Efficacy of β-lactam/β-lactamase inhibitors to treat extended-spectrum beta-lactamase-producing Enterobacterales bacteremia secondary to urinary tract infection in kidney transplant recipients (INCREMENT-SOT Project)

REIPI/INCREMENT-SOT Group.[Background] Whether active therapy with β-lactam/β-lactamase inhibitors (BLBLI) is as affective as carbapenems for extended-spectrum β-lactamase-producing Enterobacterales (ESBL-E) bloodstream infection (BSI) secondary to urinary tract infection (UTI) in kidney transplant recipients (KTRs) remains unclear.[Methods] We retrospectively evaluated 306 KTR admitted to 30 centers from January 2014 to October 2016. Therapeutic failure (lack of cure or clinical improvement and/or death from any cause) at days 7 and 30 from ESBL-E BSI onset was the primary and secondary study outcomes, respectively.[Results] Therapeutic failure at days 7 and 30 occurred in 8.2% (25/306) and 13.4% (41/306) of patients. Hospital-acquired BSI (adjusted OR [aOR]: 4.10; 95% confidence interval [CI]: 1.50-11.20) and Pitt score (aOR: 1.47; 95% CI: 1.21-1.77) were independently associated with therapeutic failure at day 7. Age-adjusted Charlson Index (aOR: 1.25; 95% CI: 1.05-1.48), Pitt score (aOR: 1.72; 95% CI: 1.35-2.17), and lymphocyte count ≤500 cells/μL at presentation (aOR: 3.16; 95% CI: 1.42-7.06) predicted therapeutic failure at day 30. Carbapenem monotherapy (68.6%, primarily meropenem) was the most frequent active therapy, followed by BLBLI monotherapy (10.8%, mostly piperacillin-tazobactam). Propensity score (PS)-adjusted models revealed no significant impact of the choice of active therapy (carbapenem-containing vs any other regimen, BLBLI- vs carbapenem-based monotherapy) within the first 72 hours on any of the study outcomes.[Conclusions] Our data suggest that active therapy based on BLBLI may be as effective as carbapenem-containing regimens for ESBL-E BSI secondary to UTI in the specific population of KTR. Potential residual confounding and unpowered sample size cannot be excluded (ClinicalTrials.gov identifier: NCT02852902).This work was supported by: (1) Plan Nacional de I+D+i 2013-2016 and Instituto de Salud Carlos III (ISCIII), Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Ciencia, Innovación y Universidades, Spanish Network for Research in Infectious Diseases [RD16/0016/0001, RD16/0016/0002, REIPI RD16/0016/0008; RD16/0016/00010], co-financed by European Development Regional Fund “A way to achieve Europe”, Operative Program Intelligent Growth 2014-2020; (2) European Society of Clinical Microbiology and Infectious diseases Study Group for Infections in Compromised Hosts (ESGICH, grant to J.M.A.); (3) Sociedad Andaluza de Trasplante de Órgano Sólido (SATOT, grant to L.M.M.); (4) Research project PI16/01631 integrated into the Plan Estatal de I+D+I 2013-2016 and co-financed by the ISCIII-Subdirección General de Evaluación y Fomento de la Investigación and the Fondo Europeo de Desarrollo Regional (FEDER); (5) M.F.R. holds a research contract “Miguel Servet” (CP 18/00073) from ISCIII, Ministerio de Ciencia, Innovación y Universidades. The work was also supported by the following European Society of Clinical Microbiology and Infectious diseases (ESCMID) study groups: Infections in Compromised Hosts (ESGICH), Bloodstream Infections and Sepsis (ESGBIS) and Antimicrobial Resistance Surveillance (ESGARS).Peer reviewe

Impacto de un nuevo escenario socioeconómico en la percepción y posicionamientos de los y las jóvenes

Depto. de Sociología: Metodología y TeoríaFac. de Ciencias Políticas y SociologíaTRUEpu

Jóvenes y diversidad ante un futuro condicionado por la crisis

The article presents a typology essay that shows the diversity of the young collective regarding the prospects for the future from the theoretical model and the social contract and based on the data analyzed for the report “The young people in the society of the future” (Rodríguez San Julián, E.; Ballesteros Guerra, JC. 2013). Five types of young people characterized by their opinions and assessments about their personal situation, the role of studies regarding their future employment, the more relevant aspects to get a job, the influence of the crisis, the aspects that have worsened the most in the last years, and the prospect of having to change things in their lives are presented through an analysis of cluster. One of the groups is the average group, not differentiated from the general results of the report. The other four differential groups are called Trusting and well positioned people, Pessimistic people striving for adaptation, and Self-sacrificing people in a cycle of discomfort. The differences among the groups show themselves to be expressive enough to make it possible to visualize the divergences in the possible future paths and reveal the crucial importance of the social, structural and ideological differences at the present time.El artículo presenta un ensayo de tipología que muestra la diversidad del colectivo joven respecto a las perspectivas del futuro, desde el modelo teórico del contrato social, y a partir de los datos analizados para el informe “Los jóvenes en la sociedad del futuro” (Rodríguez San Julián, E.; Ballesteros Guerra, JC. 2013). Mediante un análisis de clúster, se presentan cinco tipos de jóvenes caracterizados por sus opiniones y valoraciones respecto a su situación personal, el papel de los estudios en su futuro laboral, los aspectos más relevantes para conseguir empleo, la influencia de la crisis, los aspectos que más han empeorado en los últimos años y la perspectiva de tener que cambiar cosas en su vida. Siendo uno de los grupos el tipo medio, no diferenciado respecto a los resultados generales del informe, los cuatro grupos diferenciales se denominan Confiados y bien posicionados, Pesimistas esforzándose para la adaptación, Bloqueados fatalistas y Abnegados en un ciclo de malestar. Las diferencias entre los grupos se muestran suficientemente expresivas como para visualizar las divergencias en las posibles trayectorias futuras, y revelan la crucial importancia de las diferencias sociales, estructurales e ideológicas en el momento actual

Determinación de estrategias para la mejora de la rentabilidad social del Patrimonio Histórico de la Comunidad de Madrid

Depto. de Prehistoria, Historia Antigua y ArqueologíaFac. de Geografía e HistoriaFALSEpu