Effectiveness of Fosfomycin for the Treatment of Multidrug-Resistant Escherichia coli Bacteremic Urinary Tract Infections

IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections

Reseñas

[ES] Seguí de la Riva , Javier. Sobre dibujar y proyectar (por Javier Seguí de la Riva) pp. 4.-- Dibujar, proyectar LVI y LVII Arte y muerte I y II ( por Javier Seguí de la Riva) pp. 6.-- dibujar, proyectar LVIII El imaginario del dibujar (por Javier Seguí de la Riva) pp. 6 y 7.-- Dibujar, proyectar LVI y LVII Diagrama, diagramar I y II ( por Javier Seguí de la Riva) pp. 7.-- DIBUJAR, proyectar LVIII El imaginario del dibujar ( por Javier Seguí de la Riva) pp. 6 y 7.-- DIBUJAR, PROYECTAR LVI y LVII Diagrama, diagramar I y II (por Javier Seguí de la Riva) pp.7.-- DIBUJAR, PROYECTAR LIX, LX y LXI Escritos críticos I, II y III ( por Javier Seguí de la Riva) pp. 7 .-- Rehabilitacion del Antiguo Hospital San Juan de Dios para Biblioteca y Archivo Historico de Orihuela (por Ana Torres Barchino) pp. 8.-- Arnau Amo, Joaquín. Arquitectura. Ritos y ritmos (por María Elia Gutiérrez Mozo) pp. 8 y 9.—Cardone, Vito. Viaggiatori d’architettura in Italia. Da Brunelleschi a Charles Garnier (por Cesare Cundari) pp. 9 y 10.-- Casado de Amezúa Vázquez, Joaquín. Las casas reales de la Alhambra. Geometría y espacio. Una aproximación al proceso de formación del espacio ( por Pilar Chías Navarro)pp. 10.-- Jaén i Urban, Gaspar; Baldomá Soto, Montserrat y Carrasco Martí, Maria Antonia. One century of photography and preservation in catalonia: the service for local architectural heritage ( por Pilar Chías Navarro) pp. 10 y 11.-- Jaén i Urban, Gaspar. El paisaje urbano de Nueva York en la obra escrita de Federico García Lorca (por Concepción López González y Jorge García valldecabres) pp. 11.—Trachana, Angelique. Urbe Ludens ( por Gonzalo García-Rosales) pp. 12.-- Fernández-Palacios, Victoria; Yanguas, Ana; Jiménez Fdez-Palacios, Luz. Manuel Aires Mateus. Cuaderno de La Alhambra ( por José Mª Gentil Baldrich) pp. 12 y 13.-- Agustín, Luis; Miret, Elena; Vallespín, Aurelio. Representación del espacio arquitectónico. 2011.12 (por Jesús Aparicio Guisado) pp. 14.—Herschdorfer, Nathalie y Lada Umstätter, Thames. Le Corbusier and the Power of Photography (por víctor A. Lafuente Sánchez) pp. 14 y 15.-- Roma en el bolsillo. Cuadernos de dibujo y aprendizaje artístico en el siglo XVIII ( por Fernando Linares García) pp. 15 y 16.-- Vicens y Hualde, Ignacio. Dicho y hecho ( por Fernando Linares García) pp 16.-- Le Corbusier. El arte decorativo de hoy ( por Carlos Montes Serrano )pp. 16 y 17.—Jenkins Birkhäuser, Eric J. Drawn to Design: Analyzing Architecture Through Freehand Drawing ( por víctor A. Lafuente Sánchez) pp. 17 y 18.—Sobrino, Miguel. Monasterios. Las biografías desconocidas de los cenobios de España ( por Javier García-Gutiérrez Mosteiro) pp. 18 y 19.-- Jiménez Martín, Alfonso. Anatomía de la Catedral de Sevilla ( por Francisco Pinto Puerto) pp. 19.-- Raposo Grau, Javier Fco; Butragueño Díaz-Guerra, Belen y Paredes Maldonado, Miguel. Dibujar, analizar, proyectar (2010) Título I. Colección dibujo, proyecto y arquitectura ( por Mariasun Salgado de la Rosa) pp. 19 y 20.-- Raposo Grau, Fco Javier; Butragueño Díaz-Guerra, Belen y Paredes Maldonado, Miguel. Dibujar, analizar, proyectar (2011) Título III. Colección dibujo, proyecto y arquitectura ( por Carlos L. Marcos Alba) pp. 20-22.-- García Doménech, Sergio. Reflexiones urbanas sobre el espacio público de Alicante. Una interpretación de la ciudad y sus escenarios ( por Juan Calduch Cervera) pp. 22 y 23.—Cundari, Casere. Il rilievo architettonico. Ragioni. Fondamenti. Applicazioni ( por Antonio Álvaro Tordesillas) pp. 23 y 24.—Autores varios. Perspectiva-Prospettiva. La práctica de la perspectiva ( por José Mª Gentil Baldrich) pp. 24 y 25.-- Soler Sanz, Felipe. Trazados Reguladores en la Arquitectura ( por Jorge García Valldecabres) pp. 25.-- Jiménez Alcañiz, Cesar. Análisis de las metodologías para la recuperación patrimonial de entornos urbanos protegidos. Propuesta metodológica: desde los valores históricos a los nuevos modelos energéticos. Russafa desde el siglo XIX( Por Pablo Navarro Esteve) pp. 26.-- de Coca Leicher, José. El recinto ferial de la Casa de Campo de Madrid (1950-75)( por Esteban Herrero Cantalapiedra) pp. 27.-- La arquitectura religiosa renacentista en tierras del Maestre: la iglesia de Nuestra Señora de la Asunción de Vistabella del Maestrazgo ( por José Teodoro Garfella Rubio) pp. 27 y 28.-- Arquitectura de los balnearios en Galicia. Cuenca del Miño. 1816-1936 ( por José Antonio Franco Taboada)pp. 28 y 29.-- Barros da Rocha e Costa. Historia de la representación gráfica del Castillo de Peñíscola. Del grafito al láser ( por Pablo Navarro Esteve) pp. 29.-- Rivas López, Esteban José. El Carmen de la fundación Rodríguez-Acosta. Una indagación gráfica ( por Joaquín Casado de Amezúa) pp.30.-- Verdejo Gimeno, Pedro. Estaciones intermedias de ferrocarril. La sección “Non nata” Teruel-Alcañiz (por Jorge Girbés Pérez) pp. 30 y 31.-- Sender Contell, Marina. El Monasterio de Santa María de la Murta. Análisis arquitectónico de un Monasterio Jerónimo ( por Pablo Navarro Esteve) pp. 32.-- Iñarra Abad, Susana. El Render de Arquitectura. Análisis de la Respuesta Emocional del Observador ( por Pablo Navarro Esteve) pp. 32 y 33.-- Fernández Morales, Angélica. De concreto a conceptual. Relaciones entre arte y arquitectura en el contexto helvético contemporáneo ( por Luis Agustín) pp. 33.—EXPOSICIÓN: Intervenciones cromáticas en los comercios del centro histórico ( por Jorge Llopis verdú) pp. 34 y 35.Seguí De La Riva, J.; Torres Barchino, A.; Gutiérrez Mozo, ME.; Cundari, C.; Chías Navarro, P.; López González, C.; García Valldecabres, J.... (2014). Reseñas. EGA. Revista de Expresión Gráfica Arquitectónica. 19(24):4-35. https://doi.org/10.4995/ega.2014.3268SWORD435192

Autoantibodies against type I IFNs in patients with critical influenza pneumonia

In an international cohort of 279 patients with hypoxemic influenza pneumonia, we identified 13 patients (4.6%) with autoantibodies neutralizing IFN-alpha and/or -omega, which were previously reported to underlie 15% cases of life-threatening COVID-19 pneumonia and one third of severe adverse reactions to live-attenuated yellow fever vaccine. Autoantibodies neutralizing type I interferons (IFNs) can underlie critical COVID-19 pneumonia and yellow fever vaccine disease. We report here on 13 patients harboring autoantibodies neutralizing IFN-alpha 2 alone (five patients) or with IFN-omega (eight patients) from a cohort of 279 patients (4.7%) aged 6-73 yr with critical influenza pneumonia. Nine and four patients had antibodies neutralizing high and low concentrations, respectively, of IFN-alpha 2, and six and two patients had antibodies neutralizing high and low concentrations, respectively, of IFN-omega. The patients' autoantibodies increased influenza A virus replication in both A549 cells and reconstituted human airway epithelia. The prevalence of these antibodies was significantly higher than that in the general population for patients 70 yr of age (3.1 vs. 4.4%, P = 0.68). The risk of critical influenza was highest in patients with antibodies neutralizing high concentrations of both IFN-alpha 2 and IFN-omega (OR = 11.7, P = 1.3 x 10(-5)), especially those <70 yr old (OR = 139.9, P = 3.1 x 10(-10)). We also identified 10 patients in additional influenza patient cohorts. Autoantibodies neutralizing type I IFNs account for similar to 5% of cases of life-threatening influenza pneumonia in patients <70 yr old

Behavioral, Biochemical, and Molecular Indices of Stress are Enhanced in Female Versus Male Rats Experiencing Nicotine Withdrawal

Stress is a major factor that promotes tobacco use and relapse during withdrawal. Although women are more vulnerable to tobacco use than men, the manner in which stress contributes to tobacco use in women versus men is unclear. Thus, the goal of this study was to compare behavioral and biological indices of stress in male and female rats during nicotine withdrawal. Since the effects of nicotine withdrawal are age-dependent, this study also included adolescent rats. An initial study was conducted to provide comparable nicotine doses across age and sex during nicotine exposure and withdrawal. Rats received sham surgery or an osmotic pump that delivered nicotine. After 14 days of nicotine, the pumps were removed and controls received a sham surgery. Twenty-four hours later, anxiety-like behavior and plasma corticosterone were assessed. The nucleus accumbens (NAcc), amygdala, and hypothalamus were examined for changes in corticotropin-releasing factor (CRF) gene expression. In order to differentiate the effects of nicotine withdrawal from exposure to nicotine, a cohort of rats did not have their pumps removed. The major finding is that during nicotine withdrawal, adult females display higher levels of anxiety-like behavior, plasma corticosterone, and CRF mRNA expression in the NAcc relative to adult males. However, during nicotine exposure, adult males exhibited higher levels of corticosterone and CRF mRNA in the amygdala relative to females. Adolescents displayed less nicotine withdrawal than adults. Moreover, adolescent males displayed an increase in anxiety-like behavior and an up-regulation of CRF mRNA in the amygdala during nicotine exposure and withdrawal. These findings are likely related to stress produced by the high doses of nicotine that were administered to adolescents to produce equivalent levels of cotinine as adults. In conclusion, these findings suggest that intense stress produced by nicotine withdrawal may contribute to tobacco use in women

Pharmacokinetics and safety of aztreonam/avibactam for the treatment of complicated intra-abdominal infections in hospitalized adults: results from the REJUVENATE study

Objectives: To investigate pharmacokinetics (PK) and safety (primary objectives) and efficacy (secondary objective) of the investigational monobactam/b-lactamase inhibitor combination aztreonam/avibactam in patients with complicated intra-abdominal infection (cIAI). Methods: This Phase 2a open-label, multicentre study (NCT02655419; EudraCT 2015-002726-39) enrolled adults with cIAI into sequential cohorts for 5–14 days treatment. Cohort 1 patients received an aztreonam/avibactam loading dose of 500/137 mg (30 min infusion), followed by maintenance doses of 1500/410 mg (3 h infusions) q6h; Cohort 2 received 500/167 mg (30 min infusion), followed by 1500/500 mg (3 h infusions) q6h. Cohort 3 was an extension of exposure at the higher dose regimen. Doses were adjusted for creatinine clearance of 31–50 mL/min (Cohorts 2!3). All patients received IV metronidazole 500 mg q8h. PK, safety and efficacy were assessed. Results: Thirty-four patients (Cohort 1, n = 16; Cohorts 2!3, n = 18) comprised the modified ITT (MITT) population. Mean exposures of aztreonam and avibactam in Cohorts 2!3 were consistent with those predicted to achieve joint PK/pharmacodynamic target attainment in >90% patients. Adverse events (AEs) were similar between cohorts. The most common AEs were hepatic enzyme increases [n = 9 (26.5%)] and diarrhoea [n = 5 (14.7%)]. Clinical cure rates at the test-of-cure visit overall were 20/34 (58.8%) (MITT) and 14/23 (60.9%) (microbiological-MITT population). Conclusions: Observed AEs were consistent with the known safety profile of aztreonam monotherapy, with no new safety concerns identified. These data support selection of the aztreonam/avibactam 500/167 mg (30 min infusion) loading dose and 1500/500 mg (3 h infusions) maintenance dose q6h regimen, in patients with creatinine clearance >50 mL/min, for the Phase 3 development programm

DHPR α1S subunit controls skeletal muscle mass and morphogenesis

The α1S subunit has a dual function in skeletal muscle: it forms the L-type Ca2+ channel in T-tubules and is the voltage sensor of excitation–contraction coupling at the level of triads. It has been proposed that L-type Ca2+ channels might also be voltage-gated sensors linked to transcriptional activity controlling differentiation. By using the U7-exon skipping strategy, we have achieved long-lasting downregulation of α1S in adult skeletal muscle. Treated muscles underwent massive atrophy while still displaying significant amounts of α1S in the tubular system and being not paralysed. This atrophy implicated the autophagy pathway, which was triggered by neuronal nitric oxide synthase redistribution, activation of FoxO3A, upregulation of autophagy-related genes and autophagosome formation. Subcellular investigations showed that this atrophy was correlated with the disappearance of a minor fraction of α1S located throughout the sarcolemma. Our results reveal for the first time that this sarcolemmal fraction could have a role in a signalling pathway determining muscle anabolic or catabolic state and might act as a molecular sensor of muscle activity