Evaluation of Matrix-Assisted Laser Desorption Ionization-Time of Flight Mass Spectrometry for Molecular Typing of Acinetobacter baumannii in Comparison with Orthogonal Methods

Colonization and subsequent health care-associated infection (HCAI) with Acinetobacter baumannii are a concern for vulnerable patient groups within the hospital setting. Outbreaks involving multidrug-resistant strains are associated with increased patient morbidity and mortality and poorer overall outcomes. Reliable molecular typing methods can help to trace transmission routes and manage outbreaks. In addition to methods deployed by reference laboratories, matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) may assist by making initial in-house judgments on strain relatedness. However, limited studies on method reproducibility exist for this application. We applied MALDI-TOF MS typing to A. baumannii isolates associated with a nosocomial outbreak and evaluated different methods for data analysis. In addition, we compared MALDI-TOF MS with whole-genome sequencing (WGS) and Fourier transform infrared spectroscopy (FTIR) as orthogonal methods to further explore their resolution for bacterial strain typing. A related subgroup of isolates consistently clustered separately from the main outbreak group by all investigated methods. This finding, combined with epidemiological data from the outbreak, indicates that these methods identified a separate transmission event unrelated to the main outbreak. However, the MALDI-TOF MS upstream approach introduced measurement variability impacting method reproducibility and limiting its reliability as a standalone typing method. Availability of in-house typing methods with well-characterized sources of measurement uncertainty could assist with rapid and dependable confirmation (or denial) of suspected transmission events. This work highlights some of the steps to be improved before such tools can be fully integrated into routine diagnostic service workflows for strain typing. IMPORTANCE Managing the transmission of antimicrobial resistance necessitates reliable methods for tracking outbreaks. We compared the performance of MALDI-TOF MS with orthogonal approaches for strain typing, including WGS and FTIR, for Acinetobacter baumannii isolates correlated with a health care-associated infection (HCAI) event. Combined with epidemiological data, all methods investigated identified a group of isolates that were temporally and spatially linked to the outbreak, yet potentially attributed to a separate transmission event. This may have implications for guiding infection control strategies during an outbreak. However, the technical reproducibility of MALDI-TOF MS needs to be improved for it to be employed as a standalone typing method, as different stages of the experimental workflow introduced bias influencing interpretation of biomarker peak data. Availability of in-house methods for strain typing of bacteria could improve infection control practices following increased reports of outbreaks of antimicrobial-resistant organisms during the COVID-19 pandemic, related to sessional usage of personal protective equipment (PPE)

Adjunctive rifampicin for Staphylococcus aureus bacteraemia (ARREST): a multicentre, randomised, double-blind, placebo-controlled trial.

BACKGROUND: Staphylococcus aureus bacteraemia is a common cause of severe community-acquired and hospital-acquired infection worldwide. We tested the hypothesis that adjunctive rifampicin would reduce bacteriologically confirmed treatment failure or disease recurrence, or death, by enhancing early S aureus killing, sterilising infected foci and blood faster, and reducing risks of dissemination and metastatic infection. METHODS: In this multicentre, randomised, double-blind, placebo-controlled trial, adults (≥18 years) with S aureus bacteraemia who had received ≤96 h of active antibiotic therapy were recruited from 29 UK hospitals. Patients were randomly assigned (1:1) via a computer-generated sequential randomisation list to receive 2 weeks of adjunctive rifampicin (600 mg or 900 mg per day according to weight, oral or intravenous) versus identical placebo, together with standard antibiotic therapy. Randomisation was stratified by centre. Patients, investigators, and those caring for the patients were masked to group allocation. The primary outcome was time to bacteriologically confirmed treatment failure or disease recurrence, or death (all-cause), from randomisation to 12 weeks, adjudicated by an independent review committee masked to the treatment. Analysis was intention to treat. This trial was registered, number ISRCTN37666216, and is closed to new participants. FINDINGS: Between Dec 10, 2012, and Oct 25, 2016, 758 eligible participants were randomly assigned: 370 to rifampicin and 388 to placebo. 485 (64%) participants had community-acquired S aureus infections, and 132 (17%) had nosocomial S aureus infections. 47 (6%) had meticillin-resistant infections. 301 (40%) participants had an initial deep infection focus. Standard antibiotics were given for 29 (IQR 18-45) days; 619 (82%) participants received flucloxacillin. By week 12, 62 (17%) of participants who received rifampicin versus 71 (18%) who received placebo experienced treatment failure or disease recurrence, or died (absolute risk difference -1·4%, 95% CI -7·0 to 4·3; hazard ratio 0·96, 0·68-1·35, p=0·81). From randomisation to 12 weeks, no evidence of differences in serious (p=0·17) or grade 3-4 (p=0·36) adverse events were observed; however, 63 (17%) participants in the rifampicin group versus 39 (10%) in the placebo group had antibiotic or trial drug-modifying adverse events (p=0·004), and 24 (6%) versus six (2%) had drug interactions (p=0·0005). INTERPRETATION: Adjunctive rifampicin provided no overall benefit over standard antibiotic therapy in adults with S aureus bacteraemia. FUNDING: UK National Institute for Health Research Health Technology Assessment

Oral versus intravenous antibiotics for bone and joint infection

BACKGROUND The management of complex orthopedic infections usually includes a prolonged course of intravenous antibiotic agents. We investigated whether oral antibiotic therapy is noninferior to intravenous antibiotic therapy for this indication. METHODS We enrolled adults who were being treated for bone or joint infection at 26 U.K. centers. Within 7 days after surgery (or, if the infection was being managed without surgery, within 7 days after the start of antibiotic treatment), participants were randomly assigned to receive either intravenous or oral antibiotics to complete the first 6 weeks of therapy. Follow-on oral antibiotics were permitted in both groups. The primary end point was definitive treatment failure within 1 year after randomization. In the analysis of the risk of the primary end point, the noninferiority margin was 7.5 percentage points. RESULTS Among the 1054 participants (527 in each group), end-point data were available for 1015 (96.3%). Treatment failure occurred in 74 of 506 participants (14.6%) in the intravenous group and 67 of 509 participants (13.2%) in the oral group. Missing end-point data (39 participants, 3.7%) were imputed. The intention-to-treat analysis showed a difference in the risk of definitive treatment failure (oral group vs. intravenous group) of −1.4 percentage points (90% confidence interval [CI], −4.9 to 2.2; 95% CI, −5.6 to 2.9), indicating noninferiority. Complete-case, per-protocol, and sensitivity analyses supported this result. The between-group difference in the incidence of serious adverse events was not significant (146 of 527 participants [27.7%] in the intravenous group and 138 of 527 [26.2%] in the oral group; P=0.58). Catheter complications, analyzed as a secondary end point, were more common in the intravenous group (9.4% vs. 1.0%). CONCLUSIONS Oral antibiotic therapy was noninferior to intravenous antibiotic therapy when used during the first 6 weeks for complex orthopedic infection, as assessed by treatment failure at 1 year. (Funded by the National Institute for Health Research; OVIVA Current Controlled Trials number, ISRCTN91566927. opens in new tab.

Condition physique et santé : du diagnostic à l'activité physique personnalisée chez le senior (ASM Vitaly Test)

The objective of the thesis was to create and test a fitness assessment tool promoting resume of physical activity for healthy people. The device must make it possible to create a cohort of subjects followed in their physical activity and their health in partnership with associations or health care institutions.L'objectif de la thèse était de créer et de tester un dispositif d'évaluation de la condition physique afin de permettre une reprise d'activité physique pour des personnes en bonne santé. Le dispositif doit permettre de créer une cohorte de sujets suivi dans leur activité physique et leur santé en partenariat avec des associations ou des établissements de soins

Fitness and Health : From Diagnosis to Personalized Physical Activity in the Senior (ASM Vitality Test)

L'objectif de la thèse était de créer et de tester un dispositif d'évaluation de la condition physique afin de permettre une reprise d'activité physique pour des personnes en bonne santé. Le dispositif doit permettre de créer une cohorte de sujets suivi dans leur activité physique et leur santé en partenariat avec des associations ou des établissements de soins.The objective of the thesis was to create and test a fitness assessment tool promoting resume of physical activity for healthy people. The device must make it possible to create a cohort of subjects followed in their physical activity and their health in partnership with associations or health care institutions

The Effect of Resident Participation on Appendectomy Operative Times.

OBJECTIVE: To assess the association between level of resident autonomy and operative times for appendectomies. DESIGN: A single center retrospective analysis of electronic medical record data of patients who underwent an appendectomy from 1/1/2017 to 12/31/2018. Medical record numbers s were matched with cases entered in the ACGME Resident Case Log system. Cases were stratified by resident role ( First Assistant, Surgeon Junior, Surgeon Chief, or Teaching Assistant ) and operative times were compared to cases without resident participation using student\u27s t test. SETTING: Maine Medical Center, Department of Surgery, Portland, Maine. PARTICIPANTS: Inclusion criteria: ≥5 years old, underwent appendectomy at a tertiary medical center during the study duration, and either had corresponding Case-log data or had no resident involvement. Patients who underwent appendectomy as part of a larger procedure were excluded. RESULTS: Six hundred eighty-eight patients met inclusion criteria, with residents participating in 574 (83.5%) cases. Overall mean operating time was 51 ± 21.5 minutes. Attending physicians without resident participation had the shortest OR times (43 ± 19.1 minutes). There was no difference in operating time between chief resident involvement and attending physicians without resident participation (45 ± 21; p = 0.43). Cases with residents involved as First Assistant (53 ± 18.6 minutes; p = 0.04) Surgeon Junior (52 ± 24.0 minutes; p \u3c 0.001), or Teaching Assistant (57 ± 21.6 minutes; p \u3c 0.001) were found to have longer operating times as compared to attending physicians operating without a resident. CONCLUSIONS: Operative times for appendectomies are impacted by resident role. Chief residents\u27 operative times approach that of attendings when operating as Surgeon Chief, however they are significantly longer when operating as Teaching Assistant. Involvement of junior residents in any role lengthen operating times. This suggests that surgical education influences operating room efficiency

Adherence to a Physical Activity Program Depends on Individual Fitness Purpose in Older Persons

International audienceThe effect of a long-term program on adherence in older adults seeking to improve low physical fitness compared to a multiactivity practice was studied. Seventy persons (+ 60 years) took part in 10 months program, distributing in three groups: low cardiorespiratory and muscular fitness (n=25, CMF), low coordination and motor skills (n=21, CBM) and free-choice multi-physical activities (n=24, MPA). Adherence was assessed by quantitative indicators and analysis of temporal dynamics. Adherence was 61.3 ± 25.8% for the CMF group, 49.7 ± 25.0% for the CBM and 33.3 ± 25.8 for the MPA. Only about 42% of the participants in MPA would continue the program for 10 consecutive months. The curve of adherence decreased regularly during the 10-month program: after 6 months adherence had fallen by 20% for CMF and by 14% for CBM, and after 10 months by 24% for CMF and by 19% for CBM. When physical activity program was supervised by the same instructor and when the participant's individual goal was clear, adherence was significantly higher (p<0.05) in the range 76-81%

Large-Scale Assessment of Health-Related Physical Fitness in French Older Adults: Feasibility and Validity

International audienceObjectives: This study aims to assess the validity, internal consistency, implementation, and feasibility of a sequence of tests, the Vitality Test Battery, designed to measure physical fitness, at a large scale in French older adults. Methods: A total of 528 volunteers (age ≥60 years) took the battery of 10 tests: 6-min walk, trunk strength, hand grip strength, medicine ball throwing, 30-s chair stand, flexibility, balance, plate tapping, ruler drop, and dual task. Results: Internal consistency was high, with the Cronbach alpha coefficients at around 0.77, explaining 64% of the variance. The test–retest correlations (0.3–0.6) between the items were acceptable and displayed an internal consistency property. Although five components explained 65% of the variance, all the items were kept because their eigenvalues were near to 0.9. External consistency was validated by a significant decrease in fitness scores ( p &lt; 0.001) with age and body mass index. Discussion: The Vitality Test Battery is a safe, valid tool for assessing physical fitness in persons aged over 60 years