The most appropriate therapeutic strategy for acute lower respiratory tract infections: a Delphi-based approach.

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Prevalence, molecular epidemiology and intra-hospital acquisition of Klebsiella pneumoniae strains producing carbapenemases in an Italian teaching hospital from January 2015 to September 2016

Abstract Objectives We described Klebsiella pneumoniae producing carbapenemase (CPKP) spread from 01/01/2015 to 13/09/16 in a tertiary level hospital. Methods The first positive surveillance rectal swab (SRS) or clinical sample (CS) collected in the medical department (MD), surgical department (SD) and intensive care department (ICD) were included in the study. A validated in-house Real-Time PCR method was used to detect carbapenemases; multilocus sequence typing (MLST) was used for further characterization of the strains. Results 21535 patients were included: 213 CPKP strains from surveillance rectal swab (SRS) and 98 from clinical samples (CS) were collected. The percentage of CPKP detected in SRS with respect to CS increased in the medical MD from 2015 to 2016 (p=0.01) and in ICD from 2012 to 2015 (p=0.0001), while it decreased in SD from 2014 to 2016 (p=0.003); 68.5% of the positive SRS had a previous negative SRS; CPKP was more frequently identified in CS than in SRS in MD. Twelve strains harboured more than one carbapenemase gene. Many other species harbouring a carbapenemase gene were collected. Conclusions MDs need more inclusive surveillance criteria. The late detection of positive SRS underlined the risk of colonization during hospitalization

Methicillin-resistant Staphylococcus aureus: related infections and antibiotic resistance

Summary Staphylococcus aureus is a well adapted human pathogen, capable of living freely in the inanimate environment and spreading from person to person, existing as a colonizer or commensal, hiding in intracellular compartments and, most importantly, inducing various forms of human disease. Infections caused by S. aureus , above all by antibiotic-resistant strains, have reached epidemic proportions globally. The overall burden of staphylococcal disease caused by antibiotic-resistant S. aureus , particularly by the methicillin-resistant strains, is increasing in many countries, including Italy, in both healthcare and community settings. The widespread use of antibiotics has undoubtedly accelerated the evolution of S. aureus , which, acquiring multiple resistance genes, has become able to survive almost all antibiotic families; this evolution versus more resistant phenotypes has continued among the newer agents, including linezolid and daptomycin. The diminished clinical usefulness of vancomycin is seen as one of the most worrisome problems in many clinical settings and in many countries. In fact, the increasing spread of heteroresistant vancomycin-intermediate S. aureus (hVISA) and vancomycin intermediate (VISA) strains adds new problems, not only in terms of the treatment of severe infections sustained by these microorganisms, but also in the microbiological definition of susceptibility

Protein Folding and Aggregation into Amyloid: The Interference by Natural Phenolic Compounds

Amyloid aggregation is a hallmark of several degenerative diseases affecting the brain or peripheral tissues, whose intermediates (oligomers, protofibrils) and final mature fibrils display different toxicity. Consequently, compounds counteracting amyloid aggregation have been investigated for their ability (i) to stabilize toxic amyloid precursors; (ii) to prevent the growth of toxic oligomers or speed that of fibrils; (iii) to inhibit fibril growth and deposition; (iv) to disassemble preformed fibrils; and (v) to favor amyloid clearance. Natural phenols, a wide panel of plant molecules, are one of the most actively investigated categories of potential amyloid inhibitors. They are considered responsible for the beneficial effects of several traditional diets being present in green tea, extra virgin olive oil, red wine, spices, berries and aromatic herbs. Accordingly, it has been proposed that some natural phenols could be exploited to prevent and to treat amyloid diseases, and recent studies have provided significant information on their ability to inhibit peptide/protein aggregation in various ways and to stimulate cell defenses, leading to identify shared or specific mechanisms. In the first part of this review, we will overview the significance and mechanisms of amyloid aggregation and aggregate toxicity; then, we will summarize the recent achievements on protection against amyloid diseases by many natural phenols

Genomic Diversification of Enterococci in Hosts: The Role of the Mobilome

Enterococci are ubiquitous lactic acid bacteria, possessing a flexible nature that allows them to colonize various environments and hosts but also to be opportunistic pathogens. Many papers have contributed to a better understanding of: (i) the taxonomy of this complex group of microorganisms; (ii) intra-species variability; (iii) the role of different pathogenicity traits; and (iv) some markers related to the character of host-specificity, but the reasons of such incredible success of adaptability is still far from being fully explained. Recently, genomic-based studies have improved our understanding of the genome diversity of the most studied species, i.e., E. faecalis and E. faecium. From these studies, what is becoming evident is the role of the mobilome in adding new abilities to colonize new hosts and environments, and eventually in driving their evolution: specific clones associated with human infections or specific hosts can exist, but probably the consideration of these populations as strictly clonal groups is only partially correct. The variable presence of mobile genetic elements may, indeed, be one of the factors involved in the evolution of one specific group in a specific host and/or environment. Certainly more extensive studies using new high throughput technologies are mandatory to fully understand the evolution of predominant clones and species in different hosts and environments

Ulrich Döring, Spurensuche. Kultur und kulturelle Identität in Driss Chra bis Berber-Trilogie

Ulrich Döring (Leipzig, 1951), germanista e francesista, si addottora nel 1984 con una tesi sulla letteratura fantastica francese e ottiene il Prix Strasbourg. Fino al 1992 collabora alla cattedra di Romanistica dell’Università di Tübingen. Fra i suoi contributi alla ricerca è da menzionare uno studio sulla ricezione di Antoine Furetières (Peter Lang, 1995). Questo invece il titolo, reso in italiano, che la Döring sceglie per il presente studio critico, e che già si rivela efficace sunto dell..

Ulrich Döring, Spurensuche. Kultur und kulturelle Identität in Driss Chraïbis Berber-Trilogie

Prima di concentrarsi sull’analisi della “trilogia berbera” di Chraïbi, ambientata in un Marocco ancestrale che si oppone ad una certa “modernità” occidentale percepita come “isterilita”, lo studioso ripercorre le varie fasi della produzione e del pensiero dell’autore, noto soprattutto per avere creato il personaggio dell’ispettore Alì, eroe seriale dei suoi romanzi polizieschi. I romanzi di questa trilogia di carattere storico-epico, sono studiati da Döring in una trattazione sistematica nei..

In vitro fosfomycin study on concordance of susceptibility testing methods against ESBL and carbapenem-resistant Enterobacteriaceae.

Abstract Objectives The increasing emergence and diffusion of multidrug-resistant (MDR) pathogenic bacteria, both in hospital and community settings, is inducing clinicians to reconsider old antibiotics, such as fosfomycin, to overcome the difficulties posed by these microorganisms. Recent studies have reported good in vitro activity of fosfomycin against extended spectrum s-lactamases (ESBL) and carbapenem-resistant Enterobacteriaceae. The aim of this study was to assess thein vitro activity of fosfomycin by different methods against 120 clinical MDR isolates. Methods Fosfomycin minimum inhibitory concentrations were determined using the agar dilution reference method (AD), gradient test (GT), broth microdilution method (BMD), according to CLSI recommendations, and automated systems (VITEK 2 and BD Phoenix) against 85 carbapenem-resistant Klebsiella pneumoniae and 35 ESBL-producing Escherichia coli. Agreement and discrepancies between the evaluated methods and the reference method were calculated. Results Fosfomycin showed very good activity against ESBL-producing E. coli (88.6%). Excellent agreement (100%) between the three (AD, BMD and GT) susceptibility methods was found for E. coli. No major errors were observed. The fosfomycin resistance rate ranged from 24% (KPC-producing) to 100% (NDM-OXA-48 co-producing) K. pneumoniae. For all carbapenem-resistant K. pneumoniae strains, categorical agreement was >90% for all methods except for VITEK 2, which was 84%. Conclusions When ESBL E. coli isolates are found to be susceptible to fosfomycin with automated systems, it is not necessary to verify these results with the AD reference method; while for resistant strains, the GT can be used. In cases of KPC K. pneumoniae resistant to fosfomycin, the AD method is the only reference method