Impact of Sepsis Flow Chip, a novelty fast microbiology method, in the treatment of bacteremia caused by Gram-negative bacilli

Objective

The aim of this study was to assess the impact of the information provided by the new Sepsis Chip Flow system (SFC) and other fast microbiological techniques on the selection of the appropriate antimicrobial treatment by the clinical researchers of an antimicrobial stewardship team.

Methods

Two experienced clinical researchers performed the theoretical exercise of independently selecting the treatment for patients diagnosed by bacteremia due to bacilli gram negative (BGN). At first, the clinicians had only available the clinical characteristics of 74 real patients. Sequentially, information regarding the Gram stain, MALDI-TOF, and SFC from Vitro were provided. Initially, the researchers prescribed an antimicrobial therapy based on the clinical data, later these data were complementing with information from microbiological techniques, and the clinicians made their decisions again.

Results

The data provided by the Gram stain reduced the number of patients prescribed with combined treatments (for clinician 1, from 23 to 7, and for clinician 2, from 28 to 12), but the use of carbapenems remained constant. In line with this, the data obtained by the MALDI-TOF also decreased the combined treatment, and the use of carbapenems remained unchanged. By contrast, the data on antimicrobial resistance provided by the SFC reduced the carbapenems treatment.

Conclusions

From the theoretical model the Gram stain and the MALDI-TOF results achieved a reduction in the combined treatment. However, the new system tested (SFC), due to the resistance mechanism data provided, not only reduced the combined treatment, it also decreased the prescription of the carbapenems.

Impact of a stewardship program on bacteraemia in adult inpatients

OBJECTIVE

Bloodstream infections (BSIs) are associated with considerable morbidity and mortality among inpatients. The aim of this study was to evaluate the impact of a stewardship program on clinical and antimicrobial therapy-related outcomes in patients with bacteraemia.

METHODS

Single-centre, before-and-after quasi-experimental study in adult inpatients. Over 1 January 2013 to 31 June 2013 all patients aged 18 years or older with a bacteraemia (interven-tion group, N=200) were compared to a historical cohort (1 Janu-ary 2012 to 31 December 2012) (control group, N=200).

RESULTS

Following blood culture results and adjusting for potential confounders, the stewardship program was associated with more changes to antibiotic regimens (adjusted odds ratio [ORa]: 4.6, 95% CI 2.9, 7.4), more adjustments to antimicrobial therapy (ORa: 2.4, 95% CI 1.5, 3.8), and better source control in the first five days (ORa 1.6, 95% CI: 1.0, 2.7). In the subgroup that initially received inappropriate empiric treatment (n=138), the intervention was associated with more antibiotic changes (OR: 3.9, 95% CI: 1.8, 8.5) and a better choice of definitive antimicrobial therapy (OR 2.3 95% CI: 1.2, 4.6). There were also more antibiotic changes in the subgroups with both Gram-negative (OR: 2.8, 95% CI: 1.6, 4.9; n=217) and Gram-positive (OR: 4.6, 95% CI: 1.8, 9.9; n=135) bacteraemia among those receiving the intervention, while the Gram-positive subgroup also received more appropriate definitive antimicrobial therapy (OR: 3.9, 95% CI: 1.8, 8.8).

CONCLUSIONS

The stewardship program improved treatment of patients with bacteraemia and appropriateness of therapy.

Effect of recombinant growth hormone on leptin, adiponectin, resistin, interleukin-6, tumor necrosis factor-α and ghrelin levels in growth hormone-deficient children

BACKGROUND

Treatment with GH promotes linear growth and decreases body fat in patients with isolated GH deficiency (GHD). However, few studies have analyzed how GH replacement modifies ghrelin levels and the adipokine profile and the relationship of these modifications with the metabolic changes.

AIMS

To analyze the eventual differences between serum levels of leptin, leptin soluble receptor (sOBR), resistin, adiponectin, interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), total (TG) and acylated ghrelin (AG) and lipid and glycemic profiles in children with GHD, as well as to determine the effect of GH replacement on these parameters during the first year of therapy.

SUBJECTS AND METHODS

Thirty pre-pubertal (Tanner stage I) GHD children and 30 matched controls were enrolled. Children with GHD were studied before and after 6 and 12 months of GH treatment. Weight, height, BMI, fasting glucose, insulin, lipid profile and serum levels of adipokines and ghrelin were studied at every visit. Adi - pokines, insulin and ghrelin levels were determined by using commercial radio- and enzymoimmunoassays.

RESULTS

At baseline children with GHD had significantly higher sOBR (p<0.01) and adiponectin (p<0.01) levels than controls. Treatment with GH resulted in a decline in leptin (p<0.05) and TG (p<0.001) levels, an increase of homeostasis model assessment index and restored IGF-I levels (p<0.001).

CONCLUSIONS

These data indicate that GH replacement has a negative effect on leptin levels and may also produce a slight unfavorable effect on carbohydrate metabolism. In addition, the changes observed in the adipokine profile appear to be independent of body mass index.

Synthesis and application of a carbamazepine-imprinted polymer for solid-phase extraction from urine and wastewater

A molecularly imprinted polymer (MIP) designed to enable the selective extraction of carbamazepine (CBZ) from effluent wastewater and urine samples has been synthesised using a non-covalent molecular imprinting approach. The MIP was evaluated chromatographically in the first instance and its affinity for CBZ also confirmed by solid-phase extraction (SPE). The optimal conditions for SPE consisted of conditioning of the cartridge using acidified water purified from a Milli-Q system, loading of the sample under basic aqueous conditions, clean-up using acetonitrile and elution with methanol. The attractive molecular recognition properties of the MIP gave rise to good CBZ recoveries (80%) when 100 mL of effluent water spiked with 1 microg L(-1) was percolated through the polymer. For urine samples, 2 mL samples spiked with 2.5 microg L(-1) CBZ were extracted with a recovery of 65%. For urine, the linear range was 0.05-24 mg L(-1), the limit of detection was 25 microg L(-1) and precision, expressed as relative standard deviation at 0.5 mg L(-1) (n=3), was 3.1% and 12.6% for repeatability and reproducibility between days, respectively.

Direct determination of ciprofloxacin by mass spectrometry after a two-step solid-phase extraction using a molecularly imprinted polymer

A molecularly imprinted polymer (MIP) has been prepared for the first time with ciprofloxacin (CIPRO) as the template molecule, via a noncovalent synthetic procedure. Prior to its use as a sorbent in SPE, the MIP was evaluated chromatographically to confirm that it was indeed molecularly imprinted. The MIP was then used to extract CIPRO selectively from urine samples by means of a two-step SPE procedure in which a commercial Oasis cartridge and a molecularly imprinted SPE cartridge were combined in series. This approach allowed the matrix compounds present in the samples to be removed effectively. The urine extracts obtained after this two-step SPE procedure was applied were relatively clean compared to the original samples, and this made it possible to inject directly the extracts into a mass spectrometer and thus quantify CIPRO in urine samples at low levels and reduce the time of analysis.

Selective enrichment of anti-inflammatory drugs from river water samples by solid-phase extraction with a molecularly imprinted polymer

A molecularly imprinted polymer (MIP) is synthesised by a noncovalent protocol in which ibuprofen was used as a template molecule. The polymer was evaluated chromatographically and it was seen that the MIP showed cross-reactivity. Subsequently, when this polymer was used as sorbent in SPE it was possible to selectively extract a mixture of nonsteroidal anti-inflammatory drugs from aqueous samples when a cleanup step with dichloromethane was performed. The performance of the MIP was evaluated with river water and water from a wastewater treatment plant, and compared with the performance of a commercial Isolute ENV+ sorbent.

Molecularly imprinted solid-phase extraction of naphthalene sulfonates from water

A new polymeric sorbent synthesised by exploiting molecular imprinting technology has been used to selectively extract naphthalene sulfonates (NSs) directly from aqueous samples. In the non-covalent molecular imprinting approach used to prepare this polymer, 1-naphthalene sulfonic acid (1-NS) and 4-vinylpyridine (4-VP) were used as a template molecule and functional monomer, respectively, and both dissolved in a mixture of methanol/water (4:1) as porogen together with the cross-linker ethylene glycol dimethacrylate. The new non-covalent molecularly imprinted polymer (MIP) prepared in aqueous environment was used as a sorbent in solid-phase extraction (SPE) to selectively extract a group of naphthalene mono- and disulfonates. When one litre of a standard aqueous solution, which contained a mixture of eight NSs, was percolated through the SPE cartridge, all the NSs were retained on the MIP because of the cross-reactivity of the polymer. Recoveries were higher than 80% for all the compounds even after a clean-up step with methanol (MeOH). The MIP was also used to analyse water from the Ebro river.

A new molecularly imprinted polymer for the selective extraction of naproxen from urine samples by solid-phase extraction

A non-covalent molecularly imprinted polymer (MIP) was synthesised using naproxen (a non-steroidal, anti-inflammatory drug (NSAID)) as a template molecule. The MIP was chromatographically evaluated to confirm the imprinting effect, and was then applied as a selective sorbent in solid-phase extraction (SPE) to selectively extract naproxen. After this study, the MIP was used to extract naproxen from urine samples; it was demonstrated that by applying a selective washing step with acetonitrile (ACN) the compounds in the sample that were structurally related to naproxen could be eliminated.

On-line solid-phase extraction with molecularly imprinted polymers to selectively extract substituted 4-chlorophenols and 4-nitrophenol from water

Three polymers have been synthesised using 4-chlorophenol (4-CP) as the template, following different protocols (non-covalent and semi-covalent) and using different functional co-monomers, 4-vinylpyridine (4-VP) and methacrylic acid (MAA). The polymers were evaluated to check their selectivity as molecularly imprinted polymers (MIPs) in solid-phase extraction (SPE) coupled on-line to liquid chromatography. The solid-phase extraction procedure using MIPs (MISPE), including the clean-up step to remove any interferences, was optimised. The 4-VP non-covalent polymer was the only one which showed a clear imprint effect. This MIP also showed cross-reactivity for the 4-chloro-substituted phenols and for 4-nitrophenol (4-NP) from a mixture containing the 11 priority EPA (Environmental Protection Agency) phenolic compounds and 4-chlorophenol. The MIP was applied to selectively extract the 4-chloro-substituted compounds and 4-NP from river water samples.

Non-covalent and semi-covalent molecularly imprinted polymers for selective on-line solid-phase extraction of 4-nitrophenol from water samples

Two molecularly imprinted polymers (MIPs) have been synthesised for the selective extraction of 4-nitrophenol (4-NP) from water samples. One polymer was synthesised via a non-covalent approach and the other via a semi-covalent approach. The selectivity of the polymers for 4-NP was evaluated when these polymers were applied in on-line solid-phase extraction (MISPE) coupled to reversed-phase HPLC. The MISPE conditions for both MIPs were optimised and a clean-up step was included to eliminate non-specific interactions. Differences between the two MIPs were observed with the non-covalent MIP being the more selective of the two, whereas the recoveries were slightly higher for the semi-covalent MIP. The performance of the imprinted polymers in the MISPE of real water samples was also evaluated.

The hyperferremic mouse model for the evaluation of the effectiveness of VA-MENGOC-BC against Neisseria meningitidis B clinical isolates

VA-MENGOC-BC is a vaccine against B and C serogroups of Neisseria meningitidis. Its effectiveness at population level has been shown after the application of the vaccine in Cuba, Brazil, Argentina and Colombia. In vitro assays are not always able to reproduce the microorganism-host relationships and this makes it necessary to compile and standardize results obtained in animal models to extrapolate them with a greater degree of safety for humans. We evaluated the effectiveness of VA-MENGOC-BC against Neisseria meningitidis group B isolates from clinically ill patients in Latin America (Argentina, B not typeable: P1; Chile, not typed; Colombia, B4:P1.15 and Cuba B4:P1.15) using Balb/cJ mice treated with iron to make them susceptible to Neisseria meningitidis. The lethal median dose of each strain and of two others that were not included in challenge assays (Brazil: P1.15 and Argentina, B2b:P1.10) were determined. Results were 2.68 x 10(6), 3.16 x 10(7), 1.98 x 10(8), 1.28 x 10(9), 6.42 x 10(6) and 3.88 x 10(7) colony forming units (CFU), respectively. Non-immunized animals and mice treated with one and two doses of VA-MENGOC-BC were challenged with 10(3)-(10) CFU. Protection ranged from 30 to 100% with one dose and was equal to or higher than 70% with the two-dose immunization schedule. A significant protection could not be observed against the Colombian isolate from the lethality point of view, but the mean time of survival lengthened in immunized animals in relation to the controls. The applied inoculum of this strain was much higher (505 x LD50) than the remaining ones. The protection conferred was evident; nevertheless, more data are needed to determine how relevant the results are to humans.

[Microbiology and conservative surgery of serious infections of the diabetic foot]

Between June of 1987 and August 1988 we evaluated 31 diabetic patients hospitalized for severe foot infections to determine the etiologic agents, the value of the bacteriologic samples obtained, the benefits of conservative surgery and variable predictors of a major amputation. Sixteen patients suffered from necrosis, 16 osteomyelitis, 14 ulcers, 5 cellulitis, and/or abscesses and 22 had vascular compromise. Samples were taken from these infections excluding necrotic material. We isolate 76 microorganisms (2.4/pt), 57% Gram-positive cocci (predominantly S. aureus and enterococci), and 43% Gram-negative bacilli. Anaerobes were not isolated probably secondary to the exclusion of necrotic samples. There was high incidence of skin and soft tissue sampling (79%) bone (13/16) and surgical curettage (11/11). In 9 patients the correlation of soft tissue sampling and bone sampling was assessed with a positive correlation with respect to Gram-positive cocci. Twenty-one patients required conservative surgeries of the foot (9 underwent revascularization), 67% of which avoided a mayor amputation. However no significant variables predictive of a major amputation were detected in this study. In summary, the conservative surgery allowed to 2 out of 3 patients to preserve the foot.