Community- and hospital-acquired Klebsiella pneumoniae urinary tract infections in Portugal : virulence and antibiotic resistance

© 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).Klebsiella pneumoniae is a clinically relevant pathogen and a frequent cause of hospital-acquired (HA) and community-acquired (CA) urinary tract infections (UTI). The increased resistance of this pathogen is leading to limited therapeutic options. To investigate the epidemiology, virulence, and antibiotic resistance profile of K. pneumoniae in urinary tract infections, we conducted a multicenter retrospective study for a total of 81 isolates (50 CA-UTI and 31 HA-UTI) in Portugal. The detection and characterization of resistance and virulence determinants were performed by molecular methods (PCR, PCR-based replicon typing, and multilocus sequence typing (MLST)). Out of 50 CA-UTI isolates, six (12.0%) carried β-lactamase enzymes, namely blaTEM-156 (n = 2), blaTEM-24 (n = 1), blaSHV-11 (n = 1), blaSHV-33 (n = 1), and blaCTX-M-15 (n = 1). All HA-UTI were extended-spectrum β-lactamase (ESBL) producers and had a multidrug resistant profile as compared to the CA-UTI isolates, which were mainly resistant to ciprofloxacin, levofloxacin, tigecycline, and fosfomycin. In conclusion, in contrast to community-acquired isolates, there is an overlap between virulence and multidrug resistance for hospital-acquired UTI K. pneumoniae pathogens. The study is the first to report different virulence characteristics for hospital and community K. pneumoniae pathogens, despite the production of β-lactamase and even with the presence of CTX-M-15 ESBL, a successful international ST15 clone, which were identified in both settings. This highlights that a focus on genomic surveillance should remain a priority in the hospital environment.This research was funded by the Research Institute for Medicines (iMed.ULisboa), Faculty of Pharmacy, Universidade de Lisboa (ULisboa).info:eu-repo/semantics/publishedVersio

Business consulting report de Impemar Group

El presente trabajo de investigación es un Business Consulting aplicado a la empresa IMPEMAR GROUP de Comas Lima, empresa que brinda servicios de distribución a Arca Continental S.A. la representante de Coca Cola Company en Perú. Dicha empresa solicitó la consultoría ya que los dueños no están del todo conformes con los resultados financieros de los tres últimos años. En el desarrollo de la investigación se identificó que, la empresa tenía toda la mercadería y los costos operativos solventados por Arca Continental obteniendo en retribución por ello, las bonificaciones por la cobranza y el reparto a tiempo dentro de los indicadores establecidos por Arca Continental. Por ende, el objetivo era poder encontrar las causas o problemáticas que inducían a la pérdida, se determinaron que las causas de esta problemática estaba en eliminar los errores que inducían a la pérdida de las bonificaciones de la empresa, en consecuencia mediante un análisis costo impacto se determinó la alternativa de solución de menor costo y mayor impacto para la empresa, fruto de este análisis se determinó una inversión en mejoras que generan un VAN de S/ 41,602,854.73 soles y el TIR 48.15% en función a una serie de proyectos para reducir los excesivos gastos en alquileres y las pérdidas en bonificaciones, por un total de S/87,722,912 Soles, lo que permite respaldar la propuesta de solución al problema mencionado.This research work is a Business Consulting applied to the company IMPEMAR GROUP of Comas Lima, a company that provides distribution services to Arca Continental S.A. the representative of Coca Cola Company in Peru. This company requested the consultancy since the owners are not entirely satisfied with the financial results of the last three years. In the development of the investigation, it was identified that the company had all the merchandise and operating costs paid by Arca Continental, obtaining in compensation for it, the bonuses for collection and distribution on time within the indicators established by Arca Continental. Therefore, the objective was to be able to find the causes or problems that led to the loss, it was determined that the causes of this problem was to eliminate the errors that led to the loss of the company's bonuses, consequently through a cost-impact analysis. The alternative solution with the lowest cost and the greatest impact for the company was determined. As a result of this analysis, an investment was determined in improvements that generate a NPV of S/ 41,602,854.73 soles and an IRR of 48.15% based on a series of projects to reduce costs. excessive expenses in rentals and losses in bonuses, for a total of S/87,722,912 Soles, which allows supporting the proposed solution to the aforementioned problem

Key comparison CCQM-K73 amount content of H+ in hydrochloric acid (0.1 mol·kg-1)

This key comparison (KC), CCQM-K73, was performed to demonstrate the capability of the participating National Metrology Institutes (NMIs) to measure the amount content of H+ , νH + , in an HCl solution with a nominal νH + of 0.1 mol·kg-1 . A parallel Pilot Study, CCQM-P19.2, was performed for NMIs that did not desire to participate in the KC. The comparison was a joint activity of the Electrochemical Working Group (EAWG) and Inorganic Analysis Working Group (IAWG) of the CCQM and was coordinated by NIST (USA) and CENAM (México). The method of determination of νH + was left to the individual participant. All participants used either coulometry or titrimetry with potentiometric determination of the endpoint. The agreement of the results was not commensurate with the claimed uncertainties of the subset of participants that claimed small uncertainties for this determination. A workshop on technical issues relating to the CCQM-K73 measurements was conducted at the joint IAWGEAWG meeting at the Bureau International des Poids et Mesures (BIPM), Paris (Sèvres) in April 2010. Several possible sources of bias were investigated, but none could explain the observed dispersion among the participants’ results. In the absence of a specific cause for the dispersion, the IAWG and EAWG decided to assign a Key Comparison Reference Value, KCRV, and standard uncertainty of the KCRV, uKCRV, based on the DerSimonian-Laird statistical estimator. The uKCRV is dominated by the between-laboratory scatter of results in CCQM-K73. The uncertainty estimates from the participants with the lowest reported uncertainties remain unsupported by this KC.Fil: Pratt, Kenneth W. National Institute of Standards and Technology (NIST); Estados UnidosFil: Ortiz-Aparicio, Jose Luis. Centro Nacional de Metrología (CENAM); MéxicoFil: Matehuala-Sanchez, Francisco Javier. Centro Nacional de Metrología (CENAM); MéxicoFil: Jakobsen, Pia Tønnes. Dansk Fundamental Metrology (DFM); DinamarcaFil: Pawlina, Monika. Główny Urząd Miar (GUM); PoloniaFil: Kozłowski, Władysław. Główny Urząd Miar (GUM); PoloniaFil: Borges, Paulo P. Instituto Nacional de Metrologia, Qualidade e Tecnologia (INMetro); BrasilFil: da Silva Junior, Wiler B. Instituto Nacional de Metrologia, Qualidade e Tecnologia (INMetro); BrasilFil: Borinsky, Mónica B. Instituto Nacional de Tecnología Industrial (INTI); ArgentinaFil: Hernandez, Ana. Instituto Nacional de Tecnología Industrial (INTI); ArgentinaFil: Puelles, Mabel. Instituto Nacional de Tecnología Industrial (INTI); ArgentinaFil: Hatamleh, Nadia. Instituto Nacional de Tecnología Industrial (INTI); ArgentinaFil: Acosta, Osvaldo. Instituto Nacional de Tecnología Industrial (INTI); ArgentinaFil: Nunes, João. Instituto Português da Qualidade (IPQ); PortugalFil: Guiomar Lito, M. J. Instituto Português da Qualidade (IPQ); PortugalFil: Camões, M. Filomena. Instituto Português da Qualidade (IPQ); PortugalFil: Filipe, Eduarda. Instituto Português da Qualidade (IPQ); PortugalFil: Hwang, Euijin. Korea Research Institute of Standards and Science (KRISS); Corea del SurFil: Lim, Youngran. Korea Research Institute of Standards and Science (KRISS); Corea del SurFil: Bing, Wu. National Institute of Metrology (NIM); ChinaFil: Qian, Wang. National Institute of Metrology (NIM); ChinaFil: Chao, Wei. National Institute of Metrology (NIM); ChinaFil: Hioki, Akiharu. National Metrology Institute of Japan (NMIJ); JapónFil: Asakai, Toshiaki. National Metrology Institute of Japan (NMIJ); JapónFil: Máriássy, Michal. Slovenský Metrologický Ústav (SMU); EslovaquiaFil: Hanková, Zuzana. Slovenský Metrologický Ústav (SMU); EslovaquiaFil: Nagibin, Sergey. Ukrainian State Research and Production Center of Standardization Metrology, Certification, and Consumers’ Rights Protection (UMTS); UcraniaFil: Manska, Olexandra. Ukrainian State Research and Production Center of Standardization Metrology, Certification, and Consumers’ Rights Protection (UMTS); UcraniaFil: Gavrilkin, Vladimir. Ukrainian State Research and Production Center of Standardization Metrology, Certification, and Consumers’ Rights Protection (UMTS); UcraniaFil: Kutovoy, Viatcheslav. All-Russian Scientific Institute for Physical-Technical and Radiological Measurements (VNIIFTRI); Rusi

First Description of Colistin and Tigecycline-Resistant <i>Acinetobacter baumannii</i> Producing KPC-3 Carbapenemase in Portugal

Herein, we describe a case report of carbapenem-resistant Acinetobacter baumannii and Klebsiella pneumoniae isolates that were identified from the same patient at a Tertiary University Hospital Centre in Portugal. Antimicrobial susceptibility and the molecular characterization of resistance and virulence determinants were performed. PCR screening identified the presence of the resistance genes blaKPC-3, blaTEM-1 and blaSHV-1 in both isolates. The KPC-3 K. pneumoniae isolate belonged to the ST-14 high risk clone and accumulated an uncommon resistance and virulence profile additional to a horizontal dissemination capacity. In conclusion, the molecular screening led to the first identification of the A. baumannii KPC-3 producer in Portugal with a full antimicrobial resistance profile including tigecycline and colistin

Isolation of Rasamsonia argillacea species complex in a Cystic Fibrosis Adult Patient - First Case in Portugal

Abstract publicado em: J Fungi. 2021;7(11):263-64 (P176). https://doi.org/10.3390/jof7110916Objectives: Cystic fibrosis (CF) is the most common monogenetic autosomal reces sive disease in the human population. An important fungal biota has been described in respiratory secretions of patients suffering from CF being Aspergillus fumigatus and Candida albicans the most common fungi found. We report the isolation, for the first time in Portugal, of the emerging fungal pathogen Rasamsonia argillacea species complex, from a respiratory sample of an adult patient with CF. Material & Methods: A 51-year-old male patient with heterozygous CF due to muatations ΔF508/P205S, is being followed in Cystic Fibrosis Reference Center for about 10 years. In the last years, he has been consistently colonized with Methicilin-susceptible Staphylococcus aureus, Pseudomonas aeruginosa and Aspergillus section Fumigati whereby is under chronic suppression therapy with two inhaled antibiotics. Recently, there has been a progressive clinical respiratory functional deterioration. In a periodic evaluation, a miccrobiology control sputum was requested. Sample was cultured, in parallel, for bacteriol ogy and mycology evaluation. Results: Apart from detection of S. aureus and Raoultella ornithinolytica, after 3-5 days of incubation at 37ºC, the cultures showed several cream-coloured colonies, powdery to velvety. Microscopic examination showed hyaline septate hyphae, Penicillium-like conid iophores with rough wall, ovoid to cylindrical phyalides with a narrow neck and cylin drical unicellular smooth-walled microconidia, arranged in unbranched basipetal chains arising from phialides. The isolate was identified as Rasamsonia argillacea species complex based on its mor phology and confirmed by MALDI-TOF mass spectrometry. As no septate hyphae were seen on direct examination, a new sample was requested to exclude extrinsic contamina tion. The second sample was inoculated as previously, confirming the persistent presence of Rasamsonia argillacea species complex in the sputum of this patient. The identification of this isolate was further confirmed by sequencing the internal transcribed spacer (ITS) region of ribosomal DNA, showing 100% homology with sequences deposited on data bases. Antifungal susceptibility testing showed high minimal inhibitory concentrations (MIC) to almost all tested antifungals (posaconazole, voriconazole, amphotericin B) and low MIC to anidulafungin. The patient had no great exacerbation of his respiratory prob lems and the isolated fungus was interpreted as colonization being the patient under more frequent surveillance. Conclusion: Although colonization of the upper respiratory tract in CF patients by R. argillacea species complex has been described as an emerging situation, the role of these fungi in clinical or functional deterioration of the disease remains controversial. Indeed, data about its real prevalence in the CF population are lacking. However, taking into ac count the ability of this species to predominantly affect the lungs, to induce pneumonia and to disseminate to adjacent organs or even to the central nervous system (CNS) in imunocompromised patients, it is essential to promote its accurate identification that is often misidentified as Penicillium spp. or Paecilomyces species. Antifungal susceptibility testing should be performed for epidemiological purposes and to guide therapy, as Rasamsonia spp. usually presents a marked antifungal resistance profileinfo:eu-repo/semantics/publishedVersio

Survey of extended-spectrum beta-lactamases in Escherichia coli isolates from a Portuguese hospital and characterisation of a novel class 1 integron (In60A) carrying the bla(CTX-M-9) gene

Between November 2001 and November 2004, 231 Escherichia coli isolates resistant to P-lactam antibiotics were identified. In 14 isolates, bla(TEM-24) (2 isolates), bla(TEM-52) (5 isolates) and bla(TEM-26) (7 isolates) were identified. In 145 E. coli isolates with the same M13 fingerprinting profile and the same resistance phenotype, the bla(CTX-M-15) gene was found in association with an insertion sequence ISEcp1. The bla(CTX-M-2) gene was identified in one E. coli isolate (290HSM), and in other E. coli isolate (246HSM) the bla(CTX-M-9) gene was contained in a new complex sull-type class 1 integron (named In60A). This is the first report of three cefotaximases (CTX-M-15, CTX-M-2 and CTX-M-9) in E. coli isolates from a Portuguese hospital. (c) 2006 Elsevier B.V. and the International Society of Chemotherapy. All rights reserved

Subcutaneous phaeohyphomycosis due to Phaeoacremonium parasiticum in a patient with Chronic Granulomatous Disease

Abstract publicado em J Fungi. 2021;7(11):213-14 (P252). https://doi.org/10.3390/jof7110Objectives: Phaeoacremonium parasiticum is a ubiquitous dematiaceous mold that rarely causes infection in humans. Its spectrum of disease ranges from subcutaneous infections to disseminated disease. The majority of those reported few cases involve immunocompromised patients. Chronic granulomatous disease (CGD) is an inherited disorder affecting nicotinamide adenine dinucleotide phosphate (NADPH) oxidase complex. CGD patients are susceptible to a broad spectrum of opportunistic infections, being fungal infections a major determinant of survival. We report a case of Subcutaneous phaeohyphomycosis due to P. parasiticum in a young adult with CGD. Material and methods: A 28-year-old male patient with autossomic recessive CGD, due to mutations in CYBA, is followed in Primary Immunodeficiency Center since childhood. He has been under prophylaxis with itraconazole, cotrimoxazole and IFNg and tapering oral steroids, started for granulomatous colitits 2 years earlier. In a regular visit to the clinical center, he complained of persistent pain on his left leg with no history of recent injury in the affected area and without external inflammatory signs. An ultrasound was performed after 2 weeks revealing a heterogeneous liquid of slightly irregular contour in the sinus of the left anterior tibial muscle with heterogeneity of the adjacent muscle. This piomiositis collection was punctured, under ultrasound control, with drainage of about 7cm3 of hemato-purulent exsudate that was promptly processed for bacteriology (aerobic and anaerobic) and mycology studies. Results: Cultures for bacteria were sterile. Culture on Sabouraud was positive after 5 days of incubation, showing slow growing and initially white colonies. Microscopic examination showed hyaline, septate mycelium with long, thin conidiophores and curved, aseptate conidia.The fungus was initially identified as an Acremonium sp. and was sent to the Mycology Reference Laboratory for molecular identification and antifungal susceptibility testing. Its identification was performed by sequencing the internal transcribed spacer (ITS) region of ribosomal DNA, being the isolate identified as Phaeoacremonium parasiticum (100% homology). After 3 weeks incubation, coloration of the colonies emerged, becoming greyish black upon subculture, with velvety texture and black reverse. Microscopically, pigmented hyphae with tapering, funnel-shaped phialides were observed, and conidia were hyaline and oblong, forming clusters at the tip of the phialides. At this point, macroscopic and microscopic morphology was consistent with Phaeoacremonium species. Susceptibility pattern showed low minimal inhibitory concentrations (MIC) to posaconazole and voriconazole, and higher MIC values to anidulafungin and amphotericin B. The patient has improved under voriconazol therapy (200 mg; bid) Conclusions: Phaeoacremonium parasiticum is an uncommon infection and its appropriate identification is often difficult because morphologically, the genus Phaeoacremonium show morphological features resembling both Acremonium and Phialophora genera. Molecular identification is determinant to confirm morphology, as many species have indistinguishable characteristics that may lead to incorrect antifungal options. Also, susceptibility testing should be done for these so rare fungi as optimal treatment has not yet been clearly defined.info:eu-repo/semantics/publishedVersio

Otro título: [Música folklórica argentina]

Intérpretes: Víctor Palermo y su conjunto. Guitarristas: Eugenio Estébanez. Arturo GonzálezMadrid, Instituto de Cultura Hispánica. Sábado, 19 de enero de 1957Cinta 1: Paisajes de Catamarca / Rodolfo Jiménez – Min. 04.13: Aplausos – Min. 04.33: Mamá vieja / Lito Bayardo – Min. 08.37: Aplausos – Min. 09.07: En blanco y negro / Néstor Feria – Min. 12.11: Aplausos – Min. 12.24: Los ejes de mi carreta / Atahualpa Yupanqui – Min. 14.59: Aplausos – Min. 15.17: ¿Quién será? / Luis Rubistein – Min. 18.27: Aplausos – Min. 18.42: Nelly / Luis y Héctor Bates – Min. 21.41: Aplausos – Min. 21.59: Hopa, hopa / Fugazot – Min. 25.35: Aplausos -- Cinta 2: Criollita de mis amores / Carlos Gardel y J. Razzano – Min. 03.20: Aplausos – Min. 04.27: Silencio / Carlos Gardel y Le Pera – Min. 07.54: Aplausos – Min. 08.12: Yira, yira / Discépolo – Min. 11.08: Aplausos – Min. 12.33: Mano a mano / Carlos Gadel – Min. 15.47: Aplausos – Min. 16.06: Hacelo por la vieja – Min. 19.03: Aplausos – Min. 19.25: La cieguita / Kepler Lais – Min. 22.39: Aplausos -- Cinta 3: Caminito del indio / Atahualpa Yupanqui – Min. 04.45: Aplausos – Min. 05.06: Para quererte nací / Carlos Gardel y J. Razzano – Min. 07.43: Aplausos – Min. 08.01: Gajito de cedrón / Carlos Gardel y J. Razzano – Min. 10.54: Aplausos – Min. 11.12: La tabaquerita / Eduardo Falú – Min. 13.06: Aplausos – Min. 13.23: Nostalgias tucumanas / Atahualpa Yupanqui – Min. 17.03: Aplausos – Min. 18.11: La última copa – Min. 20.53: Aplausos – Min. 21.38: Margot – Min. 22.50: se corta la canción – Cinta 4: Continúa la canción – Min. 00.33: se corta la canción – Cinta 5: Continúa la canción -- Min. 00.23: Aplausos – Min. 01.20: Te crees que sos Gardel / Víctor Palermo – Min. 03.28: Aplauso