Burden and risk factors for Pseudomonas aeruginosa community-acquired pneumonia:a Multinational Point Prevalence Study of Hospitalised Patients

Pseudornonas aeruginosa is a challenging bacterium to treat due to its intrinsic resistance to the antibiotics used most frequently in patients with community-acquired pneumonia (CAP). Data about the global burden and risk factors associated with P. aeruginosa-CAP are limited. We assessed the multinational burden and specific risk factors associated with P. aeruginosa-CAP. We enrolled 3193 patients in 54 countries with confirmed diagnosis of CAP who underwent microbiological testing at admission. Prevalence was calculated according to the identification of P. aeruginosa. Logistic regression analysis was used to identify risk factors for antibiotic-susceptible and antibiotic-resistant P. aeruginosa-CAP. The prevalence of P. aeruginosa and antibiotic-resistant P. aeruginosa-CAP was 4.2% and 2.0%, respectively. The rate of P. aeruginosa CAP in patients with prior infection/colonisation due to P. aeruginosa and at least one of the three independently associated chronic lung diseases (i.e. tracheostomy, bronchiectasis and/or very severe chronic obstructive pulmonary disease) was 67%. In contrast, the rate of P. aeruginosa-CAP was 2% in patients without prior P. aeruginosa infection/colonisation and none of the selected chronic lung diseases. The multinational prevalence of P. aeruginosa-CAP is low. The risk factors identified in this study may guide healthcare professionals in deciding empirical antibiotic coverage for CAP patients

Surface instabilities of ferrofluids

We report on recent progress in understanding the formation of surface protuberances on a planar layer of ferrofluid in a magnetic field oriented normally to the surface. This normal field or Rosensweig instability can be tackled by a linear and a nonlinear description. In the linear regime of small amplitudes we focus on the wave number of maximal growth, its corresponding growth rate and the oscillatory decay of metastable pattern, accessible via a pulse technique. A quantitative comparison of measurements with predictions of the linear stability analysis is performed, whereby the viscosity and the finite depth of the liquid layer are taken into account. In the nonlinear regime the fully developed peak pattern can be predicted by a minimization of the free energy and by numerics employing the finite element method. For a comparison with the results of both methods, the three-dimensional surface profile is recorded by a radioscopic measurement technique. In the bistable regime of the flat and patterned state we generate localized states (ferrosolitons) which are recovered in analytical and numerical model descriptions. For higher fields an inverse hysteretic transition from hexagonal to square planforms is measured. % Via a horizontal field component the symmetry can be broken in the experiment, resulting in liquid ridges and distorted hexagons, as predicted by theory. Replacing ferrofluid by ferrogel also an elastic energy contribution has to be taken into account for a proper model description, yielding a linear shift of the threshold and an increased bistability range. Parametric excitation in combination with magnetic fields is widening the horizon of pattern formation even further. For the mono-spike oscillator harmonic and subharmonic response as well as deterministic chaos is observed and modeled. In a ring of spikes the formation of domains of different wavelengths and spatio-temporal intermittency is quantitatively studied. For an extended layer of ferrofluid we predict that a stabilizing horizontal field counteracted by vertical vibrations will result in oblique rolls with preselected orientation

Prevalence and risk factors for Enterobacteriaceae in patients hospitalized with community-acquired pneumonia

Background and objective Enterobacteriaceae (EB) spp. family is known to include potentially multidrug-resistant (MDR) microorganisms, and remains as an important cause of community-acquired pneumonia (CAP) associated with high mortality. The aim of this study was to determine the prevalence and specific risk factors associated with EB and MDR-EB in a cohort of hospitalized adults with CAP. Methods We performed a multinational, point-prevalence study of adult patients hospitalized with CAP. MDR-EB was defined when >= 3 antimicrobial classes were identified as non-susceptible. Risk factors assessment was also performed for patients with EB and MDR-EB infection. Results Of the 3193 patients enrolled with CAP, 197 (6%) had a positive culture with EB. Fifty-one percent (n = 100) of EB were resistant to at least one antibiotic and 19% (n = 38) had MDR-EB. The most commonly EB identified were Klebsiella pneumoniae (n = 111, 56%) and Escherichia coli (n = 56, 28%). The risk factors that were independently associated with EB CAP were male gender, severe CAP, underweight (body mass index (BMI) < 18.5) and prior extended-spectrum beta-lactamase (ESBL) infection. Additionally, prior ESBL infection, being underweight, cardiovascular diseases and hospitalization in the last 12 months were independently associated with MDR-EB CAP. Conclusion This study of adults hospitalized with CAP found a prevalence of EB of 6% and MDR-EB of 1.2%, respectively. The presence of specific risk factors, such as prior ESBL infection and being underweight, should raise the clinical suspicion for EB and MDR-EB in patients hospitalized with CAP