Interplay between Intestinal Bacterial Communities and Unicellular Parasites in a Morbidly Obese Population: A Neglected Trinomial

Obesity is an epidemic causing a metabolic health crisis. Herein, the interactions between the gut prokaryotic and eukaryotic communities, metabolic comorbidities and diet were studied. Stool samples from 56 subjects, 47 with type III obesity and 9 with type II obesity and cardiovascular risk or metabolic disease, were assessed for the richness, diversity and ecology of the bacterial gut community through metagenomics, together with the study of the presence of common unicellular eukaryote parasites (Blastocystis sp., Dientamoeba fragilis and Giardia intestinalis) by qPCR. Clinical information regarding metabolic comorbidities and non-alcoholic hepatic fatty liver disease was gathered. To assess the quality of the patients' diet, each participant filled in three dietary questionnaires. The most prevalent parasite Blastocystis sp. (46.4%), together with D. fragilis (8.9%), was found to be associated with higher mean diversity indexes regarding non-colonized subjects; the opposite of that which was observed in those with G. intestinalis (16.1%). In terms of phyla relative abundance, with Blastocystis sp. and D. fragilis, very slight differences were observed; on the contrary, G. intestinalis was related to an increase in Bacteroidetes and Proteobacteria, and a decrease in Firmicutes and Actinobacteria, presenting the lowest Firmicutes/Bacteroidetes ratio. At genus level, Blastocystis sp. and/or D. fragilis was accompanied with an increase in Lactobacillus spp., and a decrease in Akkermansia spp., Bifidobacterium spp. and Escherichia spp., while G. intestinalis was associated with an increase in Bacteroides spp., and a decrease in Faecalibacterium spp., Prevotella spp. and Lactobacillus spp., and the highest Bacteroides spp./Prevotella spp. ratio. Participants with non-alcoholic hepatic fatty liver presented a higher Firmicutes/Bacteroidetes ratio, and those with type 2 diabetes displayed a significantly lower Faecalibacterium spp./Escherichia spp. ratio, due to an overrepresentation of the genus Escherichia spp. The presence of parasites was associated with variations in the richness, diversity and distribution of taxa in bacterial communities, confirming a gain in diversity associated with Blastocystis sp. and providing different functioning of the microbiota with a potential positive effect on comorbidities such as type 2 diabetes, insulin resistance and metabolic syndrome. Future basic and clinical studies should assess the beneficial or pathogenic effect of these eukaryotes on obese subjects and focus on deciphering whether they may imply a healthier metabolic profile

Micromón València (Universitat de València)

En Julio de 2017 se creó la red SWI@Spain, auspiciada por el grupo de Docencia y Difusión de la Microbiología (DDM) de la Sociedad Española de Microbiología (SEM), para desarrollar la iniciativa internacional Small World Initiative (SWI) en la península ibérica. En la Universitat de València (UV) se constituyó entonces el grupo de Innovación Docente en Microbiología (IDM) para implementar el proyecto a nivel local. Avalados por el Servei de Formació Permanent i Innovació Educativa (SFPIE) de la UV, el grupo ha llevado a cabo diferentes iniciativas relacionadas con el objetivo fundamental del proyecto: divulgar la problemática actual relacionada con el uso inadecuado de antibióticos, el incremento de bacterias resistentes a éstos y la necesidad de encontrar nuevas moléculas con actividad antibacteriana para combatir las infecciones que provocan

Treatment with tocilizumab or corticosteroids for COVID-19 patients with hyperinflammatory state: a multicentre cohort study (SAM-COVID-19)

Objectives: The objective of this study was to estimate the association between tocilizumab or corticosteroids and the risk of intubation or death in patients with coronavirus disease 19 (COVID-19) with a hyperinflammatory state according to clinical and laboratory parameters. Methods: A cohort study was performed in 60 Spanish hospitals including 778 patients with COVID-19 and clinical and laboratory data indicative of a hyperinflammatory state. Treatment was mainly with tocilizumab, an intermediate-high dose of corticosteroids (IHDC), a pulse dose of corticosteroids (PDC), combination therapy, or no treatment. Primary outcome was intubation or death; follow-up was 21 days. Propensity score-adjusted estimations using Cox regression (logistic regression if needed) were calculated. Propensity scores were used as confounders, matching variables and for the inverse probability of treatment weights (IPTWs). Results: In all, 88, 117, 78 and 151 patients treated with tocilizumab, IHDC, PDC, and combination therapy, respectively, were compared with 344 untreated patients. The primary endpoint occurred in 10 (11.4%), 27 (23.1%), 12 (15.4%), 40 (25.6%) and 69 (21.1%), respectively. The IPTW-based hazard ratios (odds ratio for combination therapy) for the primary endpoint were 0.32 (95%CI 0.22-0.47; p < 0.001) for tocilizumab, 0.82 (0.71-1.30; p 0.82) for IHDC, 0.61 (0.43-0.86; p 0.006) for PDC, and 1.17 (0.86-1.58; p 0.30) for combination therapy. Other applications of the propensity score provided similar results, but were not significant for PDC. Tocilizumab was also associated with lower hazard of death alone in IPTW analysis (0.07; 0.02-0.17; p < 0.001). Conclusions: Tocilizumab might be useful in COVID-19 patients with a hyperinflammatory state and should be prioritized for randomized trials in this situatio

Commensal Staphylococcus isolates from the nasal cavity of community older adults in Valencia (Spain) and their resistance to methicillin and other antibiotics

Methicillin-resistant Staphylococcus aureus strains (MRSA) have been gradually disseminated worldwide, causing nosocomial and community-acquired infections, and healthy carriers of commensal MRSA constitute a reservoir of the pathogen. Other Staphylococcus species (coagulase-negative, CoNS) colonize animals and humans and include also methicillin-resistant strains (MRCoNS). Here we have determined the prevalence of S. aureus and CoNS species in the nasal cavity of community healthy older adults (n= 27, average age: 63.7 years) and their resistance to methicillin and other antibiotics. A total of 35 Staphylococcus isolates were obtained. All individuals (100%) were carriers of at least one Staphylococcus strain; 15% of subjects were S. aureus carriers, and eight subjects (30%) carried two strains. Prevalence of resistance to methicillin was 25% and 35% for S. aureus and CoNS isolates, respectively. Most isolates were resistant to penicillin G (90%) and clarithromycin (45%). Other resistances were less frequent (rifampicin, tetracycline, fosfomycin, ciprofloxacin), and no resistant isolates to chloramphenicol or vancomycin were found. Multiresistant isolates to three or four chemotherapeutic agents were detected (20% of isolates). These results suggest that the nasal cavity of healthy adults may represent an ecological niche for the transfer of resistant determinants between staphylococcal species, and point out that epidemiological surveillance of commensal MRSA carriers should extended also to MRCoNS carriers.Las cepas de Staphylococcus aureus resistentes a meticilina (SARM) están ampliamente diseminadas, causando infecciones hospitalarias y comunitarias, y los portadores sanos de SARM constituyen un reservorio del patógeno. Otras especies de estafilococos coagulasa negativos (CoNS) colonizan animales y humanos, e incluyen cepas resistentes a meticilina (CoNSRM). En este trabajo hemos determinado la prevalencia de S. aureus y CoNS en la cavidad nasal de adultos mayores sanos (n= 27, edad media: 63.7 años) y su resistencia a meticilina y otros antibióticos. Se obtuvieron 35 aislados de Staphylococcus. Todos los individuos (100%) portaban al menos una cepa de Staphylococcus; el 15% eran portadores de S. aureus, y en ocho sujetos (30%) se aislaron dos cepas. La resistencia a meticilina fue del 25% y del 35% para los aislados de S. aureus y CoNS, respectivamente. La mayoría de aislados fueron resistentes a penicilina G (90%) y claritromicina (45%). Otras resistencias fueron menos frecuentes (rifampicina, tetraciclina, fosfomicina, ciprofloxacino) y no se encontraron resistencias a cloranfenicol ni vancomicina. Se detectaron aislados multirresistentes a tres o cuatro quimioterápicos (20% de aislados). Estos resultados sugieren que la cavidad nasal puede constituir un nicho para la transferencia de resistencias entre estafilococos, y que la vigilancia epidemiológica debe incluir tanto a los portadores de SARM como de CoNSMR