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Objectives: This study aimed to assess the real use of cefazolin for methicillin-susceptible Staphylococcus aureus (MSSA) infective endocarditis (IE) in the Spanish National Endocarditis Database (GAMES) and to compare it with antistaphylococcal penicillin (ASP). Methods: Prospective cohort study with retrospective analysis of a cohort of MSSA IE treated with cloxacillin and/or cefazolin. Outcomes assessed were relapse; intra-hospital, overall, and endocarditis-related mortality; and adverse events. Risk of renal toxicity with each treatment was evaluated separately. Results: We included 631 IE episodes caused by MSSA treated with cloxacillin and/or cefazolin. Antibiotic treatment was cloxacillin, cefazolin, or both in 537 (85%), 57 (9%), and 37 (6%) episodes, respectively. Patients treated with cefazolin had significantly higher rates of comorbidities (median Charlson Index 7, P

Abstract Introduction Infective endocarditis (IE) has undergone important changes in its epidemiology worldwide. Methods The study aimed to compare IE epidemiological features and outcomes according to predefined European regions and between two different time periods in the twenty-first century. Results IE cases from 13 European countries were included. Two periods were considered: 2000–2006 and 2008–2012. Two European regions were considered, according to the United Nations geoscheme for Europe: Southern (SE) and Northern–Central Europe (NCE). Comparisons were performed between regions and periods. A total of 4195 episodes of IE were included, 2113 from SE and 2082 from NCE; 2787 cases were included between 2000 and 2006 and 1408 between 2008 and 2012. Median (IQR) age was 63.7 (49–74) years and 69.4% were males. Native valve IE (NVE), prosthetic valve IE (PVE), and device-related IE were diagnosed in 68.3%, 23.9%, and 7.8% of cases, respectively; 52% underwent surgery and 19.3% died during hospitalization. NVE was more prevalent in NCE, whereas device-related IE was more frequent in SE. Higher age, acute presentation, hemodialysis, cancer, and diabetes mellitus all were more prevalent in the second period. NVE decreased and PVE and device-related IE both increased in the second period. Surgical treatment also increased from 48.7% to 58.4% (p

Background. In kidney transplant recipients, there is discordance between the development of cellular and humoral response after vaccination against SARS-CoV-2. We sought to determine the interplay between the 2 arms of adaptive immunity in a 3-dose course of mRNA-1273 100 μg vaccine. Methods. Humoral (IgG/IgM) and cellular (N- and S-ELISpot) responses were studied in 117 kidney and 12 kidney-pancreas transplant recipients at the following time points: before the first dose, 14 d after the second dose‚ and before and after the third dose, with a median of 203 and 232 d after the start of the vaccination cycle, respectively. Results. After the second dose, 26.7% of naive cases experienced seroconversion. Before the third dose and in the absence of COVID-19, this percentage increased to 61.9%. After the third dose, seroconversion occurred in 80.0% of patients. Naive patients who had at any time point a detectable positivity for S-ELISpot were 75.2% of the population, whereas patients who maintained S-ELISpot positivity throughout the study were 34.3%. S-ELISpot positivity at 42 d was associated with final seroconversion (odds ratio‚ 3.14; 95% confidence interval‚ 1.10-8.96; P = 0.032). Final IgG titer was significantly higher in patients with constant S-ELISpot positivity (P

Several genetic polymorphisms of the innate immune system have been described to increase the risk of cytomegalovirus (CMV) infection in transplant patients. The aim of this study was to assess the impact of a polygenic score to predict CMV infection and disease in high risk CMV transplant recipients (heart, liver, kidney or pancreas). On hundred and sixteen CMV-seronegative recipients of grafts from CMV-seropositive donors undergoing heart, liver, and kidney or pancreas transplantation from 7 centres were prospectively included for this purpose during a 2-year period. All recipients received 100-day prophylaxis with valganciclovir. CMV infection occurred in 61 patients (53%) at 163 median days from transplant, 33 asymptomatic replication (28%) and 28 CMV disease (24%). Eleven patients (9%) had recurrent CMV infection. Clinically and/or functionally relevant single nucleotide polymorphisms (SNPs) from TLR2, TLR3, TLR4, TLR7, TLR9, AIM2, MBL2, IL28, IFI16, MYD88, IRAK2 and IRAK4 were assessed by real time polymerase chain reaction (RT-PCR) or sequence-based typing (PCR-SBT). A polygenic score including the TLR4 (rs4986790/rs4986791), TLR9 (rs3775291), TLR3 (rs3775296), AIM2 (rs855873), TLR7 (rs179008), MBL (OO/OA/XAO), IFNL3/IL28B (rs12979860) and IFI16 (rs6940) SNPs was built based on the risk of CMV infection and disease. The CMV score predicted the risk of CMV disease with an AUC of the model of 0.68, with sensitivity and specificity of 64.3 and 71.6%, respectively. Even though further studies are needed to validate this score, its use would represent an effective model to develop more robust scores predicting the risk of CMV disease in donor/recipient mismatch (D+/R-) transplant recipients.

Background: Calcium is an essential ion for pathogen survival and virulence and is involved in the regulation of the inflammatory response. Hypocalcemia is a common laboratory finding in critically ill patients. Data regarding levels of calcium in SARS-CoV-2 infection is scarce. Patients with SARS-CoV-2 infection who present with hypocalcemia could have a worse outcome. Methods: We performed a retrospective analysis of hospitalized patients with SARS-CoV-2 infection and included all patients who had any serum calcium measurement in the first 72 h since hospital admission. The main objective was to investigate the relation of low serum calcium with adverse outcome, measured by the requirement of high oxygen support – defined as high flow nasal cannula oxygen, non-invasive mechanical ventilation and/or invasive ventilation – intensive care unit admission or death. Results: A total of 316 patients were included in the study. Median age was 65 years (IQR 55–74); 65% were men. Hypocalcemia within 72 h since hospital admission was present in 63% of patients. A higher number of patients in the hypocalcemia group required high oxygen support during hospitalization (49% vs 32%; p = 0,01) and were admitted to the ICU (42% vs 26%; p = 0,005). No differences in mortality were observed between groups. Conclusions: Hypocalcemia is frequent in hospitalized patients with SARS-CoV-2 infection and can identify patients who will have a worse outcome. More studies are needed to understand the role of calcium metabolism in SARS-CoV-2 infection and to address the clinical implications and therapeutic interventions it might have.

Introduction: Infection remains a major complication among heart transplant (HT) recipients, causing approximately 20% of deaths in the first year after transplantation. In this population, Aspergillus species can have various clinical presentations including invasive pulmonary aspergillosis (IPA), which has high mortality (53-78%). Aims: To establish the characteristics of IPA infection in HT recipients and their outcomes in our setting. Methods: Of 328 heart transplantations performed in our center between 1998 and 2016, five cases of IPA were identified. Patient medical records were examined and clinical variables were extracted. Results: All cases were male, with a mean age of 62 years. The most common indication for HT was nonischemic dilated cardiomyopathy. Productive cough was reported as the main symptom. The imaging assessment was based on chest radiography and chest computed tomography. The most commonly reported radiological abnormality was multiple nodular opacities in both techniques. Bronchoscopy was performed in all patients and A. fumigatus was isolated in four cases on BAL culture. Treatment included amphotericin in four patients, subsequently changed to voriconazole in three patients, and posaconazole in one patient, with total treatment lasting an average of 12 months. Neutropenia was found in only one patient, renal failure was observed in two patients, and concurrent cytomegalovirus infection occurred in three patients. All patients survived after a mean follow-up of 18 months. Conclusions: IPA is a potentially lethal complication after HT. An early diagnosis and prompt initiation of aggressive treatment are the cornerstone for better survival. Resumo: Introdução: A infeção continua a ser a principal complicação dos doentes submetidos a transplante cardíaco (TC), originando aproximadamente 20% de mortalidade no primeiro ano pós transplante. Nesta população, a infeção Aspergillus pode causar diferentes quadros clínicos, incluindo a aspergilose pulmonar invasiva (API), com elevada mortalidade (53 a 78%). Objetivos: Estabelecer as características da infeção por API nos doentes de TC e apresentar os respetivos resultados do nosso centro. Métodos: De 328 transplantes cardíacos realizados no nosso centro entre 1998 e 2016, identificámos cinco casos de API. Os registos médicos dos doentes foram examinados e as variáveis clínicas foram analisadas Resultados: Todos os casos corresponderam a doentes do sexo masculino com a idade média de 62 anos. A indicação mais comum para TC foi a miocardiopatia dilatada não isquémica. A tosse produtiva foi registada como principal sintoma. A avaliação radiológica baseou-se na radiografia e na tomografia computorizada ao tórax. A alteração radiológica mais comum foi, em ambas as técnicas, o registo de densidades nodulares múltiplas. A broncoscopia foi realizada em todos os doentes e o aspergillus fumigatus foi isolado em quarto casos de cultura BAL. O tratamento incluiu anfotericina em quatro doentes com mudança subsequente para voriconazol em três doentes e posaconazol em um doente, duração média do tratamento total de 12 meses. A neutropenia foi observada apenas num doente, a insuficiência renal em dois doentes e a infeção por CMV concomitante ocorreu em três doentes. Todos os doentes sobreviveram após um seguimento médio até 18 meses. Conclusões: A API representa uma complicação potencialmente letal após TC. O diagnóstico precoce e a instituição também precoce de tratamento agressivo constituem a pedra angular para uma melhor sobrevivência.

ABSTRACT De novo mutations in the UL56 terminase subunit and its associated phenotypes were studied in the context of cytomegalovirus (CMV) transplant recipients clinically resistant to DNA-polymerase inhibitors, naive to letermovir. R246C was the only UL56 variant detected by standard and deep sequencing, located within the letermovir-resistance-associated region (residues 230–370). R246C emerged in 2/80 transplant recipients (1 hematopoietic and 1 heart) since first cytomegalovirus replication and responded transiently to various alternative antiviral treatments in vivo. Recombinant phenotyping showed R246C conferred an advanced viral fitness and was sensitive to ganciclovir, cidofovir, foscarnet, maribavir, and letermovir. These results demonstrate a low rate (2.5%) of natural occurring polymorphisms within the letermovir-resistant-associated region before its administration. Identification of high replicative capacity variants in patients not responding to treatment or experiencing relapses could be helpful to guide further therapy and dosing of antiviral molecules. IMPORTANCE We provide comprehensive data on the clinical correlates of both CMV genotypic follow-up by standard and deep sequencing and the clinical outcomes, as well as recombinant phenotypic results of this novel mutation. Our study emphasizes that the clinical follow-up in combination with genotypic and phenotypic studies is essential for the assessment and optimization of patients experiencing HCMV relapses or not responding to antiviral therapy. This information may be important for other researchers and clinicians working in the field to improve the care of transplant patients since drug-resistant CMV infections are an important emerging problem even with the new antiviral development.

Herpes virus infections is not uncommon in solid organ transplantation patients. We report 3 cases with primary Herpes simplex virus type-1 (HSV1) infection with acute liver failure (ALF). This is a rare and potentially fatal entity that could be a donor-derived infection. Although the initial clinical presentation is non-specific, it should be considered as a differential diagnosis in HSV-negative serology patients with liver failure and empirical treatment must be started in combination with a drastic reduction of immunosuppression. A strategy of HSV prophylaxis for pre-transplant HSV seronegative patients must be stablished in order to reduce the risk of clinical disease.

El tratamiento de residuales mediante biodigestores se ha generalizado en la provincia de Cienfuegos, usado para tratar los residuos porcinos originados en fincas agropecuarias, pero es común que se viertan al entorno o se utilicen en la agricultura sin conocer su efecto sobre los cultivos. Con el objetivo de evaluar efecto del biol líquido sobre las variables morfoagronómicas en el cultivo de la habichuela (Vigna unguiculata L. Walp) variedad Cantón-1 se desarrolló esta investigación en la finca “La Oriental”, ubicada en municipio de Cienfuegos, en un suelo Pardo con Carbonato durante el período de noviembre 2016 a enero 2017. El diseño de investigación fue de bloques completos al azar con cuatro tratamientos y cuatro réplicas en 16 parcelas de 5x4 m2, fueron muestreadas 12 plantas y 48 por tratamiento. Sobre el área foliar de la planta, se aplicaron dosis de biol (previamente caracterizado) de 0,5, 1,0 y 2,0 L/m2, en un intervalo de 7 días. La aplicación del análisis de varianza reveló que la mayor dosis fue la más efectiva sobre las variables morfoagronómicas. La dosis 1,0 y 2,0 L/m2 tuvieron un efecto similar sobre el rendimiento, mientras que en el testigo se observó la menor efectividad. Estos resultados informan que la aplicación de la dosis 1,0 L/m2es la idónea para incrementar los rendimientos del cultivo.

Introduction: Infection remains a major complication among heart transplant (HT) recipients, causing approximately 20% of deaths in the first year after transplantation. In this population, Aspergillus spp. can have various clinical presentations including invasive pulmonary aspergillosis (IPA), with high mortality (53-78%). Objectives: To establish the characteristics of IPA infection in HT recipients and their outcomes in our center. Methods: Among 328 HTs performed in our center between 1998 and 2016, we identified five cases of IPA. Patient medical records were examined and clinical variables were extracted. Results: All cases were male, and mean age was 62 years. The most common indication for HT was non-ischemic dilated cardiomyopathy. Productive cough was reported as the main symptom. The radiological assessment was based on chest X-ray and chest computed tomography. The most commonly reported radiographic abnormality was multiple nodular opacities in both techniques. Bronchoscopy was performed in all patients and Aspergillus fumigatus was isolated in four cases on bronchoalveolar lavage culture. Treatment included amphotericin in four patients, subsequently changed to voriconazole in three, and posaconazole in one patient, with total treatment lasting an average of 12 months. Neutropenia was found in only one patient, renal failure was observed in two patients, and concurrent cytomegalovirus infection in three patients. All patients were alive after a mean follow-up of 18 months. Conclusions: IPA is a potentially lethal complication after HT. Early diagnosis and prompt initiation of aggressive treatment are the cornerstone of better survival. Resumo: Introdução: A infeção continua a ser uma complicação major nos recipientes para transplante cardíaco (TC), causando cerca de 20% de mortes no primeiro ano após o transplante. Nestes doentes, o Aspergillus species pode levar a várias apresentações clínicas incluindo a aspergilose pulmonar invasiva (API), com uma mortalidade elevada (53% a 78%). Objetivos: Estabelecer as características da infeção por API nos recipientes para TC e os respetivos resultados no nosso serviço. Métodos: Dos 328 transplantes cardíacos realizados no nosso centro entre 1998 e 2016, identificámos cinco casos de API. Foram examinados os registos dos doentes e foram identificadas variáveis clínicas. Resultados: Em todos os casos os doentes eram do sexo masculino com idade média de 62 anos. A indicação mais comum para TC foi a miocardiopatia não isquémica dilatada. O principal sintoma foi tosse produtiva. A avaliação radiológica baseou-se na radiografia e na TAC torácicas. A alteração radiológica mais comum foi a densidade nodular múltipla em ambas as técnicas. A broncoscopia foi realizada em todos os doentes e o Aspergillus fumigatus foi isolado em quatro casos de cultura BAL. O tratamento incluiu anfotericina em quatro doentes com alteração subsequente para voriconazol em três doentes e posaconazol num doente, tendo o tratamento durado uma média de 12 meses. A neutropenia foi encontrada num doente apenas, a insuficiência renal foi observada em dois doentes e a infeção por CMV ocorreu em três doentes. Todos os doentes sobreviveram após seguimento de 18 meses. Conclusão: A API representa uma complicação potencialmente mortal após o TC. Um diagnóstico precoce e a iniciação de um tratamento rapidamente agressivo constituem a pedra angular para uma melhor sobrevivência. Keywords: Heart transplantation, Invasive pulmonary aspergillosis, Immunosuppression, Palavras-chave: Transplante cardíaco, Aspergilose pulmonar invasiva, Imunossupressão

Abstract Backgound In recent years we have witnessed an increase in infections due to multidrug-resistant organisms in kidney transplant recipients (KTR). In our setting, we have observed a dramatic increase in infections caused by extended-spectrum betalactamase-producing (ESBL) Enterobacteriaceae in KTR. In 2014 we changed surgical prophylaxis from Cefazolin 2 g to Ertapenem 1 g. Methods We compared bacterial infections and their resistance phenotype during the first post-transplant month with an historical cohort collected during 2013 that had received Cefazolin. Results During the study period 110 patients received prophylaxis with Cefazolin and 113 with Ertapenem. In the Ertapenem cohort we observed a non-statistically significant decrease in the percentage of early bacterial infection from 57 to 47%, with urine being the most frequent source in both. The frequency of infections caused by Enterobacteriaceae spp. decreased from 64% in the Cefazolin cohort to 36% in the Ertapenem cohort (p = 0.005). In addition, percentage of ESBL-producing strains decreased from 21 to 8% of all Enterobacteriaceae isolated (p = 0.015). After adjusted in multivariate Cox regression analysis, male sex (HR 0.16, 95%CI: 0.03–0.75), cefazolin prophylaxis (HR 4.7, 95% CI: 1.1–22.6) and acute rejection (HR 14.5, 95% CI: 1.3–162) were associated to ESBL- producing Enterobacteriaceae infection. Conclusions Perioperative antimicrobial prophylaxis with a single dose of Ertapenem in kidney transplant recipients reduced the incidence of early infections due to ESBL-producing Enterobacteriaceae without increasing the incidence of other multidrug-resistant microorganisms or C. difficile.

Objectives: The study aimed to describe the epidemiological, microbiological, and clinical features of a population sample of 17 patients with HACEK infective endocarditis (HACEK-IE) and to compare them with matched control patients with IE caused by viridans group streptococci (VGS-IE). Methods: Cases of definite (n = 14, 82.2%) and possible (n = 3, 17.6%) HACEK-IE included in the Infective Endocarditis Hospital Clinic of Barcelona (IE-HCB) database between 1979 and 2016 were identified and described. Furthermore, a retrospective case–control analysis was performed, matching each case to three control subjects with VGS-IE registered in the same database during the same time period. Results: Seventeen out of 1209 IE cases (1.3%, 95% confidence interval 0.69–1.91%) were due to HACEK group organisms. The most frequently isolated HACEK species were Aggregatibacter spp (n = 11, 64.7%). Intracardiac vegetations were present in 70.6% of cases. Left heart failure (LHF) was present in 29.4% of cases. Ten patients (58.8%) required in-hospital surgery and none died during hospitalization. In the case–control analysis, there was a trend towards larger vegetations in the HACEK-IE group (median (interquartile range) size 11.5 (10.0–20.0) mm vs. 9.0 (7.0–13.0) mm; p = 0.068). Clinical manifestations, echocardiographic findings, LHF rate, systemic emboli, and other complications were all comparable (p > 0.05). In-hospital surgery and mortality were similar in the two groups. One-year mortality was lower for HACEK-IE (1/17 vs. to 6/48; p = 0.006). Conclusions: HACEK-IE represented 1.3% of all IE cases. Clinical features and outcomes were comparable to those of the VGS-IE control group. Despite the trend towards a larger vegetation size, the embolic event rate was not higher and the 1-year mortality was significantly lower for HACEK-IE. Keywords: Endocarditis, HACEK, Viridans group streptococci, epidemiology, clinical characteristics, outcome, case-control

In the context of COVID-19 pandemic, we aimed to analyze the epidemiology, clinical characteristics, risk factors for mortality and impact of COVID-19 on outcomes of solid organ transplant (SOT) recipients compared to a cohort of non transplant patients, evaluating if transplantation could be considered a risk factor for mortality. From March to May 2020, 261 hospitalized patients with COVID-19 pneumonia were evaluated, including 41 SOT recipients. Of these, thirty-two were kidney recipients, 4 liver, 3 heart and 2 combined kidney-liver transplants. Median time from transplantation to COVID-19 diagnosis was 6 years. Thirteen SOT recipients (32%) required Intensive Care Unit (ICU) admission and 5 patients died (12%). Using a propensity score match analysis, we found no significant differences between SOT recipients and non-transplant patients. Older age (OR 1.142; 95% [CI 1.08-1.197]) higher levels of C-reactive protein (OR 3.068; 95% [CI 1.22-7.71]) and levels of serum creatinine on admission (OR 3.048 95% [CI 1.22-7.57]) were associated with higher mortality. The clinical outcomes of SARS-CoV-2 infection in our cohort of SOT recipients appear to be similar to that observed in the non-transplant population. Older age, higher levels of C-reactive protein and serum creatinine were associated with higher mortality, whereas SOT was not associated with worse outcomes.

IntroductionOur goal was to study whether influenza vaccination induced antibody mediated rejection in a large cohort of solid organ transplant recipients (SOTR).MethodsSerum anti-Human Leukocyte Antigen (HLA) antibodies were determined using class I and class II antibody-coated latex beads (FlowPRATM Screening Test) by flow cytometry. Anti-HLA antibody specificity was determined using the single-antigen bead flow cytometry (SAFC) assay and assignation of donor specific antibodies (DSA) was performed by virtual-crossmatch.ResultsWe studied a cohort of 490 SOTR that received an influenza vaccination from 2009 to 2013: 110 (22.4%) received the pandemic adjuvanted vaccine, 59 (12%) within the first 6 months post-transplantation, 185 (37.7%) more than 6 months after transplantation and 136 (27.7%) received two vaccination doses. Overall, no differences of anti-HLA antibodies were found after immunization in patients that received the adjuvanted vaccine, within the first 6 months post-transplantation, or based on the type of organ transplanted. However, the second immunization dose increased the percentage of patients positive for anti-HLA class I significantly compared with patients with one dose (14.6% vs. 3.8%; P = 0.003). Patients with pre-existing antibodies before vaccination (15.7% for anti-HLA class I and 15.9% for class II) did not increase reactivity after immunization. A group of 75 (14.4%) patients developed de novo anti-HLA antibodies, however, only 5 (1.02%) of them were DSA, and none experienced allograft rejection. Only two (0.4%) patients were diagnosed with graft rejection with favorable outcomes and neither of them developed DSA.ConclusionOur results suggest that influenza vaccination is not associated with graft rejection in this cohort of SOTR.

El presente artículo versa sobre poblamiento en la provincia de Cienfuegos, Cuba; que entretejiendo el vínculo constante con el crecimiento de su población y procesos socioespaciales actuantes, construye un perfil de cambios geográficos y temporales como parte de la conformación de este territorio. Desde la pluralidad metodológica se emplean métodos y técnicas cualitativas y cuantitativas que permiten caracterizar a la distribución geográfica de la población y sus cambios en el tiempo, que determinados por factores geográficos como la presencia de la bahía, las plantaciones cañeras y la producción industrial de azúcar, distingue un poblamiento inicial expansivo y creciente desde una base económica agroazucarera y que se reacomoda desde dos procesos opuestos en el siglo XX: acelerado crecimiento en asentamientos urbanos y de mayor tamaño, versus agudo despoblamiento rural como tendencias geográficas que se refuerzan hacia el siglo XXI y que son dominantes en la actualidad. De esta forma, el presente artículo brinda elementos claves para el posterior trazado de políticas territoriales, que orientadas a la corrección de las deformaciones y dificultades heredadas de un desarrollo provincial desproporcionado, aseguren la continuidad en la elevación del nivel y del modo de vida a través de una organización espacial más articulada y armónica de acuerdo a la distribución geográfica que presenta la población, sus actividades y la utilización de recursos en su territorio.

Background: In people living with HIV, much is known about chronic kidney disease, defined as a glomerular filtration rate under 60 mL/min. However, there is scarce data about prevalence and risk factors for milder impairment (60–89 mL/min). Objective: The present study aims to assess the influence of sex, antiretroviral therapy, and classical risk factors on the occurrence of mild decreased renal function in a large Spanish cohort of HIV-infected patients. Methods: Cross-sectional, single center study, including all adult HIV-1-infected patients under antiretroviral treatment with at least two serum creatinine measures during 2014, describing the occurrence of and the risk factors for mildly decreased renal function (eGFR by CKD-EPI creatinine equation of 60–89 mL/min). Results: Among the 4337 patients included, the prevalence rate of mildly reduced renal function was 25%. Independent risk factors for this outcome were age older than 50 years (OR 3.03, 95% CI 2.58–3.55), female sex (OR 1.23, 95% CI 1.02–1.48), baseline hypertension (OR 1.57, 95% CI 1.25–1.97) or dyslipidemia (OR 1.48, 95% CI 1.17–1.87), virologic suppression (OR 1.88, 95% CI 1.39–2.53), and exposure to tenofovir disoproxil-fumarate (OR 1.67, 95% CI 1.33–2.08) or ritonavir-boosted protease-inhibitors (OR 1.19, 95% CI 1.03–1.39). Conclusions: Females and patients over 50 seem to be more vulnerable to renal impairment. Potentially modifiable risk factors and exposure to tenofovir disoproxil-fumarate or ritonavir-boosted protease-inhibitors are present even in earlier stages of chronic kidney dysfunction. It remains to be determined whether early interventions including antiretroviral therapy changes (tenofovir alafenamide, cobicistat) or improving comorbidities management will improve the course of chronic kidney disease. Keywords: HIV-infection, Antiretroviral drugs, Chronic kidney disease, Glomerular filtration rate estimates

ObjetivesThe aim of this study was to identify CMV drug resistance mutations (DRM) in solid organ transplant (SOT) recipients with suspected resistance comparing next-generation sequencing (NGS) with Sanger sequencing and assessing risk factors and the clinical impact of resistance.MethodsUsing Sanger sequencing as the reference method, we prospectively assessed the ability of NGS to detect CMV DRM in the UL97 and UL54 genes in a nationwide observational study from September 2013 to August 2016.ResultsAmong 44 patients recruited, 14 DRM were detected by Sanger in 12 patients (27%) and 20 DRM were detected by NGS, in 16 (36%). NGS confirmed all the DRM detected by Sanger. The additional six mutations detected by NGS were present in ConclusionsNGS showed a higher yield than Sanger sequencing for detecting CMV resistance mutations in SOT recipients. The presence of DRM detected by NGS was independently associated with longer antiviral treatment.

El crecimiento progresivo de la ciudad de Cienfuegos, su población y el incremento del número de fuentes de contaminación atmosférica, que afectan cada vez más la salud de la población, revelan la necesidad de perfeccionar el Ordenamiento Territorial y Urbano, así como las políticas de manejo territorial que contribuyan a su sostenibilidad. Por ello, es objetivo de la investigación caracterizar la agricultura urbana que se realiza en la ciudad de Cienfuegos y determinar los ejes estratégicos, para la realización ulterior de su plan de ordenamiento territorial y urbano. La transformación de la agricultura urbana demanda de un proceso de ordenamiento territorial y urbano del sector que permita el mejor aprovechamiento de los recursos y el manejo sostenible. Para la determinación de los ejes estratégicos se procedió con métodos participativos a elaborar la visión de futuro deseada para la agricultura urbana, con la elaboración de la matriz DAFO, que representa una técnica pertinente para el análisis estratégico y la formulación del problema y la solución. La identificación y caracterización de variables y análisis espacial mediante un Sistema de Información Geográfica, permitieron determinar los impactos positivos y negativos en su entorno urbanístico, ambiental, económico y social, enunciando los ejes estratégicos para el ordenamiento urbano. El artículo presente da cuenta de esa experiencia. The progressive growth of the city of Cienfuegos, its population and increase of the number of sources of air pollution, affecting increasingly health of the population, reveal the need for improve the land use and urban and policies land management that contribute to sustainability. Therefore, it is research objective to characterize urban agriculture that held in the city of Cienfuegos and determine the strategic axes, for the further implementation of its plan of land use and urban. The transformation of urban agriculture demands of a process of territorial and urban planning of the sector to the best use of resources and sustainable management. For the determination of the strategic priorities proceeded methods develop participatory vision of desired future for agriculture urban, with the development of the SWOT matrix, which is a technical relevant for strategic analysis and the formulation of the problem and solution. The identification and characterization of variables and analysis space using a GIS, allowed determine the positive and negative impacts on the urban environment, environmental, economic and social, enunciating the strategic priorities for urban planning. This article reports the experience.

[This corrects the article DOI: 10.1371/journal.pone.0192387.].

International guidelines recommend 4 weeks of treatment with ampicillin plus gentamicin (A+G) for uncomplicated native valve Enterococcus faecalis infective endocarditis (EFIE) and 6 weeks in the remaining cases. Ampicillin plus ceftriaxone (A+C) is always recommended for at least 6w, with no available studies assessing its suitability for 4w. We aimed to investigate differences in the outcome of EFIE according to the duration (4 versus 6 weeks) of antibiotic treatment (A+G or A+C).Retrospective analysis from a prospectively collected cohort of 78 EFIE patients treated with either A+G or A+C.32 cases (41%) were treated with A+G (9 for 4w, 28%) and 46 (59%) with A+C (14 for 4w, 30%). No significant differences were found in 1-year mortality according to the type of treatment (31% and 24% in A+G and A+C, respectively; P = 0.646) or duration (26% and 27% at 4 and 6w, respectively; P = 0.863). Relapses were more frequent among survivors treated for 4w than in those treated for 6w (3/18 [17%] at 4w and 1/41 [2%] at 6w; P = 0.045). Three out of 4 (75%) relapses occurred in cirrhotic patients.A 4-week course of antibiotic treatment might not be suitable neither for A+G nor A+C for treating uncomplicated native valve EFIE.