Imipenem as mono therapy in the treatment of intensive care patients with severe infections

In an open study, 24 intensive care patients were treated with imipenem/cilastatin as monotherapy for serious bacterial infections. Twenty-one patients were treated for bronchopulmonary infection, two patients for septicaemia, and one patient for an empyema. Initially all strains were susceptible to imipenem. Gram-negative bacilli accounted for 80% of these isolates. The most frequently isolated species were Proteus mirabilis, Escherichia coli and Pseudomonas aeruginosa. All 24 patients were considered clinically cured. Sixteen of these patients (67%) were both clinically and microbiologically cured. In eight of the 24 patients (33%), the strains isolated initially persisted. In eight of the 24 patients (33%), colonization of the respiratory tract developed. Two of the five Ps. aeruginosa isolates developed resistance during therapy but in none of these patients was therapy considered to have failed. In 12 patients (50%), transient elevations in hepatic function tests were observed and these were probably drugrelated. The present study supports the view that imipenem/cilastatin may be useful as monotherapy in the treatment of severe infections in intensive care patients

Enhanced wheat yield by biochar addition under different mineral fertilization levels

Climate change and global warming have worldwide adverse consequences. Biochar production and its use in agriculture can play a key role in climate change mitigation and help improve the quality and management of waste materials coming from agriculture and forestry. Biochar is a carbonaceous material obtained from thermal decomposition of residual biomass at relatively low temperature and under oxygen limited conditions (pyrolysis). Biochar is currently a subject of active research worldwide because it can constitute a viable option for sustainable agriculture due to its potential as a long-term sink for carbon in soil and benefits for crops. However, to date, the results of research studies on biochar effects on crop production show great variability, depending on the biochar type and experimental conditions. Therefore, it is important to identify the beneficial aspects of biochar addition to soil on crop yield in order to promote the adoption of this practice in agriculture. In this study, the effects of two types of biochar from agricultural wastes typical of Southern Spain: wheat straw and olive tree pruning, combined with different mineral fertilization levels on the growth and yield of wheat (Triticum durum L. cv. Vitron) were evaluated. Durum wheat was pot-grown for 2 months in a growth chamber on a soil collected from an agricultural field near Córdoba, Southern Spain. Soil properties and plant growth variables were studied in order to assess the agronomic efficiency of biochar. Our results show that biochar addition to a nutrientpoor, slightly acidic loamy sand soil had little effect on wheat yield in the absence of mineral fertilization. However, at the highest mineral fertilizer rate, addition of biochar led to about 20–30 % increase in grain yield compared with the use of the mineral fertilizer alone. Both biochars acted as a source of available P, which led to beneficial effects on crop production. In contrast, the addition of biochar resulted in decreases in available N and Mn. A maximum reduction in plant nutrient concentration of 25 and 80% compared to nonbiochar-treated soils for N and Mn, respectively, was detected. This fact was related to the own nature of biochar: low available nitrogen content, high adsorption capacity, and low mineralization rate for N; and alkaline pH and high carbonate content for Mn. Our results indicate that biochar-based soil management strategies can enhance wheat production with the environmental benefits of global warming mitigation. This can contribute positively to the viability and benefits of agricultural production systems. However, the nutrient–biochar interactions should receive special attention due to the great variability in the properties of biochar-type materials

National laboratory-based surveillance system for antimicrobial resistance: a successful tool to support the control of antimicrobial resistance in the Netherlands

An important cornerstone in the control of antimicrobial resistance (AMR) is a well-designed quantitative system for the surveillance of spread and temporal trends in AMR. Since 2008, the Dutch national AMR surveillance system, based on routine data from medical microbiological laboratories (MMLs), has developed into a successful tool to support the control of AMR in the Netherlands. It provides background information for policy making in public health and healthcare services, supports development of empirical antibiotic therapy guidelines and facilitates in-depth research. In addition, participation of the MMLs in the national AMR surveillance network has contributed to sharing of knowledge and quality improvement. A future improvement will be the implementation of a new semantic standard together with standardised data transfer, which will reduce errors in data handling and enable a more real-time surveillance. Furthermore, the

Molecular characteristics of carbapenemase-producing Enterobacterales in the Netherlands; results of the 2014–2018 national laboratory surveillance

Objectives: Carbapenem resistance mediated by mobile genetic elements has emerged worldwide and has become a major public health threat. To gain insight into the molecular epidemiology of carbapenem resistance in The Netherlands, Dutch medical microbiology laboratories are requested to submit suspected carbapenemase-producing Enterobacterales (CPE) to the National Institute for Public Health and the Environment as part of a national surveillance system. Methods: Meropenem MICs and species identification were confirmed by E-test and MALDI-TOF and carbapenemase production was assessed by the Carbapenem Inactivation Method. Of all submitted CPE, one species/carbapenemase gene combination per person per year was subjected to next-generation sequencing (NGS). Results: In total, 1838 unique isolates were received between 2014 and 2018, of which 892 were unique CPE isolates with NGS data available. The predominant CPE species were Klebsiella pneumoniae (n = 388, 43%), Escherichia coli (n = 264, 30%) and Enterobacter cloacae complex (n = 116, 13%). Various carbapenemase alleles of the same carbapenemase gene resulted in different susceptibilities to meropenem and this effect varied between species. Analyses of NGS data showed variation of prevalence of carbapenemase alleles over time with blaOXA-48 being predominant (38%, 336/892), followed by blaNDM-1 (16%, 145/892). For the first time in the Netherlands, blaOXA-181, blaOXA-232 and blaVIM-4 were detected. The genetic background of K. pneumoniae and E. coli isolates was highly diverse. Conclusions: The CPE population in the Netherlands is diverse, suggesting multiple introductions. The predominant carbapenemase alleles are blaOXA-48 and blaNDM-1. There was a clear association between species, carbapenemase allele and susceptibility to meropenem