Non-fermentative gram-negative bloodstream infection in northern Italy: a multicenter cohort study

Background: The management of non-fermentative gram-negative bloodstream infection (NFGN-BSI) offers numerous challenges. In this study the aim is to analyse a large cohort of patients with NFGN-BSI recruited in the northern Italy to describe epidemiology, etiological and susceptibility pattern, therapeutic management and outcome. Methods: Multicentre retrospective cohort study of patients hospitalised at three large teaching hospitals in northern Italy in a fourth year period. Results: 355 BSI episodes were analyzed, due to P. aeruginosa (72.7%), A. baumannii (16.6%), and Stenotrophomonas maltophilia (10.7%). Overall, 21.4% of isolates were defined as DTR, highest rate among A. baumannii (64.4%). All-cause 30-day mortality rate was 17.5%. Rates of XDR or DTR A. baumannii isolation were significantly higher in non-surviving patients. Independent risk factors for 30-day mortality were: age (HR 1.03, 95%CI 1.00–1.04, p = 0.003), septic shock (HR 2.84, 95%CI 1.67–4.82, p < 0.001) and BSI due to Acinetobacter baumannii (HR 2.23, 95%CI 1.27–3.94, p = 0.005). Conclusion: The overall prevalence of DTR was high in the NFGN BSI cohort analyzied, mainly among Acinetobacter baumannii episodes (64.4%). Acinetobacter baumannii is showed to be an independent predictor of mortality. These evidences marked the urgent need of new therapeutic options against this pathogen. Trial registration number: 79/2017/O/OssN. Approved: March14th, 2017

Non-fermentative gram-negative bloodstream infection in northern Italy: a multicenter cohort study

BACKGROUND: The management of non-fermentative gram-negative bloodstream infection (NFGN-BSI) offers numerous challenges. In this study the aim is to analyse a large cohort of patients with NFGN-BSI recruited in the northern Italy to describe epidemiology, etiological and susceptibility pattern, therapeutic management and outcome. METHODS: Multicentre retrospective cohort study of patients hospitalised at three large teaching hospitals in northern Italy in a fourth year period. RESULTS: 355 BSI episodes were analyzed, due to P. aeruginosa (72.7%), A. baumannii (16.6%), and Stenotrophomonas maltophilia (10.7%). Overall, 21.4% of isolates were defined as DTR, highest rate among A. baumannii (64.4%). All-cause 30-day mortality rate was 17.5%. Rates of XDR or DTR A. baumannii isolation were significantly higher in non-surviving patients. Independent risk factors for 30-day mortality were: age (HR 1.03, 95%CI 1.00–1.04, p = 0.003), septic shock (HR 2.84, 95%CI 1.67–4.82, p < 0.001) and BSI due to Acinetobacter baumannii (HR 2.23, 95%CI 1.27–3.94, p = 0.005). CONCLUSION: The overall prevalence of DTR was high in the NFGN BSI cohort analyzied, mainly among Acinetobacter baumannii episodes (64.4%). Acinetobacter baumannii is showed to be an independent predictor of mortality. These evidences marked the urgent need of new therapeutic options against this pathogen. Trial registration number: 79/2017/O/OssN. Approved: March14th, 2017. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-021-06496-8

From Cheese Whey Permeate To An Anti-Listeria Food Packaging Device: Bacterial Cellulose Nanocrystals/Sakacin-A Conjugates (Nanosak)

In the present project cheese whey permeate (CWP), the residual by-product obtained by extraction of whey proteins from cheese whey, was used as substrate for the growth of bacterial species that produce two appealing molecules: the anti-listerial bacteriocin sakacin-A and bacterial cellulose (BC). BC is then turned into nanocrystals (BCNCs) that are finally conjugated with sakacin-A to obtain an innovative antimicrobial device for food which could support Listeria monocytogenes growth. Sakacin-A was produced by Lactobacillus sakei DSMZ 6333 in liquid cultures. The highest bacteriocin production (around 300 AU/mL) was achieved after 9 h at 26\ub0C; a food-grade, salt-free enriched sakacin-A extract was obtained by using a gravity reverse phase chromatography. BC was produced by Komagataeibacter xylinus DSMZ 2325 by static fermentation of CWP in presence of 0.5 U/mL of \u3b2-galactosidase at 30\ub0C; after 7 days, BC yield was around 7 g/L. BCNCs were then obtained by acid hydrolysis mediated by sulfuric acid, with the goal of removing the amorphous regions of BC and introduce a net negative charge by esterification on the hydroxyl group on C6. BCNCs/sakacin-A conjugates were prepared by exploiting their opposite charge: enriched sakacin-A extract was mixed with BCNCs and, after incubation, conjugates collected by centrifugation have a specific activity of 100 AU/mg BCNCs. Among all peptides present in the enriched sample, sakacin-A appears to preferentially absorb onto BCNCs, thus allowing its further purification. Sakacin-A as well its BCNCs conjugates were then included in a hydroxypropil-cellulose coating spread onto paper sheets at a concentration of 5 and 25 AU/cm2. The addition of the coating did not bring any significant change in the oxygen barrier properties of the cellulosic substrate. In a similar way, the static contact angle of both uncoated and coated substrate was of approximately 130\ub0. However, the presence of BCNCs seemed to increase the swelling phenomenon of the coating. Sakacin A was also included in whey, caseine and cellulose derived matrices to prepare films and coatings with diverse results. The kinetics of Sakacin-A released from active films to aqueous food was analyzed by immersion of samples in water (as simulant) and measuring the anti-Listeria activity of the simulant after increasing times of exposure. In vitro and in vivo antimicrobial trials were carried out on real food products demonstrated their anti-listerial effectiveness, proving that the developed devices can contribute to increase shelf life, quality and safety of perishable foods

Incidence and prognosis of ventilator-associated pneumonia in critically ill patients with covid-19: A multicenter study

The primary objective of this multicenter, observational, retrospective study was to assess the incidence rate of ventilator-associated pneumonia (VAP) in coronavirus disease 2019 (COVID-19) patients in intensive care units (ICU). The secondary objective was to assess predictors of 30-day case-fatality of VAP. From 15 February to 15 May 2020, 586 COVID-19 patients were admitted to the participating ICU. Of them, 171 developed VAP (29%) and were included in the study. The incidence rate of VAP was of 18 events per 1000 ventilator days (95% confidence intervals [CI] 16–21). Deep respiratory cultures were available and positive in 77/171 patients (45%). The most frequent organisms were Pseudomonas aeruginosa (27/77, 35%) and Staphylococcus aureus (18/77, 23%). The 30-day case-fatality of VAP was 46% (78/171). In multivariable analysis, septic shock at VAP onset (odds ratio [OR] 3.30, 95% CI 1.43–7.61, p = 0.005) and acute respiratory distress syndrome at VAP onset (OR 13.21, 95% CI 3.05–57.26, p &lt; 0.001) were associated with fatality. In conclusion, VAP is frequent in critically ill COVID-19 patients. The related high fatality is likely the sum of the unfavorable prognostic impacts of the underlying viral and the superimposed bacterial diseases

Comparative life cycle assessment of cellulose nanofibres production routes from virgin and recycled raw materials

Nanocellulose-based materials are attracting an increasing interest for the positive role they could play in sustainable development; being originated from renewable resources. Moreover, cellulose has a high potential of recycling from both post-consumer waste and industrial waste. Both factors, i.e., recyclability and renewable resources; results are also extremely favourable in the perspective of circular economy. Despite all these positive aspects, an industrial production has yet to start. At the lab scale, many preparation methods of cellulose nanofibres (CNF) are available; here, the three most common are analysed: (1) enzymatic pre-treatment followed by homogenisation (ENZHO), (2) oxidative pre-treatment combined with homogenisation (TOHO) or (3) oxidative pre-treatment followed by sonication (TOSO). All three processes have been experimentally carried out starting from both virgin and recycled cellulose from industrial waste sludge. The environmental sustainability of these three routes is estimated by the Life Cycle Assessment (LCA) using experimental lab scale data. In this scenario, the comparative LCA has pointed out a superior performance of the ENZHO process, followed by TOHO and, lastly, by TOSO. The influence of energy consumption on the final results has been further investigated by a sensitivity analysis, showing that the TOHO and TOSO routes could reach similar performances by scaling-up the process from the laboratory. The different typology of CNF obtained by conducting the ENZHO process with respect to the TEMPO-mediated oxidation approach is also outlined as an additional element to be considered for the final selection of a suitable process

Plasma trough concentrations of darunavir/ritonavir and raltegravir in older patients with HIV-1 infection.

OBJECTIVES: The aim of the study was to assess plasma concentrations of darunavir/ritonavir and raltegravir in older patients compared with younger patients with HIV-1 infection. METHODS: In this observational, open-label study, adult HIV-infected out-patients aged 64 40 years (younger patients) or 65 60 years (older patients) and treated with tenofovir/emtricitabine plus darunavir/ritonavir (800/100 mg daily) or raltegravir (400 mg twice daily) were asked to participate. The trough concentrations (Ctrough ) of darunavir/ritonavir and raltegravir were assessed at steady state using a validated high-performance liquid chromatography (HPLC)-tandem mass spectrometry method. RESULTS: A total of 88 HIV-positive patients were enrolled in the study. Forty-six patients were treated with darunavir/ritonavir, and 42 with raltegravir. The geometric mean plasma Ctrough (coefficient of variation) of raltegravir was comparable between the 19 older and 23 younger subjects: 106 ng/mL (151%) and 94 ng/mL (129%), respectively [geometric mean ratio (GMR) 0.85; 95% confidence interval (CI) 0.71-1.57; P = 0.087]. In contrast, the geometric mean plasma Ctrough of darunavir was significantly higher among the 21 older patients [2209 ng/mL (139%)] than among the 25 younger patients [1876 ng/mL (162%); GMR 1.56; 95% CI: 1.22-1.88; P = 0.004]. Similarly, the geometric mean Ctrough of ritonavir was significantly higher among older than among younger individuals. CONCLUSIONS: The mean plasma Ctrough of darunavir and ritonavir was significantly higher in older patients than in younger patients with HIV-1 infection, while the mean plasma level of raltegravir was comparable in the two groups. However, both regimens showed good tolerability in both younger and older subjects

Full-Scale Shake Table Tests of a Reinforced Concrete Building Equipped with a Novel Servo-Hydraulic Active Mass Damper

This paper presents the results of an experimental program involving shake table testing of two full-scale reinforced concrete frame buildings. These tests were conducted to investigate the effectiveness and reliability of a newly proposed servo-hydraulic Active Mass Damper (AMD) that can be designed to enhance the target seismic performance of a building at multiple earthquake intensity levels. The two nominally identical case-study buildings were intentionally designed to exhibit a "soft story" mechanism at the first level when subject to ground shaking of sufficient intensity, but one was equipped with the newly proposed AMD, installed on the roof. The two specimens were then subject to the same loading protocol consisting of a ground shaking sequence of varying intensity, with the seismic input consisting of a selected natural ground motion.The experimental results demonstrated that the proposed AMD is extremely effective at enhancing building seismic performance. Specifically, the AMD provided peak displacement reductions in the order of 70% and was shown capable of absorbing more than 60% of the total input energy. As a consequence, the un-retrofitted structure suffered nontrivial structural and non-structural damage, while the AMD-retrofitted building remained virtually undamaged at all shaking intensities considered

Induction of adhesion molecules on human Schwann cells, an immunofluorescence study.

The presence of cytokines in the peripheral nerve was positively correlated to the induction and progression of inflammation during experimental allergic neuritis (EAN) and Guillain Barr\ue9 syndrome (GBS). We investigated the induction of adhesion molecules such as L-selectin, E-selectin, ICAM-1, VCAM-1 and Mac-1 on Schwann cells by proinflammatory cytokines. Cultured human Schwann cells from normal adult, fetal and diabetic nerves were studied by immunofluorescence at basal condition and after stimulation with cytokines for 6, 24, 48 and 96 h. Incubation of human Schwann cells with TNF\u3b1, IFN\u3b3 and IL-1\u3b2 induces the expression of ICAM-1 starting at 6 h and reaching a peak at 24 h on more than 90% of cells. VCAM-1 expression was induced after 6 h of treatment with TNF\u3b1 and IL-1\u3b2 on almost 100% of Schwann cells. Surprisingly, stimulation with TNF\u3b1, IFN\u3b3 and IL-1\u3b2 also induced the expression of L-selectin on fetal and diabetic Schwann cells, but not on normal adult cells. E-selectin, an adhesion molecule classically upregulated during inflammation, as well as Mac-1, a ligand for ICAM-1, were not expressed on human Schwann cells at basal condition or after treatment with cytokines. No ICAM-1, VCAM-1 and L-selectin expression was found on unstimulated Schwann cells. Our results suggest that upregulation of adhesion molecules on Schwann cells may have a role in the pathogenesis of inflammation in the peripheral nerve

Follow-up blood cultures are associated with improved outcome of patients with gram-negative bloodstream infections: retrospective observational cohort study

none12noObjectives: We examined factors associated with follow-up blood cultures (FUBCs) in patients with monomicrobial Gram-negative (GN) bloodstream infection (BSI) and investigated the impact of FUBCs on therapeutic management and patient outcome. Methods: A retrospective cohort analysis was conducted of adult patients diagnosed with GN-BSI at a tertiary-care university hospital during 2013–2016. FUBCs performed between 24 hours and 7 days after index BCs was the exposure variable. Risk factors for 30-day mortality were analysed by multivariate Cox analysis on the overall cohort, including FUBCs as a time-varying covariate and on 1:1 matched patients according to Sequential Organ Failure Assessment (SOFA) score and time to FUBC. Results: In 278 (17.6%) of 1576 patients, FUBCs were performed within a median of 3 and 2 days after index BCs and active antibiotic therapy initiation. Persistent BSI was found in 107 (38.5%) of 278 patients. FUBCs were performed in more severely ill patients, with nonurinary sources, difficult-to-treat pathogens and receipt of initial inappropriate therapy. Source control and infectious disease consultation rates were higher among patients with preceding FUBCs and was associated with longer treatment duration. Thirty-day mortality was 10.4%. Independent risk factors for mortality were Charlson comorbidity index (hazard ratio (HR) 1.12) SOFA (HR 1.11), septic shock (HR 2.64), urinary source (HR 0.60), central venous catheter source (HR 2.30), complicated BSI (HR 2.10), carbapenem resistance (HR 2.34), active empiric therapy (HR 0.68), source control (HR 0.34) and FUBCs (HR 0.48). Association between FUBCs and lower mortality was confirmed in the 274 matched pairs. Conclusions: FUBCs were performed in more severe GN-BSIs, yielding a high rate of persistent BSI. In this context, FUBCs were associated with lower mortality.mixedGiannella M.; Pascale R.; Pancaldi L.; Monari C.; Ianniruberto S.; Malosso P.; Bussini L.; Bartoletti M.; Tedeschi S.; Ambretti S.; Lewis R.; Viale P.Giannella M.; Pascale R.; Pancaldi L.; Monari C.; Ianniruberto S.; Malosso P.; Bussini L.; Bartoletti M.; Tedeschi S.; Ambretti S.; Lewis R.; Viale P