Virulence Genes and Phylogenetic Group in Isolates of Escherichia Coli Pathogenic Avian

Avian pathogenic Escherichia coli (APEC) shares virulence attributes with strains of E. coli that cause extraintestinal infections in humans and it is considered that it could cause a zoonosis; therefore, the objective of this work was to determine prevalence in a group of APEC isolates of twelve genes associated with virulence as well as identifying the phylogenetic groups to which they belong. According to the results it was found that one of the isolates harbors 91.6% of the virulence genes analyzed and that most of these have between 7 and 8 of these genes. feoB and iss had the highest prevalence with 95.6% and the genes related to iron acquisition were present in more than 60% of APEC, while those of the ibeA invasin and vat toxin were those that were detected with the lowest prevalence The results showed the great genetic diversity of APEC isolates and suggest that bacterial systems of iron acquisition, as well as those related to resistance to host are fundamental virulence factors in these bacteria, however, the presence The rest of the virulence genes is important, since it provides valuable information for the development of vaccines against avian colibacilosis. It was determined that a high percentage of APEC belongs to the phylogenetic group B1 group from which mainly commensal and pathogenic E. coli strains derive, this result strengthens findings on the evolution of pathogens through the acquisition of virulence genes through the horizontal route.Escherichia coli patogénica aviar (APEC) comparte atributos de virulencia con cepas de E. coli causantes de infecciones extraintestinales en humanos y se considera que pudiera ocasionar una zoonosis por lo cual el objetivo de este trabajo fue determinar en un grupo de aislados de APEC la prevalencia de doce genes asociados a la virulencia así como identificar los grupos filogenéticos a los que pertenecen. De acuerdo a los resultados se encontró que uno de los aislados alberga el 91.6% de los genes de virulencia analizados y que la mayoría de estos tiene entre 7 y 8 de estos genes. feoB e iss tuvieron la mayor prevalencia con un 95.6% y los genes relacionados con la adquisición de hierro estuvieron presentes en más del 60% de APEC, mientras que los de la invasina ibeA y de la toxina vat fueron los que se detectaron con la menor prevalencia. Los resultados mostraron la gran diversidad genética de los aislados APEC y sugieren que los sistemas bacterianos de adquisición de hierro, así como los relacionados con la resistencia a los mecanismos de defensa del hospedero son factores de virulencia fundamentales en estas bacterias, sin embargo, la presencia del resto de genes de virulencia es importante, ya que proporciona información valiosa para el desarrollo de vacunas contra la colibacilosis aviar. Se determinó que un alto porcentaje de APEC pertenece al grupo filogenético B1 grupo del que derivan principalmente cepas de E. coli comensales y patogénicas intestinales, este resultado fortalece hallazgos sobre la evolución de patógenos a través de la adquisición de genes de virulencia mediante la vía horizontal

Effectiveness of an intervention for improving drug prescription in primary care patients with multimorbidity and polypharmacy:Study protocol of a cluster randomized clinical trial (Multi-PAP project)

This study was funded by the Fondo de Investigaciones Sanitarias ISCIII (Grant Numbers PI15/00276, PI15/00572, PI15/00996), REDISSEC (Project Numbers RD12/0001/0012, RD16/0001/0005), and the European Regional Development Fund ("A way to build Europe").Background: Multimorbidity is associated with negative effects both on people's health and on healthcare systems. A key problem linked to multimorbidity is polypharmacy, which in turn is associated with increased risk of partly preventable adverse effects, including mortality. The Ariadne principles describe a model of care based on a thorough assessment of diseases, treatments (and potential interactions), clinical status, context and preferences of patients with multimorbidity, with the aim of prioritizing and sharing realistic treatment goals that guide an individualized management. The aim of this study is to evaluate the effectiveness of a complex intervention that implements the Ariadne principles in a population of young-old patients with multimorbidity and polypharmacy. The intervention seeks to improve the appropriateness of prescribing in primary care (PC), as measured by the medication appropriateness index (MAI) score at 6 and 12months, as compared with usual care. Methods/Design: Design:pragmatic cluster randomized clinical trial. Unit of randomization: family physician (FP). Unit of analysis: patient. Scope: PC health centres in three autonomous communities: Aragon, Madrid, and Andalusia (Spain). Population: patients aged 65-74years with multimorbidity (≥3 chronic diseases) and polypharmacy (≥5 drugs prescribed in ≥3months). Sample size: n=400 (200 per study arm). Intervention: complex intervention based on the implementation of the Ariadne principles with two components: (1) FP training and (2) FP-patient interview. Outcomes: MAI score, health services use, quality of life (Euroqol 5D-5L), pharmacotherapy and adherence to treatment (Morisky-Green, Haynes-Sackett), and clinical and socio-demographic variables. Statistical analysis: primary outcome is the difference in MAI score between T0 and T1 and corresponding 95% confidence interval. Adjustment for confounding factors will be performed by multilevel analysis. All analyses will be carried out in accordance with the intention-to-treat principle. Discussion: It is essential to provide evidence concerning interventions on PC patients with polypharmacy and multimorbidity, conducted in the context of routine clinical practice, and involving young-old patients with significant potential for preventing negative health outcomes. Trial registration: Clinicaltrials.gov, NCT02866799Publisher PDFPeer reviewe

Prospective observational cohort study on grading the severity of postoperative complications in global surgery research

Background The Clavien–Dindo classification is perhaps the most widely used approach for reporting postoperative complications in clinical trials. This system classifies complication severity by the treatment provided. However, it is unclear whether the Clavien–Dindo system can be used internationally in studies across differing healthcare systems in high- (HICs) and low- and middle-income countries (LMICs). Methods This was a secondary analysis of the International Surgical Outcomes Study (ISOS), a prospective observational cohort study of elective surgery in adults. Data collection occurred over a 7-day period. Severity of complications was graded using Clavien–Dindo and the simpler ISOS grading (mild, moderate or severe, based on guided investigator judgement). Severity grading was compared using the intraclass correlation coefficient (ICC). Data are presented as frequencies and ICC values (with 95 per cent c.i.). The analysis was stratified by income status of the country, comparing HICs with LMICs. Results A total of 44 814 patients were recruited from 474 hospitals in 27 countries (19 HICs and 8 LMICs). Some 7508 patients (16·8 per cent) experienced at least one postoperative complication, equivalent to 11 664 complications in total. Using the ISOS classification, 5504 of 11 664 complications (47·2 per cent) were graded as mild, 4244 (36·4 per cent) as moderate and 1916 (16·4 per cent) as severe. Using Clavien–Dindo, 6781 of 11 664 complications (58·1 per cent) were graded as I or II, 1740 (14·9 per cent) as III, 2408 (20·6 per cent) as IV and 735 (6·3 per cent) as V. Agreement between classification systems was poor overall (ICC 0·41, 95 per cent c.i. 0·20 to 0·55), and in LMICs (ICC 0·23, 0·05 to 0·38) and HICs (ICC 0·46, 0·25 to 0·59). Conclusion Caution is recommended when using a treatment approach to grade complications in global surgery studies, as this may introduce bias unintentionally

The surgical safety checklist and patient outcomes after surgery: a prospective observational cohort study, systematic review and meta-analysis

© 2017 British Journal of Anaesthesia Background: The surgical safety checklist is widely used to improve the quality of perioperative care. However, clinicians continue to debate the clinical effectiveness of this tool. Methods: Prospective analysis of data from the International Surgical Outcomes Study (ISOS), an international observational study of elective in-patient surgery, accompanied by a systematic review and meta-analysis of published literature. The exposure was surgical safety checklist use. The primary outcome was in-hospital mortality and the secondary outcome was postoperative complications. In the ISOS cohort, a multivariable multi-level generalized linear model was used to test associations. To further contextualise these findings, we included the results from the ISOS cohort in a meta-analysis. Results are reported as odds ratios (OR) with 95% confidence intervals. Results: We included 44 814 patients from 497 hospitals in 27 countries in the ISOS analysis. There were 40 245 (89.8%) patients exposed to the checklist, whilst 7508 (16.8%) sustained ≥1 postoperative complications and 207 (0.5%) died before hospital discharge. Checklist exposure was associated with reduced mortality [odds ratio (OR) 0.49 (0.32–0.77); P\u3c0.01], but no difference in complication rates [OR 1.02 (0.88–1.19); P=0.75]. In a systematic review, we screened 3732 records and identified 11 eligible studies of 453 292 patients including the ISOS cohort. Checklist exposure was associated with both reduced postoperative mortality [OR 0.75 (0.62–0.92); P\u3c0.01; I2=87%] and reduced complication rates [OR 0.73 (0.61–0.88); P\u3c0.01; I2=89%). Conclusions: Patients exposed to a surgical safety checklist experience better postoperative outcomes, but this could simply reflect wider quality of care in hospitals where checklist use is routine

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

This was an investigator initiated study funded by Nestle Health Sciences through an unrestricted research grant, and by a National Institute for Health Research (UK) Professorship held by RP. The study was sponsored by Queen Mary University of London