Quality indicators for appropriate antibiotic prescribing in urinary tract infections in children

BACKGROUND: The aim of this study was to define a set of urinary tract infections (UTIs)-specific quality indicators for appropriate prescribing in children and evaluate clinical practices in a district general hospital in Greece. METHODS: The aim of this study was to define a set of urinary tract infections (UTIs)-specific quality indicators for appropriate prescribing in children and evaluate clinical practices in a district general hospital in Greece. METHODS: The aim of this study was to define a set of urinary tract infections (UTIs)-specific quality indicators for appropriate prescribing in children and evaluate clinical practices in a district general hospital in Greece. RESULTS: Twelve quality indicators were adapted or developed for prescribing in childhood UTIs. A broad variety of antibiotics were prescribed for UTIs, with a drug utilization (DU) 90% rate of 6 and 9 different antibiotics for febrile and afebrile UTIs, respectively. Despite the low incidence of multi-drug resistant UTIs in the study period (9/261, 3.4%), broad-spectrum antibiotics were prescribed in 33.5% (164/490) of prescriptions. A total of 62.8% (164/261) of patients were started on empiric combined therapies, while opportunities to de-escalate were missed in 37.8% (62/164) of them. One quarter (67/261, 25.7%) of patients did not fulfil the criteria for receiving treatment, while nearly half of those prescribed prophylaxis (82/175, 46.9%) could have avoided having a prophylaxis prescription. CONCLUSIONS: Our study identified substantial gaps for improvement in antimicrobial prescribing for UTIs in children. The application of the proposed quality indicators could help to limit unnecessary antibiotics use in children with UTI

Synthesis and Study of Fully Biodegradable Composites Based on Poly(butylene succinate) and Biochar

Biodegradable polymers offer a promising alternative to the global plastic problems and especially in the last decade, to the microplastics problems. For the first time, samples of poly(butylene succinate) (PBSu) biocomposites containing 1, 2.5, and 5 wt% biochar (BC) were prepared by in situ polymerization via the two-stage melt polycondensation procedure. BC was used as a filler for the PBSu to improve its mechanical properties, thermal transitions, and biodegradability. The structure of the synthesized polymers was examined by 1H and 13C nuclear magnetic resonance (NMR) and X-Ray diffraction (XRD) along with an estimation of the molecular weights, while differential scanning calorimetry (DSC) and light flash analysis (LFA) were also employed to record the thermal transitions and evaluate the thermal conductivity, respectively. It was found that the amount of BC does not affect the molecular weight of PBSu biocomposites. The fine dispersion of BC, as well as the increase in BC content in the polymeric matrix, significantly improves the tensile and impact strengths. The DSC analysis results showed that BC facilitates the crystallization of PBSu biocomposites. Due to the latter, a mild and systematic increase in thermal diffusivity and conductivity was recorded indicating that BC is a conductive material. The molecular mobility of PBSu, local and segmental, does not change significantly in the biocomposites, whereas the BC seems to cause an increase in the overall dielectric permittivity. Finally, it was found that the enzymatic hydrolysis degradation rate of biocomposites increased with the increasing BC content

Neurological and neurourological complications of electrical injuries

Electrical injury can affect any system and organ. Central nervous system (CNS) complications are especially well recognised, causing an increased risk of morbidity, while peripheral nervous system (PNS) complications, neurourological and cognitive and psychological abnormalities are less predictable after electrical injuries.PubMed was searched for English language clinical observational, retrospective, review and case studies published in the last 30 years using the key words: electrical injury, electrocution, complications, sequelae, neurological, cognitive, psychological, urological, neuropsychological, neurourological, neurogenic, and bladder.In this review, the broad spectrum of neurological, cognitive, psychological and neurourological consequences of electrical trauma are discussed, and clinical features characteristic of an underlying neurological, psychological or neurourological disorder are identified. The latest information about the most recently discovered forms of nervous system disorders secondary to electrical trauma, such as the presentation of neurological sequelae years after electrocution, in other words long-term sequelae, are presented. Unexpected central nervous system or muscular complications such as hydrocephalus, brain venous thrombosis, and amyotrophic lateral sclerosis are described. Common and uncommon neuropsychological syndromes after electrical trauma are defined. Neurourological sequelae secondary to spinal cord or brain trauma or as independent consequences of electrical shock are also highlighted

Comparative analysis of pSMA198 found in Streptococcus macedonicus ACA-DC 198, the first streptococcal plasmid of the pCI305/pWV02 family of theta-replicating replicons

Here we analyze pSMA198, the first plasmid isolated from Streptococcus macedonicus ACA-DC 198, and we attempt to clarify the route of its original acquisition. Based on the similarity profiles of the plasmid’s replication initiation protein (Rep) and its origin of replication (ori), pSMA198 was found to be a novel member of the pCI305/pWV02 family of theta-replicating plasmids. The pCI305/pWV02 family consists of plasmids of narrow host range that are mainly found in lactococcal species. Comparative analysis of the pSMA198 revealed a high degree of similarity with plasmids pSK11b, pVF22 and pIL5 over its replication backbone, its mobilization backbone and most of its length, respectively. All these three plasmids have been isolated from Lactococcus lactis strains deriving from milk or its products supporting that S. macedonicus acquired pSMA198 from the latter species and that this acquisition took place in the dairy environment. Both pSMA198 and the chromosome of S. macedonicus exhibit a high degree of pseudogenes, indicating that they must have evolved under the same gene decay processes. Furthermore, we were able to determine chromosomal regions that may have originated from pSMA198, also supporting a long co-existence of the two replicons. In addition, pSMA198 is carried by S. macedonicus strains segregated in five different genotypes by pulsed-field gel electrophoresis (PFGE), showing that pSMA198’s acquisition is not a recent event. We propose that our overall analysis of pSMA198 points towards the habituation of S. macedonicus ACA-DC 198 to the dairy environment

Characterization of plasmid pSMA198 found in Streptococcus macedonicus ACA-DC 198 supports the relation of the species to the milk environment

Background: Streptococcus macedonicus is an intriguing streptococcal species whose most frequent source of isolation is fermented foods similarly to Streptococcus thermophilus. During the genome sequencing of S. macedonicus ACA-DC 198 a plasmid was identified. Objectives: To analyse pSMA198, the first plasmid isolated from S. macedonicus and to shed light onto its acquisition path. Methods: Similarity searches of nucleotide and protein sequences, comparative analysis of whole plasmid sequences and phylogenetic analysis were performed using the appropriate bioinformatics tools. Methods: Based on the similarity profiles of the plasmid’s replication initiation protein (Rep) and its origin of replication (ori), pSMA198 belongs to the narrow host range pCI305/pWV02 family found primarily in lactococci and it is the first such plasmid to be reported in streptococci. Comparative analysis of the pSMA198 over its ori, origin of transfer (oriT) or entire length revealed a high degree of similarity with plasmids pSK11b, pVF22 and pIL5, respectively, all isolated from Lactococcus lactis strains from milk or milk products. Phylogenetic analysis of the pSMA198 Rep showed that the vast majority of closely related proteins derive from lactococcal dairy isolates. Conclusions: Our findings demonstrate that S. macedonicus ACA-DC 198 acquired most probably plasmid pSMA198 from L. lactis during an ancestral genetic exchange event that took place in milk or dairy products. Based on our analysis we provide the first molecular and evolutionary evidence for the habituation of S. macedonicus to the dairy environment

Comparative genomics of the dairy isolate Streptococcus macedonicus ACA-DC 198 against related members of the Streptococcus bovis/Streptococcus equinus complex

Background: Within the genus Streptococcus, only Streptococcus thermophilus is used as a starter culture in food fermentations. Streptococcus macedonicus though, which belongs to the Streptococcus bovis/Streptococcus equinus complex (SBSEC), is also frequently isolated from fermented foods mainly of dairy origin. Members of the SBSEC have been implicated in human endocarditis and colon cancer. Here we compare the genome sequence of the dairy isolate S. macedonicus ACA-DC 198 to the other SBSEC genomes in order to assess in silico its potential adaptation to milk and its pathogenicity status. Results: Despite the fact that the SBSEC species were found tightly related based on whole genome phylogeny of streptococci, two distinct patterns of evolution were identified among them. Streptococcus macedonicus, Streptococcus infantarius CJ18 and Streptococcus pasteurianus ATCC 43144 seem to have undergone reductive evolution resulting in significantly diminished genome sizes and increased percentages of potential pseudogenes when compared to Streptococcus gallolyticus subsp. gallolyticus. In addition, the three species seem to have lost genes for catabolizing complex plant carbohydrates and for detoxifying toxic substances previously linked to the ability of S. gallolyticus to survive in the rumen. Analysis of the S. macedonicus genome revealed features that could support adaptation to milk, including an extra gene cluster for lactose and galactose metabolism, a proteolytic system for casein hydrolysis, auxotrophy for several vitamins, an increased ability to resist bacteriophages and horizontal gene transfer events with the dairy Lactococcus lactis and S. thermophilus as potential donors. In addition, S. macedonicus lacks several pathogenicity-related genes found in S. gallolyticus. For example, S. macedonicus has retained only one (i.e. the pil3) of the three pilus gene clusters which may mediate the binding of S. gallolyticus to the extracellular matrix. Unexpectedly, similar findings were obtained not only for the dairy S. infantarius CJ18, but also for the blood isolate S. pasteurianus ATCC 43144. Conclusions: Our whole genome analyses suggest traits of adaptation of S. macedonicus to the nutrient-rich dairy environment. During this process the bacterium gained genes presumably important for this new ecological niche. Finally, S. macedonicus carries a reduced number of putative SBSEC virulence factors, which suggests a diminished pathogenic potential

Milk adaptation and pathogenic potential among members of the Streptococcus bovis/Streptococcus equinus complex

The Streptococcus bovis/Streptococcus equinus complex (SBSEC) consists of species commonly found in the gastrointestinal tract (GIT) of herbivores. Certain members of the complex like Streptococcus macedonicus and Streptococcus infantarius are frequently isolated from traditional fermented foods, mostly of dairy origin. However, some species of this complex, like Streptococcus gallolyticus and Streptococcus pasteurianus are known pathogens of humans involved in a range of diseases including endocarditis, menengitis, bacteremia, colon cancer etc. Analysis of the genome of S. macedonicus strain ACA-DC 198 isolated from traditional Greek Kasseri cheese revealed important traits of adaptation to the dairy environment. The strain contains a significant percentage of potential pseudogenes indicating that it may have evolved through genome decay processes. Streptococcus macedonicus has an extra gene cluster for lactose and galactose metabolism unique among the SBSEC members and a typical proteolytic system required for casein hydrolysis. Furthermore, we found evidence in the genome of S. macedonicus suggesting HGT (horizontal gene transfer) events with potential donors Lactococcus lactis and Streptococcus thermophilus. Perhaps the most pronounced among these HGT events is the presence in S. macedonicus of pSMA198 which belongs to the lactococcal pCI305/pWV02 family of plasmids. Our analysis suggests that pSMA198 may have been acquired by S. macedonicus from L. lactis. Analogous traits have been reported for S. infantarius suggesting that at least these two strains present adaptations to the dairy environment among SBSEC. Finally, we were able to identify a number of potential virulence factors (VFs) within the SBSEC members whose presence varied among species of the complex. Streptococcus macedonicus and S. infantarius miss some of the VFs present in S. gallolyticus suggesting a diminished pathogenic potential for the two species

Acquisition through Horizontal Gene Transfer of Plasmid pSMA198 by Streptococcus macedonicus ACA-DC 198 Points towards the Dairy Origin of the Species

Background: Streptococcus macedonicus is an intriguing streptococcal species whose most frequent source of isolation is fermented foods similarly to Streptococcus thermophilus. However, S. macedonicus is closely related to commensal opportunistic pathogens of the Streptococcus bovis/Streptococcus equinus complex. Methodology/Principal Findings: We analyzed the pSMA198 plasmid isolated from the dairy strain Streptococcus macedonicus ACA-DC 198 in order to provide novel clues about the main ecological niche of this bacterium. pSMA198 belongs to the narrow host range pCI305/pWV02 family found primarily in lactococci and to the best of our knowledge it is the first such plasmid to be reported in streptococci. Comparative analysis of the pSMA198 sequence revealed a high degree of similarity with plasmids isolated from Lactococcus lactis strains deriving from milk or its products. Phylogenetic analysis of the pSMA198 Rep showed that the vast majority of closely related proteins derive from lactococcal dairy isolates. Additionally, cloning of the pSMA198 ori in L. lactis revealed a 100% stability of replication over 100 generations. Both pSMA198 and the chromosome of S. macedonicus exhibit a high percentage of potential pseudogenes, indicating that they have co-evolved under the same gene decay processes. We identified chromosomal regions in S. macedonicus that may have originated from pSMA198, also supporting a long co-existence of the two replicons. pSMA198 was also found in divergent biotypes of S. macedonicus and in strains isolated from dispersed geographic locations (e.g. Greece and Switzerland) showing that pSMA198’s acquisition is not a recent event. Conclusions/Significance: Here we propose that S. macedonicus acquired plasmid pSMA198 from L. lactis via an ancestral genetic exchange event that took place most probably in milk or dairy products. We provide important evidence that point towards the dairy origin of this species