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Objectives: Carbapenemase-mediated carbapenem resistance in Pseudomonas aeruginosa is a relevant health problem. We detected for the first time in Spain two clinical NDM-producing P. aeruginosa (NDM-Pa) isolates in two Ukrainian patients admitted to our hospital between April and August 2022. Methods: Antimicrobial susceptibility was studied by microdilution and MIC gradient strips (EUCAST-2022 criteria). Carbapenemase genes were detected by the Xpert Carba-R and immunochromatography assays. WGS (Illumina and Oxford-Nanopore) was also performed. Results: In May 2022, we detected an NDM-Pa in a sternotomy wound in a patient. In June-2022, a second NDM-Pa along with an OXA-48-Klebsiella pneumoniae (OXA-48-Kp) isolate was detected in a mandibular abscess from an unrelated patient. Moreover, an NDM+OXA-48-K. pneumoniae (NDM+OXA-48-Kp) was also found in a rectal sample of this patient. Both patients had undergone surgery in Ukraine before their transfer to our hospital. NDM-Pa isolates were resistant to all tested antimicrobials with the exception of aztreonam (MIC = 8 mg/L), colistin (MIC =2 mg/L) and cefiderocol (MIC range = 0.75–2 mg/L). WGS confirmed that both P. aeruginosa isolates were NDM-1 producers, belonged to ST773 and shared an identical resistome. blaNDM-1 was located on a ∼117-Kb chromosomally integrated integrative conjugative element (ICE). OXA-48-Kp and NDM+OXA-48-Kp belonged to ST147 and contained blaOXA-48 on an identical ∼300-Kb IncHIB-plasmid. blaNDM-1 was located on a 51-Kb IncFIB-plasmid only found in NDM+OXA-48-Kp. Conclusions: This is the first description of NDM-Pa in Spain. We highlight the threat of further cross-border dissemination of NDM-1 through P. aeruginosa along with K. pneumoniae high-risk clones also carrying OXA-48, which draws a complex epidemiological scenario.

Four organic solid wastes (coffee grounds, ground nut shell, paper money sewage sludge and cork powder) have been investigated as bloating inducing agents in lightweight aggregate (LWA) manufacturing when mixed in small proportions (2.5 wt.%) with three types of clays. The pellets obtained were fired in a rotary kiln at the maximum feasible temperature for 4 min. A similar impact was observed both in the working conditions and in the properties of the LWAs, showing that the differences between said residues are not as decisive as those of the clays to which they are added. The organic wastes have played a crucial role in achieving reducing conditions inside the aggregate. Thus, their addition has led to substantial improvements both from an operational point of view, lowering the working temperature, and from a technological perspective, favoring bloating and the development of a highly porous and lightweight structure. Leachate studies have shown that the LWAs meet the regulatory limits. The outcomes of this investigation show that, in line with the precepts of the Circular Economy, the recovery of organic wastes of different nature can have a place in the production of environmentally friendly LWAs. Resumen: Se han investigado cuatro residuos sólidos orgánicos (posos de café, cáscara molida de frutos secos, lodos de depuradora de papel moneda y polvo de corcho) como agentes expansivos en la fabricación de áridos ligeros (LWAs) al mezclarse en pequeñas proporciones (2,5 wt.%) con tres tipos de arcillas. Los pellets conformados se han cocido en un horno rotatorio a la máxima temperatura viable durante 4 min. Se observó un impacto similar tanto en las condiciones de trabajo como en las propiedades de los LWAs, mostrando que las diferencias entre dichos residuos no son tan influyentes como las de las arcillas a las que se añaden. El componente orgánico ha jugado un papel crucial en la consecución de las condiciones reductoras dentro del árido. Así, su adición ha supuesto mejoras sustanciales tanto desde el punto de vista operativo, reduciendo la temperatura de trabajo, como desde una perspectiva tecnológica, favoreciendo la expansión y el desarrollo de una estructura altamente porosa y ligera. Por otro lado, los LWAs obtenidos cumplirían con los límites reglamentarios de lixiviación de metales pesados. Se demuestra que la valorización de residuos orgánicos de distinta naturaleza puede tener cabida en la producción de LWAs respetuosos con el medio ambiente.

The effect of the addition of Fe0 and Fe3+ on the formation of expanded clay aggregates was studied using iron-free kaolin as an aluminosilicates source. Likewise, the incorporation of cork powder as a source of organic carbon and Na2CO3 as a flux in the mixtures was investigated in order to assess its effect in combination with the iron phases. An experimental protocol, statistically supported by a mixture experiments/design of experiments approach, was applied to model and optimize the bloating index, density, absorption capacity, and mechanical strength. The process of expansion and pore generation and the associated decrease in density required the addition of iron, such that the optimum mixtures of these properties presented between 25 and 40 wt.% of Fe0 or Fe3+, as well as the incorporation of 3.5–5 wt.% of organic carbon. The addition of Fe3+ produced a greater volumetric expansion (max. 53%) than Fe0 (max. 8%), suggesting that the formation of the FeO leading to this phenomenon would require reducing and oxidizing conditions in the former and the latter, respectively. The experimental and model-estimated results are in good agreement, especially in the aggregates containing Fe0. This reinforces the application of statistical methods for future investigations.

The application of Life Cycle Assessment in the construction sector can be a very useful tool to reduce the environmental impact generated by the sector. In order to quantify the improvement in environmental terms with the use of artificial lightweight aggregates (LWA) manufactured with waste, in this work, we conducted a comparative evaluation of the life cycle of LWAs for a total of five different scenarios: LWAs obtained in a traditional way, i.e., using exclusively clay in their manufacture (Spanish blond clay, Portuguese red clay and Portuguese blond clay), and LWAs manufactured with four different wastes, with a partial substitution of 2.5% for each of the clays per waste (almond and hazelnut shells, sludge from the purification of paper money, cork dust and coffee grounds). The functional unit was set as the production of 1 kilo of lightweight aggregates and the CML 2000 methodology and the SimaPro software were used. The results obtained in this research allow us to conclude that the addition of organic wastes showed a slightly higher environmental performance than the conventional system, the ALAs manufactured with almond and hazelnut shells being the most environmentally friendly option, with reductions of more than 30% in some cases, followed by the LWAs manufactured with coffee grounds. On the other hand, the addition of paper sewage sludge and cork dust represents minimal environmental optimization.

The treatment of prosthetic joint infections (PJIs) is a complex matter in which surgical, microbiological and pharmacological aspects must be integrated and, above all, placed in the context of each patient to make the best decision. Sometimes it is not possible to offer curative treatment of the infection, and in other cases, the probability that the surgery performed will be successful is considered very low. Therefore, indefinite administration of antibiotics with the intention of “suppressing” the course of the infection becomes useful. For decades, we had little information about suppressive antibiotic treatment (SAT). However, due to the longer life expectancy and increase in orthopaedic surgeries, an increasing number of patients with infected joint prostheses experience complex situations in which SAT should be considered as an alternative. In the last 5 years, several studies attempting to answer the many questions that arise on this issue have been published. The aim of this publication is to review the latest published evidence on SAT.

The availability of highly sensitive molecular tests for the detection of Clostridioides difficile in feces leads to overtreatment of patients who are probably only colonized. In this prospective study, the usefulness of fecal calprotectin (fCP) is evaluated in a cohort of patients with detection of toxigenic C. difficile in feces. Patients were classified by an infectious diseases consultant blinded to fCP results into three groups—group I, presumed Clostridioides difficile infection (CDI); group II, doubtful but treated CDI; and group III, presumed C. difficile colonization or self-limited CDI not needing treatment. One hundred and thirty-four patients were included. The median fCP concentrations were 410 (138–815) μg/g in group I, 188 (57–524) μg/g in group II, and 51 (26–97) μg/g in group III (26 cases); p < 0.05 for all comparisons. In forty-five out of 134 cases (33.5%), the fCP concentrations were below 100 µg/g. In conclusion, fCP is low in most patients who do not need treatment against C. difficile, and should be investigated as a potentially useful test in the management of patients with detected toxigenic C. difficile.

Investigations on the application of Life Cycle Assessment (LCA) to the construction sector have shown that the environmental impact of construction products can be significantly reduced. To achieve this, the use of best available techniques and eco-innovation in production plants must be promoted. In this way, the use of finite natural resources can be replaced by waste generated in other production processes, preferably available locally, stimulating the creation of more sustainable products. Conducting a comparative LCA study between the traditional ceramic brick manufacturing process and the ceramic brick manufacturing process incorporating ‘alperujo’ (waste generated in the virgin oil extraction process), is an inevitable step to achieve the integration of circularity and eco-innovation in the production system of traditional ceramic materials, through the CML(Centrum voor Milieukunde Leiden) and IPCC(The Intergovernmental Panel on Climate Change) methodology. The obtained results suggest that the environmental benefits in this practice are very limited, even taking into account the contribution of different amounts of this waste to the production of bricks.

Objectives: To compare the characteristics and outcomes of cases with acute prosthetic joint infection (PJI; early post-surgical or hematogenous) by Staphylococcus aureus managed with implant removal (IRm) or debridement and retention (DAIR). To analyze the outcomes of all cases managed with IRm (initially or after DAIR failure). Methods: Retrospective, multicenter, cohort study of PJI by S. aureus (2003–2010). Overall failure included mortality within 60 days since surgery and local failure due to staphylococcal persistence/relapse. Results: 499 cases, 338 initially managed with DAIR, 161 with IRm. Mortality was higher in acute PJI managed initially with IRm compared to DAIR, but not associated with the surgical procedure, after propensity score matching. Underlying conditions, hemiarthroplasty, and methicillin-resistant S. aureus were risk factors for mortality. Finally, 249 cases underwent IRm (88 after DAIR failure); overall failure was 15.6%. Local failure (9.3%) was slightly higher in cases with several comorbidities, but independent of previous DAIR, type of IRm, and rifampin treatment. Conclusions: In a large multicenter study of S. aureus PJI managed with IRm, failure was low, but mortality significant, especially in cases with acute PJI and underlying conditions, but not associated with the IRm itself. Rifampin efficacy was limited in this setting.

Bezlotoxumab is marketed for the prevention of recurrent Clostridioides difficile infection (rCDI). Its high cost could be determining its prescription to a different population than that represented in clinical trials. The objective of the study was to verify the effectiveness and safety of bezlotoxumab in preventing rCDI and to investigate factors related to bezlotoxumab failure in the real world. A retrospective, multicentre cohort study of patients treated with bezlotoxumab in Spain was conducted. We compared the characteristics of cohort patients with those of patients treated with bezlotoxumab in the pivotal MODIFY trials. We assessed recurrence rates 12 weeks after completion of treatment against C. difficile, and we analysed the factors associated with bezlotoxumab failure. Ninety-one patients were included in the study. The cohort presented with more risk factors for rCDI than the patients included in the MODIFY trials. Thirteen (14.2%) developed rCDI at 12 weeks of follow-up, and rCDI rates were numerically higher in patients with two or more previous episodes (25%) than in those who had fewer than two previous episodes of C. difficile infection (CDI) (10.4%); p = 0.09. There were no adverse effects attributable to bezlotoxumab. Despite being used in a more compromised population than that represented in clinical trials, we confirm the effectiveness of bezlotoxumab for the prevention of rCDI.

The aim was to describe the safety of indefinite administration of antibiotics, the so-called suppressive antibiotic therapy (SAT) and to provide insight into their impact on gut microbiota. 17 patients with SAT were recruited, providing a fecal sample. Bacterial composition was determined by 16S rDNA massive sequencing, and their viability was explored by PCR-DGGE with and without propidium monoazide. Presence of antibiotic multirresistant bacteria was explored through the culture of feces in selective media. High intra-individual variability in the genera distribution regardless of the antibiotic or antibiotic administration ingestion period, with few statistically significant differences detected by Bray-Curtis distance-based principle component analysis, permutational multivariate analysis of variance and linear discriminant analysis effect size analysis. However, the microbiota composition of patients treated with both beta-lactams and sulfonamides clustered by a heat map. Curiously, the detection of antibiotic resistant bacteria was almost anecdotic and CTX-M-15-producing E. coli were detected in two subjects. Our work demonstrates the overall clinical safety of SAT and the low rate of the selection of multidrug-resistant bacteria triggered by this therapy. We also describe the composition of intestinal microbiota under the indefinite use of antibiotics for the first time.

A Life Cycle Assessment (LCA) using SimaPro software has been carried out concerning the manufacture of artificial lightweight aggregates (LWAs). The study aims to evaluate the changes in the environmental impact when an additive of residual origin, specifically olive pomace (OP), is added following the principles of the Circular Economy. This residue (commonly known as alperujo) was used as a substitute for clay in 1.25, 2.5 and 5 wt%. The environmental impact related to the use of olive pomace in the mixture was estimated using the CML 2000 methodology, yielding improvements of 3.8%, 7.7% and 15.3% for 1.25, 2.5 and 5 wt% OP added, respectively. Optimum addition results are in the range of 1.25 and 2.5 wt% OP. In this way, the reduction of emissions associated with LWA manufacture would be favored without negatively affecting the technological properties of the resulting material.

The aim of our study was to characterize the etiology of prosthetic joint infections (PJIs)—including multidrug-resistant organisms (MDRO)—by category of infection. A multicenter study of 2544 patients with PJIs was performed. We analyzed the causative microorganisms according to the Tsukayama’s scheme (early postoperative, late chronic, and acute hematogenous infections (EPI, LCI, AHI) and “positive intraoperative cultures” (PIC)). Non-hematogenous PJIs were also evaluated according to time since surgery: 12 months. AHIs were mostly caused by Staphylococcus aureus (39.2%) and streptococci (30.2%). EPIs were characterized by a preponderance of virulent microorganisms (S. aureus, Gram-negative bacilli (GNB), enterococci), MDROs (24%) and polymicrobial infections (27.4%). Conversely, coagulase-negative staphylococci (CoNS) and Cutibacterium species were predominant in LCIs (54.5% and 6.1%, respectively) and PICs (57.1% and 15.1%). The percentage of MDROs isolated in EPIs was more than three times the percentage isolated in LCIs (7.8%) and more than twice the proportion found in AHI (10.9%). There was a significant decreasing linear trend over the four time intervals post-surgery for virulent microorganisms, MDROs, and polymicrobial infections, and a rising trend for CoNS, streptococci and Cutibacterium spp. The observed differences have important implications for the empirical antimicrobial treatment of PJIs.

Objectives: We evaluated the treatment outcome in late acute (LA) periprosthetic joint infections (PJI) treated with debridement and implant retention (DAIR) versus implant removal.Methods: In a large multicenter study, LA PJIs of the hip and knee were retrospectively evaluated. Failure was defined as: PJI related death, prosthesis removal or the need for suppressive antibiotic therapy. LA PJI was defined as acute symptoms <3 weeks in patients more than 3 months after the index surgery and with a history of normal joint function.Results: 445 patients were included, comprising 340 cases treated with DAIR and 105 cases treated with implant removal (19% one-stage revision (n = 20), 74.3% two-stage revision (n = 78) and 6.7% definitive implant removal (n = 7). Overall failure in patients treated with DAIR was 45.0% (153/340) compared to 24.8% (26/105) for implant removal (p < 0.001). Difference in failure rate remained after 1:1 propensity-score matching. A preoperative CRIME80-score ≥3 (OR 2.9), PJI caused by S. aureus (OR 1.8) and implant retention (OR 3.1) were independent predictors for failure in the multivariate analysis.Conclusion: DAIR is a viable surgical treatment for most patients with LA PJI, but implant removal should be considered in a subset of patients, especially in those with a CRIME80-score ≥3. [ABSTRACT FROM AUTHOR]

Objectives: Debridement, antibiotics and implant retention (DAIR) is the recommended treatment for all acute prosthetic joint infections (PJI), but its efficacy in patients with late acute (LA) PJI is not well described.Methods: Patients diagnosed with LA PJI between 2005 and 2015 were retrospectively evaluated. LA PJI was defined as the development of acute symptoms (≤ 3 weeks) occurring ≥ 3 months after arthroplasty. Failure was defined as: (i) the need for implant removal, (ii) infection related death, (iii) the need for suppressive antibiotic therapy and/or (iv) relapse or reinfection during follow-up.Results: 340 patients from 27 centers were included. The overall failure rate was 45.0% (153/340). Failure was dominated by Staphylococcus aureus PJI (54.7%, 76/139). Significant independent preoperative risk factors for failure according to the multivariate analysis were: fracture as indication for the prosthesis (odds ratio (OR) 5.4), rheumatoid arthritis (OR 5.1), age above 80 years (OR 2.6), male gender (OR 2.0) and C-reactive protein > 150 mg/L (OR 2.0). Exchanging the mobile components during DAIR was the strongest predictor for treatment success (OR 0.35).Conclusion: LA PJIs have a high failure rate. Treatment strategies should be individualized according to patients' age, comorbidity, clinical presentation and microorganism causing the infection. [ABSTRACT FROM AUTHOR]

Objectives: In vitro studies have shown good activity of linezolid against Mycobacterium tuberculosis, including multidrug-resistant strains. However, clinical experience with linezolid in tuberculosis is scarce.Methods: We report our clinical experience with five consecutive patients with multidrug-resistant tuberculosis infection treated with combination regimens that included linezolid.Results: Two patients had multidrug-resistant Mycobacterium bovis infection, with resistance to 12 antituberculous agents (one of them with HIV co-infection and <50 CD4 cells/mm3). The other three patients were infected by multidrug-resistant M. tuberculosis strains, with resistance to all first-line drugs and other second-line drugs. All patients received linezolid in combination with thiacetazone, clofazimine or amoxicillin/clavulanate. Susceptibility tests showed linezolid MIC values =0.5 mg/L against all tuberculosis strains tested (standard proportion method, Middlebrook agar 7H10). In all cases, tuberculosis cultures from respiratory samples were sterile after 6 weeks of therapy. Three patients have clinical and microbiological cure of tuberculosis with a combination regimen with linezolid (range: 524 months). One patient was lost to follow-up at month 5. The remaining patient has completed 11 months of therapy and is still on treatment. Four patients developed anaemia and needed blood transfusions. In two of these patients, the linezolid daily-dose (600 mg twice a day) was successfully reduced to 50% (300 mg twice a day) to decrease toxicity while maintaining efficacy. Peripheral neuropathy (two patients) and pancreatitis (one patient) were other adverse events observed during linezolid treatment.Conclusions: In our experience, linezolid has been a valid alternative drug in the management of multidrug-resistant tuberculosis. The prolonged use of linezolid is frequently associated with toxicity, mainly anaemia and peripheral neuropathy, that requires special management. [ABSTRACT FROM AUTHOR]

Background Limited data are available to predict the length of time required for a patient to achieve sputum culture conversion after starting therapy for pulmonary tuberculosis. Methods Rates of sputum smear and culture conversion were determined at weeks 2, 4, 8 and 16 after initiating therapy in patients admitted to our Respiratory Isolation Unit from January 1997 to December 2003. Results For the 184 patients included in the analysis, the mean time from the initiation of appropriate therapy to sputum culture and smear conversion were 34 ± 26 and 38 ± 32 days (mean ± SD) respectively. Only 53% of patients obtained negative sputum cultures within the first 4 weeks of therapy. Multivariate analysis showed that the persistence of positive cultures during the first 4 weeks of therapy was associated with high bacillary counts in sputum smears at diagnosis [OR: 2.86; 95% confidence interval (95% CI): 1.20–6.66], lung cavitations (OR: 4.0; 95% CI: 1.63–9.09) and a prolonged period of symptoms (OR: 3.57; 95% CI: 1.43–3.57). The only factor associated with the persistence of positive cultures after more than 16 weeks of therapy was infection with a multidrug-resistant strain. Conclusions High initial sputum bacillary counts and drug resistance result in delayed culture conversion. This should be taken into account when decisions regarding the potential discontinuation of isolation are made. The early identification of drug resistance is important for effective infection control in hospitals. [ABSTRACT FROM AUTHOR]

A 79-year-old male was diagnosed with a total knee prosthetic infection. He had a history of an episode of Clostridioides difficile -associated diarrhoea a year ago. Clostridioides difficile was isolated from the joint fluid and intraoperative tissue samples, and ribotyping demonstrated that the strain was the same that had caused the diarrheic episode, an infrequent ribotype (RT534). The genetic relatedness suggests that the initial infection occurred during that hospitalization, resulting in a chronic prosthetic infection. We have carried out an extensive literature review of all the cases reported in scientific databases of Clostridioides difficile infections with extraintestinal presentation and their relationship with previous colitis. [Display omitted] • Difficile causes indolent infections that can take a long time to become apparent. • Extraintestinal C. difficile infection is usually preceded by an intestinal disease. • Suspect a C. difficile joint prosthetic infection in a patient with previous diarrhoea. • There is a lack of consensus for the treatment of extraintestinal C. difficile infection. [ABSTRACT FROM AUTHOR]