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The recommended empiric ceftriaxone dosing regimen for acute bacterial meningitis in adults is 2 g every 12 h. After penicillin-susceptible Streptococcus pneumoniae is isolated as a causative microorganism, the ceftriaxone dose may be continued or reduced to a single dose of 2 g every 24 h, per institutional preference. There is no clear guidance that indicates the superiority of one regimen over the other. The objective of this study was to evaluate the susceptibility of S. pneumoniae in the cerebral spinal fluid (CSF) of patients with meningitis and the relationship between ceftriaxone dose and clinical outcomes. We identified 52 patients with S. pneumoniae meningitis with positive CSF cultures who were treated at the University Hospital, Bern, Switzerland, over a 19-year period. We collected clinical and microbiological data for evaluation. Broth microdilution and Etest methods were performed to test penicillin and ceftriaxone susceptibility. All isolates were susceptible to ceftriaxone. Ceftriaxone was empirically used in 50 patients, with a starting dosing regimen of 2 g every 24 h in 15 patients and 2 g every 12 h in 35 patients. In 32 patients started on a twice-daily regimen (91%), doses were reduced to once daily after a median of 1.5 (95% CI 1–2) days. The overall in-hospital mortality was 15.4% (n = 8), and 45.7% of patients reported at least one sequela of meningitis at the last follow-up (median 375, 95% CI 189–1585 days). We found no statistical difference in outcome between the 2 g every 24 h and the 2 g every 12 h ceftriaxone dosing regimens. A ceftriaxone total daily dose of 2 g may be associated with similar outcomes to a 4 g total daily dose, provided that the causative organism is highly susceptible to ceftriaxone. The persistence of neurological and infection sequelae at the last follow-up underscores the need for optimal treatment of these complex infections.

A large clonal outbreak caused by vancomycin-resistant Enterococcus faecium (VRE) affected the Bern University Hospital group from the end of December 2017 until July 2020. We describe the characteristics of the outbreak and the bundle of infection prevention and control (IPC) measures implemented. The outbreak was first recognised when two concomitant cases of VRE bloodstream infection were identified on the oncology ward. During 32 months, 518 patients in the 1,300-bed hospital group were identified as vanB VRE carriers. Eighteen (3.5%) patients developed an invasive infection, of whom seven had bacteraemia. In 2018, a subset of 328 isolates were analysed by whole genome sequencing, 312 of which were identified as sequence type (ST) 796. The initial IPC measures were implemented with a focus on the affected wards. However, in June 2018, ST796 caused another increase in cases, and the management strategy was intensified and escalated to a hospital-wide level. The clinical impact of this large nosocomial VRE outbreak with the emergent clone ST796 was modest. A hospital-wide approach with a multimodal IPC bundle was successful against this highly transmissible strain.

Additional file 1. Survey.

Applying our workflow adaptations can be helpful for laboratories generating low quality mass spectra. The data acquired in this study suggest that these simple workflow adaptations are not sufficient to reach highest mass spectra quality in all cases, but other factors such as device maintenance may be helpful.

Incidence of invasive pneumococcal disease (IPD) has been low during the peak of the COVID-19 pandemic. In this study, we found that the IPD numbers again increased in Switzerland during the first six months of 2021, and that this coincides with the loosening of COVID 19 measures.Vaccine pneumococcal serotypes have continued to decrease but non-vaccine type serotype 23B has emerged (8% of the isolates in 2021). Worryingly, serotype 23B is associated with reduced susceptibility to penicillin.

Additional file 1: Figure S1. Schematic representation of the workflow of the project. Figure S2. Gene accumulation curves for species of the K. pneumoniae group (A) and the K. oxytoca group (B). Figure S3. Genes associated with AMR detected in Klebsiella spp.Figure S4. Partial least squares discriminant analysis (PLS-DA) score plot containing primary metabolites measured of five Klebsiella spp.Figure S5. Species identity of datasets (a), (b) and (c) included in the statistical analysis.

We have shown that the laboratory procedures imapct spectral quality. based on the data acquired within this study, we have developed protocols, likely able to increase mass spectral quality. This will be assessed in follow-up measurements at all laboratories.

International journal of molecular sciences 22(9), 4580 (2021). doi:10.3390/ijms22094580 special issue: "Special Issue "Bacterial Carbohydrates: Structures, Applications, and Structure/Activity Relationships" / Special Issue Editor: Prof. Dr. Maria Michela Corsaro, Guest Editor", Published by MDPI, Basel

Additional file 9: Odds ratio estimates comparing Klebsiella groups and species for resistance to different antibiotic classes: Table S7. Penicillins with beta-lactamase Inhibitors. Table S8. 3rd-generation cephalosporins. Table S9. 4th-generation cephalosporins. Table S10. Aminoglycosides.

Additional file 3. Supplementary methods for: Measurement of primary metabolites. Fatty acid analysis. Statistical analysis of clinical outcome data.

Additional file 1.

Additional file 1: Table S1. Overview of environmental sampling. Sampling was performed with premoistened (0,9% NaCl) sterile swabs, direct plating of contrast agents (200 μl per sample) and direct wiping of plant material on plates. Plates were incubated at 35 °C in CO2 enriched atmosphere for 6 days. MALDI-TOF MS was used for bacterial identification. Table S2. Overview of eight isolates described in this study. The genome datasets are available in the European Nucleotide Archive repository, under Project number PRJEB34002 [ https://www.ebi.ac.uk/ena/data/view/PRJEB34002 ]. Table S3. Peak list generated from visual examination of MALDI-TOF spectra of the Isolates A-H. Presence (1) or absence (0) of peaks is indicated at the m/z positions. Potentially double-ionized peaks are indicated with an asterisk (*); numbers in bold indicate peaks with a signal-to-noise ratio > 10. Table S4. Results of digital DNA:DNA hybridization for isolates F, H, G and B performed against all known Agrobacterium genomospecies. A dDDH value over 70 ( http://ggdc.dsmz.de/; Formula 2) or ANI value over 95% ( http://enve-omics.ce.gatech.edu/ani/ ) indicates the same species. Table S5. Comparison of MALDI-TOF MS spectra with a database generated on the base of putatively ascribed ribosomal protein masses extracted from genomic data. G = genomospecies. Figure S1. Timeline of clinical, microbiological, environmental, and treatment features of the two Index cases (Cluster I). Figure S2. Representative differentiating mass to charge (m/z) peaks. The m/z peak 7882 (*) is present in isolates C (pink), D (violet), E (light green), F (dark green) and H (orange) – the peak at 7924 m/z (**) is present in isolates A (light blue) and B (dark blue). Both peaks are absent in isolate G (red). Four spectra were recorded for each isolate A-H. Figure S3. (A) Disposable contrast reservoir with the rubber seal (#) in resting position. The potential contaminable zone lies behind the rubber seal (★). (B) The contrast reservoir is filled with contrast media by pushing (1) the rubber-sealed plunger (*) and pulling it (2) back to resting position. (C) The reservoir is inserted in the injector device system and ready to use. Figure S4. Model highlighting the potentially contaminable area of the reservoir behind the rubber seal (★), for visualization a fluorescent solution was used (A: resting position, B: rubber seal pushed in, C: rubber seal back in resting position). Figure S5. Principal component analysis: Four spectra were recorded for each isolate A-H. Two-dimensional plot of the first two principal components indicating the two clusters I (isolates A and B) and II (isolates C, D, E and F) and the “unrelated” isolates G and H. Figure S6. PFGE based typing of isolates A-H. The scale indicates the degree of similarity (%) as calculated by dice correlation analysis.

INTRODUCCIÓN. El carcinoma de célula pequeña o microcítico es un tumor neuroendocrino muy agresivo, siendo el tumor con mayor mortalidad. El tratamiento de este tumor apenas ha variado, presentando muy buena respuesta quimioterápica al inicio, pero haciéndose resistente al poco tiempo. Al diagnóstico, la mayor parte de los pacientes tiene la enfermedad diseminada. En otros tumores pulmonares los avances en el campo de la biología molecular han dado lugar a efectivas terapias como la inmunoterapia, que están empezando a ser aplicadas a este tumor en diversos estudios. OBJETIVO. El objetivo principal es obtener una revisión actualizada de este tumor, incluyendo los nuevos campos como la inmunoterapia y una revisión de la biología molecular, buscando nuevas posibles terapias y diferenciando la evolución respecto al carcinoma de célula no pequeña en los últimos avances. MATERIAL Y MÉTODOS. Se realizaron 3 búsquedas principales; la primera en diciembre del 2017 en cuatro bases de datos diferentes con un resultado total de 730 artículos. La segunda se realizó para acotar datos y añadir información, en febrero del 2018 con un total de 66 resultados. En abril de 2018 se realizó la última búsqueda para buscar novedades respecto al tema en cuestión y se obtuvieron un total de 241 artículos. Finalmente, se seleccionaron 33, 6 y 14 artículos de las respectivas búsquedas. RESULTADOS. Diversos ensayos están aún en progresión para analizar si realmente la inmunoterapia es una vía factible en este tumor. El tratamiento actual sigue siendo la quimioterapia. La biopsia líquida ofrece una alternativa a la convencional, siendo las células tumorales circulantes una buena vía para ampliar la información que tenemos de este tumor mediante el estudio de la biología molecular de estas células. CONCLUSIONES. A pesar del gran avance en la información que otorga la biología molecular, no se puede decir que actualmente este avance se aprecie en los campos de la terapéutica. A diferencia con otros tumores, en el CPCP la biología molecular y la inmunoterapia, de momento, no han avanzado lo suficiente como para obtener resultados respecto a la mortalidad, lo cual no implica que en un futuro no se puedan obtener nuevas dianas terapéuticas desde estos campos de investigación.