Fungemia in Hospitalized Adult Patients with Hematological Malignancies: Epidemiology and Risk Factors.

Fungemia in hematologic malignancies (HM) has high mortality. This is a retrospective cohort of adult patients with HM and fungemia between 2012 and 2019 in institutions of Bogotá, Colombia. The epidemiological, clinical, and microbiological characteristics are described, and risk factors related to mortality are analyzed. One hundred five patients with a mean age of 48 years (SD 19.0) were identified, 45% with acute leukemia and 37% with lymphomas. In 42%, the HM was relapsed/refractory, 82% ECOG > 3, and 35% received antifungal prophylaxis; 57% were in neutropenia, with an average duration of 21.8 days. In 86 (82%) patients, Candida spp. was identified, and other yeasts in 18%. The most frequent of the isolates were non-albicans Candida (61%), C. tropicalis (28%), C. parapsilosis (17%), and C. krusei (12%). The overall 30-day mortality was 50%. The survival probability at day 30 in patients with leukemia vs. lymphoma/multiple myeloma (MM0 group was 59% (95% CI 46-76) and 41% (95% CI 29-58), p = 0.03, respectively. Patients with lymphoma or MM (HR 1.72; 95% CI 0.58-2.03) and ICU admission (HR 3.08; 95% CI 1.12-3.74) were associated with mortality. In conclusion, in patients with HM, non-albicans Candida species are the most frequent, and high mortality was identified; moreover, lymphoma or MM and ICU admission were predictors of mortality.

Structure of the heterotrimeric membrane protein complex FtsB-FtsL-FtsQ of the bacterial divisome.

The synthesis of the cell-wall peptidoglycan during bacterial cell division is mediated by a multiprotein machine, called the divisome. The essential membrane protein complex of FtsB, FtsL and FtsQ (FtsBLQ) is at the heart of the divisome assembly cascade in Escherichia coli. This complex regulates the transglycosylation and transpeptidation activities of the FtsW-FtsI complex and PBP1b via coordination with FtsN, the trigger for the onset of constriction. Yet the underlying mechanism of FtsBLQ-mediated regulation is largely unknown. Here, we report the full-length structure of the heterotrimeric FtsBLQ complex, which reveals a V-shaped architecture in a tilted orientation. Such a conformation could be strengthened by the transmembrane and the coiled-coil domains of the FtsBL heterodimer, as well as an extended ß-sheet of the C-terminal interaction site involving all three proteins. This trimeric structure may also facilitate interactions with other divisome proteins in an allosteric manner. These results lead us to propose a structure-based model that delineates the mechanism of the regulation of peptidoglycan synthases by the FtsBLQ complex.

Epidemiological characteristics and serotype distribution of culture-confirmed pediatric pneumococcal pneumonia before and after PCV 10 introduction, a multicenter study in Bogota, Colombia, 2008-2019.

BACKGROUND: Pneumococcal conjugate vaccines (PCVs) have decreased pneumonia in children. Colombia introduced mass vaccination with PCV10 in 2012. METHODS: Cases of pneumococcal pneumonia from 10 hospitals were included. Two periods were compared: pre-PCV10: 2008-2011 and post-PCV10: 2014-2019. The objective was to compare epidemiological and clinical characteristics before and after PCV10 vaccination. RESULTS: A total of 370 cases were included. Serotypes 1 (15, 11.2%) and 14 (33, 24.6%) were the most frequent in the pre-PCV10 period, with only 4 (3%) cases of serotype 19A and 1 case (0.7%) serotype 3. From the pre-PCV10 period to the post-PCV10 period, cases of serotypes 1 (6, 3.1%) and 14 (1, 7.8%) decreased, while cases of serotypes 19A (58, 30.2%), serotype 3 (32, 16.7%) and 6A (7, 3.6%) increased (p < 0.001); complicated pneumonia (CP) increased significantly (13.4% to 31.8%) (p < 0.001); hospitalizations increased from 8 (5.5-15) to 12 (7-22) days (p < 0.001); and the frequency of PICU admission increased from 32.8% to 51.6% (p = 0.001). The use of ampicillin-sulbactam (0.7% to 24%) and ceftriaxone/clindamycin (0.7% to 5.7%) increased in the post-PCV10 period. The duration of empirical antibiotic treatment was 7 (4-11) days in the pre-PCV10 period and increased to 10 (6-17) days (p < 0.001) in the post-PCV10 period. Lethality showed a slight nonsignificant increase (7.5% vs. 9.9%; p = 0.57) in the post-PCV10 period. CONCLUSIONS: PCV10 significantly decreased cases of serotypes 1 and 14, with an increase in cases of serotypes 19A, 3 and 6A, which were the predominant serotypes and had greater severity (e.g., admission to the PICU, CP and more resistance, with an increase in the use of broad-spectrum antibiotics and longer hospitalization) and subsequently included in PCV13. Current data support national and regional evidence on the importance of replacing PCV10 with a higher valence that includes 19A, such as PCV13, with the aim of reducing circulation, particularly of this serotype.

The Effect of Visible Light on Cell Envelope Subproteome during Vibrio harveyi Survival at 20 °C in Seawater.

A number of Vibrio spp. belong to the well-studied model organisms used to understand the strategies developed by marine bacteria to cope with adverse conditions (starvation, suboptimal temperature, solar radiation, etc.) in their natural environments. Temperature and nutrient availability are considered to be the key factors that influence Vibrio harveyi physiology, morphology, and persistence in aquatic systems. In contrast to the well-studied effects of temperature and starvation on Vibrio survival, little is known about the impact of visible light able to cause photooxidative stress. Here we employ V. harveyi ATCC 14126T as a model organism to analyze and compare the survival patterns and changes in the protein composition of its cell envelope during the long-term permanence of this bacterium in seawater microcosm at 20 °C in the presence and absence of illumination with visible light. We found that V. harveyi exposure to visible light reduces cell culturability likely inducing the entry into the Viable but Non Culturable state (VBNC), whereas populations maintained in darkness remained culturable for at least 21 days. Despite these differences, the starved cells in both populations underwent morphological changes by reducing their size. Moreover, further proteomic analysis revealed a number of changes in the composition of cell envelope potentially accountable for the different adaptation pattern manifested in the absence and presence of visible light.

Incidencia de la babesiosis humana en España basada en los diagnósticos al alta hospitalaria / Incidence of human babesiosis in Spain obtained from the diagnoses at hospital discharge

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Changes in the Vibrio harveyi Cell Envelope Subproteome During Permanence in Cold Seawater.

Previous work demonstrated that physiological, morphological, and gene expression changes as well as the time-dependent entry into the viable but not culturable (VBNC) state are used by Vibrio species to survive and cope with diverse stress conditions including seasonal temperature downshifts and starvation. To learn more about the nature and specific contribution of membrane proteins to cell adaptation and survival, we analyzed variations in the protein composition of cell envelope and related them to morphological and physiological changes that were taking place during the long-term permanence of Vibrio harveyi in seawater microcosm at 4 °C. We found that after 21 days of permanence, nearly all population (ca. 99 %) of V. harveyi acquired the VBNC phenotype. Although the size of V. harveyi cells gradually decreased during the incubation time, we found that this morphological change was not directly related to their entry into the VBNC state. Our proteomic study revealed that the level of membrane proteins playing key roles in cellular transport, maintenance of cell structure, and in bioenergetics processes remained unchanged along starvation at low temperature, thus suggesting that V. harveyi might need these proteins for the long-term survival and/or for the resuscitation process. On a contrary, the level of two proteins, elongation factor Tu (EF-TU) and bacterioferritin, greatly increased reaching the maximal values by the end of the incubation period. We further discuss the above data with respect to the putative roles likely exerted by membrane proteins during transition to and maintaining of the VBNC state.

Resultados obstétricos y neonatales en pacientes que presentan preeclampsia grave, en partos atendidos en el Hospital Nacional de la Mujer, desde 1 de enero a 31 de diciembre de 2015 / Obstetric and neonatal outcomes in patients with severe pre-eclampsia, in births attended at the National Hospital for Women, from January 1 to December 31, 2015

Hay numerosas causas directas e indirectas de muerte durante el embarazo, el parto y el puerperio. Las cuatro causas principales son las hemorragias, las infecciones, los trastornos hipertensivos del embarazo y el parto obstruido según la Organización Mundial de Salud. En el Hospital Nacional de la Mujer se presentan 32.5% de pacientes con diagnóstico de preeclampsia grave por lo cual esta investigación es importante ya que nos describe el perfil epidemiológico de las pacientes y del neonato. Esta patología puede favorecer a muchas complicaciones maternas, fetales y neonatales por lo que este estudio se basa en reconocer los resultados maternos y perinatales de dichas pacientes. Por lo que se realizó esta investigación en base a un estudio descriptivo, transversal, retrospectivo. En mujeres que presentaron diagnóstico de preeclampsia grave y que verificaron parto vía vaginal o abdominal desde el 1o de enero al 31 de diciembre de 2015, en el Hospital Nacional de la Mujer; con el fin de identificar los resultados maternos y perinatales de dichos casos. Con dicha investigación se concluyó que las pacientes que desarrollan preeclampsia grave se encuentra con mayor frecuencia entre las edades de 20 a 29 años se observó en 32%, primigestas en 42%, entre las semanas 37 a la 42 de estación en un 49%, pre obesas en un 27%, tenían patologías sobreagregadas en 219 casos y la que más se observo era la hipertensión arterial crónica más diabetes mellitus tipo 2, el síntoma más frecuente es la cefalea en un 59%, fueron parto vaginal en un 56%, el sexo neonatal en un 58% son masculinos, peso neonatal en un 48% es adecuado para la edad gestacional, y los recién nacidos en un 51% ingresaron a cuidados mínimos

Unveiling the Metabolic Pathways Associated with the Adaptive Reduction of Cell Size During Vibrio harveyi Persistence in Seawater Microcosms.

Owing to their ubiquitous presence and ability to act as primary or opportunistic pathogens, Vibrio species greatly contribute to the diversity and evolution of marine ecosystems. This study was aimed at unveiling the cellular strategies enabling the marine gammaproteobacterium Vibrio harveyi to adapt and persist in natural aquatic systems. We found that, although V. harveyi incubation in seawater microcosm at 20 °C for 2 weeks did not change cell viability and culturability, it led to a progressive reduction in the average cell size. Microarray analysis revealed that this morphological change was accompanied by a profound decrease in gene expression affecting the central carbon metabolism, major biosynthetic pathways, and energy production. In contrast, V. harveyi elevated expression of genes closely linked to the composition and function of cell envelope. In addition to triggering lipid degradation via the ß-oxidation pathway and apparently promoting the use of endogenous fatty acids as a major energy and carbon source, V. harveyi upregulated genes involved in ancillary mechanisms important for sustaining iron homeostasis, cell resistance to the toxic effect of reactive oxygen species, and recycling of amino acids. The above adaptation mechanisms and morphological changes appear to represent the major hallmarks of the initial V. harveyi response to starvation.

Mechanisms involved in Escherichia coli and Serratia marcescens removal during activated sludge wastewater treatment.

Wastewater treatment reduces environmental contamination by removing gross solids and mitigating the effects of pollution. Treatment also reduces the number of indicator organisms and pathogens. In this work, the fates of two coliform bacteria, Escherichia coli and Serratia marcescens, were analyzed in an activated sludge process to determine the main mechanisms involved in the reduction of pathogenic microorganisms during wastewater treatment. These bacteria, modified to express green fluorescent protein, were inoculated in an activated sludge unit and in batch systems containing wastewater. The results suggested that, among the different biological factors implied in bacterial removal, bacterivorous protozoa play a key role. Moreover, a representative number of bacteria persisted in the system as free-living or embedded cells, but their distribution into liquid or solid fractions varied depending on the bacterium tested, questioning the real value of bacterial indicators for the control of wastewater treatment process. Additionally, viable but nonculturable cells constituted an important part of the bacterial population adhered to solid fractions, what can be derived from the competition relationships with native bacteria, present in high densities in this environment. These facts, taken together, emphasize the need for reliable quantitative and qualitative analysis tools for the evaluation of pathogenic microbial composition in sludge, which could represent an undefined risk to public health and ecosystem functions when considering its recycling.

Reprogramming of Vibrio harveyi gene expression during adaptation in cold seawater.

The life and survival of the marine bacterium Vibrio harveyi during its adaptation in natural aquatic systems is highly influenced by the availability of nutrients and temperature. To learn about adaptation strategies evolved by this bacterium to cope with drastic temperature downshifts and nutrients depletion, we have studied the phenotypical and gene expression changes occurring in V. harveyi during its adaptation to cold seawater. We found that incubation in cold seawater up to 12 h did not cause any significant morphological changes in V. harveyi and had no effect on the number of viable and culturable cells. Microarray analysis revealed that the V. harveyi response to cold seawater leads to up- and downregulation of numerous genes controlling the central carbon metabolism, nucleotide and amino acid biosynthesis as well as DNA repair. In addition, expression of some genes controlling biosynthesis of lipids, molecular transport, and energy production was altered to likely affect the composition and properties of the V. harveyi cell envelope, thus implying the putative role of this compartment in adaptation to stress. Here, we discuss these results with regard to the putative adaptive responses likely triggered by V. harveyi to cope with environmental challenges in natural aquatic systems.

Optimización de la dosificación de vancomicina en pacientes críticos mediante el análisis de sus niveles plasmáticos / Dosage of vancomycin in critically ill patients: analysis of plasmatic levels

Los pacientes críticos se caracterizan por la presencia de diversos factores que pueden alterar la cinética de vancomicina, antibiótico ampliamente utilizado en las unidades de cuidados intensivos para el tratamiento de infecciones producidas por Staphylococus aureus meticilino resistente. Pacientes y métodos: Este estudio evaluó las dosis de vancomicina comúnmente utilizadas en la Unidad de Paciente Critico del Hospital Dr. Gustavo Fricke y la estrategia de administración inicial de carga endovenosa de vancomicina en dichos pacientes. Resultados: El 55,3 por ciento de los niveles plasmáticos obtenidos fueron menores de 15 mcg/mL. Bajo la estrategia de administración de carga endovenosa, solo el 13,3 por ciento de los resultados se encontraron por debajo de dicho valor. Los resultados fueron dependientes estadísticamente de la edad, índice de masa corporal y función renal del paciente. Conclusiones: La carga endovenosa de vancomicina permite alcanzar los niveles plasmáticos requeridos en pacientes críticos. Es necesario evaluar los factores de la edad, función renal e índice de masa corporal de los pacientes que se les administrará vancomicina y ajustar las dosis según las determinaciones periódicas de sus niveles plasmáticos.

Critically ill patients are characterized by the presence of various factors can alter the kinetics of vancomycin antibiotic widely used in intensive care units for treating infections caused by methicillin resistant Staphylococcusaureus. Patients and methods: This study evaluated vancomycin doses commonly used in critically ill patient Unit Dr. Gustavo Fricke Hospital and initial management strategy of charging intravenous vancomycin in such patients. Results: 55.3 percent of the plasmatic levels obtained were lower than 15 mcg / mL. Under load management strategy IV, 13.3 percent of the results were below this value. The results were statistically dependent on age, body mass index and renal function. Conclusions: The burden of vancomycin intravenously can achieve the required plasma levels in critically ill patients. It is necessary to evaluate the factors of age, renal function and body mass index of patients that will be administered according to vancomycin and adjust these measurements the periodic determination of plasma levels.

Determinación de la susceptibilidad a drogas de primera línea en aislamientos de Mycobacterium tuberculosis por la técnica del tubo indicador de crecimiento micobacteriano / Determining the susceptibility to first-line drugs in M. tuberculosis isolates using the mycobacteria growth indicator tube method

Antecedentes: La aparición de aislamientos de Mycobacterium tuberculosis resistentes a los medicamentos ha hecho que se busquen métodos más rápidos y confiables para la determinación de la susceptibilidad a las drogas antituberculosas. Objetivo. Determinación de la susceptibilidad a drogas antituberculosas de primera línea en aislamientos de M. tuberculosis utilizando el método del tubo indicador de crecimiento micobacteriano (MGIT). Material y métodos. Se estudiaron 49 aislamientos de M. tuberculosis procedentes del laboratorio de micobacteriología del departamento de Microbiología de la Universidad Nacional de Colombia. Se evaluó y comparó el método MGIT para la determinación de la resistencia o susceptibilidad a rifampicina, isoniacida, etambutol y estreptomicina con la prueba de oro, el método de las proporciones múltiples (PM). Resultados. Por el método de las PM de los 49 aislamientos, 26 (53.0 por ciento) fueron sensibles a los cuatro antibióticos, 12 (24.5 por ciento) resistentes a un antibiótico y 11 (22.5 por ciento) a más de un antibiótico. Por el método MGIT de los 49 aislamientos, 31 (63.3 por ciento) fueron sensibles a los cuatro antibióticos, ocho (16.3 por ciento) resistentes a un antibiótico y 10 (20.6 por ciento) resistentes a más de un antibiótico. Los porcentajes de concordancia observada oscilaron entre 83.7 y 97.9 por ciento y el índice kappa estuvo entre 0.61 y 0.83 para los diferentes antibióticos analizados. La sensibilidad del método MGIT a rifampicina, isoniacida, etambutol y estreptomicina fue de 88.9, 95.2, 62.5 y 58 por ciento respectivamente y la especificidad fue 97.7, 92.3, 98.8 y 98.4 por ciento respectivamente. Por el método MGIT se aislaron cepas resistentes de M. tuberculosis en un tiempo promedio de 7.85 días...

Background: The appearance of Mycobacterium tuberculosisisolates resistant to drugs has triggered the search for quicker and more reliable methods to determine the susceptibility to anti-tuberculosis drugs. Objective. To evaluate the susceptibility of M. tuberculosis isolates to anti-tuberculosis first line drugs by Mycobacterium growth indicator tube method (MGIT).Materials and methods. Forty-nine isolates of M. tuberculosis were tested, coming from the MycobacteriologyLaboratory of Microbiology Department of the Universidad Nacional de Colombia. The MGIT method wasevaluated and compared in order to determine resistance or susceptibility to rifampicin, isoniazid, ethambutol andstreptomycin with the gold standard method, the multiple proportion method (PM). Results. With the PM method, of 49 isolates, 26 (53.0%) were sensitive to all four antibiotics, 12 (24.5%) wereresistant to one antibiotic and 11 (22.5%) to more than one antibiotic. Using the MGIT method, of 49 isolates,31 (63.3%) were sensitive to all four antibiotics, 8 (16.3%) were resistant to one antibiotic and 10 (20.6%) wereresistant to more than one antibiotic. The concordance percentages observed oscillated between 83.7% and 97.9% and the kappa index was between 0.61 and 0.83 for the different antibiotics analyzed. The sensitivity of the MGIT method to the rifampicin, isoniazid, ethambutol and streptomycin was of 88.9, 95.2, 62.5 and 58% respectively and specifity was of 97.7, 92.3,98.8 y 98.4% respectively. Using the MGIT method, isolates resistant to M. tuberculosis were determined inan average time of 7.85 days...

[Search for tuberculosis in patients with the respiratory symptoms in four hospitals of Bogotá D.C]. / Búsqueda de Tuberculosis en Pacientes Sintomáticos Respiratorios en Cuatro Hospitales de Bogotá D.C.

OBJECTIVE: To identify individuals with the respiratory symptoms who receive different medical services in third level hospitals of Bogotá D.C. for early diagnosis of Tuberculosis. MATERIALS AND METHODS: An active search for individuals with Tuberculosis respiratory symptoms through promotion and prevention activities was realized utilizing a format for obtaining social, demographic and clinical data. 566 samples of sputum from 354 individuals with respiratory symptoms were investigated in four Bogota hospitals. By means of positive smear and bacillus culture the tuberculosis patients were detected. RESULTS: The gender distribution was 39 % male and 61 % female, with an average age of 57,4 years. 48,5 % had respiratory symptoms for more than two months, 53,3 % presented BCG scar, 50 % belonged to socioeconomic level 2 and 72,8 % had an education level equal to or less than basic elementary school. The percentage detected by positive smear was of 3,67 % and by positive smear and/or culture was of 4,2 %. 11 cases of Mycobacterium tuberculosis and 2 cases of non tuberculosis mycobacterium were found. The majority of patients with tuberculosis belonged to the masculine gender, presented coughing symptoms and expectoration greater than two months and 54,5 % had BCG vaccination. CONCLUSIONS: The active search patients with the respiratory symptoms detected cases of patients with positive smear, a source of contamination among the population, which facilitates the anti-tuberculosis therapy applying the DOTS strategy. The success of tuberculosis control will depend on government policies that follow the OMS recommendations.

Búsqueda de Tuberculosis en Pacientes Sintomáticos Respiratorios en Cuatro Hospitales de Bogotá D.C. / Search for Tuberculosis in patients with the respiratory symptoms in four hospitals of Bogotá D.C.

Objetivo: Identificar individuos sintomáticos respiratorios que acuden a diferentes servicios médicos en hospitales de tercer nivel de Bogotá D.C. para el diagnóstico temprano de la Tuberculosis. Materiales y métodos: Se realizó búsqueda activa de sintomáticos respiratorios a través de actividades de promoción y prevención utilizando un formulario para obtención de datos socio demográficos y clínicos. Se investigaron 566 muestras de esputo de 354 individuos sintomáticos respiratorios en cuatro hospitales de Bogotá D.C. Se detecto por baciloscopia y cultivo pacientes con tuberculosis. Resultados La distribución por género fue de 39 por ciento masculino y 61 por ciento femenino, con un promedio de 57,4 años. El 48,5 por ciento tenían síntomas respiratorios mayor a dos meses, 53,3 por ciento presentaban cicatriz BCG, 50 por ciento pertenecía al estrato 2 y 72,8 por ciento alcanzaba un nivel educativo igual o menor a primaria básica. El porcentaje de captación por baciloscopia fue de 3,67 por ciento y de baciloscopia y/o cultivo fue del 4,2 por ciento. Se encontraron 11 casos de Mycobacterium tuberculosis y 2 casos de micobacterias no tuberculosas. La mayoría de pacientes con tuberculosis perteneció al género masculino, presentaban síntomas de tos y expectoración mayor a dos meses y el 54,5 por ciento tenían vacunación BCG Conclusiones: La búsqueda activa de sintomáticos respiratorios detecta casos de pacientes bacilíferos, fuente de contaminación entre la población, facilita el inicio de la terapia antituberculosa aplicando la estrategia DOTS. El éxito en el control de la tuberculosis depende de políticas gubernamentales que sigan las recomendaciones de la OMS.

Objective: To identify individuals with the respiratory symptoms who receive different medical services in third level hospitals of Bogotá D.C. for early diagnosis of Tuberculosis. Materials and methods: An active search for individuals with Tuberculosis respiratory symptoms through promotion and prevention activities was realized utilizing a format for obtaining social, demographic and clinical data. 566 samples of sputum from 354 individuals with respiratory symptoms were investigated in four Bogota hospitals. By means of positive smear and bacillus culture the tuberculosis patients were detected. Results The gender distribution was 39 percent male and 61 percent female, with an average age of 57,4 years. 48,5 percent had respiratory symptoms for more than two months, 53,3 percent presented BCG scar, 50 percent belonged to socioeconomic level 2 and 72,8 percent had an education level equal to or less than basic elementary school. The percentage detected by positive smear was of 3,67 percent and by positive smear and/or culture was of 4,2 percent. 11 cases of Mycobacterium tuberculosis and 2 cases of non tuberculosis mycobacterium were found. The majority of patients with tuberculosis belonged to the masculine gender, presented coughing symptoms and expectoration greater than two months and 54,5 percent had BCG vaccination. Conclusions: The active search patients with the respiratory symptoms detected cases of patients with positive smear, a source of contamination among the population, which facilitates the anti-tuberculosis therapy applying the DOTS strategy. The success of tuberculosis control will depend on government policies that follow the OMS recommendations.