Epidemiologic and clinical impact of acinetobacter baumannii colonization and infection: A reappraisal

Abstract: Acinetobacter baumannii is one of the most important antibiotic-resistant nosocomial bacteria. We investigated changes in the clinical and molecular epidemiology of A. baumannii over a 10-year period. We compared the data from 2 prospective multicenter cohort studies in Spain, one performed in 2000 (183 patients) and one in 2010 (246 patients), which included consecutive patients infected or colonized by A. baumannii. Molecular typing was performed by repetitive extragenic palindromic polymerase chain reaction (REP-PCR), pulsed-field gel electrophoresis (PFGE), and multilocus sequence typing (MLST). The incidence density of A. baumannii colonization or infection increased significantly from 0.14 in 2000 to 0.52 in 2010 in medical services (p<0.001). The number of non-nosocomial health careassociated cases increased from 1.2% to 14.2%, respectively (p<0.001). Previous exposure to carbapenems increased in 2010(16.9% in 2000 vs 27.3% in 2010, p¼0.03). The drugs most frequently used for definitive treatment of patients with infections were carbapenems in 2000 (45%) and colistin in 2010 (50.3%). There was molecular-typing evidence of an increase in the frequency of A. baumannii acquisition in non-intensive care unit wards in 2010 (7.6% in 2000 vs 19.2% in 2010, p¼0.01). By MSLT, the ST2 clonal group predominated and increased in 2010. This epidemic clonal group was more frequently resistant to imipenem and was associated with an increased risk of sepsis, although not with severe sepsis or mortality. Some significant changes were noted in the epidemiology of A. baumannii, which is increasingly affecting patients admitted to conventional wards and is also the cause of non-nosocomial health care-associated infections. Epidemic clones seem to combine antimicrobial resistance and the ability to spread, while maintaining their clinical virulence.ACKNOWLEDGMENTS: The authors thank the Platform for Genotyping of Pathogens and Public Health (Institut Pasteur, Paris, France) for coding MLST alleles and profiles as available at www. pasteur.fr/mlst. The authors are grateful for the support of the Spanish Group for Nosocomial Infections (GEIH) and the Spanish Group for Antimicrobial Mechanisms of Action and Resistance (GEMARA) from the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) for their support in the development of the project

Genomic Evolution of Two Acinetobacter baumannii Clinical Strains from ST-2 Clones Isolated in 2000 and 2010 (ST-2_clon_2000 and ST-2_clon_2010)

Acinetobacter baumannii is a successful nosocomial pathogen due to its ability to persist in hospital environments by acquiring mobile elements such as transposons, plasmids, and phages. In this study, we compared two genomes of A. baumannii clinical strains isolated in 2000 (ST-2_clon_2000) and 2010 (ST-2_clon_2010) from GenBank project PRJNA308422

Workshop to compare the indicators for CFP and MSFD D3 management objectives through simulations (WKSIMULD3)

Rapports Scientifiques du CIEM. Volume 6, nº 4The WKSIMULD3 meeting provided a platform for experts from the EU member states to meet and progress the assessment methodology on Criteria 3 of Descriptor 3 upon request by EC (DGENV). WKSIMULD3 is the third of a series of three workshops (WKD3C3SCOPE and WKD3C3THRESHOLDS being the first two) to identify operational indicators for MSFD D3C3. The workshop was organised as a series of presentations with intermittent discussions. The group agreed on a number of stocks to run simulations to explore the relationships between indicators of population traits/dynamics and healthy population structure. The participants found that for demersal stocks in the North Sea, MSE simulations showed decreasing values of D3C3 indicators with increasing fishing mortality. However, the use of age-structure indicators for these stocks is likely to lead to frequent false positives due to the high interannual variability. Age-based simulations were implemented also for pelagic and short-lived stocks, such as mackerel, sprat, and sandeel. The distribution of the threshold values implemented for the stocks did not show a clear response to the fishing regime. As a result, the use of age-structure indicators for these stocks is likely to lead to frequent false positives/negatives. The simulations aimed to validate the population size structure and calculate indicators under different fishing scenarios. In the Mediterranean Sea, length-based simulations were conducted for two hake stocks and one sole stock. The length indicators obtained were compared to historical data to assess the responsiveness of the indicators to exploitation. These results show the behaviour of the length based and of the age-based indicators calculated on observed data. Overall, the indicator status can be well below the average value at Fmsy. Additionally, an exploratory run tested a harvest control rule driven by age-based indicator targets. The outputs can provide directions on how to choose a threshold that can ensure the stock to be in GES. Overall, the workshop findings highlighted the complexity of evaluating indicators for CFP and MSFD D3 management objectives, particularly in relation to the responsiveness of the indicators to fishing pressure and environmental variation. The group emphasized the need for robust and peer-reviewed models to ensure reliable results when evaluating indicators for fish stocks. Additionally, it underscores the challenges associated with using age- and length-based indicators for different species and the importance of considering environmental and recruitment variability in simulations. In conclusion, the series of the 3 workshops contributed valuable insights into the complexities of assessing and comparing indicators for MSFD D3 management objectives, providing important considerations for future assessments and management strategies.info:eu-repo/semantics/publishedVersio

Ten Issues for Updating in Community-Acquired Pneumonia: An Expert Review

Community-acquired pneumonia represents the third-highest cause of mortality in industrialized countries and the first due to infection. Although guidelines for the approach to this infection model are widely implemented in international health schemes, information continually emerges that generates controversy or requires updating its management. This paper reviews the most important issues in the approach to this process, such as an aetiologic update using new molecular platforms or imaging techniques, including the diagnostic stewardship in different clinical settings. It also reviews both the Intensive Care Unit admission criteria and those of clinical stability to discharge. An update in antibiotic, in oxygen, or steroidal therapy is presented. It also analyzes the management out-of-hospital in CAP requiring hospitalization, the main factors for readmission, and an approach to therapeutic failure or rescue. Finally, the main strategies for prevention and vaccination in both immunocompetent and immunocompromised hosts are reviewed

Workshop to scope and preselect indicators for criterion D3C3 under MSFD decision (EU) 2017/848 (WKD3C3SCOPE)

The workshop to scope and preselect indicators for Descriptor 3 criterion 3 under MSFD Commission Decision (EU) 2017/848 (WKD3C3SCOPE) provided a platform for experts from the EU member states and relevant regional bodies to meet and support development and progress the assessment methodology, based on a request by the EC (DGENV). WKD3C3SCOPE is the first of a series of three workshops (WKD3C3THRESHOLDS and WKSIMULD3) to provide guidance in relation to operational indicators for MSFD D3C3. The workshop was organized as a series of presentations with intermittent group discussions. On the first day of the workshop the participants discussed what defines a ‘healthy population structure’ for species with different life history traits (ToR a). During the following days, the group discussed and identified relevant D3C3 indicators (ToR b) and developed criteria to select among the identified D3C3 indicators to allow further testing and setting of thresholds at WKD3C3THRESHOLDS (ToR c). The participants found that overall, healthy fish stocks are characterized by high productivity, wide age and size structuring in the population, and the ability to quickly recover from disturbances. The groups noted that environmental factors, along with stock biomass and fishing pressure, influence the productivity and health of a stock, with environment playing a particularly large role in the recruitment of short-lived stocks. It was suggested that the age structure of a stock might be more relevant for evaluating the health of long-lived stocks. However, it was acknowledged that not all stocks have sufficient data to evaluate all proposed indicators, and a single indicator is unlikely to suffice for all stocks. Data availability, species- specific factors and regional or sub-regional variation are thus also important considerations. In relation to ToR b, the participants presented their work on potential indicators including: recruitment time-series, proportion of fish larger than the mean size of first sexual maturation, F rec/Fbar, length distribution L 90, relative proportion of old fish above A 90, indicators of spawner quality, and SSB/R. A discussion on pros/cons, benefits to the population of high or low indicator values, benefits supported by empirical evidence, applicability to data-poor stocks and benefits supported by simulation/theoretical considerations followed the presentations. Finally, in relation to ToR c, the difficulty emerged in ranking the indicators alone without considering the data used to estimate them and a new set of evaluation criteria for use in WKD3C3THRESHOLDS were defined. Based on the outputs of the meeting a list of indicators to be further evaluated has been drafted, which also emphasizes the stocks for which studies have empirically demonstrated effects on productivity. In addition to the listed indicators, indicators of genetic diversity and proportion of fish with parasite infestation were mentioned but to the knowledge of the participants, widespread data for these are currently not publicly available.info:eu-repo/semantics/publishedVersio

Clustering COVID-19 ARDS patients through the first days of ICU admission. An analysis of the CIBERESUCICOVID Cohort

Background Acute respiratory distress syndrome (ARDS) can be classified into sub-phenotypes according to different inflammatory/clinical status. Prognostic enrichment was achieved by grouping patients into hypoinflammatory or hyperinflammatory sub-phenotypes, even though the time of analysis may change the classification according to treatment response or disease evolution. We aimed to evaluate when patients can be clustered in more than 1 group, and how they may change the clustering of patients using data of baseline or day 3, and the prognosis of patients according to their evolution by changing or not the cluster.Methods Multicenter, observational prospective, and retrospective study of patients admitted due to ARDS related to COVID-19 infection in Spain. Patients were grouped according to a clustering mixed-type data algorithm (k-prototypes) using continuous and categorical readily available variables at baseline and day 3.Results Of 6205 patients, 3743 (60%) were included in the study. According to silhouette analysis, patients were grouped in two clusters. At baseline, 1402 (37%) patients were included in cluster 1 and 2341(63%) in cluster 2. On day 3, 1557(42%) patients were included in cluster 1 and 2086 (57%) in cluster 2. The patients included in cluster 2 were older and more frequently hypertensive and had a higher prevalence of shock, organ dysfunction, inflammatory biomarkers, and worst respiratory indexes at both time points. The 90-day mortality was higher in cluster 2 at both clustering processes (43.8% [n = 1025] versus 27.3% [n = 383] at baseline, and 49% [n = 1023] versus 20.6% [n = 321] on day 3). Four hundred and fifty-eight (33%) patients clustered in the first group were clustered in the second group on day 3. In contrast, 638 (27%) patients clustered in the second group were clustered in the first group on day 3.Conclusions During the first days, patients can be clustered into two groups and the process of clustering patients may change as they continue to evolve. This means that despite a vast majority of patients remaining in the same cluster, a minority reaching 33% of patients analyzed may be re-categorized into different clusters based on their progress. Such changes can significantly impact their prognosis

The evolution of the ventilatory ratio is a prognostic factor in mechanically ventilated COVID-19 ARDS patients

Background: Mortality due to COVID-19 is high, especially in patients requiring mechanical ventilation. The purpose of the study is to investigate associations between mortality and variables measured during the first three days of mechanical ventilation in patients with COVID-19 intubated at ICU admission. Methods: Multicenter, observational, cohort study includes consecutive patients with COVID-19 admitted to 44 Spanish ICUs between February 25 and July 31, 2020, who required intubation at ICU admission and mechanical ventilation for more than three days. We collected demographic and clinical data prior to admission; information about clinical evolution at days 1 and 3 of mechanical ventilation; and outcomes. Results: Of the 2,095 patients with COVID-19 admitted to the ICU, 1,118 (53.3%) were intubated at day 1 and remained under mechanical ventilation at day three. From days 1 to 3, PaO2/FiO2 increased from 115.6 [80.0-171.2] to 180.0 [135.4-227.9] mmHg and the ventilatory ratio from 1.73 [1.33-2.25] to 1.96 [1.61-2.40]. In-hospital mortality was 38.7%. A higher increase between ICU admission and day 3 in the ventilatory ratio (OR 1.04 [CI 1.01-1.07], p = 0.030) and creatinine levels (OR 1.05 [CI 1.01-1.09], p = 0.005) and a lower increase in platelet counts (OR 0.96 [CI 0.93-1.00], p = 0.037) were independently associated with a higher risk of death. No association between mortality and the PaO2/FiO2 variation was observed (OR 0.99 [CI 0.95 to 1.02], p = 0.47). Conclusions: Higher ventilatory ratio and its increase at day 3 is associated with mortality in patients with COVID-19 receiving mechanical ventilation at ICU admission. No association was found in the PaO2/FiO2 variation

Ecotoxicology and ecophysiology of mysids, with special reference to copper toxicity in Praunus flexuosus

Toxicity of dissolved copper was examined in a common coastal mysid population {Praunusflexuosus}. The life cycle and ecophysiology were studied under natural conditions throughout the year, and responses to dissolved copper were determined in the laboratory. Pronounced and ontogenic seasonal differences in copper toxicity for the mysid Praunusflexuosus were observed. Sublethal and lethal parameters (mortality, behaviour, metabolism, reproduction, and bioaccumulation) showed seasonal variation in response to copper toxicity, being highest toxicity in summer. Changes in the form of dissolved copper were measured during toxicity testing, using the chelating resin method to provide a measurement of total and labile (Chelex-available) dissolved copper in the natural seawater used in the toxicity tests. Labile dissolved copper did not show significant variations in the test seawater, confirming that organisms were exposed to constant labile copper concentrations during the toxicity test. The total dissolved copper concentration was significantly higher than the labile form, as organic complexation occurred in natural seawater and during toxicity tests. The labile fraction could be less than 50% of the total fraction. The total dissolved copper concentration decreased significantly when the organism was under stress. While the mortality of the population was insignificant after 10 days of copper exposure (0, 5,25, 75 and 200µg 1-1) in winter, lethal effects occurred at every copper exposure level after 24 hours (96h LC50 =30.8 µg 1-1) in summer. The effects of copper on metabolism (respiration and excretion) were very sensitive indicators of sublethal toxicity, which resulted in lethal effects with a prolonged time of exposure. Metabolism shifted to a greater reliance on protein catabolism under copper exposure in both seasons, demonstrating a stronger effect in summer. Total copper content accumulated in the organism increased with increasing copper concentration in solution. Copper accumulation rate was higher in summer. than in winter, increasing to rates of 7.9µg g-1 dry weight day per day. Reproductive processes were severely disrupted at any copper treatment. Production of juveniles was reduced to zero, because of the high abortion rate, reduction on brood survival and damage to fertilisation processes

Targeting European R&D for accidental marine pollution

Accidental marine pollution can have major ecological and economic consequences at national and trans-national levels, and there is a need to achieve a better integration of science into actual decision-making systems to support prevention measures, response systems and management activities.. Effective linking mechanisms between R&D and end-users/policy stakeholders are required to ensure the relevance of R&D, effective uptake of R&D outputs, and suitable policy development. Different issues and barriers to effectively link accidental marine pollution R&D effort to end-users concerns and needs and to develop a trans-national strategic approach are identified, analysed, and further developed into recommendations.Accidental marine pollution Oil spills Hazardous and noxious substances Research and development Policy stakeholders Trans-national strategies