The Different Microbial Etiology of Prosthetic Joint Infections according to Route of Acquisition and Time after Prosthesis Implantation, Including the Role of Multidrug-Resistant Organisms

The aim of our study was to characterize the etiology of prosthetic joint infections (PJIs)—including multidrug-resistant organisms (MDRO)—by category of infection. A multicenter study of 2544 patients with PJIs was performed. We analyzed the causative microorganisms according to the Tsukayama’s scheme (early postoperative, late chronic, and acute hematogenous infections (EPI, LCI, AHI) and “positive intraoperative cultures” (PIC)). Non-hematogenous PJIs were also evaluated according to time since surgery: 12 months. AHIs were mostly caused by Staphylococcus aureus (39.2%) and streptococci (30.2%). EPIs were characterized by a preponderance of virulent microorganisms (S. aureus, Gram-negative bacilli (GNB), enterococci), MDROs (24%) and polymicrobial infections (27.4%). Conversely, coagulase-negative staphylococci (CoNS) and Cutibacterium species were predominant in LCIs (54.5% and 6.1%, respectively) and PICs (57.1% and 15.1%). The percentage of MDROs isolated in EPIs was more than three times the percentage isolated in LCIs (7.8%) and more than twice the proportion found in AHI (10.9%). There was a significant decreasing linear trend over the four time intervals post-surgery for virulent microorganisms, MDROs, and polymicrobial infections, and a rising trend for CoNS, streptococci and Cutibacterium spp. The observed differences have important implications for the empirical antimicrobial treatment of PJIs.Instituto de Salud Carlos IIIMinisterio de Economía y Competitividad PI15/1026European Regional Development Fund (FEDER)European Social Fund "Investing in your future"European Development Regional Fund “A way to achieve Europe

Stenotrophomonas maltophilia: estudio clínico, epidemiológico y pronóstico

Stenotrophomonas maltophilia es un patógeno emergente oportunista. Con este trabajo se pretende conocer las características clínicas de los pacientes que adquieren este microorganismo (tanto si están infectados o sólo colonizados), su epidemiología, y el pronóstico de los pacientes que tienen infecciones por este microorganismo. Se diseñó un estudio multicéntrico de casos y controles para el estudio de los factores de riesgo asociados a la adquisición de este microorganismo, y un estudio de cohorte de los pacientes que adquirieron S. maltophilia en el Hospital Virgen Macarena de Sevilla, con el que se pretendía describir la clínica asociada a las infecciones por este microorganismo, su epidemiología clínica y molecular, la sensibilidad antimicrobiana, y los factores asociados a la mortalidad, así como la respuesta a los distintos tratamientos antimicrobianos. Las conclusiones finales fundamentales del trabajo fueron: 1) S. maltophilia es un microorganismo que, en ausencia de brotes epidémicos, se encuentra en nuestros hospitales en forma de baja endemia. Las áreas de mayor incidencia son las Unidades de Cuidados Intensivos. 2) Los factores de riesgo para la adquisición de S. maltophilia son el consumo previo de carbapenemas, ceftazidima y quinolonas, y la ventilación mecánica, así como la duración de los mismos. 3) En algunas ocasiones, incrementos en el número de casos de colonización o infección por S. maltophilia en unidades de hospitalización específicas, pueden estar asociados a incrementos en el consumo de carbapenemas. 4) Existe una gran variabilidad genética en S. maltophilia que no se corresponde con la gran homogeneidad de la sensibilidad antimicrobiana de las cepas. Aunque se ha demostrado la transmisión cruzada de forma ocasional, nuestros datos sugieren que la forma más habitual de transmisión del microorganismo podría estar en relación con la adquisición independiente desde diversas fuentes ambientales. 5) Trimetoprim-sulfametoxazol continúa siendo uno de los fármacos más activos in vitro frente a S. maltophilia. Doxiciclina fue el fármaco más activo (100% de las cepas sensibles). Las nuevas fluoroquinolonas, como moxifloxacino, son fármacos con buenas expectativas para el tratamiento. 6) Entre los pacientes que adquieren S. maltophilia en nuestro estudio, la administración previa de ceftazidima y el no estar ingresado en UCI se asociaron a la presencia de infección por este microorganismo. 7) S. maltophilia produce un amplio espectro clínico de infecciones, fundamentalmente nosocomiales, y en pacientes predispuestos. Las infecciones más frecuentes son las del tracto respiratorio inferior, sobre todo neumonías. Estas ocurren en pacientes severamente enfermos, tienen un curso clínico grave y se asocian a una elevada mortalidad. En general, el resto de las infecciones evolucionan favorablemente con un tratamiento antimicrobiano adecuado, drenaje quirúrgico o limpieza de heridas y abscesos, y retirada de dispositivos invasivos. 8) La adquisición nosocomial de S. maltophilia no parece suponer un marcador de riesgo de mortalidad hospitalaria. El pronóstico de la mayoría de las infecciones producidas por S. maltophilia es favorable. Los factores de riesgo asociados a la mortalidad en los pacientes que adquieren S. maltophilia están relacionados con la edad y la severidad de su enfermedad de base. La mortalidad asociada a la infección por S. maltophilia está relacionada con la edad y la neumonía (50% de las muertes).Premio Extraordinario de Doctorado U

UV-induced degradation of securin is mediated by SKP1-CUL1-βTrCP E3 ubiquitin ligase

Securin is a chaperone protein with bifunctional properties. It binds to separase to inhibit premature sister chromatid separation until the onset of anaphase, and it also takes part in cell-cycle arrest after UV irradiation. At metaphase-to-anaphase transition, securin is targeted for proteasomal destruction by the anaphase-promoting complex or cyclosome (APC/C), allowing activation of separase. However, although securin is reported to undergo proteasome-dependent degradation after UV irradiation, the ubiquitin ligase responsible for securing ubiquitylation has not been well characterized. In this study, we show that UV radiation induced a marked reduction of securin in both the nucleus and cytoplasm. Moreover, we show that GSK-3β inhibitors prevent securin degradation, and that CUL1 and βTrCP are involved in this depletion. We also confirmed that SKP1-CUL1-βTrCP (SCFβTrCP) ubiquitylates securin in vivo, and identified a conserved and unconventional βTrCP recognition motif (DDAYPE) in the securin primary amino acid sequence of humans, nonhuman primates and rodents. Furthermore, downregulation of βTrCP caused an accumulation of securin in non-irradiated cells. We conclude that SCFβTrCP is the E3 ubiquitin ligase responsible for securing degradation after UV irradiation, and that it is involved in securin turnover in nonstressed cells.Ministerio de Educación y Ciencia SAF 2005-07713-C03-0

Long-Term Control of Endemic Hospital-Wide Methicillin-Resistant Staphylococcus aureus (MRSA): The Impact of Targeted Active Surveillance for MRSA in Patients and Healthcare Workers

To evaluate the long-term impact of successive interventions on rates of methicillin-resistant Staphylococcus aureus (MRSA) colonization or infection and MRSA bacteremia in an endemic hospital-wide situation. DESIGN:Quasi-experimental, interrupted time-series analysis. The impact of the interventions was analyzed by use of segmented regression. Representative MRSA isolates were typed by use of pulsed-field gel electrophoresis. SETTING:A 950-bed teaching hospital in Seville, Spain. PATIENTS:All patients admitted to the hospital during the period from 1995 through 2008. METHODS:Three successive interventions were studied: (1) contact precautions, with no active surveillance for MRSA; (2) targeted active surveillance for MRSA in patients and healthcare workers in specific wards, prioritized according to clinical epidemiology data; and (3) targeted active surveillance for MRSA in patients admitted from other medical centers. RESULTS:Neither the preintervention rate of MRSA colonization or infection (0.56 cases per 1,000 patient-days [95% confidence interval {CI}, 0.49-0.62 cases per 1,000 patient-days]) nor the slope for the rate of MRSA colonization or infection changed significantly after the first intervention. The rate decreased significantly to 0.28 cases per 1,000 patient-days (95% CI, 0.17-0.40 cases per 1,000 patient-days) after the second intervention and to 0.07 cases per 1,000 patient-days (95% CI, 0.06-0.08 cases per 1,000 patient-days) after the third intervention, and the rate remained at a similar level for 8 years. The MRSA bacteremia rate decreased by 80%, whereas the rate of bacteremia due to methicillin-susceptible S. aureus did not change. Eighty-three percent of the MRSA isolates identified were clonally related. All MRSA isolates obtained from healthcare workers were clonally related to those recovered from patients who were in their care. CONCLUSION:Our data indicate that long-term control of endemic MRSA is feasible in tertiary care centers. The use of targeted active surveillance for MRSA in patients and healthcare workers in specific wards (identified by means of analysis of clinical epidemiology data) and the use of decolonization were key to the success of the program

A new method for fluoride determination by using fluorophores and dyes anchored onto MCM-41

A new colourimetric and fluorimetric method for fluoride determination in aqueous samples based on the specific reaction between fluoride and silica has been developed and applied on real samples.Descalzo Lopez, Ana Belen, [email protected] ; El Haskouri, Jamal, [email protected] ; Beltran Porter, Daniel, [email protected] ; Amoros del Toro, Pedro Jose, [email protected]

Implant Removal in the Management of Prosthetic Joint Infection by Staphylococcus aureus: Outcome and Predictors of Failure in a Large Retrospective Multicenter Study

Objectives: To compare the characteristics and outcomes of cases with acute prosthetic joint infection (PJI; early post-surgical or hematogenous) by Staphylococcus aureus managed with implant removal (IRm) or debridement and retention (DAIR). To analyze the outcomes of all cases managed with IRm (initially or after DAIR failure). Methods: Retrospective, multicenter, cohort study of PJI by S. aureus (2003–2010). Overall failure included mortality within 60 days since surgery and local failure due to staphylococcal persistence/relapse. Results: 499 cases, 338 initially managed with DAIR, 161 with IRm. Mortality was higher in acute PJI managed initially with IRm compared to DAIR, but not associated with the surgical procedure, after propensity score matching. Underlying conditions, hemiarthroplasty, and methicillin-resistant S. aureus were risk factors for mortality. Finally, 249 cases underwent IRm (88 after DAIR failure); overall failure was 15.6%. Local failure (9.3%) was slightly higher in cases with several comorbidities, but independent of previous DAIR, type of IRm, and rifampin treatment. Conclusions: In a large multicenter study of S. aureus PJI managed with IRm, failure was low, but mortality significant, especially in cases with acute PJI and underlying conditions, but not associated with the IRm itself. Rifampin efficacy was limited in this setting.Instituto de Salud Carlos III, Subdirección General de Redes y Centros de Investigación Cooperativa, Ministerio de Economía, Industria y CompetitividadMinisterio Educación Españ

Executive summary of the Consensus Document of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC) and of the Spanish Association of Surgeons (AEC) in antibiotic prophylaxis in surgery

La profilaxis antibiótica en cirugía es una de las medidas más eficaces para la prevención de la infección de localización quirúrgica, aunque su uso es con frecuencia inadecuado, pudiendo incrementar el riesgo de infección, toxicidades y resistencias bacterianas. Debido al avance en las técnicas quirúrgicas y la emergencia de microorganismos multirresistentes las actuales pautas de profilaxis precisan ser revisadas. La Sociedad Española de Enfermedades Infecciosas (SEIMC), conjuntamente con la Asociación Española de Cirujanos (AEC) ha revisado y actualizado las recomendaciones de profilaxis antimicrobiana para adaptarlas a cada tipo de intervención quirúrgica y a la epidemiología actual. En este documento se recogen las recomendaciones de los antimicrobianos utilizados en profilaxis en los diferentes procedimientos, las dosis, la duración, la profilaxis en huéspedes especiales, y en situación epidemiológica de multirresistencia, de tal forma que permitan un manejo estandarizado, un uso racional, seguro y efectivo de los mismos en la cirugía electiva.Antibiotic prophylaxis in surgery is one of the most effective measures for preventing surgical site infection, although its use is frequently inadequate and may even increase the risk of infection, toxicities and antimicrobial resistance. As a result of advances in surgical techniques and the emergence of multidrug-resistant organisms, the current guidelines for prophylaxis need to be revised. The Sociedad Española de Enfermedades Infecciosas (Spanish Society of Infectious Diseases and Clinical Microbiology) (SEIMC) together with the Asociación Española de Cirujanos (Spanish Association of Surgeons) (AEC) have revised and updated the recommendations for antibiotic prophylaxis in surgery to adapt them to any type of surgical intervention and to current epidemiology. This document gathers together the recommendations on antimicrobial prophylaxis in the various procedures, with doses, duration, prophylaxis in special patient groups, and in epidemiological settings of multidrug resistance to facilitate standardized management and the safe, effective and rational use of antibiotics in elective surgery

Silica-based powders and monoliths with bimodal pore systems

Porous pure and doped silicas with pore sizes at two length scales (meso/macroporous) have been prepared and shaped both as powders and monoliths through a one-pot surfactant assisted procedure by using a simple template agent and starting from atrane complexes as inorganic precursors.El Haskouri, Jamal, [email protected] ; Latorre Saborit, Julio, [email protected] ; Beltran Porter, Aurelio, [email protected] ; Beltran Porter, Daniel, [email protected] ; Amoros del Toro, Pedro Jose, [email protected]

Sensory hybrid host materials for the selective chromo-fluorogenic detection of biogenic amines

Pyrylium-containing mesoporous materials have been used for the chromo-fluorogenic sensing of biogenic amines in an aqueous environment.Amoros del Toro, Pedro Jose, [email protected]

How to Handle Concomitant Asymptomatic Prosthetic Joints During an Episode of Hematogenous Periprosthetic Joint Infection:a Multicenter Analysis

BACKGROUND: Prosthetic joints are at risk of becoming infected during an episode of bacteremia, especially during Staphylocococcus aureus bacteremia. However, it is unclear how often asymptomatic periprosthetic joint infection (PJI) occurs, and whether additional diagnostics should be considered. METHODS: In this multicenter study, we retrospectively analyzed a cohort of patients with a late acute (hematogenous) PJI between 2005-2015 who had concomitant prosthetic joints in situ. Patients without at least 1 year of follow-up were excluded. RESULTS: We included 91 patients with a hematogenous PJI and 108 concomitant prosthetic joints. The incident PJI was most frequently caused by Staphylococcus aureus (43%), followed by streptococci (26%) and Gram-negative rods (18%). Of 108 concomitant prosthetic joints, 13 were symptomatic, of which 10 were subsequently diagnosed as a second PJI. Of the 95 asymptomatic prosthetic joints, 1 PJI developed during the follow-up period and was classified as a "missed" PJI at the time of bacteremia with S. aureus (1.1%). Infected prosthetic joints were younger than the noninfected ones in 67% of cases, and prosthetic knees were affected more often than prosthetic hips (78%). CONCLUSIONS: During an episode of hematogenous PJI, concomitant asymptomatic prosthetic joints have a very low risk of being infected, and additional diagnostic work-up for these joints is not necessary