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IMPORTANCE The consumption of broad-spectrum drugs has increased as a consequence of the spread of multidrug-resistant (MDR) Escherichia coli. Finding alternatives for these infections is critical, for which some neglected drugs may be an option. OBJECTIVE To determine whether fosfomycin is noninferior to ceftriaxone or meropenem in the targeted treatment of bacteremic urinary tract infections (bUTIs) due to MDR E coli. DESIGN, SETTING, AND PARTICIPANTS This multicenter, randomized, pragmatic, open clinical trial was conducted at 22 Spanish hospitals from June 2014 to December 2018. Eligible participants were adult patients with bacteremic urinary tract infections due to MDR E coli; 161 of 1578 screened patients were randomized and followed up for 60 days. Data were analyzed in May 2021. INTERVENTIONS Patients were randomized 1 to 1 to receive intravenous fosfomycin disodium at 4 g every 6 hours (70 participants) or a comparator (ceftriaxone or meropenem if resistant; 73 participants) with the option to switch to oral fosfomycin trometamol for the fosfomycin group or an active oral drug or pa renteral ertapenem for the comparator group after 4 days. MAIN OUTCOMES AND MEASURES The primary outcome was clinical and microbiological cure (CMC) 5 to 7 days after finalization of treatment; a noninferiority margin of 7% was considered. RESULTS Among 143 patients in the modified intention-to-treat population (median [IQR] age, 72 [62-81] years; 73 [51.0%] women), 48 of 70 patients (68.6%) treated with fosfomycin and 57 of 73 patients (78.1%) treated with comparators reached CMC (risk difference, -9.4 percentage points; 1-sided 95% CI, -21.5 to infinity percentage points; P = .10). While clinical or microbiological failure occurred among 10 patients (14.3%) treated with fosfomycin and 14 patients (19.7%) treated with comparators (risk difference, -5.4 percentage points; 1-sided 95% CI. -infinity to 4.9; percentage points; P = .19), an increased rate of adverse event-related discontinuations occurred with fosfomycin vs comparators (6 discontinuations [8.5%] vs 0 discontinuations; P = .006). In an exploratory analysis among a subset of 38 patients who underwent rectal colonization studies, patients treated with fosfomycin acquired a new ceftriaxone-resistant or meropenem-resistant gram-negative bacteria at a decreased rate compared with patients treated with comparators (0 of 21 patients vs 4 of 17 patients [23.5%]; 1-sided P = .01). CONCLUSIONS AND RELEVANCE This study found that fosfomycin did not demonstrate noninferiority to comparators as targeted treatment of bUTI from MDR E coli; this was due to an increased rate of adverse event-related discontinuations. This finding suggests that fosfomycin may be considered for selected patients with these infections.

El ayuno de los animales antes del sacrificio es una práctica habitual con fines higiénico-sanitarios y económicos. Se evalúa el efecto que tiene sobre el valor nutricional de la carne de cerdo variaciones de 2-3 horas en el tiempo de ayuno previo al sacrificio

España destaca por ser uno de los mayores productores de aceite de oliva y subproductos asociados. El extracto de oleuropeína obtenido a partir de las hojas presenta una alta capacidad antioxidante, así como interesantes efectos a nivel biológico como una rápida utilización de la glucosa. Los estudios más recientes además apuntan a que determina cambios en el metabolismo de ácidos grasos y aminoácidos, y efectos sobre el control del stress en el animal.

Solid organ transplant (SOT) recipients are especially at risk of developing infections by multidrug resistant bacteria (MDR). In this study, the biofilm-forming capability of 209 MDR strains (Escherichia coli n = 106, Klebsiella pneumoniae n = 78, and Enterobacter spp. n = 25) isolated from rectal swabs in the first 48 hours before or after kidney (93 patients), liver (60 patients) or kidney/pancreas transplants (5 patients) were evaluated by using a microplate assay. Thirty-nine strains were isolated before transplant and 170 strains were isolated post-transplant. Overall, 16% of E. coli strains, 73% of K. pneumoniae strains and 4% Enterobacter strains showed moderate or strong biofilm production. Nine strains isolated from infection sites after transplantation were responsible of infections in the first month. Of these, 4 K. pneumoniae, 1 E. coli and 1 Enterobacter spp. strains isolated pre-transplant or post-transplant as colonizers caused infections in the post-transplant period. Our results suggest that in vitro biofilm formation could be an important factor for adhesion to intestine and colonization in MDR K. pneumoniae strains in SOT recipients, but this factor appears to be less important for MDR E. coli and Enterobacter spp. Acknowledgements: The authors thank Dr. Fidel Madrazo (Electron Microscopy Unit, Technology Support Services, IDIVAL) for helping with confocal microscopy. This research was supported by ‘Plan Nacional de I + D + i and Instituto de Salud Carlos III (Fondo de Investigaciones Sanitarias PI 13/01191 to MCF and PI 16/01103 to JRV), Subdirección General de Redes y Centros de Investigación Cooperativa, Spanish Ministry of Economy and Competitiveness, Spanish Network for Research in Infectious Diseases (REIPI RD12/0015) and (REIPI RD16/0016) co-financed by the European Development Regional Fund “A way to achieve Europe” ERDF.

ESCMID Study Group for Implant-Associated Infections (ESGIAI)., [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.

El objetivo es determinar los factores de riesgo para síndrome de flujo vaginal en adolescentes y jóvenes atendidas en el Centro Especializado en Salud Sexual y Reproductiva de Jesús María en el periodo 2016-2017. Métodos: estudio tipo retrospectivo, analítico, transversal, observacional, diseño caso control. La muestra estuvo conformada por: 200 adolescentes y jóvenes (100 casos y 100 controles). El análisis estadístico se realizó mediante odds ratio. Resultados: los factores sociodemográficos: edad, nivel de instrucción y estado conyugal no tuvieron asociación estadísticamente significativa como factor de riesgo. Los factores gineco-obstétricos con asociación estadísticamente significativa fueron: irregularidad menstrual or=2,33 (ic: 1,31 - 4,17) y antecedente de síndrome de flujo vaginal or=5,09 (ic: 2,71 - 9,55). Las variables sin asociación estadísticamente significativa fueron: edad de inicio de relaciones sexuales, número de parejas sexuales y uso de métodos anticonceptivos. Frecuencia de vaginitis 46%, vaginosis 41% y cervicitis 13%. Conclusiones: los factores sociodemográficos no tuvieron una asociación significativa como factor de riesgo. Los factores gineco-obstétricos con asociación estadísticamente significativa fueron: la irregularidad menstrual y el antecedente de flujo vaginal. La vaginitis fue la patología con mayor frecuencia dentro del grupo de síndrome de flujo vaginal.

El enfoque comunicativo en la enseñanza de lenguas extranjeras pretende desarrollar en el aprendiz las capacidades necesarias para comunicarse eficazmente, de forma similar a un hablante nativo, en diferentes tipos de contextos. Debe por tanto incluir la práctica con diferentes tipos de textos propios de diversas situaciones comunicativas. Uno de ellos es la conversación, que es el intercambio oral más natural. En este artículo se pretende describir con cierto detalle una parte de la estructura conversacional, en concreto los turnos de apoyo, y hacer una propuesta de aplicación didáctica para su tratamiento en el aula de español como lengua extranjera., The communicative approach in language teaching is aimed to develop in the learner the necessary skills in order to communicate successfully in a similar way to a native speaker, in the different contexts that might occur. Therefore it must include practice with different kinds of texts used in different communicative situations. This article is aimed to describe with some detail a part of the conversational structure, in particular the support turns and to make a teaching suggestion for its treatment in the Spanish as a foreign language class.