Mineral Phosphate Solubilization in Burkholderia tropica Involves an Inducible PQQ-Glucose Dehydrogenase

Aims: The objective of this work was to provide knowledgement about the mechanism and regulation of the mineral phosphate solubilization in Burkholderia. tropica. To this end, the expression of the direct extracellular oxidative pathway in B. tropica was studied using different culture approaches.Study Design: Plate assays and batch cultures in flasks and bioreactor were carried out in this study with B. tropica Mto-293 like target organism. The experiments were achieved at least three times with two repetitions per time.Place and Duration of Study: Departamento de Química, Centro de Investigación y Desarrollo en Fermentaciones Industriales, UNLP, CCT-La Plata-CONICET, between November 2014-2015.Methodology: Qualitative plate assays with different Carbon sources were carried out for the evaluation of Mineral Phosphate Solubilization phenotype. Batch cultures in flasks were carried out with different Carbon, Phosphorus and Nitrogen sources to determine quantitatively soluble phosphorus, gluconic acid and other ketoacids in the supernatants, and also PQQ-linked glucose and gluconate dehydrogenase activities in whole cells. Cultures with some of the conditions mentioned before were carried out in bioreactor specifically to control pH.Results: This organism was able to produce significant amounts of gluconic acid via the expression of a PQQ-GDH and also showed a significant activity of GaDH. However, the direct oxidative pathway was only observed under conditions of Phosphorus starvation and/or Nitrogen fixation.Conclusion: The Mineral Phosphate Solubilization phenotype for B. tropica can be ascribed to the expression of the direct oxidative pathway which involves the expression of an active PQQ- linked glucose dehydrogenase. Nevertheless, this pathway is not expressed constitutively in this bacterium. Environmental conditions, like low P and N availability, led to an active extracellular glucose oxidation. Therefore, mineral phosphate solubilization in B. tropica involves an inducible pyrroloquinoline quinone-linked glucose dehydrogenase. These findings may contribute to the use of this bacterium as plant growth promoting bacteria reducing the dependence on chemical fertilizer.Fil: Bernabeu, Pamela Romina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Fermentaciones Industriales. Universidad Nacional de la Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Fermentaciones Industriales; ArgentinaFil: Garcia, Sabrina Soledad. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Fermentaciones Industriales. Universidad Nacional de la Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Fermentaciones Industriales; ArgentinaFil: Garcia Ferreyra, Gimena. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Fermentaciones Industriales. Universidad Nacional de la Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Fermentaciones Industriales; ArgentinaFil: Guidi, Verónica Inés. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Fermentaciones Industriales. Universidad Nacional de la Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Fermentaciones Industriales; ArgentinaFil: Galar, Maria Lina. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Fermentaciones Industriales. Universidad Nacional de la Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Fermentaciones Industriales; ArgentinaFil: Boiardi, Jose Luis. Consejo Nacional de Investigaciones Científicas y Técnicas. Centro Científico Tecnológico Conicet - La Plata. Centro de Investigación y Desarrollo en Fermentaciones Industriales. Universidad Nacional de la Plata. Facultad de Ciencias Exactas. Centro de Investigación y Desarrollo en Fermentaciones Industriales; ArgentinaFil: Luna, Maria Flavia. Provincia de Buenos Aires. Gobernación. Comisión de Investigaciones Científicas; Argentin

Mineral Phosphate Solubilization in Burkholderia tropica Involves an Inducible PQQ-Glucose Dehydrogenase

Aims: The objective of this work was to provide knowledgement about the mechanism and regulation of the mineral phosphate solubilization in Burkholderia. tropica. To this end, the expression of the direct extracellular oxidative pathway in B. tropica was studied using different culture approaches.Study Design: Plate assays and batch cultures in flasks and bioreactor were carried out in this study with B. tropica Mto-293 like target organism. The experiments were achieved at least three times with two repetitions per time.Place and Duration of Study: Departamento de Química, Centro de Investigación y Desarrollo en Fermentaciones Industriales, UNLP, CCT-La Plata-CONICET, between November 2014-2015.Methodology: Qualitative plate assays with different Carbon sources were carried out for the evaluation of Mineral Phosphate Solubilization phenotype. Batch cultures in flasks were carried out with different Carbon, Phosphorus and Nitrogen sources to determine quantitatively soluble phosphorus, gluconic acid and other ketoacids in the supernatants, and also PQQ-linked glucose and gluconate dehydrogenase activities in whole cells. Cultures with some of the conditions mentioned before were carried out in bioreactor specifically to control pH.Results: This organism was able to produce significant amounts of gluconic acid via the expression of a PQQ-GDH and also showed a significant activity of GaDH. However, the direct oxidative pathway was only observed under conditions of Phosphorus starvation and/or Nitrogen fixation.Conclusion: The Mineral Phosphate Solubilization phenotype for B. tropica can be ascribed to the expression of the direct oxidative pathway which involves the expression of an active PQQ- linked glucose dehydrogenase. Nevertheless, this pathway is not expressed constitutively in this bacterium. Environmental conditions, like low P and N availability, led to an active extracellular glucose oxidation. Therefore, mineral phosphate solubilization in B. tropica involves an inducible pyrroloquinoline quinone-linked glucose dehydrogenase. These findings may contribute to the use of this bacterium as plant growth promoting bacteria reducing the dependence on chemical fertilizer.Centro de Investigación y Desarrollo en Fermentaciones Industriale

Mineral Phosphate Solubilization in Burkholderia tropica Involves an Inducible PQQ-Glucose Dehydrogenase

Aims: The objective of this work was to provide knowledgement about the mechanism and regulation of the mineral phosphate solubilization in Burkholderia. tropica. To this end, the expression of the direct extracellular oxidative pathway in B. tropica was studied using different culture approaches.Study Design: Plate assays and batch cultures in flasks and bioreactor were carried out in this study with B. tropica Mto-293 like target organism. The experiments were achieved at least three times with two repetitions per time.Place and Duration of Study: Departamento de Química, Centro de Investigación y Desarrollo en Fermentaciones Industriales, UNLP, CCT-La Plata-CONICET, between November 2014-2015.Methodology: Qualitative plate assays with different Carbon sources were carried out for the evaluation of Mineral Phosphate Solubilization phenotype. Batch cultures in flasks were carried out with different Carbon, Phosphorus and Nitrogen sources to determine quantitatively soluble phosphorus, gluconic acid and other ketoacids in the supernatants, and also PQQ-linked glucose and gluconate dehydrogenase activities in whole cells. Cultures with some of the conditions mentioned before were carried out in bioreactor specifically to control pH.Results: This organism was able to produce significant amounts of gluconic acid via the expression of a PQQ-GDH and also showed a significant activity of GaDH. However, the direct oxidative pathway was only observed under conditions of Phosphorus starvation and/or Nitrogen fixation.Conclusion: The Mineral Phosphate Solubilization phenotype for B. tropica can be ascribed to the expression of the direct oxidative pathway which involves the expression of an active PQQ- linked glucose dehydrogenase. Nevertheless, this pathway is not expressed constitutively in this bacterium. Environmental conditions, like low P and N availability, led to an active extracellular glucose oxidation. Therefore, mineral phosphate solubilization in B. tropica involves an inducible pyrroloquinoline quinone-linked glucose dehydrogenase. These findings may contribute to the use of this bacterium as plant growth promoting bacteria reducing the dependence on chemical fertilizer.Centro de Investigación y Desarrollo en Fermentaciones Industriale

Cama de pollo en Entre Ríos. Aportes para un mejor uso y manejo

La cama de pollo (CP) es un residuo de la producción avícola de pollos parrilleros. Entre Ríos y en particular el área de influencia de la Estación Experimental del INTA Concepción del Uruguay constituyen el principal núcleo productivo de esta rama de la avicultura a nivel país. Entre Ríos concentró el 48,7% de la faena del año 2015. El objetivo del libro es acercar a profesionales, productores, empresas e instituciones interesadas, la información obtenida relativa a la CP por esta unidad del INTA, a través de una compilación.EEA Concepción del UruguayFil: Almada, Natalia Soledad. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Araujo, Santiago Ruben. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Arias, Norma Monica. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Bernigaud, Irma Isabel. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Bueno, Dante Javier. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: De Battista, Juan José. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Duarte, Sabrina Lorena. Universidad Nacional del Litoral. Facultad de Ingeniería Química; ArgentinaFil: Duarte, Sabrina Lorena. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET). Centro Científico Tecnológico Santa Fe; ArgentinaFil: Federico, Francisco Javier. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Ferrer, José Luis. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay. Agencia de Extensión Rural Villaguay; ArgentinaFil: Gallinger, Claudia Isabel. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Gange, Juan Martí­n. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Garcia, Ana Laura. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Genta, Guillermo. Actividad privada; ArgentinaFil: Procura, Francisco. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Procura, Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET); ArgentinaFil: Pulido, Diego Germán. Actividad privada; ArgentinaFil: Re, Alejo Esteban. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Rodriguez, Francisco. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; ArgentinaFil: Rodriguez, Francisco. Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET); ArgentinaFil: Soria, Mario. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Concepción del Uruguay; Argentin

Antimicrobial resistance among migrants in Europe: a systematic review and meta-analysis

BACKGROUND: Rates of antimicrobial resistance (AMR) are rising globally and there is concern that increased migration is contributing to the burden of antibiotic resistance in Europe. However, the effect of migration on the burden of AMR in Europe has not yet been comprehensively examined. Therefore, we did a systematic review and meta-analysis to identify and synthesise data for AMR carriage or infection in migrants to Europe to examine differences in patterns of AMR across migrant groups and in different settings. METHODS: For this systematic review and meta-analysis, we searched MEDLINE, Embase, PubMed, and Scopus with no language restrictions from Jan 1, 2000, to Jan 18, 2017, for primary data from observational studies reporting antibacterial resistance in common bacterial pathogens among migrants to 21 European Union-15 and European Economic Area countries. To be eligible for inclusion, studies had to report data on carriage or infection with laboratory-confirmed antibiotic-resistant organisms in migrant populations. We extracted data from eligible studies and assessed quality using piloted, standardised forms. We did not examine drug resistance in tuberculosis and excluded articles solely reporting on this parameter. We also excluded articles in which migrant status was determined by ethnicity, country of birth of participants' parents, or was not defined, and articles in which data were not disaggregated by migrant status. Outcomes were carriage of or infection with antibiotic-resistant organisms. We used random-effects models to calculate the pooled prevalence of each outcome. The study protocol is registered with PROSPERO, number CRD42016043681. FINDINGS: We identified 2274 articles, of which 23 observational studies reporting on antibiotic resistance in 2319 migrants were included. The pooled prevalence of any AMR carriage or AMR infection in migrants was 25·4% (95% CI 19·1-31·8; I2 =98%), including meticillin-resistant Staphylococcus aureus (7·8%, 4·8-10·7; I2 =92%) and antibiotic-resistant Gram-negative bacteria (27·2%, 17·6-36·8; I2 =94%). The pooled prevalence of any AMR carriage or infection was higher in refugees and asylum seekers (33·0%, 18·3-47·6; I2 =98%) than in other migrant groups (6·6%, 1·8-11·3; I2 =92%). The pooled prevalence of antibiotic-resistant organisms was slightly higher in high-migrant community settings (33·1%, 11·1-55·1; I2 =96%) than in migrants in hospitals (24·3%, 16·1-32·6; I2 =98%). We did not find evidence of high rates of transmission of AMR from migrant to host populations. INTERPRETATION: Migrants are exposed to conditions favouring the emergence of drug resistance during transit and in host countries in Europe. Increased antibiotic resistance among refugees and asylum seekers and in high-migrant community settings (such as refugee camps and detention facilities) highlights the need for improved living conditions, access to health care, and initiatives to facilitate detection of and appropriate high-quality treatment for antibiotic-resistant infections during transit and in host countries. Protocols for the prevention and control of infection and for antibiotic surveillance need to be integrated in all aspects of health care, which should be accessible for all migrant groups, and should target determinants of AMR before, during, and after migration. FUNDING: UK National Institute for Health Research Imperial Biomedical Research Centre, Imperial College Healthcare Charity, the Wellcome Trust, and UK National Institute for Health Research Health Protection Research Unit in Healthcare-associated Infections and Antimictobial Resistance at Imperial College London

Surgical site infection after gastrointestinal surgery in high-income, middle-income, and low-income countries: a prospective, international, multicentre cohort study

Background: Surgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world. Methods: This international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231. Findings: Between Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p < 0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p < 0·001). Interpretation: Countries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication

Guidelines for the use and interpretation of assays for monitoring autophagy (3rd edition)

In 2008 we published the first set of guidelines for standardizing research in autophagy. Since then, research on this topic has continued to accelerate, and many new scientists have entered the field. Our knowledge base and relevant new technologies have also been expanding. Accordingly, it is important to update these guidelines for monitoring autophagy in different organisms. Various reviews have described the range of assays that have been used for this purpose. Nevertheless, there continues to be confusion regarding acceptable methods to measure autophagy, especially in multicellular eukaryotes. For example, a key point that needs to be emphasized is that there is a difference between measurements that monitor the numbers or volume of autophagic elements (e.g., autophagosomes or autolysosomes) at any stage of the autophagic process versus those that measure fl ux through the autophagy pathway (i.e., the complete process including the amount and rate of cargo sequestered and degraded). In particular, a block in macroautophagy that results in autophagosome accumulation must be differentiated from stimuli that increase autophagic activity, defi ned as increased autophagy induction coupled with increased delivery to, and degradation within, lysosomes (inmost higher eukaryotes and some protists such as Dictyostelium ) or the vacuole (in plants and fungi). In other words, it is especially important that investigators new to the fi eld understand that the appearance of more autophagosomes does not necessarily equate with more autophagy. In fact, in many cases, autophagosomes accumulate because of a block in trafficking to lysosomes without a concomitant change in autophagosome biogenesis, whereas an increase in autolysosomes may reflect a reduction in degradative activity. It is worth emphasizing here that lysosomal digestion is a stage of autophagy and evaluating its competence is a crucial part of the evaluation of autophagic flux, or complete autophagy. Here, we present a set of guidelines for the selection and interpretation of methods for use by investigators who aim to examine macroautophagy and related processes, as well as for reviewers who need to provide realistic and reasonable critiques of papers that are focused on these processes. These guidelines are not meant to be a formulaic set of rules, because the appropriate assays depend in part on the question being asked and the system being used. In addition, we emphasize that no individual assay is guaranteed to be the most appropriate one in every situation, and we strongly recommend the use of multiple assays to monitor autophagy. Along these lines, because of the potential for pleiotropic effects due to blocking autophagy through genetic manipulation it is imperative to delete or knock down more than one autophagy-related gene. In addition, some individual Atg proteins, or groups of proteins, are involved in other cellular pathways so not all Atg proteins can be used as a specific marker for an autophagic process. In these guidelines, we consider these various methods of assessing autophagy and what information can, or cannot, be obtained from them. Finally, by discussing the merits and limits of particular autophagy assays, we hope to encourage technical innovation in the field

Adelante / Endavant

Séptimo desafío por la erradicación de la violencia contra las mujeres del Institut Universitari d’Estudis Feministes i de Gènere "Purificación Escribano" de la Universitat Jaume

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat

Prevalence, associated factors and outcomes of pressure injuries in adult intensive care unit patients: the DecubICUs study

Funder: European Society of Intensive Care Medicine; doi: http://dx.doi.org/10.13039/501100013347Funder: Flemish Society for Critical Care NursesAbstract: Purpose: Intensive care unit (ICU) patients are particularly susceptible to developing pressure injuries. Epidemiologic data is however unavailable. We aimed to provide an international picture of the extent of pressure injuries and factors associated with ICU-acquired pressure injuries in adult ICU patients. Methods: International 1-day point-prevalence study; follow-up for outcome assessment until hospital discharge (maximum 12 weeks). Factors associated with ICU-acquired pressure injury and hospital mortality were assessed by generalised linear mixed-effects regression analysis. Results: Data from 13,254 patients in 1117 ICUs (90 countries) revealed 6747 pressure injuries; 3997 (59.2%) were ICU-acquired. Overall prevalence was 26.6% (95% confidence interval [CI] 25.9–27.3). ICU-acquired prevalence was 16.2% (95% CI 15.6–16.8). Sacrum (37%) and heels (19.5%) were most affected. Factors independently associated with ICU-acquired pressure injuries were older age, male sex, being underweight, emergency surgery, higher Simplified Acute Physiology Score II, Braden score 3 days, comorbidities (chronic obstructive pulmonary disease, immunodeficiency), organ support (renal replacement, mechanical ventilation on ICU admission), and being in a low or lower-middle income-economy. Gradually increasing associations with mortality were identified for increasing severity of pressure injury: stage I (odds ratio [OR] 1.5; 95% CI 1.2–1.8), stage II (OR 1.6; 95% CI 1.4–1.9), and stage III or worse (OR 2.8; 95% CI 2.3–3.3). Conclusion: Pressure injuries are common in adult ICU patients. ICU-acquired pressure injuries are associated with mainly intrinsic factors and mortality. Optimal care standards, increased awareness, appropriate resource allocation, and further research into optimal prevention are pivotal to tackle this important patient safety threat