Emergence of OXA-48-like producing Citrobacter species, Germany, 2011 to 2022.

BackgroundCarbapenemase-producing Enterobacterales are a public health threat worldwide and OXA-48 is the most prevalent carbapenemase in Germany and western Europe. However, the molecular epidemiology of OXA-48 in species other than Escherichia coli and Klebsiella pneumoniae remains poorly understood.AimTo analyse the molecular epidemiology of OXA-48 and OXA-48-like carbapenemases in Citrobacter species (spp.) in Germany between 2011 and 2022.MethodsData of 26,822 Enterobacterales isolates sent to the National Reference Centre (NRC) for Gram-negative bacteria were evaluated. Ninety-one Citrobacter isolates from 40 German hospitals harbouring bla OXA-48/OXA-48­like were analysed by whole genome sequencing and conjugation experiments.ResultsThe frequency of OXA-48 in Citrobacter freundii (CF) has increased steadily since 2011 and is now the most prevalent carbapenemase in this species in Germany. Among 91 in-depth analysed Citrobacter spp. isolates, CF (n = 73) and C. koseri (n = 8) were the most common species and OXA-48 was the most common variant (n = 77), followed by OXA-162 (n = 11) and OXA­181 (n = 3). Forty percent of the isolates belonged to only two sequence types (ST19 and ST22), while most other STs were singletons. The plasmids harbouring bla OXA­48 and bla OXA-162 belonged to the plasmid types IncL (n = 85) or IncF (n = 3), and plasmids harbouring bla OXA­181 to IncX3 (n = 3). Three IncL plasmid clusters (57/85 IncL plasmids) were identified, which were highly transferable in contrast to sporadic plasmids.ConclusionIn CF in Germany, OXA-48 is the predominant carbapenemase. Dissemination is likely due to distinct highly transmissible plasmids harbouring bla OXA­48 or bla OXA-48-like and the spread of the high-risk clonal lineages ST19 and ST22.

Effect of pressure management during hypothermic selective cerebral perfusion on cerebral hemodynamics and metabolism in pigs.

OBJECTIVE: The effect of perfusion pressure on cerebral hemodynamics and metabolism during selective cerebral perfusion in patients undergoing aortic surgery is still unknown. This study explored cerebral blood flow, metabolic rate, and intracranial pressure at different pressure rates. METHODS: Twenty-five pigs (32-38 kg) were cooled during cardiopulmonary bypass to 25 degrees C. After 10 minutes of hypothermic circulatory arrest, the animals were randomized to 60 minutes of selective cerebral perfusion at 3 different perfusion pressures: group I (n = 8), 40 mm Hg; group II (n = 9), 60 mm Hg; and group III (n = 8), 80 mm Hg. Microspheres were injected at baseline, the coolest temperature, and 5, 15, 25, and 60 minutes of selective cerebral perfusion, respectively, to calculate cerebral hemodynamics. RESULTS: Cerebral blood flow decreased during cooling to 54% of baseline value (50 mL/min per 100 g) and recovered in all groups during the first 15 minutes of selective cerebral perfusion. In groups I and II it reached 110% to 113% of baseline values, whereas group III animals showed significantly higher values (P(25min) = .003) during the first 25 minutes of selective cerebral perfusion (360%; 153 mL/min per 100 g). Cerebral blood flow decreased in all groups over the following 35 minutes of selective cerebral perfusion to 57% of baseline value. Cooling to 25 degrees C decreased the intracranial pressure to 10 mm Hg (93%). During selective cerebral perfusion, groups I and II showed a further intracranial pressure decrease to 45% and 82%, respectively, whereas group III, with 15 mm Hg (128%), had significantly higher intracranial pressure values at the end of selective cerebral perfusion (P(25min) = .03 and P(60min) = .02). The metabolic rate decreased to 30% of the baseline value during cooling, reaching 34% to 38% after 60 minutes of selective cerebral perfusion, with no significant differences between groups. CONCLUSION: High-pressure perfusion provides no benefit during long-term selective cerebral perfusion at 25 degrees C. Higher cerebral blood flow during the initial 25 minutes of selective cerebral perfusion leads to cerebral edema, with no alteration in metabolic rate.

Large-volume multi-tined expandable RF ablation in pig livers: comparison of 2D and volumetric measurements of the ablation zone.

OBJECTIVES: To compare two-dimensional (2D) and three-dimensional (3D) computed tomography (CT) measurements of ablation zones (AZs) related to the shaft of two different large-volume monopolar multi-tined expandable electrodes. METHODS: Percutaneous radiofrequency (RF) ablation was performed in 12 pigs (81.6 +/- 7.8 kg) using two electrodes (LeVeen 5 cm, Rita XL 5 cm; n = 6 in each group). Contrast-enhanced CT with the electrode shaft in place evaluated the AZ. The largest sphere centred on the electrode shaft within the AZ was calculated (1) based on the 2D axial CT image in the plane of the shaft assuming rotational symmetry of the AZ and (2) using prototype software and the 3D volume data of the AZ measured with CT. RESULTS: The mean largest diameter of a sphere centred on the electrode shaft was always smaller using the 3D data of the AZ than using 2D CT measurements assuming rotational symmetry of the AZ (3D vs 2D): LeVeen 18.2 +/- 4.8 mm; 24.5 +/- 3.1 mm; p = 0.001; Rita XL 20.0 +/- 3.7 mm; 28.8 +/- 4.9 mm; p = 0.0002. All AZ showed indentations around the tines. CONCLUSIONS: Two-dimensional CT measurements assuming rotational symmetry of the AZ overestimate the largest ablated sphere centred on the electrode shaft compared with 3D CT measurements.