Management of multidrug resistant Gram-negative bacilli infections in solid organ transplant recipients: SET/GESITRA-SEIMC/REIPI recommendations

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant (MDR) Gram-negative bacilli (GNB), as they are frequently exposed to antibiotics and the healthcare setting, and are regulary subject to invasive procedures. Nevertheless, no recommendations concerning prevention and treatment are available. A panel of experts revised the available evidence; this document summarizes their recommendations: (1) it is important to characterize the isolate´s phenotypic and genotypic resistance profile; (2) overall, donor colonization should not constitute a contraindication to transplantation, although active infected kidney and lung grafts should be avoided; (3) recipient colonization is associated with an increased risk of infection, but is not a contraindication to transplantation; (4) different surgical prophylaxis regimens are not recommended for patients colonized with carbapenem-resistant GNB; (5) timely detection of carriers, contact isolation precautions, hand hygiene compliance and antibiotic control policies are important preventive measures; (6) there is not sufficient data to recommend intestinal decolonization; (7) colonized lung transplant recipients could benefit from prophylactic inhaled antibiotics, specially for Pseudomonas aeruginosa; (8) colonized SOT recipients should receive an empirical treatment which includes active antibiotics, and directed therapy should be adjusted according to susceptibility study results and the severity of the infection.J.T.S. holds a research contract from the Fundación para la Formación e Investigación de los Profesionales de la Salud de Extremadura (FundeSalud), Instituto de Salud Carlos III. M.F.R. holds a clinical research contract “Juan Rodés” (JR14/00036) from the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III

Role of age and comorbidities in mortality of patients with infective endocarditis

Purpose: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. Methods: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015. Patients were stratified into three age groups:<65 years, 65 to 80 years, and = 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. Results: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 = 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients =80 years who underwent surgery were significantly lower compared with other age groups (14.3%, 65 years; 20.5%, 65-79 years; 31.3%, =80 years). In-hospital mortality was lower in the <65-year group (20.3%, <65 years;30.1%, 65-79 years;34.7%, =80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%, =80 years; p = 0.003).Independent predictors of mortality were age = 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI = 3 (HR:1.62; 95% CI:1.39–1.88), and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared, the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. Conclusion: There were no differences in the clinical presentation of IE between the groups. Age = 80 years, high comorbidity (measured by CCI), and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Role of age and comorbidities in mortality of patients with infective endocarditis

[Purpose]: The aim of this study was to analyse the characteristics of patients with IE in three groups of age and to assess the ability of age and the Charlson Comorbidity Index (CCI) to predict mortality. [Methods]: Prospective cohort study of all patients with IE included in the GAMES Spanish database between 2008 and 2015.Patients were stratified into three age groups:<65 years,65 to 80 years,and ≥ 80 years.The area under the receiver-operating characteristic (AUROC) curve was calculated to quantify the diagnostic accuracy of the CCI to predict mortality risk. [Results]: A total of 3120 patients with IE (1327 < 65 years;1291 65-80 years;502 ≥ 80 years) were enrolled.Fever and heart failure were the most common presentations of IE, with no differences among age groups.Patients ≥80 years who underwent surgery were significantly lower compared with other age groups (14.3%,65 years; 20.5%,65-79 years; 31.3%,≥80 years). In-hospital mortality was lower in the <65-year group (20.3%,<65 years;30.1%,65-79 years;34.7%,≥80 years;p < 0.001) as well as 1-year mortality (3.2%, <65 years; 5.5%, 65-80 years;7.6%,≥80 years; p = 0.003).Independent predictors of mortality were age ≥ 80 years (hazard ratio [HR]:2.78;95% confidence interval [CI]:2.32–3.34), CCI ≥ 3 (HR:1.62; 95% CI:1.39–1.88),and non-performed surgery (HR:1.64;95% CI:11.16–1.58).When the three age groups were compared,the AUROC curve for CCI was significantly larger for patients aged <65 years(p < 0.001) for both in-hospital and 1-year mortality. [Conclusion]: There were no differences in the clinical presentation of IE between the groups. Age ≥ 80 years, high comorbidity (measured by CCI),and non-performance of surgery were independent predictors of mortality in patients with IE.CCI could help to identify those patients with IE and surgical indication who present a lower risk of in-hospital and 1-year mortality after surgery, especially in the <65-year group

Vampires in the village Žrnovo on the island of Korčula: following an archival document from the 18th century

Središnja tema rada usmjerena je na raščlambu spisa pohranjenog u Državnom arhivu u Mlecima (fond: Capi del Consiglio de’ Dieci: Lettere di Rettori e di altre cariche) koji se odnosi na događaj iz 1748. godine u korčulanskom selu Žrnovo, kada su mještani – vjerujući da su se pojavili vampiri – oskvrnuli nekoliko mjesnih grobova. U radu se podrobno iznose osnovni podaci iz spisa te rečeni događaj analizira u širem društvenom kontekstu i prate se lokalna vjerovanja.The main interest of this essay is the analysis of the document from the State Archive in Venice (file: Capi del Consiglio de’ Dieci: Lettere di Rettori e di altre cariche) which is connected with the episode from 1748 when the inhabitants of the village Žrnove on the island of Korčula in Croatia opened tombs on the local cemetery in the fear of the vampires treating. This essay try to show some social circumstances connected with this event as well as a local vernacular tradition concerning superstitions

Synergy between crystalline admixtures and nano-constituents in enhancing autogenous healing capacity of cementitious composites under cracking and healing cycles in aggressive waters

More than one century after its massive introduction in the building industry, concrete is still the most popular building material. Nevertheless, several critical infrastructures show severe signs of distress. This fact fostered, in recent years, the need of rethinking the design process of concrete structures, in view of reducing maintenance costs and extending their service life. This work has been performed in the framework of the H2020 project ReSHEALience (GA760824). The main idea behind the project is that the long-term behaviour of structures under extremely aggressive exposure conditions can highly benefit from the use of high performance materials, in the framework of durability-based design approaches. The project will tailor the composition of Ultra High Durability Concrete (UHDC), by upgrading the High-Performance Cementitious Composite/High-Performance Fibre Reinforced Cementitious Composite (HPCC/HPFRCC) concept through the incorporation of tailored nanoscale constituents focusing, among the others, on stimulating the autogenous self-healing capacity. This work shows the effectiveness of the aforementioned concept achieved through the incorporation in a reference HPFRCC of three types of nano-constituents: alumina nanofibers (0.25% by weight of cement), cellulose nanocrystals (0.15% by weight of cement) and cellulose nano-fibrils (0.15% by weight of cement). The influence of the nano-constituents has been analysed in terms of mechanical properties, such as flexural and compressive strength and on shrinkage and durability properties, analysed by means of sorptivity tests on un-cracked, cracked and self-healed specimens with reference to selected aggressive exposure scenarios representative of intended engineering applications of the investigated materials

Crystalline Admixture as Healing Promoter in Concrete Exposed to Chloride-Rich Environments: Experimental Study

The requirements on service life of reinforced concrete structures, as prescribed by design codes, may be difficult to be fulfilled in highly aggressive environments such as marine ones, in which premature degradation is most likely to occur. In the aforementioned situations, to avoid expensive repair activities, different protective systems, including, among the others, self-healing concrete, could be adopted. Researchers have found self-healing as a way to face degradation problems in chloride-rich environments. If a significant degree of crack sealing can be achieved, the physical properties of a cracked element can trend back to those of an identical uncracked element, which may also result in a slower penetration rate of aggressive substances. The main problem in exploiting this methodology is related to its reliability. In this context, an experimental program aimed at investigating the effectiveness of crystalline admixtures as healing stimulating agent in chloride-rich environments was carried out. The influence of the exposure conditions on the compressive strength development and on its recovery in predamaged specimens was first analyzed. Afterwards, crack sealing and chloride permeability of sealed cracks were evaluated for specimens continuously immersed or subjected to wet/dry cycles in a 16.5% NaCl aqueous solution. Both an enhanced recovery of compressive strength and an improved crack sealing ability were observed for samples containing the healing agent. A microstructure study of the healing products was conducted by means of scanning electron microscope (SEM) and energy dispersive X-ray spectroscopy (EDS) analysis as well

Nanomaterials in concrete: a step forward in improving the durability of concrete structures

he present paper summarizes the experience of the last four years regarding the use of nanomaterials for concrete in the framework of the H2020 project ReSHEALience (GA760824). The main goals of this project have been to extend the service life and to reduce the maintenance costs of concrete structures subjected to very aggressive environments, rich in chlorides and sulphates. It has been demonstrated that both objectives can be reached using high performance and durable materials such as Ultra High Performance Fiber Reinforced Concrete with nanomaterials. The nanomaterials employed in this research have been alumina nanofibers, cellulose nanocrystals and cellulose nanofibers. Their effects have been analyzed in terms of mechanical, durability and self-healing properties

Nanocellulose enriched mortars: Evaluation of nanocellulose properties affecting microstructure, strength and development of mixing protocols

In this work, four different nanocellulose (NCs) aqueous suspensions (two Cellulose Nano-Fibrils-CNF and a pair of Cellulose Nano-Crystals-CNC) were selected for the evaluation of key aspects that potentially affect the final performance of mortars. The main objective was the development of appropriate mixing protocols that will allow the incorporation of cellulose nanoadditives into cementitious blends. Inclusion of two different NC species into mortars will provide a side-by-side performance comparison between CNCs and CNFs leading to a better understanding of particle morphology impact on the properties of cementitious composites. Moreover, preliminary structural and physicochemical NC characterization tests were performed to enlighten the effects of NC intrinsic features on the final efficiency of the materials. Strength tests of as-obtained NC enriched specimens revealed an enhanced performance when compared to respective reference samples. In particular the presence of CNFs – and specifically AVAP® CNFs– in the mortar mixture resulted in an increase up to 43% in flexural strength values, whereas CNCs were more effective in raising compressive strength values (up to 21%). Supposing that this improvement, emanates from evolving interactions between NCs and defects existing in the matrix at the onset of their formation a more detailed study is on-going aiming at the in depth comprehension of all synoptic parameters that will enable a straight correlation between mortars and nanocellulose properties and will facilitate the use of NCs to upgrade cementitious materials into tailored made composites

Mechanical and Durability Assessment of Concretes Obtained from Recycled Ultra-High Performance Concretes

The aim of this work is to analyse the mechanical and durability properties of Recycled Ultra High Performance Concretes (RUHPC) containing different amounts of recycled fine aggregate obtained from crushing Ultra High Performance Concretes (UHPC). This paper summarizes and compares the results from different experimental campaigns carried out in the framework of the ReSHEALience project (Rethinking coastal defence and Green-energy service infrastructures through enhanced-durAbiLity high-performance cement-based materials) which has received funding from the European Union’s Horizon 2020 programme (GA 760824). Mechanical performance was evaluated by means of compressive and flexural tests, whereas durability was evaluated by means of chloride penetration, chloride migration and water absorption capillary tests. The results indicated that replacing 50% or 100% of natural aggregates with recycled aggregates did not significantly affect neither compressive strength nor flexural strength. In the case of high replacement rates, a slight decrease in workability was detected, but the mix retained its self-compacting properties. RUHPC had similar durability performance as UHPC. In conclusion, the results have shown that it is feasible to produce RUHPC; the recycled fine aggregate has shown great potential to be used in the production of new UHPC. Scalability of the recycling procedure to industrial level was also addressed in order to pave the way towards the uptake from the different value chain actors of the construction industry of the innovation potential demonstrated by the research

AN EXPERIMENTAL METHODOLOGY TO ASSESS EFFECTS OF HEALING ON FREEZE-THAW DAMAGED ULTRA HIGH-PERFORMANCE CONCRETE

This paper presents the experimental investigation of the self-healing capacity and ability to maintain the structural performance of a Ultra High-Performance (Fiber Reinforced) Concrete (UHPC/UHPFRC), with a crystalline admixture to stimulate the healing, after freeze-thaw cycles. To the aforesaid purpose ultrasonic pulse velocity tests, four-point flexural tests (before and after freeze-thaw, and after self-healing), and crack closure quantification have been performed. 20 mm thin beams were pre-cracked up to a cumulative crack width of 0.3 mm by means of four-point flexural test and subjected to freeze and thaw cycles between -20° C to 38° C for 17 days, each cycle lasting for 20 hrs. The flexural tests showed that freeze-thaw did not deteriorate the specimens' flexural strength. However, freeze-thaw caused some damage which was noticeable in the ultrasonic test. After the freeze and thaw cycles specimens were immersed in water for self-healing. The self-healing progress was measured periodically after 1, 2, 3, and 6 months of healing through ultrasonic test and microscopy image processing. The results showed that the freeze-thaw damages were healed throughout the specimens, and that previously undergone damage didn't affect neither the stimulated autogenous healing capacity of the investigated material nor its mechanical performance. This can be likely attributed to both closure of the cracks, which were almost fully healed within 3 months, and likely also to improved bond strength between the fibers and concrete matrix, due to the deposition of the healing products along the interface