Search

Background: Infection is one of the challenging complications after open reduction and internal fixation for ankle fractures. Previously published case series conclude that Staphylococcus aureus is the most frequent causative microorganism. An unexpected increase in Enterobacter cloacae infections after this surgery was observed in a preliminary analysis of data at the promoting center of the study. In traumatology, its incidence has been reported in chronic osteomyelitis, prosthetic infections, septic osteoarthritis, open fractures in children and adults, and fractures other than the ankle. Because of this unexpected finding, we decided to perform this study to analyze the demographic and microbiological variables of acute osteosynthesis infection after ankle fracture and determine the distinctive features of the patients with E cloacae infection. Methods: We performed a retrospective multicenter study including 4 university hospitals. All patients diagnosed with acute osteosynthesis infection after ankle fracture fixation between January 2015 and December 2018 were included. We analyzed demographic data, type of fracture, surgical technique, and microorganisms responsible for the infection. We performed a descriptive statistical analysis of the variables. Univariate and multivariate regression analysis were performed to compare patients with E cloacae infection to patients with infection caused by other microorganisms. Results: A total of 65 patients were included. A predominance of polymicrobial infections (24.62%), followed by infections caused by S aureus (23.07%) and E cloacae (23.07%) was observed. When E cloacae isolated in polymicrobial infections were added, the incidence of E cloacae as a causative microorganism increased to 32.3%. Patients with E cloacae infection were older (64/53, P = .008) and had a higher requirement of negative-pressure therapy after surgical debridement (71%/40%, P = .017). Conclusion: A high incidence of E cloacae infections was observed. Patients with E cloacae infection were generally older and required a higher use of negative-pressure therapy after debridement. Level of Evidence: Level V, mechanism-based reasoning.

Despite recent advances during the last few years, microbiological diagnosis of prosthetic joint infections remains a challenge. Molecular biology techniques have been developed to try to overcome this problem, and recently, many of them have become available for many laboratories. Some of them, especially commercial multiplex PCR-based assays and universal 16S rDNA homemade PCR assays, are now available in many laboratories. Moreover, new technologies have appeared, especially metagenomics and next-generation sequencing. These techniques have demonstrated their potential in many studies but appear to be experimental at present. A few studies have evaluated the possible use of these methods in the clinical routine, and a review of the critical aspects for the selection of a molecular method (accuracy, complexity, cost) was performed. Finally, a proposal for a protocol that includes molecular biology techniques was made according to the literature published in this field. In conclusion, molecular biology techniques are ready to be used in the clinical routine of a microbiology laboratory, but their use must be carried out in accordance with the many special characteristics of each laboratory. In all cases, the interpretation of the results must be conducted by a multidisciplinary team with experience in the management of these patients.

Introduction The incidence of infections caused by aerobic actinomycetes is increasing. Recent changes in taxonomy and the variability in susceptibility patterns among species make necessary a proper identification and antibiotic susceptibility testing. Material and methods Fifty-three strains of aerobic actinomycetes were identified by MALDI-TOF MS using the VITEK MS Mycobacterium/Nocardia kit (bioMerieux, France) in a tertiary hospital in Spain during a six-year period. Antimicrobial susceptibility testing of the isolates was performed using the Sensititre Rapmycoi microdilution panel (Thermo Fisher Scientific, Massachusetts, USA). Results Forty strains of Nocardia spp. were identified in the study, being N. farcinica and N. cyriacigeorgica the most prevalent ones. All isolates were susceptible to linezolid and the resistance to amikacin was only observed in one isolate of Gordonia sputi. Resistance to cotrimoxazole was only found in five isolates. Conclusions Routine identification and antimicrobial susceptibility testing of aerobic actinomycetes is advisable for an efficient identification of species and effective treatment.

Infections caused by Mycobacterium abscessus (MABS) are increasingly being reported worldwide. Identifying MABS subspecies and assessing their phenotypic resistance profiles are crucial for optimal management and better patient outcomes. M. abscessus subspecies differ in erm (41) gene functionality, which is a critical determinant of macrolide resistance.

Nontuberculous mycobacteria (NTM) are gaining interest with the increased number of infected patients. NTM Elite agar is designed specifically for the isolation of NTM without the decontamination step.

Objective The purpose of this study was to evaluate the in vitro antibacterial effects of a p‐Cymene‐based bis(pyrazolyl)methane derivative (SC‐19) to advance in developing alternative therapeutic compounds to fight against bacterial isolates from patients with otitis externa (OE). Methods Eighteen swab specimens were collected from patients aged over 18 years diagnosed with OE within at least 7 days of symptom onset, contaminated by only one bacterium type: Pseudomonas aeruginosa (n = 5); Staphylococcus aureus (n = 8); Klebsiella aerogenes (n = 2); Serratia marcescens (n = 1); Morganella morganii (n = 2). To appraise antibacterial activity, minimal inhibitory concentration (MIC), minimal bactericidal concentration (MBC), minimum biofilm inhibitory concentration (MBIC), and minimum biofilm eradication concentration (MBEC) assays were run at different SC‐19 concentrations. Results When using SC‐19, S. aureus strains showed less bacterial growth, but no bactericidal effect was observed. The MIC and MBC of SC‐19 were 62.5 and 2000 μg/ml against S. aureus and were >2000 μg/ml against the other isolates obtained from OE, respectively. In addition, the MBICs and MBECs of SC‐19 against S. aureus were 125 and >2000 μg/ml, respectively. Conclusion Nowadays the acquired antibiotic resistance phenomenon has stimulated research into novel and more efficient therapeutic agents. Hence, we report that, helped by the structural diversity fostered herein by a range of bis(pyrazolyl)methane derivatives, SC‐19 can be a promising alternative therapeutic option for treating OE caused by S. aureus given the observed effects on both planktonic state and biofilm. Level of Evidence IV

We report that ribavirin exerts an inhibitory and mutagenic activity on SARS-CoV-2-infecting Vero cells, with a therapeutic index higher than 10. Deep sequencing analysis of the mutant spectrum of SARS-CoV-2 replicating in the absence or presence of ribavirin indicated an increase in the number of mutations, but not in deletions, and modification of diversity indices, expected from a mutagenic activity. Notably, the major mutation types enhanced by replication in the presence of ribavirin were A→G and U→C transitions, a pattern which is opposite to the dominance of G→A and C→U transitions previously described for most RNA viruses. Implications of the inhibitory activity of ribavirin, and the atypical mutational bias produced on SARS-CoV-2, for the search for synergistic anti-COVID-19 lethal mutagen combinations are discussed.

A novel vector network analyzer multimode multiline thru-reflect-line calibration is presented. It has the advantage over previous calibrations that it is accurate for all measured modes, and more important, accuracy can be increased by simply adding more transmission medium sections to the calibration standards set. The calibration is based on considering each of the k measurements of k transmission media lengths as part of a tensor that takes into account N modes. The measurement of a WR-90 band-pass filter in multimode operation, from 20.5 GHz to 23.5 GHz, has been carried out by implementing a multimode multiline calibration kit. Measurements show excellent agreement with theory.

This study is the first one to analyze a high number of isolates of Gram-negative bacilli that are the cause of prosthetic joint infection. The analysis includes biofilm development and antimicrobial susceptibility testing of both planktonic and sessile bacteria. The obtained results support the clinical knowledge about the treatment of these bacteria when biofilms are involved.

This study aimed to characterize 79Isolates were phylotyped according to the single-locus sequence typing (SLST) scheme. We evaluated the ability of the biofilm formation ofMost of the isolates from PJIs belonged to the SLST class H/phylotype IB (34.2%), followed by class D/phylotype IA

Prosthetic joint infections (PJIs) are typically caused by microorganisms that grow in biofilms. Traditional antimicrobial susceptibility tests are based on the study of planktonic bacteria that might lead to missing the biofilm behavior and to a treatment failure. This study was designed to analyze the antimicrobial susceptibility of clinical Gram-negative bacilli (GNB) isolates from PJIs in planktonic and sessile states and the possible relationship between antimicrobial resistance and biofilm formation. A total of 46 clinical isolates from patients with PJIs (mainly hip and knee prostheses) plus three GNB ATCC isolates were studied. The Minimal Inhibitory Concentration (MIC), minimal bactericidal concentration (MBC), minimal biofilm inhibitory concentration (MBIC), and minimal biofilm eradication concentration (MBEC) were assessed using a previously published methodology. Almost all of the GNB clinical isolates tested were biofilm forming. Pseudomonas aeruginosa was the largest biofilm-forming species. A comparison of MBIC

Despite different criteria to diagnose a prosthetic joint infection (PJI), aetiological diagnosis of the causing microorganism remains essential to guide treatment. Molecular-biology-based PJI diagnosis is progressing (faster, higher specificity) in different techniques, from the experimental laboratory into clinical use. Multiplex polymerase chain reaction techniques (custom-made or commercial) provide satisfactory results in clinical series of cases, with specificity close to 100% and sensitivity over 70–80%. Next-generation metagenomics may increase sensitivity while maintaining high specificity. Molecular biology techniques may represent, in the next five years, a significant transformation of the currently available microbiological diagnosis in PJI. Cite this article: EFORT Open Rev 2021;6:93-100. DOI: 10.1302/2058-5241.6.200118

Introduction: Despite efforts to the contrary, tuberculosis remains one of the leading causes of death in the world. The appearance of multidrug-resistant (MDR) and extensively drug-resistant (XDR) strains of Mycobacterium tuberculosis has increased the need for new therapeutic options against these strains.Areas covered: This review covers the in vitro susceptibility, pharmacokinetics, and pharmacodynamics of bedaquiline, a new drug shown to be active against M. tuberculosis-resistant strains. The authors further review clinical data concerning its use against MDR and XDR strains, discussing recent clinical guidelines from different international societies.Expert opinion: Available data demonstrate the usefulness of bedaquiline against resistant M. tuberculosis. Despite the difficulty in analyzing multidrug therapies, the use of bedaquiline in MDR and XDR tuberculosis increases success rates, allowing shortened treatments and lower drug use than previously recommended regimens. Moreover, the fact that MDR and XDR strains are common in many places creates a need to include this drug in the currently available protocols. It is essential to overcome the substantial barriers that some countries encounter in obtaining bedaquiline, as doing so will make therapeutic regimens including this drug available for all patients.

BackgroundThis study aims to give an overview on how microbiology diagnosis tests of Prosthetic joint infections (PJI) is performed in Europe, and to explore whether any factor influences the decision on implementing a test.MethodsAn extensive online survey of clinical microbiologists from seven European countries (Belgium, Estonia, Germany, Italy, Netherlands, Switzerland, and Spain). Following items were assessed: (i). general information on the laboratory, (ii) preference of the laboratory and clinical microbiologists regarding samples, (iii) transportation and (iv) processing of explanted foreign bodies and tissues and synovial fluid, (v) culture media and culture duration, (vi) reporting (identification and susceptibility testing), and (vii) use of molecular microbiology techniques.ResultsInvited were 163 clinical microbiologists. The response rate from each country was above 50% (range 51–78%), except for Germany (36%). Frequent PJI diagnostics were the use of tissue pre-processing (58.1%), culturing synovial fluid in blood culture bottles (45.5%), use of sonication for processing explanted prosthesis (56.8%), reporting the presence of synovial leukocyte counts (67%), use of blood aerobic and anaerobic agar (97.7%), and enrichment media thioglycolate (69.3%). The most common incubation time of the culture media is 7–14 days (34.1–70.5%). The clinicians were called to report the culture results (80.7%), and to give antibiotic recommendation (67%).ConclusionThere are common practices in processing PJI samples and reporting results, which is promising for harmonization of PJI diagnostic in the future. However, variation in diagnostic tests should also be considered in interpreting and comparing clinical microbiology results.

One of the most commonly used treatments for acute prosthetic joint infection (PJI) is DAIR (debridement, antibiotics and implant retention), which comprises the debridement and the retention of the implant, followed by antibiotic treatment. The efficacy of DAIR remains unclear, as the literature has demonstrated variable success rates, ranging from 26% to 92%. The

Infection is one of the most common causes that leads to joint prosthesis failure. In the present work, biodegradable sol-gel coatings were investigated as a promising controlled release of antibiotics for the local prevention of infection in joint prostheses. Accordingly, a sol-gel formulation was designed to be tested as a carrier for 8 different individually loaded antimicrobials. Sols were prepared from a mixture of MAPTMS and TMOS silanes, tris(tri-methylsilyl)phosphite, and the corresponding antimicrobial. In order to study the cross-linking and surface of the coatings, a battery of examinations (Fourier-transform infrared spectroscopy, solid-state 29Si-NMR spectroscopy, thermogravimetric analysis, SEM, EDS, AFM, and water contact angle, thickness, and roughness measurements) were conducted on the formulations loaded with Cefoxitin and Linezolid. A formulation loaded with both antibiotics was also explored. Results showed that the coatings had a microscale roughness attributed to the accumulation of antibiotics and organophosphites in the surface protrusions and that the existence of chemical bonds between antibiotics and the siloxane network was not evidenced. This research was funded by the Regional Government of Madrid through the program ADITIMAT (ref. P2018/NMT-4411) and CIBERINFEC-CIBER of Infectious Diseases (CB21/13/00043). B.T. would like to thank the Spanish Ministry of Education, Culture, and Sports for the support through FPU grant (FPU17/05977).

A broadband technique to extract the attenuation and phase constants of the slot mode in a rectangular waveguide from either simulation or measurement results is proposed in this letter. The method is based on processing the values of the reflection coefficient of several slotted waveguides with different lengths and the same termination and feeding. The accuracy of the method can be improved by increasing the number of simulated or measured waveguides. The proposed technique is specially conceived to separate the contribution of the slot mode from other modes. An implementable structure and a measurement method to apply the extraction technique are proposed and used. Measured and simulation results of the proposed technique obtained from waveguides filled with two different materials are shown up to 10 GHz and validated using an approximate model. The proposed method can be regarded as a powerful technique to compute the propagation constants of leaky modes in leaky-wave antennas.

An analytic broadband design method for four-port N-branch branch-line couplers with outputs terminated by arbitrary impedances is given. An alternative, more practical design method has also been included, which avoids impedance discontinuities in the branches and retrieves the outputs-in-quadrature property lost in the asymmetrization. The doubly asymmetrical couplers so obtained are then used in a proposed design methodology for three-way power dividers that can include, if desired, an impedance level transformation. This article relies on the analysis of a class of asymmetrical structures by means of the odd and even excitations. Therefore, the formalization of this analysis is also detailed.

Non-tuberculous Mycobacteria (NTM) are a group of organisms whose importance in medicine seems to be increasing in recent times. The increasing number of patients susceptible to these diseases make it necessary to expand our knowledge of therapeutic options and to explore future possibilities for the development of a therapeutic arsenal.In this review, the authors provide a brief introduction about the present importance of NTM and describe the present recommendations of the available guidelines for their treatment. They include a description of the future options for the management of these patients, especially focusing on new antibiotics. The authors also look at possibilities for future therapeutic options, such as antibiofilm strategies.No actual changes have been made to the current recommendations for the management of most NTM infections (except perhaps the availability of nebulized amikacin). However, it is also true that we have increased the number of available antibiotic treatment options with good in vitro activity against NTM. The use of these drugs in selected cases could increase the therapeutic possibilities. However, some problems are still present, such as the knowledge of the actual meaning of a NTM isolate, and will probably be a key part of future research.

We describe a method for the broadband measurement of the even- and odd-mode propagation constants of symmetrical coupled transmission lines. The main advantage of the method, its simplicity, lies in the lack of need for four-port measurements. Only two-port measurements are required, and thus just a two-port vector network analyzer (VNA). The accuracy of the results can be increased at the cost of a higher number of measured coupled-line lengths. The new approach has been successfully applied for the determination of coupled microstrip lines in the 2- to 20-GHz frequency band in both simulated and experimental cases. A brief discussion about the repeatability of the microstrip launcher and the adverse effects of radiation is included.

The epidemiology of non-tuberculous mycobacteria (NTM) in Spain is largely unknown because systematic reporting is not compulsory. The aim of our study was to describe the frequency and diversity of NTM species in our region and their distribution according to the source sample, gender, and age of the patients. We performed a multicenter study of all NTM isolated in 24 public hospitals in Madrid from 2013 to 2017. A total of 6.923 mycobacteria were isolated: 4535 (65.5%) NTM, and 2.388 (34.5%) Mycobacterium tuberculosis complex (MTB). Overall, 61 different NTM species were identified. The most frequently isolated species were Mycobacterium avium complex (47.7%), M. lentiflavum (12.2%), M. gordonae (9.2%), M. fortuitum (8.9%), and M. abscessus (3.9%). Whereas MTB cases were stable during the study period, the number of NTM isolates increased considerably from 930 isolates in 2013 to 1012 in 2017; a sharp increase occurred in the last year. The rise in NTM isolates was mostly due to M. lentiflavum, M. kansasii, and M. abscessus mainly isolated from respiratory specimens in patients older than 60. The increase in isolation rate of NTM in our region is consistent with the increasing rates reported worldwide in the last decades. The rise in NTM isolates was mainly attributed to M. lentiflavum but it also should be noted the increasing of species with high pathogenic potential such as M. kansasii and M. abscessus.

Background: Debridement, antibiotic agents, and implant retention (DAIR) is a currently accepted approach for the treatment of early prosthetic joint infections (PJI). The success of a DAIR procedure has shown variable results throughout the published literature. Scoring systems such as the Kidney, Liver, Index surgery, Cemented prosthesis, and C-reactive protein value (KLIC) score for the selection of patients that are likely to benefit from DAIR have proved to be helpful in decision making. Our study aims to further validate the KLIC score using a large external multicentric cohort and to evaluate other risk factors for failure. Patients and Methods: A retrospective analysis of patients with an early acute PJI who were treated with DAIR and recorded in a database of eight Spanish university hospitals was performed. According to pre-operative variables of the KLIC study, patients were categorized into five groups: group A, =2 points; group B, 2.5-3.5 points; group C, 4-5 points; group D, 5.5-6.5 points; and group E, =7 points. Failure rates were compared between groups at 60 days and after 60 days of DAIR. Further variables for risk of failure were also analyzed. Results: A total of 455 patients with early acute PJI were included in the analyses. At 60 days, patients presenting with pre-operative elevated C-reactive protein serum levels, Staphylococcus aureus, and polymicrobial infections were associated with failure. Failure rates recorded were 12% for group A (n = 210), 18% for group B (n = 83), 26% for group C (n = 89), 24% for group D (n = 66), and 0% for group E (n = 7). Univariable analysis between consecutive groups of the KLIC score showed no differences for failure before 60 days of the DAIR procedure. Scheduled surgery and having the procedure performed by a specialized unit were also identified as important factors for DAIR success. Conclusions: Our results suggest the KLIC score was not useful for predicting failure in our cohort. Furthermore, our results indicate a specialized unit should conduct DAIR procedures.

A comprehensive comparison between two multi-line thru-reflect-line calibration techniques is provided.One of the methods is based on the classical combination of N measurements following the Gauss-Markov theorem.The other one has been developed along this paper in a complete and detailed way using the recently published idea of considering each of the N measurements as part of a tensor.The measurement of a calibration kit that covers from 500 MHz to 20.5 GHz has been carried out for both methods and the results discussed.From the analysis of the results, it seems that the tensor approach could show some advantages in the (not uncommon) cases where a strictly white and Gaussian noise is not the only perturbation of the measurements. On the other hand, the decomposition of the tensor requires a higher computational effort, which would better be reduced.

Pseudomonas aeruginosa (PA) is one of the most common bacteria isolated from chronic wounds and burns. Its treatment is a challenge due to antimicrobial drug resistance and biofilm formation. In this context, this study aimed to perform the synthesis and full characterization of hybrid nanosystems based on mesoporous silica nanoparticles (MSNs) functionalized with a nicotinic ligand and silver chloride nanoparticles, both phenytoin sodium (Ph)-loaded and unloaded, to evaluate the antibacterial properties against three different strains of PA (including two clinical strains) in a planktonic state and as biofilms. Ph is a well-known proliferative agent, which was incorporated into the hybrid nanomaterials to obtain an effective material for tissue healing and prevention of infection caused by PA. The Ph-loaded materials promoted a quasi-complete inhibition of bacterial growth in wound-like medium and biofilm development, with values of 99% and 96%, respectively, with selectivity indices above the requirements for drugs to become promising agents for the topic preventive treatment of chronic wounds and burns. We would like to thank funding from Agencia Estatal de Investigación—Ministerio de Ciencia e Innovación of Spain and FEDER Una Manera de Hacer Europa for the grant RTI2018-094322- B-I00 and the University of the Basque Country UPV/EHU (GIC18/143). A.M. was funded by grants from Instituto de Salud Carlos III through the “Miguel Servet” program (CP15/00053)

Replication of SARS-CoV-2 in the human population is defined by distributions of mutants that are present at different frequencies within the infected host and can be detected by ultra-deep sequencing techniques. In this study, we examined the SARS-CoV-2 mutant spectra of amplicons from the spike-coding (S-coding) region of 5 nasopharyngeal isolates derived from patients with vaccine breakthrough. Interestingly, all patients became infected with the Alpha variant, but amino acid substitutions that correspond to the Delta Plus, Iota, and Omicron variants were present in the mutant spectra of the resident virus. Deep sequencing analysis of SARS-CoV-2 from patients with vaccine breakthrough revealed a rich reservoir of mutant types and may also identify tolerated substitutions that can be represented in epidemiologically dominant variants., This work was supported by the Instituto de Salud Carlos III, Spanish Ministry of Science and Innovation (COVID-19 Research Call COV20/00181) and co-financed by the European Development Regional Fund “A way to achieve Europe.” The work was also supported by grants CSIC-COV19-014 from the CSIC, project 525/C/2021 from the Fundació La Marató de TV3; PID2020-113888RB-I00 from the Ministerio de Ciencia e Innovación; BFU2017-91384-EXP from the Ministerio de Ciencia, Innovación y Universidades (MCIU);PI18/00210 and PI21/00139 from the Instituto de Salud Carlos III; and S2018/BAA-4370 (PLATESA2) from the Comunidad de Madrid/ FEDER. This research work was also funded by the European Commission – NextGenerationEU (regulation EU 2020/2094), through the CSIC’s Global Health Platform (PTI Salud Global). CP and PM are supported by the Miguel Servet programme of the Instituto de Salud Carlos III (CPII19/00001 and CP16/00116, respectively), cofinanced by the European Regional Development Fund (ERDF). CIBERehd is funded by the Instituto de Salud Carlos III. Institutional grants from the Fundación Ramón Areces and Banco Santander to the CBMSO are also acknowledged. The team at CBMSO belongs to the Global Virus Network (GVN). BMG is supported by predoctoral contract PFIS FI19/00119 from the Instituto de Salud Carlos III (Ministerio de Sanidad y Consumo), cofinanced by the Fondo Social Europeo (FSE). CGC is supported by predoctoral contract PRE2018- 083422 from the MCIU. BS was supported by a predoctoral research fellowship (Doctorados Industriales, DI-17-09134) from the Spanish Ministry of Economy and Competitiveness (MINECO).

The purpose of this study was to evaluate the in vitro antibacterial effects of aEighteen swab specimens were collected from patients aged over 18 years diagnosed with OE within at least 7 days of symptom onset, contaminated by only one bacterium type:When using SC-19,Nowadays the acquired antibiotic resistance phenomenon has stimulated research into novel and more efficient therapeutic agents. Hence, we report that, helped by the structural diversity fostered herein by a range of bis(pyrazolyl)methane derivatives, SC-19 can be a promising alternative therapeutic option for treating OE caused byIV.

To evaluate the usefulness of a multiplex polymerase chain reaction (PCR) assay as a complementary tool in the diagnosis of prosthetic joint infections in the routine setting of a clinical microbiology laboratory, with a special focus on patients at high risk of culture-negative infections and high suspicion of infection.The results obtained in the routine care setting with the use of the commercial multiplex PCR (Unyvero i60©, Curetis AG, Holzgerlingen, Germany) were retrospectively reviewed. The test was performed in samples of patients with suspected prosthetic joint infection, which were also processed for conventional diagnostic methods, including sonication of the implant when possible. Patients selected for the test were those with negative cultures after a 24-h incubation period.Ninety-nine PCRs were performed, 57 of which were diagnostic of infection according to 2018 MSIS criteria. Nine patients received antibiotics within the 15 days prior to the diagnostic procedure. Tested samples included synovial fluid (33), sonication fluid (56) and tissue biopsies (10). The PCR test detected microorganisms in 26 samples: including two cases of polymicrobial infection. Eleven patients were diagnosed by using PCR only. The most frequently detected microorganism in PCR was Coagulase-Negative Staphylococcus in 11 samples, followed by Staphylococcus aureus in five. One sample was positive for the bacteria universal primer, included in the 2.0 version of the kit. Only one discrepancy was detected between a negative PCR and a positive culture. One sample was also positive for a resistance marker (detection of mecA gene in a case of methicillin-resistant S. aureus infection).The incorporation of the Unyvero ITI multiple PCR technique in patients selected by clinical experts is a useful tool for the diagnosis of bone and joint infections in a routine care setting. A close clinical-microbiological collaboration improves the usefulness of this kit for the management of patients with these infections.

(1) Background: Carbapenem-resistant

Staphylococcus aureus is the most common cause of surgical site infections and its treatment is challenging due to the emergence of multi-drug resistant strains such as methicillin-resistant S. aureus (MRSA). Natural berry-derived compounds have shown antimicrobial potential, e.g., ellagitannins such as sanguiin H-6 and lambertianin C, the main phenolic compounds in Rubus seeds, have shown antimicrobial activity. The aim of this study was to evaluate the effect of sanguiin H-6 and lambertianin C fractionated from cloudberry seeds, on the MRSA growth, and as treatment of a MRSA biofilm development in different growth media in vitro and in vivo by using a murine wound infection model where sanguiin H-6 and lambertianin C were used to prevent the MRSA infection. Sanguiin H-6 and lambertianin C inhibited the in vitro biofilm development and growth of MRSA. Furthermore, sanguiin H-6 showed significant anti-MRSA effect in the in vivo wound model. Our study shows the possible use of sanguiin H-6 as a preventive measure in surgical sites to avoid postoperative infections, whilst lambertianin C showed no anti-MRSA activity.

The use of an eigenstate based equivalent circuit topology is proposed for the analysis and modeling of lossless and lossy bi-periodic scatterers. It can significantly simplify the design of this kind of surfaces, since it reduces the number of elements with respect to other general circuits. It contains at most only two admittances and two transformers depending on one unique transformation ratio. The real parts of these admittances can be assured to be non-negative, an interesting aspect in the modeling of lossy surfaces such as those present in asorbers. Moreover, due to the capability of decomposition into the eigenexcitations of the structure, the circuit provides important physical insight. Different cases of scatterers have been analyzed: symmetric and asymmetric, lossy and lossless. In all these cases, the modeling of the circuit admittances has been successfully achieved with a few RLC elements, positive and frequency independent. In the case of structures with symmetries, the transformation ratio directly reflects the physical orientation of the eigenexcitations of the scatterer. Furthermore, in the case of lossy scatterers but without symmetries, the resulting equivalent circuit reveals that their eigenexcitations are not linear polarizations, but elliptic polarizations whose properties are described by the complex transformation ratio.

In recent years, Mycobacterium abscessus has appeared as an emerging pathogen, with an increasing number of disease cases reported worldwide that mainly occur among patients with chronic lung diseases or impaired immune systems. The treatment of this pathogen represents a challenge due to the multi-drug-resistant nature of this species and its ability to evade most therapeutic approaches. However, although predisposing host factors for disease are well known, intrinsic pathogenicity mechanisms of this mycobacterium are still not elucidated. Like other mycobacteria, intracellular invasiveness and survival inside different cell lines are pathogenic factors related to the ability of M. abscessus to establish infection. Some of the molecular factors involved in this process are well-known and are present in the mycobacterial cell wall, such as trehalose-dimycolate and glycopeptidolipids. The ability to form biofilms is another pathogenic factor that is essential for the development of chronic disease and for promoting mycobacterial survival against the host immune system or different antibacterial treatments. This capability also seems to be related to glycopeptidolipids and other lipid molecules, and some studies have shown an intrinsic relationship between both pathogenic mechanisms. Antimicrobial resistance is also considered a mechanism of pathogenicity because it allows the mycobacterium to resist antimicrobial therapies and represents an advantage in polymicrobial biofilms. The recent description of hyperpathogenic strains with the potential interhuman transmission makes it necessary to increase our knowledge of pathogenic mechanisms of this species to design better therapeutic approaches to the management of these infections.

Background Reports on the occurrence and outcome of Visceral Leishmaniasis (VL) in pregnant women is rare in published literature. The occurrence of VL in pregnancy is not systematically captured and cases are rarely followed-up to detect consequences of infection and treatment on the mother and foetus. Methods A review of all published literature was undertaken to identify cases of VL infections during pregnancy by searching the following database: Ovid MEDLINE®; Ovid Embase; Cochrane Database of Systematic Reviews; Cochrane Central Register of Controlled Trials; World Health Organization Global Index Medicus: LILACS (Americas); IMSEAR (South- East Asia); IMEMR (Eastern Mediterranean); WPRIM (Western Pacific); ClinicalTrials.gov; and the WHO International Clinical Trials Registry Platform. Selection criteria included any clinical reports describing the disease in pregnancy or vertical transmission of the disease in humans. Articles meeting pre-specified inclusion criteria and non-primary research articles such as textbook, chapters, letters, retrospective case description, or reports of accidental inclusion in trials were also considered. Results We screened 272 publications and identified a total of 70 records (1926–2020) describing 447 VL cases in pregnant women. The disease was detected during pregnancy in 394 (88.1%), retrospectively confirmed after giving birth in 52 (11.6%), and the time of identification was not clear in 1 (0.2%). Of the 394 mothers whose infection was identified during pregnancy, 344 (89.1%) received a treatment, 3 (0.8%) were untreated, and the treatment status was not clear in the remaining 47 (12.2%). Of 344 mothers, Liposomal Amphotericin B (L-AmB) was administered in 202 (58.7%) and pentavalent antimony (PA) in 92 (26.7%). Outcomes were reported in 176 mothers treated L-AmB with 4 (2.3%) reports of maternal deaths, 5 (2.8%) miscarriages, and 2 (1.1%) foetal death/stillbirth. For PA, outcomes were reported in 87 mothers of whom 4 (4.6%) died, 24 (27.6%) had spontaneous abortion, 2 (2.3%) had miscarriages. A total of 26 cases of confirmed, probable or suspected cases of vertical transmission were identified and the median time to detection was 6 months (range: 0–18 months). Conclusions Outcomes of VL treatment during pregnancy is rarely reported and under- researched. When it is reported, information is often incomplete and it is difficult to derive generalisable information on outcomes for mothers and babies, although reported data favours the usage of liposomal amphotericin B for the treatment of VL in pregnant women. Author summary Visceral Leishmaniasis (VL) is a neglected tropical disease with an estimated incidence of 50,000 to 90,000 cases in 2019. Women who are susceptible to becoming pregnant or those who are pregnant and lactating are regularly excluded from clinical studies of VL. A specific concern of public health relevance is the little knowledge of the consequences of VL and its treatment on the mother and the foetus. We did a systematic review of all published literature with an overarching aim of identifying cases of VL in pregnancy and assess the risk-benefit balance of antileishmanial therapies to the mother and the child. We identified a total of 70 records (1926–2020) describing 447 VL cases in pregnant women. In 394 mothers, infection was identified during pregnancy of whom 202 received Liposomal Amphotericin B (L-AmB) and 92 received pentavalent antimony (PA). Reports of maternal deaths, abortion, and miscarriages were proportionally lower among those who received L- AmB compared to PA regimens. A total of 26 cases of confirmed, probable or suspected cases of vertical transmission were identified and the median time to detection was 6 months (range: 0–18 months). Our review brings together scattered observations of VL in pregnant women in the clinical literature and clearly highlights that the disease in pregnancy is under-reported and under-studied. Our findings indicate that L-AmB should be the preferred treatment for VL during pregnancy.

Methylobacterium sp. is isolated from water distribution systems and has been linked in the biofilms of the systems with a lower presence of Mycobacterium avium. In this study we aimed to determine the in vitro activity of Methylobacterium sp. in the development of rapidly growing mycobacteria (RGM) biofilms. Methylobacterium sp. CECT 7805 was added as a suspension of living bacteria (LB), an autoclaved suspension (AS), and an extract obtained after sonication (ES) at different times (24, 48, and 72 h), to preformed biofilms of Mycobacterium abscessus DSM 44196, Mycobacterium chelonae ATCC 19235, and Mycobacterium fortuitum ATCC 6841, using a 96 h control of each species. The biofilms were analyzed by confocal laser scanning microscopy and by the Calgary biofilm device using the plates MBECTM Biofilm Inoculator. A statistically significant reduction in the thickness and covered surface was observed in all mycobacterial biofilms with all forms of Methylobacterium sp. A statistically significant increase in the autofluorescence was observed in M. abscessus biofilms but not in other biofilms. The increased percentage of dead mycobacteria was statistically significant in all cases. The reduced log CFU (colony-forming units)/peg recount was statistically significant in M. chelonae biofilms after treatment with AS and ES, but in M. fortuitum biofilms the recount decreased only with AS. M. abscessus biofilms were always significantly reduced with AS at 72 h and with ES. Methylobacterium sp. could inhibit RGM biofilm formation. Living cells of Methylobacterium sp. were not necessary to inhibit the growth of a preformed biofilm. M. chelonae biofilms were the most greatly reduced.

Introduction. Candida auris is a pathogenic yeast that mainly affects immunosuppressed patients and those with implanted medical devices. This pathogen also displays elevated resistance to common antifungals and high survival and spreading capacities. Since no antifungal breakpoints have yet been defined for this pathogen, the data obtained here can be useful for further research concerning treatment or implementation of a prevention and disinfection protocol. Our aim was to study the antifungal resistance of C. auris to current antifungals in planktonic and sessile states. Using confocal laser scanning microscopy and viable biomass production, we demonstrated the ability of C. auris to develop a mature biofilm. We compared the minimal inhibitory concentration (MIC) and the minimal biofilm eradication concentration (MBEC) for the C. auris DSM 21092 strain plus two clinical isolates, and the results were compared with those obtained for Candida albicans and Candida parapsilosis, two species strongly linked to bloodstream infections and infections associated with biomaterials. We found that the clinical isolates of C. auris were resistant to fluconazole and sensitive to echinocandins and polyenes. The C. auris biofilms did not show susceptibility to any antifungal agent, showing MBECs that were up to 512-fold higher than the MICs. These findings highlight the importance of biofilm formation as a key factor underlying the resistance of this species to antifungals and suggest that the presence of implantable medical devices is one of the major risk factors in immunocompromised patients.

Ti-doped ZnO thin films were obtained with the aim of tailoring ZnO film bioadhesiveness and making the optoelectronic properties of ZnO materials transferable to biological environments. The films were prepared on silicon substrates by sol–gel spin-coating and subsequent annealing. A Ti–O segregation limits the ZnO crystallite growth and creates a buffer out-layer. Consequently, the Ti-doped ZnO presents slightly increased resistivity, which remains in the order of 10–3 Ω·cm. The strong biochemical interference of Zn2+ ions released from pure ZnO surfaces was evidenced by culturing Staphylococcus epidermidis with and without the Zn2+ coupling agent clioquinol. The Ti-doped ZnO surfaces showed a considerable increase of bacterial viability with respect to pure ZnO. Cell adhesion was assayed with human mesenchymal stem cells (hMSCs). Although hMSCs find difficulties to adhere to the pure ZnO surface, they progressively expand on the surface of ZnO when the Ti doping is increased. A preliminary microdevice has been built on the Si substrate with a ZnO film doped with 5% Ti. A one-dimensional micropattern with a zigzag structure shows the preference of hMSCs for adhesion on Ti-doped ZnO with respect to Si. The induced contrast of surface tension further induces a cell polarization effect on hMSCs. It is suggested that the presence of Ti–O covalent bonding on the doped surfaces provides a much more stable ground for bioadhesion. Such fouling behavior suggests an influence of Ti doping on film bioadhesiveness and sets the starting point for the selection of optimal materials for implantable optoelectronic devices.

La influencia que tiene la radiación solar sobre la germinación y emergencia de plántulas no ha sido descrita para muchas de las especies tropicales de importancia maderable. La presente investigación se enfoca en la emergencia de plántulas de taxa maderables nativas de la Península de Yucatán bajo diferentes grados de sombra (0%, 35% , 60% y 90 %). Para ello, se realizó la evaluación de las especies de Caesalpinia mollis (chakté) , (Piscidia piscipula) (jabín) y jujuché (Albizia tomentosa). C. molli y A. tomentosa presentaron diferencias entre tratamientos (p < 0.0001 y p < 0.0,1 respectivamente), ambas tuvieron mayor emergencia de plántulas con la luminosidad más elevada (0% de sombra). El tiempo de inicio de emergencia de las plántulas fue de cuatro a cinco días y la emergencia del 100% se logró en menos días con el 90% de sombra para las tres especies. Los resultados expresan que el porcentaje de sombra influye en la emergencia total de las plántulas.

Mycobacterium abscessus complex is extremely difficult to treat. Intrinsic and acquired bacterial resistance makes this species one of the most challenging pathogens and treatments last from months to years, associated with potential risky antibiotic toxicity and a high number of failures. Nonantibiotic antimicrobial agents against this microorganism have recently been studied so as to offer an alternative to current drugs. This review summarizes recent research on different strategies such as host modulation using stem cells, photodynamic therapy, antibiofilm therapy, phage therapy, nanoparticles, vaccines and antimicrobial peptides against M. abscessus both in vitro and in vivo.

Background The positive-intraoperative-cultures-type prosthetic joint infection (PIOC-PJI) is considered when surgical cultures yield microorganisms in presumed aseptic arthroplasty revisions. Herein we assess the risk factors for failure in the largest cohort of PIOC-PJI patients reported to date. Methods A retrospective, observational, multicenter study was performed during 2007–2017. Surgeries leading to diagnose PIOC-PJI included only one-stage procedures with either complete or partial prosthesis revision. Failure was defined as recurrence caused by the same microorganism. Results 203 cases were included (age 72 years, 52% females). Coagulase-negative staphylococci (n = 125, 62%) was the main etiology, but some episodes were caused by virulent bacteria (n = 51, 25%). Prosthesis complete and partial revision was performed in 93 (46%) and 110 (54%) cases, respectively. After a median of 3.4 years, failure occurred in 17 episodes (8.4%, 95%CI 5.3–13.1). Partial revision was an independent predictor of failure (HR 3.63; 95%CI 1.03–12.8), adjusted for gram-negative bacilli (GNB) infection (HR 2.68; 95%CI 0.91–7.89) and chronic renal impairment (HR 2.40; 95%CI 0.90–6.44). Treatment with biofilm-active antibiotics (rifampin/fluoroquinolones) had a favorable impact on infections caused by staphylococci and GNB. Conclusion Overall prognosis of PIOC-PJI is good, but close follow-up is required in cases of partial revision and in infections caused by GNB.

The increase of multiresistance in bacteria and the shortage of new antibiotics in the market is becoming a major public health concern. The World Health Organization (WHO) has declared critical priority to develop new antimicrobials against three types of bacteria: carbapenem-resistant A. baumannii, carbapenem-resistant P. aeruginosa and carbapenem-resistant and ESBL-producing Enterobacteriaceae. Phage therapy is a promising alternative therapy with renewed research in Western countries. This field includes studies in vitro, in vivo, clinical trials and clinical cases of patients receiving phages as the last resource after failure of standard treatments due to multidrug resistance. Importantly, this alternative treatment has been shown to be more effective when administered in combination with antibiotics, including infections with biofilm formation. This review summarizes the most recent studies of this strategy in animal models, case reports and clinical trials to deal with infections caused by resistant A. baumannii, K. pneumoniae, E. coli, and P. aeruginosa strains, as well as discusses the main limitations of phage therapy.