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Background: Extended‐spectrum beta‐lactamase–producing gram‐negative rods (ESBL‐GNR) are a rising cause of bacteremia in kidney transplant recipients (KT). The study purpose was to examine patient mortality, allograft survival, estimated glomerular filtration rate (eGFR) at the end of 1 year, and readmission rates while looking at treatment strategies among KTs with ESBL‐GNR and non–ESBL‐GNR bacteremia at our institution. Methods: This study was a retrospective, cohort analysis of KTs with gram‐negative bacteremia from January 1, 2020, to December 31, 2021. The primary outcome of the study was mortality. Patient outcomes were assessed for 365 days after positive blood cultures. Results: The study included 63 patients. Of these, 18 (29%) patients had bacteremia caused by an ESBL‐GNR and 45 (71%) patients had bacteremia caused by a non–ESBL‐GNR. Patient survival at 90 days was 94% in the ESBL‐GNR group and 96% in the non–ESBL‐GNR group. Ciprofloxacin was the most common antimicrobial therapy at discharge (68.9%) in the non–ESBL‐GNR group whereas ertapenem was the most common in the ESBL‐GNR group (44.5%). Median eGFR at discharge was 41 mL/min/1.73 m2 in the ESBL‐GNR group and 48 mL/min/1.73 m2 in the non–ESBL‐GNR group. Ninety‐day readmission occurred in 9 (50%) ESBL‐GNR patients and 14 (32%) non–ESBL‐GNR patients. None of the above comparisons are statistically significant (p > 0.05). Eleven (61%) ESBL‐GNR and 2 (4%) non–ESBL‐GNR patients used outpatient parenteral antimicrobial therapy (p < 0.001). Conclusions: Among KTs with ESBL‐GNR bacteremia, no significant difference was detected in mortality or allograft function compared to non–ESBL‐GNR bacteremia. [ABSTRACT FROM AUTHOR]

The solvothermal synthesis and characterization of a three-dimensional, interpenetrated uranyl dicyanoaurate coordination polymer, [K.sub.2][(U[O.sub.2]).sub.2][(U[O.sub.2]).sub.2][(Au[(CN).sub.2]).sub.2][(O).sub.2][(N[O.sub.3]).sub.4], from U[O.sub.2][(N[O.sub.3]).sub.2]*6[H.sub.2]O and KAu[(CN).sub.2] is described. The structure contains a three-dimensional (3D) lattice of planar tetranuclear uranyl-oxo-nitrate clusters connected by dicyanoaurate linkers, with the rotation of the clusters providing the increased dimensionality. The material undergoes a reversible single-crystal to single-crystal transformation on exposure to water vapour, which is taken up in the channels of the 3D system. A second uranyl dicyanoaurate coordination polymer of the form [U[O.sub.2][(DMSO).sub.3]([H.sub.2]O)(Au[(CN).sub.2])][Au[(CN).sub.2]] was structurally characterized as a linear chain of dicyanoaurate units connected by gold-gold bonds with pendant uranyl-water-DMSO adducts that are hydrogen bonded into a two-dimensional sheet. Both materials exhibit emission arising from both the uranyl moiety and the gold(I) centre and represent the first multidimensional uranyl-dicyanoaurate coordination polymers. Key words: coordination polymer, aurophilic interactions, uranyl, cyanide, emission. Nous decrivons la synthese solvothermale d'un polymere de coordination tridimensionnel interpenetre forme de dicyanoaurate d'uranyle, le [K.sub.2][(U[O.sub.2]).sub.2][(U[O.sub.2]).sub.2][(Au[(CN).sub.2]).sub.2][(O).sub.2][(N[O.sub.3]).sub.4], a partir de U[O.sub.2][(N[O.sub.3]).sub.2]*6[H.sub.2]O et de KAu[(CN).sub.2], et nous presentons la caracterisation de ce polymere. La structure se compose d'un reseau tridimensionnel d'agregats tetranucleaires planaires formes d'unites d'uranyl-oxo-nitrate reliees par des espaceurs dicyanoaurate, dans lequel la rotation des agregats constitue une dimension supplementaire. Cette substance subit une transformation monocristal a monocristal reversible sous l'effet de la vapeur d'eau, qui s'introduit dans les canaux du systeme tridimensionnel. Nous avons caracterise un second polymere de coordination a base de dicyanoaurate d'uranyle de formule [U[O.sub.2][(DMSO).sub.3]([H.sub.2]O)(Au[(CN).sub.2])][Au[(CN).sub.2]] se presentant sous la forme d'une chaine lineaire d'unites de dicyanoaurate reliees par des liaisons Au-Au, a laquelle sont attaches des adduits d'uranyleau-DMSO maintenus par des liaisons hydrogene et disposes en pendentifs dans un feuillet bidimensionnel. Les deux substances presentent des proprietes d'emission provenant des motifs uranyle et des centres Au(I) et constituent les premiers polymeres de coordination multidimensionnels a base de dicyanoaurate d'uranyle. [Traduit par la Redaction] Mots-cles: polymere de coordination, interactions aurophiles, uranyle, cyanure, emission., Introduction The creation of coordination polymers through self-assembly allows for the design and generation of functional materials. The modular construction of coordination polymers from linking units, metal centres, and ancillary [...]

Background: Vancomycin loading doses are commonly used to quickly attain target serum concentrations; however, data supporting their effect on clinical patient outcomes is limited. In April 2020, our institution revised our pharmacist-driven vancomycin dosing protocol to reserve loading doses for hemodynamically unstable patients with suspected serious methicillin-resistant Staphylococcus aureus (MRSA) infections. Prior to the protocol update, all patients treated with vancomycin at our institution received a weight-based loading dose. The purpose of this study is to assess clinical efficacy and safety outcomes related to the use of vancomycin loading doses. Methods: A retrospective, quasi-experimental study was performed to compare clinical outcomes in adult patients treated with vancomycin for laboratory-confirmed MRSA infections. Patients who received vancomycin therapy prior to our institution's vancomycin dosing protocol revisions (pre-intervention) were compared to patients who received vancomycin after the revisions (post-intervention). The primary outcome was all-cause, inpatient mortality. Secondary outcomes included persistent signs and symptoms of infection ≥5 days after vancomycin initiation, switch to alternative anti-MRSA therapy, and nephrotoxicity. Results: A total of 122 patients (63 pre-intervention patients and 59 post-intervention patients) were included. Receipt of a vancomycin loading dose did not impact the rate of inpatient mortality (4.76%vs 6.78%; OR 1.46, 95% CI [0.31, 6.79]). All secondary outcomes were similar between the two groups, including persistent signs and symptoms of infection, switch to alternative anti-MRSA therapy, and nephrotoxicity. Conclusions: Routine use of vancomycin loading doses is not associated with improved outcomes in hemodynamically stable patients with MRSA infections. [ABSTRACT FROM AUTHOR]

A series of lanthanide dicyanoaurate coordination polymers with 2,2′-bipyridine dioxide (OOBipy) has been created with the formula Ln(OOBipy)2(H2O)x[Au(CN)2]3·yEtOH·zH2O, where x and y = 0–2, and z = 0–4. It is possible to convert between these coordination polymers through the addition of heat (removing water, aqua ligands, or ethanol) or by exposure to water vapour (adding a full complement of aqua ligands and water molecules to a partially or fully dehydrated structure). The coordination polymers containing Sm, Eu, and Tb were emissive, with quantum yields between 0.43–0.66 and 0.09–0.72 for Eu- and Tb-containing materials respectively, depending on the solvation state. Atypically for emissive lanthanide materials, the highest quantum yields were found for the hydrated species, with a substantial drop in quantum yields as aqua units were sequentially removed. Eu/Tb-containing solid-solutions were prepared but only showed Eu-based emission, while Sm/Tb-containing solid-solutions had quantum yields of less than 0.02. [ABSTRACT FROM AUTHOR]

Purpose: This study aims to compare the performance of alternative weight-based vancomycin dosing strategies to traditional dosing in obese patients using area under the curve (AUC) monitoring. Methods: This retrospective study compared target attainment of an AUC between 400–600mcg*H/mL using alternative vancomycin dosing strategies. All patients received allometrically dosed vancomycin, with patient-specific AUCs calculated using 2 post-infusion steady-state vancomycin serum concentrations using the trapezoidal rule. Predicted AUCs were calculated using the following: 15 mg/kg total body weight (TBW), 15 mg/kg corrected body weight (CBW), and 12.5 mg/kg TBW. Predicted AUCs from the traditional 15 mg/kg TBW dosing were then compared to alternative dosing strategies using the predicted AUCs from 12.5 mg/kg TBW, 15 mg/kg CBW, and the actual AUCs calculated using allometrically scaled vancomycin dosing. The primary outcome was attainment of initial AUC within the target range of 400–600mcg*H/mL for each dosing method. Results: Eighty-four patients were included. When AUCs were compared to traditional 15 mg/kg dosing strategy, the CBW, 12.5 mg/kg, and allometric dosing strategies were significantly more likely to result in initial attainment of an AUC within a target range of 400–600 mcg*H/mL (P = 0.0003, 0.0135, and 0.0088, respectively). No significant differences were seen between each of the alternative dosing methods (P = 0.73). Conclusion: The 3 alternative vancomycin dosing strategies examined were all significantly more likely to achieve an initial AUC within the target range compared to traditional vancomycin dosing in obese patients. Clinicians should strongly consider one of these alternative dosing strategies for obese patients as opposed to traditional vancomycin dosing. [ABSTRACT FROM AUTHOR]

Background: Despite the high success rate of total hip arthroplasty (THA), new implant technologies continue to be developed. Although potentially useful, such novel developments may result in unintended consequences, leading to revision surgery, often prematurely. In several instances, new technology that appeared promising was later found to be inferior to existing technology and resulting in early revision surgery. Additionally, technical surgical errors may also lead to early revisions. Some have argued that revisions related to such phenomena are potentially avoidable. The present analysis investigates to what extent the contribution of "failed new technology" and "technical errors" contributes to the revision burden and to the need for premature revision arthroplasty. Methods: We retrospectively analysed 432 revision THAs and categorised them as either "late revisions" based on survivorship of 10 years or "premature revisions". Among both cohorts, we determined what percentage of revisions were potentially avoidable and due to failed novel technologies and technical errors, and what percent were "unavoidable". Results: Of the 432 revisions, 267 (62%) were considered premature and 38% were considered late. Of the premature revisions, 108 were considered potentially avoidable (81 failed novel technologies, 27 technical errors). Conclusions: Our data demonstrates that new technology and surgical techniques can result in premature failure of THA. Surgeons should take caution when incorporating new implant technology or surgical techniques into their practice. [ABSTRACT FROM AUTHOR]

The scope of antimicrobial stewardship programs has expanded beyond the acute hospital setting. The need to optimize antimicrobial use in emergency departments, urgent, primary, and specialty care clinics, nursing homes, and long-term care facilities prompted the development of core elements of stewardship programs in these settings. Identifying the most innovative and well-designed stewardship literature in these novel stewardship areas can be challenging. The Southeastern Research Group Endeavor (SERGE-45) network evaluated antimicrobial stewardship–related, peer-reviewed literature published in 2021 that detailed actionable interventions specific to the nonhospital setting. The top 13 publications were summarized following identification using a modified Delphi technique. This article highlights the selected interventions and may serve as a key resource for expansion of antimicrobial stewardship programs beyond the acute hospital setting. [ABSTRACT FROM AUTHOR]

V(D)J recombination is critical to the generation of a functional immune system. Intrinsic to the assembly of antigen receptor genes is the formation of endogenous DNA double-strand breaks, which normally are excluded from the cellular surveillance machinery because of their sequestration in a synaptic complex and/or rapid resolution. In cells deficient in double-strand break repair, such recombination-induced breaks fail to be joined promptly and therefore are at risk of being recognized as DNA damage. Poly(ADP-ribose) polymerase-1 is an important factor in the maintenance of genomic integrity and is believed to play a central role in DNA repair. Here we provide visual evidence that in a recombination inducible severe combined immunodeficient cell line poly(ADP-ribose) formation occurs during the resolution stage of V(D)J recombination where nascent opened coding ends are generated. Poly(ADP-ribose) formation appears to facilitate coding end resolution. Furthermore, formation of Mre11 foci coincide with these areas of poly(ADP-ribosyl)ation. In contrast, such a response is not observed in wild-type cells possessing a functional catalytic sub-unit of DNA-dependent protein kinase (DNA-P[K.sub.cs]). Thus, V(D)J recombination invokes a DNA damage response in cells lacking DNA-P[K.sub.cs] activity, which in turn promotes DNA-P[K.sub.cs]-independent resolution of recombination intermediates.