Assessment of three antibiotic combination regimens against Gram-negative bacteria causing neonatal sepsis in low- and middle-income countries.

Gram-negative bacteria (GNB) are a major cause of neonatal sepsis in low- and middle-income countries (LMICs). Although the World Health Organization (WHO) reports that over 80% of these sepsis deaths could be prevented through improved treatment, the efficacy of the currently recommended first- and second-line treatment regimens for this condition is increasingly affected by high rates of drug resistance. Here we assess three well known antibiotics, fosfomycin, flomoxef and amikacin, in combination as potential antibiotic treatment regimens by investigating the drug resistance and genetic profiles of commonly isolated GNB causing neonatal sepsis in LMICs. The five most prevalent bacterial isolates in the NeoOBS study (NCT03721302) are Klebsiella pneumoniae, Acinetobacter baumannii, E. coli, Serratia marcescens and Enterobacter cloacae complex. Among these isolates, high levels of ESBL and carbapenemase encoding genes are detected along with resistance to ampicillin, gentamicin and cefotaxime, the current WHO recommended empiric regimens. The three new combinations show excellent in vitro activity against ESBL-producing K. pneumoniae and E. coli isolates. Our data should further inform and support the clinical evaluation of these three antibiotic combinations for the treatment of neonatal sepsis in areas with high rates of multidrug-resistant Gram-negative bacteria

Single-Center Retrospective Analysis of the Outcomes of Patients Undergoing Staged Peritoneal Lavage for Secondary Peritonitis

Background!#!Secondary peritonitis is associated with high rates of morbidity and mortality. Data on the effect of staged re-laparotomy or re-laparoscopy as a surgical option in the management of abdominal sepsis due to secondary peritonitis are limited and conflicting. Herein, we report the outcomes of patients undergoing staged peritoneal lavage (SPL) for secondary peritonitis in our department.!##!Methods!#!This is a single-center retrospective analysis of the data of patients undergoing SPL for secondary peritonitis. SPL was performed via either re-laparotomy or re-laparoscopy. The simplified acute physiology score (SAPS II) was calculated at the time of the initial operation and for each SPL. The end points of interest included: the evolution of sepsis characterized by the SAPS II score, the mortality rate and the rate of definitive abdominal wall closure.!##!Results!#!The data of 74 patients with a median age of 73 years requiring at least one SPL between 2012 and 2019 were analyzed. The median number of SPL performed was three (range 1-12). A sequential drop of SAPS II score from 41 at the initial procedure to 32 at the third SPL was documented. The overall mortality rate was 16.2%, definitive abdominal closure was achieved in all surviving patients and the median length of stay was 17.5d CONCLUSION: Staged re-laparotomy or re-laparoscopy with peritoneal lavage may reduce the severity of peritonitis and reduce the risk of mortality in patients with abdominal sepsis. Maintaining the abdominal wall under constant retraction using a rigid mesh while creating an open abdomen is a crucial step in achieving definite abdominal wall closure. Thus, staged peritoneal lavage may be a good surgical option for selected patients with peritonitis

k-subscription: Privacy-preserving Microblogging Browsing through Obfuscation

Over the past few years, microblogging social networking services have become a popular means for information sharing and com-munication. Besides sharing information among friends, such ser-vices are currently being used by artists, politicians, news chan-nels, and information providers to easily communicate with their constituency. Even though following specific channels on a mi-croblogging service enables users to receive interesting informa-tion in a timely manner, it may raise significant privacy concerns as well. For example, the microblogging service is able to observe all the channels that a particular user follows. This way, it can infer all the subjects a user might be interested in and generate a detailed profile of this user. This knowledge can be used for a variety of purposes that are usually beyond the control of the users. To address these privacy concerns, we propose k-subscription

Architectural Description of Dependable Software Systems

Architectural description languages (ADLs) are used within the software engineering community to support the description of high-level structure, or architecture, of software systems. A major advantage of this is the ability to analyze and evaluate trade-off among alternative solutions. This chapter will discuss the role of ADLs for representing and analyzing the architecture of software systems. Since ADLs vary considerably on the modeling aspects that they cover, we will focus our discussions on how ADLs support structuring dependability issues