Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia:a Multinational Point Prevalence Study of Hospitalised Patients

Pseudornonas aeruginosa is a challenging bacterium to treat due to its intrinsic resistance to the antibiotics used most frequently in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with P. aeruginosa-CAP are limited. We assessed the multinational burden and specific risk factors associated with P. aeruginosa-CAP. We enrolled 3193 patients in 54 countries with confirmed diagnosis of CAP who underwent microbiological testing at admission. Prevalence was calculated according to the identification of P. aeruginosa. Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant P. aeruginosa-CAP. The prevalence of P. aeruginosa and antibiotic-resistant P. aeruginosa-CAP was 4.2% and 2.0%, respectively. The rate of P. aeruginosa CAP in patients with prior infection/colonisation due to P. aeruginosa and at least one of the three independently associated chronic lung diseases (i.e. tracheostomy, bronchiectasis and/or very severe chronic obstructive pulmonary disease) was 67%. In contrast, the rate of P. aeruginosa-CAP was 2% in patients without prior P. aeruginosa infection/colonisation and none of the selected chronic lung diseases. The multinational prevalence of P. aeruginosa-CAP is low. The risk factors identified in this study may guide healthcare professionals in deciding empirical antibiotic coverage for CAP patients

Microbiological testing of adults hospitalised with community-acquired pneumonia: An international study

This study aimed to describe real-life microbiological testing of adults hospitalised with community-acquired pneumonia (CAP) and to assess concordance with the 2007 Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) and 2011 European Respiratory Society (ERS) CAP guidelines. This was a cohort study based on the Global Initiative for Methicillin-resistant Staphylococcus aureus Pneumonia (GLIMP) database, which contains point-prevalence data on adults hospitalised with CAP across 54 countries during 2015. In total, 3702 patients were included. Testing was performed in 3217 patients, and included blood culture (71.1%), sputum culture (61.8%), Legionella urinary antigen test (30.1%), pneumococcal urinary antigen test (30.0%), viral testing (14.9%), acute-phase serology (8.8%), bronchoalveolar lavage culture (8.4%) and pleural fluid culture (3.2%). A pathogen was detected in 1173 (36.5%) patients. Testing attitudes varied significantly according to geography and disease severity. Testing was concordant with IDSA/ATS and ERS guidelines in 16.7% and 23.9% of patients, respectively. IDSA/ATS concordance was higher in Europe than in North America (21.5% versus 9.8%; p<0.01), while ERS concordance was higher in North America than in Europe (33.5% versus 19.5%; p<0.01). Testing practices of adults hospitalised with CAP varied significantly by geography and disease severity. There was a wide discordance between real-life testing practices and IDSA/ATS/ERS guideline recommendations

Atypical pathogens in hospitalized patients with community-acquired pneumonia: A worldwide perspective

Background: Empirical antibiotic coverage for atypical pathogens in community-acquired pneumonia (CAP) has long been debated, mainly because of a lack of epidemiological data. We aimed to assess both testing for atypical pathogens and their prevalence in hospitalized patients with CAP worldwide, especially in relation with disease severity. Methods: A secondary analysis of the GLIMP database, an international, multicentre, point-prevalence study of adult patients admitted for CAP in 222 hospitals across 6 continents in 2015, was performed. The study evaluated frequency of testing for atypical pathogens, including L. pneumophila, M. pneumoniae, C. pneumoniae, and their prevalence. Risk factors for testing and prevalence for atypical pathogens were assessed through univariate analysis. Results: Among 3702 CAP patients 1250 (33.8%) underwent at least one test for atypical pathogens. Testing varies greatly among countries and its frequency was higher in Europe than elsewhere (46.0% vs. 12.7%, respectively, p < 0.0001). Detection of L. pneumophila urinary antigen was the most common test performed worldwide (32.0%). Patients with severe CAP were less likely to be tested for both atypical pathogens considered together (30.5% vs. 35.0%, p = 0.009) and specifically for legionellosis (28.3% vs. 33.5%, p = 0.003) than the rest of the population. Similarly, L. pneumophila testing was lower in ICU patients. At least one atypical pathogen was isolated in 62 patients (4.7%), including M. pneumoniae (26/251 patients, 10.3%), L. pneumophila (30/1186 patients, 2.5%), and C. pneumoniae (8/228 patients, 3.5%). Patients with CAP due to atypical pathogens were significantly younger, showed less cardiovascular, renal, and metabolic comorbidities in comparison to adult patients hospitalized due to non-atypical pathogen CAP. Conclusions: Testing for atypical pathogens in patients admitted for CAP in poorly standardized in real life and does not mirror atypical prevalence in different settings. Further evidence on the impact of atypical pathogens, expecially in the low-income countries, is needed to guidelines implementation

Prevalence and etiology of community-acquired pneumonia in immunocompromised patients

Background. The correct management of immunocompromised patients with pneumonia is debated. We evaluated the prevalence, risk factors, and characteristics of immunocompromised patients coming from the community with pneumonia. Methods. We conducted a secondary analysis of an international, multicenter study enrolling adult patients coming from the community with pneumonia and hospitalized in 222 hospitals in 54 countries worldwide. Risk factors for immunocompromise included AIDS, aplastic anemia, asplenia, hematological cancer, chemotherapy, neutropenia, biological drug use, lung transplantation, chronic steroid use, and solid tumor. Results. At least 1 risk factor for immunocompromise was recorded in 18% of the 3702 patients enrolled. The prevalences of risk factors significantly differed across continents and countries, with chronic steroid use (45%), hematological cancer (25%), and chemotherapy (22%) the most common. Among immunocompromised patients, community-acquired pneumonia (CAP) pathogens were the most frequently identified, and prevalences did not differ from those in immunocompetent patients. Risk factors for immunocompromise were independently associated with neither Pseudomonas aeruginosa nor non\u2013community-acquired bacteria. Specific risk factors were independently associated with fungal infections (odds ratio for AIDS and hematological cancer, 15.10 and 4.65, respectively; both P = .001), mycobacterial infections (AIDS; P = .006), and viral infections other than influenza (hematological cancer, 5.49; P < .001). Conclusions. Our findings could be considered by clinicians in prescribing empiric antibiotic therapy for CAP in immunocompromised patients. Patients with AIDS and hematological cancer admitted with CAP may have higher prevalences of fungi, mycobacteria, and noninfluenza viruses

Connaissance et conservation de la flore de l’île de Crète

The flora of Crete is now rather well known. The knowledges should be completed with datas about the ecological claims of the taxa and about the ecosystems. The Red lists of threatened plants of Crete should be corrected and actualised. The Cretan natural habitats are threats for a long time by human activities which endanger the survival of rare and endemic plants of the island. The planification and the gestion of protected areas is urgent.Les connaissances scientifiques relatives à la flore spontanée de la Crète sont actuellement relativement satisfaisantes. Elles devraient être complétées dans les domaines des exigences écologiques des espèces et du fonctionnement des écosystèmes. Les listes rouges des plantes menacées mériteraient d’être corrigées et actualisées. Les milieux naturels crétois subissent depuis très longtemps des atteintes dues aux activités humaines qui mettent en danger la survie d’espèces rares ou menacées, souvent endémiques de l’île. La détermination des zones à protéger et l’élaboration de plans de gestion est urgente.Montmollin Bertrand de, Iatrou Grigoris A. Connaissance et conservation de la flore de l’île de Crète. In: Ecologia mediterranea, tome 21 n°1-2, 1995. Connaissance et conservation de la flore des îles de la Méditerrannée. Ajaccio, Corse, France (5-8 octobre 1993) pp. 173-184

Latent Images : Monique Bertrand, Gabrielle de Montmollin, Ethan Eisenberg, Scott McLeod

Four photographers make brief remarks on their subject matter, which ranges from miniature figures, biker gangs in Florida and the Jewish cemetary in Prague to symbolic and allegorical imagery. Piitz states the gallery's objectives in holding exhibitions of contemporary Canadian photography. Biographical notes

Broad-ranged, highly disjunct, locally rare and severely endangered: the challenging risk assessment and a global conservation strategy for Erica sicula Guss. sensu lato (Ericaceae)

The distribution of Erica sicula Guss. sensu lato ranges throughout the central-Eastern Mediterranean Basin. However, this species, which probably represents one of the most ancestral members of the genus Erica, shows a significantly disjointed and fragmented distribution pattern and is subject to multiple threats, leading to continuous regression at the local scale. The species is distributed across five regions, Sicily, Libya, Cyprus, Anatolia and Lebanon, and counts two subspecies, subsp. sicula and subsp. bocquetii, represented by 29 and 8 subpopulations, respectively. This work provides a global update on the knowledge related to the distribution, ecology and conservation status of its two subspecies. New distributional analyses and ecologically relevant data were collected from fieldwork, literature and herbarium specimens. In Sicily, unmanned aerial systems and high-resolution digital elevation models were employed to perform a detailed census of the only extant subpopulation. This enabled a comprehensive mapping of its distribution and the calculation of its 3D occupation surface. Based on the result of our analyses, species is Least Concern (LC) at the global level, despite each subspecies and subpopulation being classified as nationally endangered. Erica sicula subsp. sicula was assessed as Critically Endangered (CR) (B1ab(i,ii,iii,iv) + 2ab(i,ii,iii,iv)) in northwestern Sicily where two out of the three subpopulations have probably disappeared. The situation of E. sicula subsp. sicula in eastern Mediterranean is equally alarming, being assessed under the category VU B1ab(i,ii,iii,iv) + 2ab(i,ii,iii,iv) in the three countries where it occurs; in Lebanon, it is severely threatened by the increasing impact of quarrying, urban sprawl, road and dam construction, in the island of Cyprus it is prone to the growing impact of goat overgrazing and fire, whilst in Anatolia it is affected by urban sprawl and coastal touristic development. In Libya, E. sicula subsp. sicula was evaluated as VU (B1ab(iii) + 2ab(iii)) considering the current degradation of the quality of its habitat. E. sicula subsp. bocquetii, previously known to occur only in few locations on the mountains of southern Anatolia and recently found in several other locations at lower altitudes, was assessed as VU (B1ab(iii) + 2ab(iii)). Further fieldwork is recommended to better assess the demographic trend of the different subpopulations. Moreover, genetic analyses are needed to clarify the taxonomic value of several infraspecific taxa previously described and help targeting future in-situ and ex-situ conservation projects on the most unique and genetically rich subpopulations. Improving knowledge and the conservation strategies of taxa like Erica sicula s.l. requires the expertise of specialists from all the countries concerned, making it essential to maintain networks of experts in the Mediterranean

Broad-ranged, highly disjunct, locally rare and severely endangered: the challenging risk assessment and a global conservation strategy for Erica sicula Guss. sensu lato (Ericaceae)

The distribution of Erica sicula Guss. sensu lato ranges throughout the central-Eastern Mediterranean Basin. However, this species, which probably represents one of the most ancestral members of the genus Erica, shows a significantly disjointed and fragmented distribution pattern and is subject to multiple threats, leading to continuous regression at the local scale. The species is distributed across five regions, Sicily, Libya, Cyprus, Anatolia and Lebanon, and counts two subspecies, subsp. sicula and subsp. bocquetii, represented by 29 and 8 subpopulations, respectively. This work provides a global update on the knowledge related to the distribution, ecology and conservation status of its two subspecies. New distributional analyses and ecologically relevant data were collected from fieldwork, literature and herbarium specimens. In Sicily, unmanned aerial systems and high-resolution digital elevation models were employed to perform a detailed census of the only extant subpopulation. This enabled a comprehensive mapping of its distribution and the calculation of its 3D occupation surface. Based on the result of our analyses, species is Least Concern (LC) at the global level, despite each subspecies and subpopulation being classified as nationally endangered. Erica sicula subsp. sicula was assessed as Critically Endangered (CR) (B1ab(i,ii,iii,iv) + 2ab(i,ii,iii,iv)) in northwestern Sicily where two out of the three subpopulations have probably disappeared. The situation of E. sicula subsp. sicula in eastern Mediterranean is equally alarming, being assessed under the category VU B1ab(i,ii,iii,iv) + 2ab(i,ii,iii,iv) in the three countries where it occurs; in Lebanon, it is severely threatened by the increasing impact of quarrying, urban sprawl, road and dam construction, in the island of Cyprus it is prone to the growing impact of goat overgrazing and fire, whilst in Anatolia it is affected by urban sprawl and coastal touristic development. In Libya, E. sicula subsp. sicula was evaluated as VU (B1ab(iii) + 2ab(iii)) considering the current degradation of the quality of its habitat. E. sicula subsp. bocquetii, previously known to occur only in few locations on the mountains of southern Anatolia and recently found in several other locations at lower altitudes, was assessed as VU (B1ab(iii) + 2ab(iii)). Further fieldwork is recommended to better assess the demographic trend of the different subpopulations. Moreover, genetic analyses are needed to clarify the taxonomic value of several infraspecific taxa previously described and help targeting future in-situ and ex-situ conservation projects on the most unique and genetically rich subpopulations. Improving knowledge and the conservation strategies of taxa like Erica sicula s.l. requires the expertise of specialists from all the countries concerned, making it essential to maintain networks of experts in the Mediterranean

A Common Approach to the Conservation of Threatened Island Vascular Plants: First Results in the Mediterranean Basin

The Mediterranean islands represent a center of vascular plant diversity featuring a high rate of endemic richness. Such richness is highly threatened, however, with many plants facing the risk of extinction and in need of urgent protection measures. The CARE-MEDIFLORA project promoted the use of ex situ collections to experiment with in situ active actions for threatened plants. Based on common criteria, a priority list of target plant species was elaborated, and germplasm conservation, curation and storage in seed banks was carried out. Accessions were duplicated in the seed banks of the partners or other institutions. Germination experiments were carried out on a selected group of threatened species. A total of 740 accessions from 429 vascular plants were stored in seed banks, and 410 seed germination experiments for 283 plants species were completed; a total of 63 in situ conservation actions were implemented, adopting different methodological protocols. For each conservation program, a specific monitoring protocol was implemented in collaboration with local and regional authorities. This project represents the first attempt to develop common strategies and an opportunity to join methods and methodologies focused on the conservation of threatened plants in unique natural laboratories such as the Mediterranean islands

Active management actions for the conservation of the endangered Mediterranean island flora: the CARE-MEDIFLORA project

The Mediterranean Basin is one of the world's most biodiverse regions and it roughly counts 30,000 different plant taxa, of which approximately 50% are endemic taxa to the region. Thus, this area has been recognized among the world's 34 biodiversity hotspots. Furthermore, the rate of endemism of the big Mediterranean islands is higher than that usually recorded in the neighbouring mainland areas. Plants are vulnerable to many threats mainly represented by physical factors, such as climate change, extreme weather events, recurrent fires, agriculture, as well as by biological factors, such as invasive species and pests. All these factors are particularly worrying in island ecosystems where urban sprawl and human activities may represent a major source of threat hampering the preservation of important habitats and plant species, especially when circumscribed to small areas. In addition, less than 10% of these areas is protected (e.g. nature reserves, regional or national parks, etc.) and, likely most worrying, their management is not always based on the specific scientifically based plant needs. Given these circumstances, many plant species of the Mediterranean area are facing the risk of a severe decline and require urgent protection measures. While in-situ conservation is the fundamental approach to biodiversity conservation, ex-situ conservation is an alternative and effective way to prevent immediate extinction. The CARE-MEDIFLORA project, an initiative of eigh institutions all having a long experience in plant conservation, will make a step forward by using ex situ collections to experiment with in situ active management actions and measures for some taxa within the period of three years of the project. The involved institutions will jointly work to address both short-term and long-term needs, including: (1) in situ conservation for some of the most endangered plant species of the Mediterranean islands through active management actions (e.g. reintroduction, reinforcement, fencing, etc.), in collaboration with the most relevant local authorities to ensure the sustainability of the results; (2) ex situ conservation of the most endangered plant species of the Mediterranean islands through the collection and seed banking of accessions that will be representative of the overall diversity of the selected taxa; (3) establishing a network connecting scientific institutions from the Mediterranean islands in order to ensure the circulation of information, knowledge and project results sustainability. In addition, great efforts will be devoted to the training of conservation plant specialists, in order to increase collaboration among institutions dealing with in situ and ex situ conservation and to increase awareness about the vulnerability of the native flora through the involvement of local stakeholders and environment-related agencies