Discrepancia en el resultado de la elastografía de transición realizada por dos exploradores diferentes

Conèixer la variabilitat que hi ha quan l'elastografia de transició es feta per dos exploradors diferents, i trobar factors relacionats amb eixa variabilitat. s'inclouen 333 parelles d'elastografies de transició. en 87 parelles de proves (26,7 %) hi ha una discrepància d'al menys 2 kPa entre els dos resultats, i en 15 parelles (4,6 %) hi ha una discrepància d'al menys 10 kPa entre els dos resultats. hi ha discrepància d'al menys un estadi de fibrosi entre les dos proves en 74 parelles de proves (22,8 %). la discrepància en els resultats és més freqüent amb valors majors de rigidesa hepàtica.Conocer la variabilidad que existe cuando la elastografía de transición es realizada por dos exploradores diferentes, y encontrar factores que se relacionen con dicha variabilidad. Se incluyen 333 pares de elastografías de transición. En 87 pares de pruebas (26,7 %) hay una discrepancia de al menos 2 kPa entre los dos resultados, y en 15 pares (4,6 %) hay una discrepancia de al menos 10 kPa entre los dos resultados. Hay discordancia de al menos un estadio de fibrosis entre las dos pruebas en 74 pares de pruebas (22,8 %). La discrepancia en los resultados es más común con valores altos de rigidez hepática

High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus

We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011 June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 mu g/mL and 0.5 mu g/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2-5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1-5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications

Biofilm formation by multidrug resistant Enterobacteriaceae strains isolated from solid organ transplant recipients

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant bacteria (MDR). In this study, the biofilm-forming capability of 209 MDR strains (Escherichia coli n = 106, Klebsiella pneumoniae n = 78, and Enterobacter spp. n = 25) isolated from rectal swabs in the first 48 hours before or after kidney (93 patients), liver (60 patients) or kidney/pancreas transplants (5 patients) were evaluated by using a microplate assay. Thirty-nine strains were isolated before transplant and 170 strains were isolated post-transplant. Overall, 16% of E. coli strains, 73% of K. pneumoniae strains and 4% Enterobacter strains showed moderate or strong biofilm production. Nine strains isolated from infection sites after transplantation were responsible of infections in the first month. Of these, 4 K. pneumoniae, 1 E. coli and 1 Enterobacter spp. strains isolated pre-transplant or post-transplant as colonizers caused infections in the post-transplant period. Our results suggest that in vitro biofilm formation could be an important factor for adhesion to intestine and colonization in MDR K. pneumoniae strains in SOT recipients, but this factor appears to be less important for MDR E. coli and Enterobacter spp.Acknowledgements: The authors thank Dr. Fidel Madrazo (Electron Microscopy Unit, Technology Support Services, IDIVAL) for helping with confocal microscopy. This research was supported by ‘Plan Nacional de I + D + i and Instituto de Salud Carlos III (Fondo de Investigaciones Sanitarias PI 13/01191 to MCF and PI 16/01103 to JRV), Subdirección General de Redes y Centros de Investigación Cooperativa, Spanish Ministry of Economy and Competitiveness, Spanish Network for Research in Infectious Diseases (REIPI RD12/0015) and (REIPI RD16/0016) co-financed by the European Development Regional Fund “A way to achieve Europe” ERDF

Genomics And Susceptibility Profiles Of Extensively Drug-resistant Pseudomonas Aeruginosa Isolates From Spain

This study assessed the molecular epidemiology, resistance mechanisms, and susceptibility profiles of a collection of 150 extensively drug-resistant (XDR) Pseudomonas aeruginosa clinical isolates obtained from a 2015 Spanish multicenter study, with a particular focus on resistome analysis in relation to ceftolozane-tazobactam susceptibility. Broth microdilution MICs revealed that nearly all (> 95%) of the isolates were nonsusceptible to piperacillin-tazobactam, ceftazidime, cefepime, aztreonam, imipenem, meropenem, and ciprofloxacin. Most of them were also resistant to tobramycin (77%), whereas nonsusceptibility rates were lower for ceftolozane-tazobactam (31%), amikacin (7%), and colistin (2%). Pulsed-field gel electrophoresis-multilocus sequence typing (PFGE-MLST) analysis revealed that nearly all of the isolates belonged to previously described high-risk clones. Sequence type 175 (ST175) was detected in all 9 participating hospitals and accounted for 68% (n = 101) of the XDR isolates, distantly followed by ST244 (n = 16), ST253 (n = 12), ST235 (n = 8), and ST111 (n = 2), which were detected only in 1 to 2 hospitals. Through phenotypic and molecular methods, the presence of horizontally acquired carbapenemases was detected in 21% of the isolates, mostly VIM (17%) and GES enzymes (4%). At least two representative isolates from each clone and hospital (n = 44) were fully sequenced on an illumina MiSeq. Classical mutational mechanisms, such as those leading to the overexpression of the beta-lactamase AmpC or efflux pumps, OprD inactivation, and/or quinolone resistance-determining regions (QRDR) mutations, were confirmed in most isolates and correlated well with the resistance phenotypes in the absence of horizontally acquired determinants. Ceftolozane-tazobactam resistance was not detected in carbapenemase-negative isolates, in agreement with sequencing data showing the absence of ampC mutations. The unique set of mutations responsible for the XDR phenotype of ST175 clone documented 7 years earlier were found to be conserved, denoting the long-term persistence of this specific XDR lineage in Spanish hospitals. Finally, other potentially relevant mutations were evidenced, including those in penicillin-binding protein 3 (PBP3), which is involved in beta-lactam (including ceftolozane-tazobactam) resistance, and FusA1, which is linked to aminoglycoside resistance

Discrepancia en el resultado de la elastografía de transición realizada por dos exploradores diferentes

Conèixer la variabilitat que hi ha quan l’elastografia de transició es feta per dos exploradors diferents, i trobar factors relacionats amb eixa variabilitat. s’inclouen 333 parelles d’elastografies de transició. en 87 parelles de proves (26,7 %) hi ha una discrepància d’al menys 2 kPa entre els dos resultats, i en 15 parelles (4,6 %) hi ha una discrepància d’al menys 10 kPa entre els dos resultats. hi ha discrepància d’al menys un estadi de fibrosi entre les dos proves en 74 parelles de proves (22,8 %). la discrepància en els resultats és més freqüent amb valors majors de rigidesa hepàtica.Conocer la variabilidad que existe cuando la elastografía de transición es realizada por dos exploradores diferentes, y encontrar factores que se relacionen con dicha variabilidad. Se incluyen 333 pares de elastografías de transición. En 87 pares de pruebas (26,7 %) hay una discrepancia de al menos 2 kPa entre los dos resultados, y en 15 pares (4,6 %) hay una discrepancia de al menos 10 kPa entre los dos resultados. Hay discordancia de al menos un estadio de fibrosis entre las dos pruebas en 74 pares de pruebas (22,8 %). La discrepancia en los resultados es más común con valores altos de rigidez hepática

Discrepancia en el resultado de la elastografía de transición realizada por dos exploradores diferentes

Conèixer la variabilitat que hi ha quan l'elastografia de transició es feta per dos exploradors diferents, i trobar factors relacionats amb eixa variabilitat. s'inclouen 333 parelles d'elastografies de transició. en 87 parelles de proves (26,7 %) hi ha una discrepància d'al menys 2 kPa entre els dos resultats, i en 15 parelles (4,6 %) hi ha una discrepància d'al menys 10 kPa entre els dos resultats. hi ha discrepància d'al menys un estadi de fibrosi entre les dos proves en 74 parelles de proves (22,8 %). la discrepància en els resultats és més freqüent amb valors majors de rigidesa hepàtica.Conocer la variabilidad que existe cuando la elastografía de transición es realizada por dos exploradores diferentes, y encontrar factores que se relacionen con dicha variabilidad. Se incluyen 333 pares de elastografías de transición. En 87 pares de pruebas (26,7 %) hay una discrepancia de al menos 2 kPa entre los dos resultados, y en 15 pares (4,6 %) hay una discrepancia de al menos 10 kPa entre los dos resultados. Hay discordancia de al menos un estadio de fibrosis entre las dos pruebas en 74 pares de pruebas (22,8 %). La discrepancia en los resultados es más común con valores altos de rigidez hepática

High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus

We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011–June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 μg/mL and 0.5 μg/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2–5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1–5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications

High MICs for Vancomycin and Daptomycin and Complicated Catheter-Related Bloodstream Infections with Methicillin-Sensitive Staphylococcus aureus

We investigated the prognostic role of high MICs for antistaphylococcal agents in patients with methicillin-sensitive Staphylococcus aureus catheter-related bloodstream infection (MSSA CRBSI). We prospectively reviewed 83 episodes from 5 centers in Spain during April 2011 June 2014 that had optimized clinical management and analyzed the relationship between E-test MICs for vancomycin, daptomycin, oxacillin, and linezolid and development of complicated bacteremia by using multivariate analysis. Complicated MSSA CRBSI occurred in 26 (31.3%) patients; MICs for vancomycin and daptomycin were higher in these patients (optimal cutoff values for predictive accuracy = 1.5 mu g/mL and 0.5 mu g/mL). High MICs for vancomycin (hazard ratio 2.4, 95% CI 1.2-5.5) and daptomycin (hazard ratio 2.4, 95% CI 1.1-5.9) were independent risk factors for development of complicated MSSA CRBSI. Our data suggest that patients with MSSA CRBSI caused by strains that have high MICs for vancomycin or daptomycin are at increased risk for complications