Microbiological and molecular characteristics of carbapenemase-producing klebsiella pneumoniae endemic in a tertiary Greek hospital during 2004-2010

We report 570 carbapenemase-producing Klebsiella pneumoniae (CPKP) clinical isolates in a 1,040-bed Greek tertiary hospital during 2004 to 2010. The first CPKP (VIM-producing) was isolated in September 2004. Despite initial containment, VIM producers have become endemic since 2006. KPC-producing K. pneumoniae was first isolated in August 2007 from a patient who came from Israel, spread rapidly, and outcompeted VIM. Overall, 267 (47%) VIM-producing and 301 (53%) KPC-producing strains were isolated, including 141 (24.7%) from patients with bacteraemia. Two isolates carrying both VIM and KPC were isolated in two consecutive months in 2009, but not since. The prevalence of CPKP increased from 0% in 2003 to 38.3% in 2010 (

Inflammatory cytokines in newborn infants.

Serum levels of IL-1beta, IL-6 and TNF-alpha were measured in 48 healthy, termed neonates on the 1st (N1), 5th (N5) and 40th (N40) day after birth, compared with those in maternal serum (MS), umbilical cord (UC) and adult controls. Cytokine values in N1 and N5 were significantly elevated, than those in UC and in controls (P<0.0001). IL-1beta and IL-6 declined significantly from N1 to N40 (P<0.0001), while TNF-alpha increased significantly from N1 to N5 and declined thereafter. MS infinity IL-1beta and IL-6, but not MS infinity TNF-alpha, were significantly higher than those of controls (P<0.0001). IL-1beta values depended on the mode of delivery. In conclusion, the increased concentrations of IL-1beta, IL-6 and TNF-alpha during the perinatal period might suggest their involvement in an inflammation-like process during normal parturition, and reflect also a newborn immune response to the stress of delivery and environmental changes

European CO budget and links with synoptic circulation based on GEOS-CHEM model simulations

The European carbon monoxide (CO) budget is studied in relation to the synoptic circulation throughout 2001, using the nested-grid configuration of the GEOS-CHEM global model and CO measurements from 31 rural background stations. To meet the aims of this study, a seasonal circulation type (CT) classification is developed for the Northern Hemisphere based on mean sea-level pressure (SLP) fields, as well as two upper atmospheric levels, over a 60-yr period. The highest contribution to the European surface CO concentrations is attributed to regional anthropogenic sources (up to ~80%), which become more important under the prevalence of anticyclonic circulation conditions. The corresponding contribution of the long-range transport (LRT) from North America (up to 18%) and Asia (up to 20%) is found highest (lowest) in winter and spring (summer and autumn). The transport of the CO towards Europe in winter is more intense under cyclonic circulation, while both cyclonic and anticyclonic patterns favour LRT during other seasons. Occasionally (mainly in winter and spring), LRT contribution is higher than the regional one (up to 45%). In the free troposphere, the LRT contribution increases, with the largest impact originating from Asia. This flow is favoured by the intense easterly circulation in summer, contributing up to 30% in the Eastern Mediterranean during this season. On the other hand, the regional contribution in the upper levels decreases to 22%. The contribution of CO chemical production is significant for the European CO budget at all levels and seasons, exceeding 50% in the free troposphere during summer. ©2013 A. P. Protonotariou et al

Trends in antimicrobial resistance of clinical isolates of Enterococcus faecalis and Enterococcus faecium in Greece between 2002 and 2007

We analysed trends in antimicrobial resistance of Enterococcus faecalis (N=1498) and E. faecium (N=625) recovered from clinical infections during 2002-2007 in a Greek tertiary care hospital. Molecular assays were used to confirm speciation and genotype of vancomycin-resistant enterococci (VRE). The incidence of infections per 1000 admissions caused by E. faecalis and E. faecium increased during the study period (χ2 for trend=25.5 and 13.3, respectively; P&amp;lt;0.0001). Resistance to ampicillin, high level gentamicin and streptomycin, vancomycin, teicoplanin and linezolid was found in E. faecalis/E. faecium at rates of 1.3/82.4%, 45.6/51.2%, 48.9/69.1%, 0.5/9.6%, 0.1/8.2% and 0.3/1.6%, respectively. The vanA gene was identified in 79.1% of the VRE isolates, with vanB found in the remaining 20.1%. Analysis of antimicrobial resistance trends showed consistently high rates of ampicillin resistance among E. faecium isolates. For both enterococcal species, high level resistance to gentamicin and streptomycin were noted to have increased significantly (P&amp;lt;0.0001). Regardless of these alarming trends, strains exhibiting resistance to oxazolidinones seem to be only sporadic in our region and a trend toward increasing resistance rates to glycopeptides was not detected. © 2009 The Hospital Infection Society

Alterations in Th1/Th2 cytokine concentrations in early neonatal life

Objective: To determine postnatal changes in neonatal serum concentrations of interferon-γ (IFN-γ), interleukin-4 (IL-4) and its soluble receptor (sIL-4R). Methods: Forty-five healthy term neonates, 25 of the neonates&apos; mothers and 27 healthy adults (controls) participated in the study. Cytokine concentrations were measured in blood samples from the umbilical cord, from the neonates on the 1st and 5th day after birth, from mothers and from controls. Results: IFN-γ concentrations were significantly lower in the umbilical cord, compared to concentrations in the controls (p &lt; 0.04), and increased significantly from the umbilical cord to levels in neonates on day 5 (p &lt; 0.03). In mothers and the umbilical cord, IFN-γ concentrations were dependent on the mode of delivery, being higher after vaginal delivery than after elective Cesarean section (p &lt; 0.005; p &lt; 0.006, respectively). IL-4 concentrations in the umbilical cord for 1-day and 5-day neonates were significantly elevated compared to those in mothers (p &lt; 0.001; p &lt; 0.0007; p &lt; 0.0001, respectively) and controls (p &lt; 0.05; p &lt; 0.01; p &lt; 0.006, respectively). sIL-4R concentrations in all neonatal samples were significantly elevated compared to those in controls (p &lt; 0.0001), the highest being found in 1-day-old neonates. A strong negative correlation was found between IL-4 and sIL-4R concentrations in 1- and 5-day-old neonates (r = -0.48, p &lt; 0.002; r = -0.45, p &lt; 0.0065, respectively). Moreover, IFN-γ/IL-4 ratio increased significantly from the umbilical cord to 5 days of life (p &lt; 0.03). Conclusions: Our findings indicate an earlier development of IL-4 than IFN-γ, which could be viewed as a developmental characteristic in the ontogeny of the immune system

Trends in antimicrobial resistance of clinical isolates of Enterococcus faecalis and Enterococcus faecium in Greece between 2002 and 2007

We analysed trends in antimicrobial resistance of Enterococcus faecalis (N = 1498) and E. faecium (N = 625) recovered from clinical infections during 2002-2007 in a Greek tertiary care hospital. Molecular assays were used to confirm speciation and genotype of vancomycin-resistant enterococci (VRE). The incidence of infections per 1000 admissions caused by E. faecalis and E. faecium increased during the study period (chi(2) for trend = 25.5 and 13.3, respectively; P < 0.0001). Resistance to ampicillin, high level gentamicin and streptomycin, vancomycin, teicoplanin and linezolid was found in E. faecalis I E. faecium at rates of 1.3/82.4%, 45.6/51.2%, 48.9/69.1%, 0.5/9.6%, 0.1/8.2% and 0.3/1.6%, respectively. The vanA gene was identified in 79.1% of the VRE isolates, with vanB found in the remaining 20.1%. Analysis of antimicrobial resistance trends showed consistently high rates of ampicillin resistance among E. faecium isolates. For both enterococcal species, high level resistance to gentamicin and streptomycin were noted to have increased significantly (P < 0.0001). Regardless of these alarming trends, strains exhibiting resistance to oxazolidinones seem to be only sporadic in our region and a trend toward increasing resistance rates to glycopeptides was not detected. (C) 2009 The Hospital Infection Society. Published by Elsevier Ltd. All rights reserved

Long-range transport of Saharan dust and chemical transformations over the Eastern Mediterranean

Three recent Saharan dust outbreaks during different seasons (4-6 days in winter of 2009, late autumn of 2010 and summer of 2011) are selected in order to study the chemical footprint and aging processes of dust intrusions over the Eastern Mediterranean (EM). The applied model system (PMCAMx, WRF and GEOS-CHEM) and methodology are found competent to reproduce dust production, long-range transport and chemical transformations over the EM, with the synergistic use of synoptic patterns analysis, optical depth retrievals, back-trajectories, surface and satellite aerosol measurements. The dust loads were high during the cold period events and much lighter during summertime, when transport was mainly in the free troposphere. In all cases, dust originated from the northwest and/or west Saharan desert and reached the EM from the west/southwest. Sensitivity runs underlie the effect of dust transport on the chemical constituents of aerosols over the EM and show a large impact on calcium (70-90% of maximum daily values 2-5 μg m-3), with its gradient at surface level being around -10% per 100 km along the dust pathway. For the cold period cases, this value can also be considered analogous to the dust dissipation ratio, because the plume is vertically extended down to the surface layers. Interestingly, the surface particulate nitrate concentrations over the EM are reversely affected by the approaching dust loads, exhibiting the highest values (up to 6 μg m-3) and the largest dust fraction (ca. 70%) during summertime. This is attributed to the enhanced nitric acid formation under high atmospheric temperature and insolation, its uptake onto the carbonate dust particles, and their effective accumulation, due to low deposition rates over the sea and scarce precipitation. Sulfate formation onto dust particles is found insignificant (rapid reaction with ammonia and/or sea-salt), while the influence of dust and sea-salt on sodium, when spatio-temporal averages are calculated, is approximately equal. © 2016 Elsevier Ltd

Cytokine soluble receptors in perinatal and early neonatal life

BACKGROUND: In contrast to cellular receptors, soluble receptors do not enhance the cellular activation because they do not have transmembranic and cytoplasmic parts, acting thereby as endogenous regulatory mechanisms against systemic functions of cytokines. Aim: To measure serum concentrations of the soluble interleukin-2 receptor (sIL2R), soluble interleukin-4 receptor (sIL4R), soluble interleukin-6 receptor (sIL6R), and soluble tumor necrosis factor-α receptor I and soluble tumor necrosis factor-α receptor II, during the perinatal and early neonatal period, in order to evaluate their role in activation of immune response in labor and the first days postpartum. Methods: Soluble receptor serum concentrations were determined by enzyme-linked immunosorbent assay, in 45 healthy, full-termed neonates during the first and fifth days after birth, in 25 of their mothers (MS), in 25 samples of umbilical cords (UC) and in 25 healthy adult donors age-matched with the mothers (controls). Results: Soluble receptor serum concentrations showed considerable changes during labor and early neonatal life, being significantly higher both in MS (except sIL6R) and in neonatal sample UC, first and fifth days after birth, compared with controls (p &lt; 0.0001). Neonatal serum sIL2R and sIL6R increased significantly from birth to the fifth day, while the remaining receptors showed a rapid increase in the first day (p &lt; 0.0001), declining significantly thereafter (p &lt; 0.0001). Conclusion: Our Findings suggest that the elevated concentrations of all studied soluble cytokine receptors reflect the activation of immune response, and represent also regulatory protective mechanisms for mother and fetus-neonate against the systemic function of cytokines during labor and early neonatal life