An evidence-based bundle improves the quality of care and outcomes of patients with candidaemia

Background

Candidaemia is a leading cause of bloodstream infections in hospitalized patients all over the world. It remains associated with high mortality.

Objectives

To assess the impact of implementing an evidence-based package of measures (bundle) on the quality of care and outcomes of candidaemia.

Methods

A systematic review of the literature was performed to identify measures related to better outcomes in candidaemia. Eight quality-of-care indicators (QCIs) were identified and a set of written recommendations (early treatment, echinocandins in septic shock, source control, follow-up blood culture, ophthalmoscopy, echocardiography, de-escalation, length of treatment) was prospectively implemented. The study was performed in 11 tertiary hospitals in Spain. A quasi-experimental design before and during bundle implementation (September 2016 to February 2018) was used. For the pre-intervention period, data from the prospective national surveillance were used (May 2010 to April 2011).

Results

A total of 385 and 263 episodes were included in the pre-intervention and intervention groups, respectively. Adherence to all QCIs improved in the intervention group. The intervention group had a decrease in early (OR 0.46; 95% CI 0.23–0.89; P = 0.022) and overall (OR 0.61; 95% CI 0.4–0.94; P = 0.023) mortality after controlling for potential confounders.

Conclusions

Implementing a structured, evidence-based intervention bundle significantly improved patient care and early and overall mortality in patients with candidaemia. Institutions should embrace this objective strategy and use the bundle as a means to measure high-quality medical care of patients.

High Antifungal Activity against Candida Species of Monometallic and Bimetallic Nanoparticles Synthesized in Nanoreactors

Among all novel challenges nowadays worldwide, infectious disease is probably one of the most important. It is well-known that common treatments used include high doses of antibiotics, which are very invasive therapies for patients. These treatments are more intensive when the infection is related to multidrug resistant microorganisms. In this sense, in this work we report the use of reverse micelles to form less than 5 nm gold, silver, and gold-silver nanoparticles (NPs) with biological activity against five opportunistic Candida strains responsible of several diseases in human beings. As a result, we evaluate the interface properties and droplet-droplet interactions of micelles founding high fluidity in the polar head of the surfactant, necessary to form a flexible interaction channel in the "dimmer" micelle-micelle. In this condition, we form monodispersed, highly reactive NPs with sizes less than 5 nm with high antifungal activity against C. parapsilosis, C. Krusei, C. glabrata, C. guillermondii, and C. albicans, with minimum inhibitory concentrations (MIC₅₀) less than 0.7 ppm in all cases, the lowest reported to the best of our knowledge. These are very promising results to develop alternative therapies to treat fungal diseases in humans, animals, and plants, or to coat conventional surfaces in surgery rooms.

(sub)Millimeter Emission Lines of Molecules in Born-again Stars⋆

CONTEXT

Born-again stars offer us a unique possibility of studying the evolution of the circumstellar envelope of evolved stars in human timescales. To present, most of the observations of the circumstellar material in these stars have been limited to study the relatively hot gas and dust. In other evolved stars, the emission from rotational transitions of molecules, such as CO, is commonly used to study the cool component of their circumstellar envelopes. Thus, the detection and study of molecular gas in born-again stars would be of great importance to understand their composition and chemical evolution. In addition, the molecular emission would be an invaluable tool to explore the physical conditions, kinematics and formation of asymmetric structures in the circumstellar envelopes of these evolved stars. However, until now, all attempts to detect molecular emission from the cool material around born-again stars have failed.

AIMS

We searched for emission from rotational transitions of molecules in the hydrogen-deficient circumstellar envelopes of born-again stars to explore the chemical composition, kinematics, and physical parameters of the relatively cool gas.

METHODS

We carried out observations using the APEX and IRAM 30m telescopes to search for molecular emission toward four well studied born-again stars, V4334 Sgr, V605 Aql, A30 and A78, that are thought to represent an evolutionary sequence.

RESULTS

We detected for the first time emission from HCN and H¹³CN molecules toward V4334 Sgr, and CO emission in V605 Aql. No molecular emission was detected above the noise level toward A30 and A78. The detected lines exhibit broad linewidths ≳150 km s^-1, which indicates that the emission comes from gas ejected during the born-again event, rather than from the old planetary nebula. A first estimate of the H¹²CN/H¹³CN abundance ratio in the circumstellar environment of V4334 Sgr is ≈3, which is similar to the value of the ¹²C/¹³C ratio measured from other observations. We derived a rotational temperature of T _rot=13±1 K, and a total column density of N _HCN=1.6±0.1×10¹⁶ cm^-2 for V4334 Sgr. This result sets a lower limit on the amount of hydrogen that was ejected into the wind during the born-again event of this source. For V605 Aql, we obtained a lower limit for the integrated line intensities I _¹²C/I _¹³C>4.

Embolus of surgical adhesive to the extremities causing acute ischemia: Report of two cases

We present 2 cases in which a surgical adhesive embolized to the extremities. In the first case an adhesive was successfully used in the repair of a DeBakey type I aortic dissection. The patient was seen 2 months postoperatively with acute lower extremity ischemia, and a large piece of adhesive was extracted from the iliac and femoral arteries at embolectomy. In the second case the adhesive was used to seal a pericardial patch during repair of a ventricular septal defect. This patient was seen 1 day postoperatively with acute arm ischemia, and the adhesive particle was extracted from the brachial artery during embolectomy.

In situ reverse transcription to detect the cbbL gene and visualize RuBisCO in chemoautotrophic nitrifying bacteria

AIMS

In situ methodologies targeting the cbbL gene were used to visualize cells of nitrifying bacteria. Both procaryotic in situ PCR (IS-PCR) and in situ reverse transcription (ISRT) protocols were employed to determine gene presence and expression, respectively.

METHODS AND RESULTS

Aged-oligotropic seawater samples were inoculated with microbial assemblages containing a mixture of actively growing nitrifying bacteria, starved nitrifying bacteria, and heterotrophic bacteria without cbbL. After the molecular manipulations, we found that while all the nitrifiers (healthy or starved) with the cbbL gene were detected by IS-PCR, only the actively growing autotrophic nitrifiers with detectable levels of carbon fixation and nitrification activity were detected by ISRT analysis.

CONCLUSION

These results show how IS-PCR and ISRT supplement each other, and their potential for the analysis of heterogeneous populations where an assortment of healthy and starved/dormant cells are expected.

[Implementation of a continuous quality improvement program in transfusion medicine]

The transfusion safety is one of the themes of National Quality Assurance Programme 1995/1996 (National Agency for the Promotion of Medical Evaluation-ANDEM/Direction des Hôpitaux (National Hospital Authority)). The Quality Assurance Programme (QAP) in transfusion medicine of our University Hospital has been selected. The QAP is a prospective and normative programme, in which all the actors of the transfusion process are involved. The goals are: i) to assure the quality and the safety of the blood products delivered all along the chain leading to blood or blood components transfusion; ii) the guarantee of the exhaustiveness and the quality of information about the transfusion process that are used to mark out blood products; iii) the standardization of the different steps and the creation of "tools" in order to control the application of written procedures.

Transmission of invasive aspergillosis from a subclinically infected donor to three different organ transplant recipients

OBJECTIVE

To describe a cluster of donor-transmitted cases of invasive aspergillosis.

DESIGN

Case series of epidemiologically linked cases of invasive aspergillosis.

SETTING

Two tertiary care centers with solid-organ transplant programs.

PATIENTS

Two kidney recipients, one heart recipient, and the single donor.

MEASUREMENTS

Routine clinical, microbiological, and pathologic investigation as dictated for patient care. Epidemiologic analysis to establish linkage among cases.

RESULTS

Three allografts (two kidneys and a heart) from a single donor transmitted invasive aspergillosis to the recipients. Three weeks after transplantation, the two kidney recipients had fever and urine cultures positive for Aspergillus fumigatus. The infected kidneys had multiple Aspergillus abscesses and had to be removed to cure the patients. The heart recipient had a negative workup when a diagnosis of aspergillosis was made for the kidney recipients but presented three months later with aspergillus endocarditis with hematogenous spread to the eyes and to the skin. Treatment included eye surgery, aortic valve replacement, and antifungal therapy; control of infection ensued. The donor was intensely immunosuppressed (17 days post-liver transplantation with death from intracerebral bleeding) but had no clinical or autopsy evidence of aspergillosis. Donor tracheal secretions obtained at the time of organ harvest later grew A fumigatus.

CONCLUSION

Expanded criteria for organ donation have to be balanced against infectious risk to organ recipients. A fumigatus can be transmitted from a subclinically infected donor to solid-organ transplant recipients.