fórmula empleadas (AU)

Introduction: Due to the changes at the nursery of the Paediatric Hospital an application was designed for the purpose of optimizing the request, preparation, distribution and control of use, for all the formulae elaborated in that nursery. Materials and methods: The programme in Microsoft Access 97 built, contains information about inpatients and the diets given to them, along with the classification of the formulae, trade names, their concentration, suppliers and the perishable ingredients that were involved in the preparation of these diets. In order to complete the data, several formularies were prepared which were used by the nursing staff and by those responsible for their preparation. The access to each of these functions was restricted according to the role of each group (Ward staff, preparation and administration areas) that different members belonged to. Results: The programme was initiated in a progressive fashion throughout the different wards starting in May 1999. Until to date there had been a control over the request and elaboration of 44.281 feeding bottles for 419 neonates. Conclusion: A reduction in the number of requests out of hours was observed as was the time of preparation. Also, there was a reduction in the quantity of the formulae used (AU)