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The accuracy of contemporary risk scores in predicting perioperative mortality in infective endocarditis (IE) remains controversial. The aim is to evaluate the performance of existent mortality risk scores for cardiovascular surgery in IE and the impact on operability at high-risk thresholds. A single-center retrospective review of adult patients diagnosed with acute left-sided IE undergoing surgery from May 2014 to August 2019 (n = 142) was done. Individualized risk calculation was obtained according to the available mortality risk scores: EuroScore I and II, PALSUSE, Risk-E, Costa, De Feo-Cotrufo, AEPEI, STS-risk, STS-IE, APORTEI, and ICE-PCS scores. A cross-validation analysis was performed on the score with the best area under the curve (AUC). The 30-day survival was 96.5% (95%CI 91-98%). The score with worse area under the curve (AUC = 0.6) was the STS-IE score, while the higher was for the RISK-E score (AUC = 0.89). The AUC of the majority of risk scores suggested acceptable performance; however, statistically significant differences in expected versus observed mortalities were common. The cross-validation analysis showed that a large number of survivors ( 75%) would not have been operated if arbitrary high-risk threshold estimates had been used to deny surgery. The observed mortality in our cohort is significantly lower than is predicted by contemporary risk scores. Despite the reasonable numeric performance of the analyzed scores, their utility in judging the operability of a given patient remains questionable, as demonstrated in the cross-validation analysis. Future guidelines may advise that denial of surgery should only follow a highly experienced Endocarditis Team evaluation.

Cutaneous Lupus Erythematosus (CLE) is an autoimmune skin disease that occurs in almost two-thirds of people with Systemic Lupus Erythematosus (SLE) and can exist as its own entity. Despite its negative impact on the quality of life of patients, lupus pathogenesis is not fully understood. In recent years, the role of gene expression analysis has become important in understanding cellular functions and disease causation within and across species. Interestingly, dogs also develop CLE, providing a spontaneous animal model of disease. Here, we present a targeted transcriptomic analysis of skin biopsies from a case series of four dogs with complex autoimmunity with suspected CLE. We identified 92 differentially expressed genes (DEGs), including type 1 interferon, B cell, and T cell-related genes, in the four cases compared to healthy skin margin controls. Additionally, we compared our results with existing CLE datasets from humans and mice and found that humans and canines share 49 DEGs, whereas humans and mice shared only 25 DEGs in our gene set. Immunohistochemistry of IFNG and CXCL10, two of the most highly upregulated inflammatory mediators, confirmed protein-level expression and revealed immune cells as the primary source of CXCL10 in dogs with SLE, whereas keratinocytes stained strongly for CXCL10 in dogs without SLE. We propose that gene expression analysis may aid the diagnosis of complex autoimmune skin diseases and that dogs may provide important insights into CLE and SLE pathogeneses, or more broadly, skin manifestations during systemic autoimmunity.

Pemphigus is a group of autoimmune-mediated mucocutaneous blistering diseases characterized by acantholysis. Pemphigus has also been recognized in dogs and shares similar clinical characteristics and variants with human pemphigus. While relationships between human and canine pemphigus have been reported, gene expression patterns across species have not been described in the literature. We sought to perform gene expression analysis of lesional skin tissue from four dogs with various forms of pemphigus to examine gene expression during spontaneous disease in dogs. We found increased T and B cell signatures in canine pemphigus lesions compared to controls, as well as significant upregulation ofCCL3, CCL4, CXCL10, andCXCL8 (IL8), among other genes. Similar chemokine/cytokine expression patterns and immune infiltrates have been reported in humans, suggesting that these genes play a role in spontaneous disease. Direct comparison of our dataset to previously published human pemphigus datasets revealed five conserved differentially expressed genes:CD19, WIF1, CXCL10, CD86, andS100A12. Our data expands our understanding of pemphigus and facilitates identification of biomarkers for prediction of disease prognosis and treatment response, which may be useful for future veterinary and human clinical trials.

Autoimmune skin diseases are complex and are thought to arise from a combination of genetics and environmental exposures, which trigger an ongoing immune response against self-antigens. Companion animals including cats and dogs are known to develop inflammatory skin conditions similar to humans and share the same environment, providing opportunities to study spontaneous disease that encompasses genetic and environmental factors with a One Health approach. A strength of comparative immunology approaches is that immune profiles may be assessed across different species to better identify shared or conserved pathways that might drive inflammation. Here, we performed a comparative study of skin from canine discoid lupus erythematosus (DLE) using NanoString nCounter technology. We compared these gene expression patterns to those of human DLE and a mouse model of cutaneous lupus. We found strong interferon signatures, with CXCL10, ISG15, and an S100 gene family member among the highest, most significant DEGs upregulated across species. Cell type analysis revealed marked T-cell and B-cell infiltration. Interestingly, canine DLE samples also recapitulated downregulated skin homeostatic genes observed in human DLE. We conclude that spontaneous DLE in dogs captures many features that are present in human disease and may serve as a more complete model for conducting further genomic and/or transcriptomic studies.

FOSIMI Investigators., This work was supported by the Ministerio de Sanidad y Consumo of Spain (Fondo de Investigaciones Sanitarias, Instituto de Salud Carlos III, Madrid, Spain, Grant #EC0800190). JMP received a “Rio Hortega” Research Grant (CM14/00135; 2015-16) from Instituto de Salud Carlos III and the Ministerio de Economia and Competitividad, Madrid (Spain) and the ESCMID/FEMS Research Fellowship 2016. JMM received a personal 80:20 research grant from the Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain, during 2017–19.

In dogs, melanomas are relatively common tumors and the most common form of oral malignancy. Biological behavior is highly variable, usually aggressive, and frequently metastatic, with reported survival times of three months for oral or mucosal melanomas in advanced disease stages. Classical clinical management remains challenging; thus, novel and more efficacious treatment strategies are needed. Evidence-based medicine supports the role of the immune system to treat neoplastic diseases. Besides, immunotherapy offers the possibility of a precise medicinal approach to treat cancer. In recent years, multiple immunotherapeutic strategies have been developed, and are now recognized as a pillar of treatment. In addition, dogs represent a good model for translational medicine purposes. This review will cover the most relevant immunotherapeutic strategies for the treatment of canine malignant melanoma, divided among five different categories, namely, monoclonal antibodies, nonspecific immunotherapy activated by bacteria, vaccines, gene therapy, and lymphokine-activated killer cell therapy.

Aims The EURO-ENDO registry aimed to study the management and outcomes of patients with infective endocarditis (IE). Methods and results Prospective cohort of 3116 adult patients (2470 from Europe, 646 from non-ESC countries), admitted to 156 hospitals in 40 countries between January 2016 and March 2018 with a diagnosis of IE based on ESC 2015 diagnostic criteria. Clinical, biological, microbiological, and imaging [echocardiography, computed tomography (CT) scan, 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT)] data were collected. Infective endocarditis was native (NVE) in 1764 (56.6%) patients, prosthetic (PVIE) in 939 (30.1%), and device-related (CDRIE) in 308 (9.9%). Infective endocarditis was community-acquired in 2046 (65.66%) patients. Microorganisms involved were staphylococci in 1085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). 18F-fluorodeoxyglucose positron emission tomography/computed tomography was performed in 518 (16.6%) patients and presented with cardiac uptake (major criterion) in 222 (42.9%) patients, with a better sensitivity in PVIE (66.8%) than in NVE (28.0%) and CDRIE (16.3%). Embolic events occurred in 20.6% of patients, and were significantly associated with tricuspid or pulmonary IE, presence of a vegetation and Staphylococcus aureus IE. According to ESC guidelines, cardiac surgery was indicated in 2160 (69.3%) patients, but finally performed in only 1596 (73.9%) of them. In-hospital death occurred in 532 (17.1%) patients and was more frequent in PVIE. Independent predictors of mortality were Charlson index, creatinine > 2 mg/dL, congestive heart failure, vegetation length > 10 mm, cerebral complications, abscess, and failure to undertake surgery when indicated. Conclusion Infective endocarditis is still a life-threatening disease with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles.

A one-year-old intact male German shepherd dog was referred with a 3-month history of dysuria and pollakiuria. Physical examination revealed a large firm mass in the caudal abdomen. Findings from survey radiography, negative contrast cystography, computed tomographic (CT) retrograde positive contrast cystography, and CT excretory urography were consistent with a large urinary bladder diverticulum. An exploratory laparotomy revealed a normal wall appearance in the ventral compartment (true bladder) and marked thinning of the wall in the dorsal compartment (diverticulum). Both ureters inserted into the ventral compartment. The dorsal compartment was excised and histopathology confirmed the diagnosis of urinary bladder diverticulum.

Background Oxidative stress (OS) has been shown to be involved in the pathogenesis of human and canine atopic dermatitis (AD) through several distinct mechanisms. Selected serum biomarkers of OS (sbOS) have been validated in normal dogs and studied in several canine diseases. To the best of the authors' knowledge, the sbOS evaluated in this study have not previously been described in canine AD. Hypothesis/objectives The aims of the study were to evaluate a panel of sbOS in dogs with food-induced (FIAD) and non-food-induced (NFIAD) AD: cupric reducing antioxidant capacity (CUPRAC), ferrous oxidation-xylenol orange (FOX), ferric reducing ability of the plasma (FRAP), paraoxonase-1 (PON1), trolox equivalent antioxidant capacity (TEAC) and serum total thiol (THIOL). The aim was to compare these metabolites with those in healthy control dogs, and to correlate sbOS with validated pruritus and CADESI-04 severity scales in dogs with AD. Animals Forty six healthy, nine NFIAD and three FIAD client-owned dogs were included. Methods The study was designed as a cohort study. Results There were significant differences in atopic dogs when compared to healthy dogs for all of the sbOS analysed. Conclusions and clinical relevance These findings suggest that OS could play a role in the pathogenesis of canine NFIAD and FIAD. In addition, the evaluation of sbOS could be useful for precision medicine to help to detect atopic dogs that might benefit from antioxidant-targeted therapies.

The aim of this study was to assess changes in antibiotic resistance, epidemiology and outcome among patients with Enterococcus faecalis infective endocarditis (EFIE) and to compare the efficacy and safety of the combination of ampicillin and gentamicin (A+G) with that of ampicillin plus ceftriaxone (A+C). The study was a retrospective analysis of a prospective cohort of EFIE patients treated in our centre from 1997 to 2011. Thirty patients were initially treated with A+G (ampicillin 2 g/4 h and gentamicin 3 mg/kg/day) and 39 with A+C (ampicillin 2 g/4 h and ceftriaxone 2 g/12 h) for 4–6 weeks. Increased rates of high-level aminoglycoside resistance (HLAR; gentamicin MIC ≥512 mg/L, streptomycin MIC ≥1024 mg/L or both) were observed in recent years (24% in 1997–2006 and 49% in 2007–2011; p 0.03). The use of A+C increased over time: 1997–2001, 4/18 (22%); 2002–2006, 5/16 (31%); 2007–2011, 30/35 (86%) (p

CANDIPOP Project: B. Padilla, P. Muñoz, J. Guinea, J. R. Paño Pardo, J. García-Rodríguez, C. G. Cerrada, J. Fortún, P. Martín, E. Gómez, P. Ryan, C. Campelo, I. de los Santos, Gil, V. Buendía, B. P. Gorricho, M. Alonso, F. S. Sanz, J. M. Aguado, P. Merino, F. González Romo, M. Gorgolas, I. Gadea, J. E. Losa, A. Delgado-Iribarren, A. Ramos, Y. Romero, I. S. Romero, O. Zaragoza, M. Cuenca-Estrella, J. Rodríguez-Baño, A. I. Suarez, A. Loza, A. I. Aller García, E. Martín-Mazuelos, M. R. Pérez de Pipaón, J. Garnacho, C. Ortiz, M. Chávez, F. L. Maroto, M. Salavert, J. Pemán, J. Blanquer, D. Navarro, J. J. Camarena, R. Zaragoza, V. Abril, C. Gimeno, S. Hernández, G. Ezpeleta, E. Bereciartua, J. L. Hernández Almaraz, M. Montejo, R. A. Rivas, R. Ayarza, A. M. Planes, I. R. Camps, B. Almirante, J. Mensa, M. Almela, M. Gurgui, F. Sánchez-Reus, J. Martínez-Montauti, M. Sierra, J. P. Horcajada, L.Sorli, J. Gómez, A. Gené, M. Urrea, A. Mularoni, M.Valerio, A. Díaz-Martín, F. Puchades., [Objectives] The clinical correlation of fluconazole antifungal susceptibility testing (AST) for Candida isolates and its integration with pharmacokinetics/pharmacodynamics (PK/PD) parameters is unclear. We analysed the impact of fluconazole minimum inhibitory concentration (MIC) values, 24-hour area under the concentration–time curve (AUC24) and AUC24/MIC ratio on the outcome of candidemic patients., [Methods] We included 257 episodes of candidaemia treated with fluconazole monotherapy for ≥72 hours from a population-based surveillance conducted in 29 hospitals (CANDIPOP Project). AST was centrally performed by European Committee on Antimicrobial Susceptibility Testing (EUCAST) and Clinical and Laboratory Standards Institute (CLSI) microdilution methods. Primary outcome was clinical failure (30-day mortality and/or persistent candidaemia for ≥72 hours from initiation of therapy). Secondary outcomes included early (3–7 days) and late (3–30 days) mortality., [Results] Rates of clinical failure, early and late mortality among evaluable episodes were 32.3% (80/248), 3.1% (8/257) and 23.4% (59/248). There was no relationship between fluconazole MIC values or PK/PD parameters and clinical failure. Although MIC values ≥2 mg/L by EUCAST (positive predictive value 32.1%, negative predictive value 68.7%) and ≥0.5 mg/L by CLSI (positive predictive value 34.8%, negative predictive value 74.4%) appeared to be optimal for predicting clinical failure, no significant associations remained after multivariate adjustment (odds ratio 1.67; 95% confidence interval 0.48–5.79; p 0.423). Lack of association was consistent for alternative thresholds (including proposed clinical breakpoints). The only association found for secondary outcomes was between an AUC24/MIC ratio >400 h by CLSI and early mortality (odds ratio 0.18; 95% confidence interval 0.04–0.98; p 0.026)., [Conclusions] High fluconazole MIC values did not negatively impact outcome of patients with candidaemia treated with fluconazole. No effect of PK/PD targets on the risk of clinical failure was found., Supported in part by nonrestrictive research grants from Gilead, MSD, Astellas and Pfizer. This study was cofunded by Fundación SEIMC-GESIDA; the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III (cofinanced by the European Development Regional Fund (ERDF) ‘A Way to Achieve Europe’); and the Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015). MFR holds a ‘Juan Rodés’ clinical research contract (JR14/00036) and JG a ‘Miguel Servet’ contract (CPII15/00006), both from the Spanish Ministry of Economy and Competitiveness, Instituto de Salud Carlos III. MFR has received honoraria for talks on behalf of Pfizer and Gilead Sciences. JG has received grant support from Astellas Pharma, MICOLAB, the Mutua Madrileña Foundation and the Spanish Health Research Fund (FIS). He has been paid for talks on behalf of Gilead Sciences, Merck Sharp & Dohme, Pfizer, Astellas Pharma, Hickma Pharmaceutica and United Medical. BA has received grant support from Gilead Sciences, Pfizer and the Instituto de Salud Carlos III. He has received honoraria for talks on behalf of Gilead Sciences, Merck Sharp & Dohme, Pfizer, Astellas Pharma and Novartis. BP has received honoraria for talks on behalf of Gilead Sciences, Merck Sharp & Dohme, Pfizer, Astellas Pharma and Novartis. MCE has received grant support from Astellas Pharma, bioMérieux, Gilead Sciences, Merck Sharp & Dohme, Pfizer, Schering Plough, Soria Melguizo SA, Ferrer International, the Europea Union, the ALBAN program, the Spanish Agency for International Cooperation, the Spanish Ministry of Culture and Education, the Spanish Health Research Fund, the Instituto de Salud Carlos III (Spanish Ministry of Economy and Competitiveness), the Ramon Areces Foundation and the Mutua Madrileña Foundation.

We describe regional differences in therapy for bloodstream infection (BSI) caused by extended-spectrum β-lactamase-producing Enterobacteriaceae (ESBL-E) or carbapenemase-producing Enterobacteriaceae (CPE). Patients (n = 1482) in 12 countries from an observational study of BSI caused by ESBL-E or CPE were included. Multivariate logistic regression was used to calculate adjusted odds ratios (aORs) for the influence of country of recruitment on empirical use of β-lactam/β-lactamase inhibitors (BLBLIs) or carbapenems, targeted use of BLBLIs for ESBL-E and use of targeted combination therapy for CPE. Compared with Spain, BLBLI use for empirical therapy was least likely in sites from Israel (aOR 0.34, 95% CI 0.14–0.81), Greece (aOR 0.49, 95% CI 0.26–0.94) and Canada (aOR 0.31, 95% CI 0.11–0.88) but more likely in Italy (aOR 1.58, 95% CI 1.11–2.25) and Turkey (aOR 2.09, 95% CI 1.14–3.81). Empirical carbapenem use was more likely in sites from Taiwan (aOR 1.73, 95% CI 1.03–2.92) and USA (aOR 1.89, 95% CI 1.05–3.39) and less likely in Italy (aOR 0.44, 95% CI 0.28–0.69) and Canada (aOR 0.10, 95% CI 0.01–0.74). Targeted BLBLIs for ESBL-E was more likely in Italian sites. Treatment at sites within Israel, Taiwan, Turkey and Brazil was associated with less combination therapy for CPE. Although this study does not provide precise data on the relative prevalence of ESBL-E or CPE, significant variation in therapy exists across countries even after adjustment for patient factors. Better understanding of what influences therapeutic choices for these infections will aid antimicrobial stewardship efforts. © 2017 Elsevier B.V. and International Society of Chemotherapy

We aimed to describe regional differences in therapy for bloodstream infection (BSI) caused by extended-spectrum ?-lactamase-producing Enterobacteriaceae (ESBL-E) or carbapenemase-producing Enterobacteriaceae (CPE). 1,482 patients in 12 countries were included from an observational study of BSI caused by ESBL-E or CPE. Multivariate logistic regression was used to calculate adjusted odds ratios (aORs) for the influence of country of recruitment on empirical use of ?-lactam/?-lactamase inhibitors (BLBLI) or carbapenems, targeted use of BLBLI for ESBL-E and use of targeted combination therapy for CPE. The use of BLBLI for empirical therapy was least likely in sites from Israel (aOR 0.34, 95% CI 0.14-0.81), Greece (aOR 0.49, 95% CI 0.26-0.94) and Canada (aOR 0.31, 95% CI 0.11-0.88) but more likely in Italy (aOR 1.58, 95% CI 1.11-2.2) and Turkey (aOR 2.09, 95% CI 1.14-3.81), compared to Spain as a reference. Empirical carbapenems were more likely to be used in sites from Taiwan (aOR 1.73, 95% CI 1.03-2.92) and USA (aOR 1.89; 95% CI 1.05-3.39), and less likely in Italy (aOR 0.44, 95% CI 0.28-0.69) and Canada (aOR 0.10, 95% CI 0.01-0.74). Targeted BLBLI for ESBL-E was more likely in sites from Italy. Treatment at sites within Israel, Taiwan, Turkey and Brazil was associated with less combination therapy for CPE. Although this study does not provide precise data on the relative prevalence of ESBL-E or CPE, significant variation in therapy exists across countries even after adjustment for patient factors. A better understanding of what influences therapeutic choices for these infections will aid antimicrobial stewardship efforts. PH is supported by an Australian Postgraduate Award from the University of Queensland. The study was funded by the Ministerio de Economía y Competitividad, Instituto de Salud Carlos III - co-financed by European Development Regional Fund "A way to achieve Europe" ERDF, Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015). BGG, JRB, APH and YC also received funds from the COMBACTE-CARE project (grant agreement 115620), Innovative Medicines Initiative (IMI), the European Union's Seventh Framework Programme (FP7/2007-2013) and in-kind contributions from EFPIA companies.

CANDIPOP Project from GEIH-GEMICOMED (SEIMC) and REIPI: B. Padilla, P. Muñoz, J. Guinea, J. R. Paño Pardo, J. García-Rodríguez, C. García Cerrada, J. Fortún, P. Martín, E. Gómez, P. Ryan, C. Campelo, I. de los Santos Gil, V. Buendía, B. P. Gorricho, M. Alonso, F. S. Sanz, J. M. Aguado, P. Merino, F. González Romo, M. Gorgolas, I. Gadea, J. E. Losa, A. Delgado-Iribarren, A. Ramos, Y. Romero, I. Sánchez Romero, O. Zaragoza, M. Cuenca-Estrella, J. Rodriguez-Baño, A. Isabel Suarez, A. Loza, A. I. Aller García, E. Martín-Mazuelos, M. R. Pérez de Pipaón, J. Garnacho, C. Ortiz, M. Chávez, F. L. Maroto, M. Salavert, J. Pemán, J. Blanquer, D. Navarro, J. J. Camarena, R. Zaragoza, V. Abril, C. Gimeno, S. Hernáez, G. Ezpeleta, E. Bereciartua, J. L. Hernández Almaraz, M. Montejo, R. A. Rivas, R. Ayarza, A. M. Planes, I. R. Camps, B. Almirante, J. Mensa, M. Almela, M. Gurgui, F. Sánchez-Reus, J. Martinez-Montauti, M. Sierra, J. P. Horcajada, L. Sorli, J. Gómez, A. Gené, M. Urrea, M. Valerio, A. Díaz-Martín, F. Puchades, A. Mularoni., [Objective] Paradoxical growth (PG) and trailing effect (TE) are frequently observed during antifungal susceptibility testing (AFST). These two phenomena interfere with the determination of the minimal inhibitory concentration (MIC). The aim of this study was to assess the clinical impact of TE and PG., [Methods] We analysed the frequency of TE and PG of 690 Candida isolates collected from a population-based study performed in Spain (CANDIPOP) and correlated the results with clinical outcome of the patients., [Results] Around 70% (484/690) of the isolates exhibited TE to azoles. Candida tropicalis showed the highest presence of TE (39/53 isolates exhibited residual growth >25% of control). No TE was seen in most of the isolates from the psilosis complex. PG was mainly associated with echinocandins. In patients treated with fluconazole within the first 48 hours after blood sampling (n = 221), the presence of TE to azoles tended to be associated with lower 30-day mortality (odds ratio (OR) 0.55, 95% confidence interval (CI) 0.25–1.00) but not with clinical failure (OR 0.85, 95% CI 0.45–1.54). In the subgroup of 117 patients treated with echinocandins, the presence of PG was not associated with patient's response to antifungal treatment (OR for 30-day mortality 1.63, 95% CI 0.76–4.03; OR for clinical failure 1.17, 95% CI 0.53–2.70)., [Conclusions] TE or PG are widely expressed among Candida spp., although they do not seem to influence clinical outcome., C. Rueda was funded by a Sara Borrell contract from the Fondo de Investigaciones Sanitarias (FIS, reference number CD11/00110). O. Zaragoza was funded by grant SAF2014-54336-R from the Spanish Ministry for Economics and Competitivity. The CANDIPOP study was funded by research grants from Gilead, MSD, Astellas and Pfizer and by funding from the Fundacion SEIMC-GESIDA and the Ministerio de Economía y Competitividad, Instituto de Salud Carlos III, cofinanced by the European Development Regional Fund ‘A way to achieve Europe’ ERDF and the Spanish Network for the Research in Infectious Diseases (REIPI RD12/0015). MC-E has received grant support from Astellas Pharma, bioMerieux, Gilead Sciences, Merck Sharp & Dohme, Pfizer, Schering-Plough, Soria Melguizo SA, Ferrer International, the Europea Union, the ALBAN program, the Spanish Agency for International Cooperation, the Spanish Ministry of Culture and Education, the Spanish Health Research Fund, the Instituto de Salud Carlos III (Spanish Ministry of Economy and Competitiveness), the Ramón Areces Foundation and the Mutua Madrileña Foundation.

This study evaluated the daptomycin activity against two methicillin-resistant Staphylococcus epidermidis (MRSE) clinical isolates with different vancomycin susceptibilities: MRSE-375, with a vancomycin MIC of 2 μg/ml, and NRS6, a glycopeptide-intermediate S. epidermidis (GISE) strain with a vancomycin MIC of 8 μg/ml. The in vivo activity of daptomycin at two different doses (standard dose [SD-daptomycin], 6 mg/kg of body weight/day intravenously [i.v.]; high dose [HD-daptomycin], 10 mg/kg/day i.v.) was evaluated in a rabbit model of infective endocarditis and compared with that of a standard dose of vancomycin (SD-vancomycin; 1 g i.v. every 12 h) for 2 days. For the MRSE-375 strain, high-dose vancomycin (HD-vancomycin; 1 g i.v. every 6 h) was also studied. For MRSE-375, SD- and HD-daptomycin therapy sterilized significantly more vegetations than SD-vancomycin therapy (9/15 [60%] and 11/15 [73%] vegetations, respectively, versus 3/16 [19%] vegetations; P = 0.02 and P = 0.002, respectively). HD-daptomycin sterilized more vegetations than HD-vancomycin (11/15 [73%] versus 5/15 [33%] vegetations; P = 0.03) and was more effective than SD- and HD-vancomycin in reducing the density of bacteria in valve vegetations (0 log 10 CFU/g vegetation [interquartile range {IQR}, 0 to 1 log 10 CFU/g vegetation] versus 2 log 10 CFU/g vegetation [IQR, 2 to 2 log 10 CFU/g vegetation] and 2 log 10 CFU/g vegetation [IQR, 0 to 2.8 log 10 CFU/g vegetation]; P = 0.002 and P = 0.01, respectively). For the NRS6 strain, SD- and HD-daptomycin were significantly more effective than vancomycin in reducing the density of bacteria in valve vegetations (3.7 log 10 CFU/g vegetation [IQR, 2 to 6 log 10 CFU/g vegetation] versus 7.1 log 10 CFU/g vegetation [IQR, 5.2 to 8.5 log 10 CFU/g vegetation]; P = 0.02). In all treatment arms, isolates recovered from vegetations remained susceptible to daptomycin and vancomycin and had the same MICs. In conclusion, daptomycin at doses of 6 mg/kg/day or 10 mg/kg/day is more effective than vancomycin for the treatment of experimental endocarditis due to MRSE and GISE.

The single-dose disposition kinetics of the antibiotic danofloxacin were determined in clinically normal loggerhead turtles (n = 6) after intravenous (IV), subcutaneous (SC) and intramuscular (IM) administration of 6 mg kg(-1) bodyweight. Danofloxacin concentrations were determined by high performance liquid chromatography with fluorescence detection. The concentration-time data were analyzed by non-compartmental kinetic methods. Steady-state volume of distribution, and total body clearance of danofloxacin after IV administration were estimated to be 1.02 +/- 0.17 1 kg(-1) and 0.11 +/- 0.01 1 h(-1) kg(-1), respectively. Following IM and SC administration, danofloxacin achieved maximum plasma concentrations of 10.25 +/- 4.59 and 10.35 +/- 4.45 mg l(-1) at 1.20 +/- 0.52 and 1.46 +/- 0.48 h, respectively. The absolute bioavailabilities after SC and IM routes were 98.72 +/- 11.73 and 104.81 +/- 14.97%, respectively. Danofloxacin shows a favourable pharmacokinetic profile in loggerhead turtles reflected by parameters such as a long half-life and a high bioavailability following a single dose of 6 mg kg(-1) by IM and SC routes; thus, it is likely that this treatment will be effective in loggerhead turtles with bacterial infections.

Background Extraskeletal osteosarcomas (ESOSAs) are rare neoplasms in humans and animals. In cats, ESOSA has been reported to arise from orbital, ocular, intestinal, mammary and subcutaneous locations. Subcutaneous ESOSA occurs most commonly at sites used for vaccination including interscapular, dorsal lumbar or thigh areas. Previous reports of feline cases have not documented the use of advanced diagnostic imaging to exclude a primary bone tumour. Objective To describe the clinicopathological and advanced imaging findings of a subcutaneous ESOSA occurring in a metatarsal footpad of a cat and to report the one year follow-up status. Animal A 9-year-old neutered male domestic short hair cat. Methods Physical, abdominal ultrasonographic and computed tomographic examinations, and excisional biopsy for histopathological and immunohistochemical evaluation. Results The cat presented with mild focal erythematous swelling of the left metatarsal pad. ESOSA was diagnosed through advanced diagnostic imaging and histopathological examinations. Histopathological findings were consistent with osteosarcoma. No primary bone disease was observed on computed tomography. The owners declined limb amputation. One year after diagnosis, the cat was alive without disease progression. Conclusions and clinical importance Extraskeletal osteosarcoma should be considered in the differential diagnosis of soft tissue swelling in footpads in cats. Advanced diagnostic imaging is recommended to exclude primary bone tumours.

CANDIPOP Project from GEIH-GEMICOMED (SEIMC) and REIPI., We compared the clinical efficacy of fluconazole and echinocandins in the treatment of candidemia in real practice. The CANDIPOP study is a prospective, population-based cohort study on candidemia carried out between May 2010 and April 2011 in 29 Spanish hospitals. Using strict inclusion criteria, we separately compared the impact of empirical and targeted therapy with fluconazole or echinocandins on 30-day mortality. Cox regression, including a propensity score (PS) for receiving echinocandins, stratified analysis on the PS quartiles and PS-based matched analyses, were performed. The empirical and targeted therapy cohorts comprised 316 and 421 cases, respectively; 30-day mortality was 18.7% with fluconazole and 33.9% with echinocandins (p 0.02) in the empirical therapy group and 19.8% with fluconazole and 27.7% with echinocandins (p 0.06) in the targeted therapy group. Multivariate Cox regression analysis including PS showed that empirical therapy with fluconazole was associated with better prognosis (adjusted hazard ratio 0.38; 95% confidence interval 0.17–0.81; p 0.01); no differences were found within each PS quartile or in cases matched according to PS. Targeted therapy with fluconazole did not show a significant association with mortality in the Cox regression analysis (adjusted hazard ratio 0.77; 95% confidence interval 0.41–1.46; p 0.63), in the PS quartiles or in PS-matched cases. The results were similar among patients with severe sepsis and septic shock. Empirical or targeted treatment with fluconazole was not associated with increased 30-day mortality compared to echinocandins among adults with candidemia., BA has received grant support from Gilead Sciences, Pfizer and the Instituto de Salud Carlos III, and he has received honoraria for talks on behalf of Gilead Sciences, Merck Sharp and Dohme, Pfizer, Astellas and Novartis. MCE has received grant support from Astellas Pharma, bioMerieux, Gilead Sciences, Merck Sharp and Dohme, Pfizer, Schering Plough, Soria Melguizo SA, Ferrer International, the European Union, the ALBAN programme, the Spanish Agency for International Cooperation, the Spanish Ministry of Culture and Education, the Spanish Health Research Fund, the Instituto de Salud Carlos III, the Ramon Areces Foundation and the Mutua Madrileña Foundation. MCE has received grant support from Astellas Pharma, bioMerieux, Gilead Sciences, Merck Sharp and Dohme, Pfizer, Schering Plough, Soria Melguizo SA, Ferrer International, the European Union, the ALBAN programme, the Spanish Agency for International Cooperation, the Spanish Ministry of Culture and Education, the Spanish Health Research Fund, the Instituto de Salud Carlos III, the Ramon Areces Foundation and the Mutua Madrileña Foundation.

One-hundred seventy-two consecutive adult patients with salmonella bacteremia documented by at least one positive blood culture were prospectively evaluated over a 10-year period. Salmonella enteritidis was isolated in 121 cases (70.3%), Salmonella typhimurium in 29 (16.9%), and other Salmonella species in 22 (12.8%). Twenty-seven patients (15.7%) developed septic metastasis; 21 patients (12.2%) died of bacteremia, and 24 (16.7%) of the 144 patients who survived had at least one relapse. A logistic regression analysis selected three variables as independently influencing outcome: septic shock (P = .005), coma (P = .029), and immunosuppression (P = .04). By means of the same statistical analysis, leukopenia (a white blood cell count of < 4 x 10(9)/L) was identified as an independent risk factor for relapse (P < .0001). The possibility of salmonella bacteremia must be considered when immunosuppressed patients have fever and no obvious source of infection. Treatment with a drug active against Salmonella species is essential in this population. Patients with leukopenia should be considered as recipients of prophylaxis for relapse.

The treatment of bovine leathers with wetting and lyotropic agents followed by heating produced a strengthening of the leathers which increased their joint strength properties to polyvinyl chloride (PVC). A cohesive failure of leather was always obtained. The highest cohesive strength (or point peel strength) was obtained when the treatment was carried out at 140°C with the surfactant NFOE (8.5) (nonylphenol polyoxyethylene with 8.5 mol of oxyethylene). The lyotropic agents (CaCl2, urea) gave very high values (a five-fold increase), whereas the water-dimethyl ketone blends and pure water resulted in a smaller improvement in cohesive strength (a three-fold increase). The improved cohesive strength of leather was mainly due to the destruction of the ordered structure of collagen fibres and to the creation of a complex entanglement network among the collagen fibres. The treatments applied to a bovine leather produced a shrinkage of 65%; the degree of shrinkage was not a function of the kind of treatment, but...

Wild populations of many species are declining as a result of habitat destruction and climate change but also through the over-collection for wild meat and the pet trade. With a long history of trade around the Mediterranean, populations of the spur-thighed tortoise (Testudo graeca graeca) have become highly disturbed. In this study we utilise a molecular approach to investigate the diversity, population admixture and structure of T. g. graeca populations in northern Africa and southern Spain, as well as to obtain an insight into the origin of newly established populations in the south of Europe. We infer this from the sequencing of two partial regions of the mitochondria (12s rRNA + cyt b) and genotyping at 16 microsatellite markers in 448 tortoises. Our results are consistent with the hypothesis that Spanish populations were founded from North Africa, the consequence of multiple introductions or exchanges in genetic material as a result of trans-oceanic dispersal. Despite the trade of individuals between both sides of the Gibraltar Strait, our analysis of population structure showed clear differences between both the African and European populations, suggesting an incipient evolutionary lineage in southeast of Spain. As such, these populations possess unique genetic identities and should be treated as different management units. Surprisingly, the genetic data identified a great deal of diversity contained within pet (captive) stock and also allowed us to infer hybrids among individuals with another species of terrestrial tortoise from northern Spain (T. hermanni hermanni). Additionally, our results provide insight into the local movement and trade of individuals that has occurred around the Mediterranean basin (between northern Africa and southern Spain) and as such provides guidance for the effective management of T. g. graeca captive stock and the illegal trafficking., The authors gratefully acknowledge to Fundación Global Nature (Murcia Region, Spain); the Wildlife Rehabilitation Center “El Valle” (Murcia Region, Spain); Marcos Fernández (Wildlife Rehabilitation Center Santa Faz, Alicante, Spain) and Albert Martinez-Silvestre (CRARC, Barcelona, Spain). Thanks also to Peter Spencer for his revisions of the manuscript and referees for their comments and suggestions that helped to improve the previous manuscript. The financial support was provided by both Fundación Séneca, Spain (Proyect 00655/PI/04) and by MEC, Spain (Grant AP-2004-4048).

This study evaluated the activity of daptomycin combined with either gentamicin or rifampin against three methicillin-resistant Staphylococcus aureus (MRSA) clinical isolates in vitro and one isolate in vivo against a representative strain (MRSA-572). Time-kill experiments showed that daptomycin was bactericidal against these strains at concentrations over the MIC. Daptomycin at sub-MIC concentrations plus gentamicin at 1× and 2× the MIC yielded synergy, while the addition of rifampin at 2 to 4 μg/ml resulted in indifference (two strains) or antagonism (one strain). The in vivo activity of daptomycin (6 mg/kg of body weight once a day) was evaluated ± gentamicin (1 mg/kg intravenously [i.v.] every 8 h [q8h]) or rifampin (300 mg i.v. q8h) in a rabbit model of infective endocarditis by simulating human pharmacokinetics. Daptomycin plus gentamicin (median, 0 [interquartile range, 0 to 2] log 10 CFU/g vegetation) was as effective as daptomycin alone (0 [0 to 2] log 10 CFU/g vegetation) in reducing the density of bacteria in valve vegetations ( P = 0.83), and both were more effective than daptomycin plus rifampin (3 [2 to 3.5] log 10 CFU/g vegetation; P < 0.05) for the strain studied. In addition, daptomycin sterilized a ratio of vegetations that was similar to that of daptomycin plus gentamicin (10/15 [67%] versus 9/15 [60%]; P = 0.7), and both regimens did so more than daptomycin plus rifampin (3/15 [20%]; P = 0.01 and P = 0.02, respectively). No statistical difference was noted between daptomycin plus gentamicin and daptomycin alone for MRSA treatment. In the combination arm, all isolates from vegetations remained susceptible to daptomycin, gentamicin, and rifampin. Sixty-one percent of the isolates (8/13) acquired resistance to rifampin during monotherapy. In the daptomycin arm, resistance was detected in only one case, in which the daptomycin MIC rose to 2 μg/ml among the recovered bacteria. In conclusion, the addition of gentamicin or rifampin does not enhance the effectiveness of daptomycin in the treatment of experimental endocarditis due to MRSA.

Sea turtles are of increasing interest as potential bioindicators of the heavy metal pollution in marine ecosystems. In the present work, concentrations of heavy metals and essential elements (As, Cd, Hg, Pb, Se, Zn) in different organs and tissues (liver, kidney, muscle, bone, blood, central nervous system and skin) of loggerhead sea turtles (Caretta caretta) were determined from stranded animals found along the Spanish Mediterranean coastlines of Murcia. Relatively high average levels of As (skin: 52.13 microg g(-1) dry weight; muscle: 40.95 microg g(-1) dry weight), and especially high individual levels of Zn in muscle tissue (1002.4 microg g(-1) dry weight) were detected. Furthermore, a significant degree of organotrophism of Cd was observed in kidney tissue. The concentrations detected, the distribution among the tissues and the differences observed between juvenile and adult specimens are generally compatible with chronic exposure to the elements studied, whilst levels produced by acute exposure were ruled out.

The adsorption of nonionic surfactants on hide powder previously treated with anionic surfactants has been studied. The adsorption of nonionic surfactants takes place through hydrophobic interactions. A mechanism has been proposed for this interaction, assuming that the nonionic surfactant has been fixed by means of secondary adsorption (hydrophobic interaction) after the primary adsorption of the anionic surfactant (ionic and hydrophobic interaction) which makes it possible.

A greater rate of treatment failures with vancomycin in methicillin-resistant Staphylococcus aureus (MRSA) bacteremia has been reported recently when the minimum inhibitory concentration (MIC) isor =2 mg/l. This study has aimed to evaluate if there are clinical and/or epidemiological factors that predict isolation of a MRSA strain with MIC of vancomycin ofor =2 mg/L in the bacteremia episodes collected during a 15 year period (January 1991 to December 2005) in a tertiary urban hospital. During the study period, a total of 478 episodes of MRSA bacteremia were studied prospectively. The following clinical variables were recorded for each one: age, gender, comorbidity, previous administration of vancomycin or another antibiotic, prognosis of baseline diseases, bacteremia focus, shock, empiric antibiotic received and mortality. The MIC of vancomycin of 419 strains (88%) was determined with the E-test. In 216 (52%) of the isolations the MIC of vancomycin was 1.50 mg/L, in 110 (26%) of the cases it wasor =1 mg/l and in 93 (22%) 2 mg/l. Uni-and multivariate analyses were made, comparing the clinical variables of the patients infected by strains with MIC of vancomycinor =2 mg/l regarding the MIC strainsor =1 mg/l. In the last 3 years of the study (2003-2005) the proportion of the strains with MIC of vancomycinor =2 mg/l was significantly greater than those isolated with MICor = 1 mg/L (44 % vs 3 %; p0.001). In the multivariate analysis, the only clinical characteristic associated independently to the isolation of a strain with MICor =2 mg/l was the nosocomial-acquired infection OR (95 % CI): 1.94 (1.04-3.63); p=0.04. Although the isolation of a MRSA strain with MIC of vancomycinor =2 mg/l is more frequent in the nosocomial-acquired bacteremia episodes, in the clinical practice, it is not a useful predictive parameter because the frequency of isolation of these strains in the community is also high.

CO2 chemisorption, at different temperatures, has been studied in CaO and in the CaO-carbon system by means of simultaneous TG-DTA, MS, and XRD techniques. As a whole the different techniques used show that CO2 chemisorbs in an irreversible manner and is mainly restricted to the surface of the CaO particles, provided that the chemisorption temperature is lower than 573 K. CO2 chemisorption at 573 K can be used as a tool to measure the external surface area of CaO particles. Selective CO2 chemisorption at 573 K has been applied to the CaO-carbon system in the field of catalytic carbon gasification. Several examples are given to show the usefulness of the catalyst surface area determined by CO2 chemisorption in interpreting the catalytic activity of calcium in carbon gasification.

Isothermal CO 2 (0.1 MPa) and steam (19.7 KPa) reactivities on pure polymer carbons have been studied at different temperatures as a function of their calcium contents. Ion-exchange and impregnation methods have been used to load the carbons from calcium acetate solutions. Calcium appears to be a very active catalyst for both reactions, its effectivity being much higher in CO 2 than in steam. Reactivities in both atmospheres increase linearly with Ca content up to a loading saturation level (LSL) of about 4 wt%. For comparable calcium loading, the catalyst addition method, ion-exchange or impregnation, does not produce any significant difference. Selective CO 2 chemisorption has been used to determine the Ca atoms on the surface of the catalyst (and hence its external surface area or dispersion) as functions of both the calcium loading and the preparation method. The results obtained show that CO 2 chemisorption is much more suitable than XRD. This allows interpretation of the catalytic activity of Ca in the carbon-gas reactions. Briefly, gasification rates are related to the amount of CO 2 chemisorbed. The different catalytic behaviour of calcium catalyst above and below the LSL has been interpreted as being due to catalyst dispersion conditioned by carbon carboxyl groups. Only the exchanged calcium has a catalytic activity, whereas the excess calcium has low dispersion, its mean particle size increases considerably, and does not have additional catalytic activity.

Despite the existence of published recommendations, various studies of antibiotic prophylaxis have reached conflicting conclusions, and controversy exists regarding the role of antibiotic prophylaxis in ERCP. The aim of this study was to analyze the efficacy of the intramuscular administration of clindamicine and gentamicine before ERCP.Sixty-one consecutive patients referred for ERCP were prospectively randomized to receive either clindamicine 600mg and gentamicine 80mg, both intramuscularly one hour before the ERCP (group I; 31 patients) or not (group II; 30 patients). Two blood samples were obtained from every patient (just before endoscopy and within 5 minutes of withdrawal of the endoscope) and were incubated for 7 days and examined daily for growth of bacteria. Patients were closely monitored for 7 days after endoscopy to detect the development of infectious complications.Only 7 cultures from 7 patients were positive. Four were obtained post-ERCP (two patients in group I and two in group II) and the remaining three before endoscopy. The post-ERCP isolated bacteria were: Streptococcus mitis, Peptoestreptococcus anaerobious, Moraxella spp and Escherichia coli. Two patients, one from each group, developed post-ERCP cholangitis that were solved with medical treatment.Our findings indicate that ERCP induce bacteremia in a small group of patients and suggest that prophylactic administration of clindamicine plus gentamicine does not reduce the incidence of bacteremia and cholangitis, and do not support the routine use of prophylactic antibiotics prior to ERCP.

Proinflammatory cytokines (IL-1beta, IL-6, TNF-alpha) are excellent predictive factors of tissue damage, inflammation and infection. However, there is not sufficient data about their usefulness in elderly patients with acute septic pathology. Our objective was to identify the cytokines related to bacteremia and those that predicted a bad prognosis in elderly patients.Prospective study carried out during 1999. Patients aged= 60 years with temperature= 38 C admitted to the emergency ward. We determined IL-1beta, IL-6, TNF-alpha and C-reactive protein (CRP); cultures were done according to the infectious source. On the 4th day, cytokines and CRP were recorded again. The follow-up was completed until cure or death.50 patients were included (29 males). Median age was 75.6 (SD: 8.98). The etiology was infectious in 44 (88%): respiratory in 29 (66%), urinary in 8 (18%) and other sources in 7. Thirteen patients had bacteremia (32%): Escherichia coli (4), Streptococcus pneumoniae (5) and others (4). Ten patients died (20%). Median values on admission were CRP : 6.67 mg/dl (NV 0.8), TNF-alpha: 29 pg/ml (NV 0-20), IL-1beta: 7 pg/ml (NV 15) and IL-6: 121 pg/ml (NV 5). 4th day values were: 4.23 mg/dl, 22 pg/ml, 1 pg/ml and 41 pg/ml, respectively. The levels of IL-1b in the 2nd determination were significantly lower in females (p = 0.019). Initial TNF-alpha (p = 0.033), IL-1beta (p = 0.013) and IL-6 (p = 0.031) values were significantly higher in bacteremia patients. IL-6 values on the 4th day were higher in patients who died (p = 0.06). In patients who died, IL-6 levels were higher in the 2nd determination (p = 0.09).Median values of all cytokines were higher in the bacteremia population. Patients who died showed higher levels of IL-6 on the 4th day.

Congenital coronary artery fistulas are rare malformations that may evolve to pulmonary hypertension, heart failure and myocardial ischemia, although some may close spontaneously. Complications such as endocarditis, rupture, aneurysm or thrombosis may also be observed. Most patients are asymptomatic and the fistulas are usually detected by doppler echocardiography and angiography. We report the case of an asymptomatic 10-year-old male who was submitted because he of a heart murmur, and three coronary fistulas were diagnosed. Two originated in the left coronary artery draining into the right ventricle and the other origin was in the right coronary artery draining into the pulmonary artery trunk.

The in vitro activity of 22 antimicrobial agents against 82 human Listeria monocytogenes strains isolated in Barcelona from 1994 to 1998 was determined. Ampicillin and gentamicin showed good in vitro activity against all strains (MIC90: 1 andor = 0.25 microg/ml, respectively). No resistance to rifampin or co-trimoxazole was detected and only one strain was resistant to tetracycline. Of the nine fluoroquinolones tested, clinafloxacin and gemifloxacin were the most active compounds (MIC90: 0.12 and 0.25 microg/ml, respectively). No increasing MICs values were observed during the five-year period.

Yersinia spp infection in human people are increasing attention last thirty years. We have reviewed the bacteremia in our hospital last five years. Three episodes were Yersinia spp bacteremia. Presence of disease or predisponent therapy were present in most of episodes. All patients were more than seventy years old. The septic metastasis were present in all the cases: one with meningitis, other with liver abscess and one with septic arthritis. We have documented a good clinical evolution, though the mortality in different reports is around 50%. The election therapy for all episodes were cephalosporins, and in two cases we added quinolones.

Studies have established a relationship between lipoprotein (a) [Lp(a)] levels and cardiovascular disease, but few have studied Lp(a) in patients with non-insulin-dependent diabetes mellitus (NIDDM).We determined Lp(a) concentrations, levels of glycated hemoglobin, and the personal and family history of atherosclerosis in 88 patients with NIDDM (53 men and 35 women; age, 33-70 years) and 90 age- and sex-matched controls. Twenty-three patients with NIDDM had cardiovascular disease (CVD group) and 65 did not (non-CVD group).Lp(a) levels were higher in CVD than non-CVD patients (P0.01). Triglyceride levels negatively correlated with Lp(a) (r = -0.51, P0.05), independently of the metabolic control of diabetes. Patients with poor metabolic control (glycated hemoglobin7.5%) had higher Lp(a) levels than the control group (P0.05). Lp(a) levels were higher than 0.30 milligram in 11% of patients without CVD and 55% of those with CVD (P0.05). Cluster analysis showed that Lp(a), as well as total cholesterol, triglycerides, apolipoprotein B100, and age were independently related to CVD in patients with NIDDM (P0.001 for triglycerides and P0.05 for the other variables).Lp(a) levels can be considered an independent risk factor for the development of atherosclerosis in NIDDM.

To study the bacteremias and fungemias of the patients with solid organ transplantation (kidney or liver) and analyze the differences according to the type of graft.A prospective study included in a control program of bacteremias of a 1000-bed hospital and a follow up study of the infections of the patients who had undergone kidney transplantation (KT) (1985-1991) and liver transplantation (LT) (1988-1991) were carried out.One hundred thirty-one bacteremias and 5 fungemias, 75 in 62 patients with KT out of a total of 568 transplantations (11%) and 63 out of 54 patients with LT out of a total of 185 transplantations (29%) were identified. The prevalence of bacteremia in LT was greater (p0.001). The origin was nosocomial in 95% in LT and 70% in KT (p0.001). Around 50% of the bacteremias occurred during the first month post LT and KT. The microorganisms isolated were: Staphylococcus sp. (21 in KT and 30 in LT), with greater incidence in LT (p0.05); Enterococcus sp. (9 and 5, respectively), enterobacterias (12 and 12, respectively), Pseudomonas sp. (14 and 6, respectively), Candida sp. (2 and 3, respectively) with similar rates in both transplants. The origin of bacteremia was; renal and urinary tract, most frequent in KT (21 and 2 respectively) (p = 0.001). The origin of bacteremia was: renal and urinary tract, most frequent in KT (21 and 2 respectively) (p0.001), intraabdominal and biliary tract, most frequent in LT (4 and 14, respectively) (p = 0.007); intravenous catheter, most frequent in LT (16 and 24 respectively) (p0.05); lung, most frequent in LT although without statistical significance (3 and 8, respectively), (p = NS), and finally, surgical wound (4 and 1, respectively) (p = NS). Seventeen patients died (14 with LT and 3 with KT).The incidence of bacteremia and the mortality related, was greater in LT than that observed in KT. The most frequent origin in KT was the kidney and urinary tract and the biliary and intraabdominal organs and the intravenous catheter were most prevalent in liver transplants. Staphylococcus sp was the most frequent germ in both types of transplantation and polymicrobian infection in liver transplants. Gram-negative germs caused higher mortality in liver transplantation.

A population-based register of cases of listeriosis admitted to acute-care hospitals has been established in Barcelona, Spain, in order to estimate the basal incidence of sporadic cases and to facilitate epidemiological surveillance of potential epidemics. Eleven acute-care hospitals reported all cases of listeriosis to a central unit following a standardized protocol. During 1990, 31 patients with listeriosis were identified, 18 of whom were residents of the city, resulting in an annual incidence of 10.95 cases per million inhabitants. Twelve of the 31 cases occurred in the period from July to September 1990, ten of them being community-acquired. The incidence of listeriosis was higher in elderly (or = 65 years) and immunosuppressed persons. Forty-two percent of the cases were considered to be nosocomial infections. The overall mortality rate was 51.6%. The incidence of listeriosis in the present study is one of the highest reported in the literature. A high sensitivity of the reporting system with good case identification techniques, or demographic and environmental characteristics related to Listeria monocytogenes infection in our area, might be possible reasons for this geographic variation.

Two carbon precursors with very different initial pore size distributions (from almond shells and phenolformaldehyde polymer resin) have been activated in CO 2 and steam. Catalyzed and uncatalyzed activations have been compared using calcium as catalyst. The addition of a catalyst to the carbon activation process influences both the gasification rate and the adsorption capacity of the activated carbon allowing to reduce reaction temperature and to select tailoring of the activated carbon pore size distribution. Total pore volume increases in both carbon series with the extent of burn-off. Catalytic activation in CO 2 produces, in respect to the uncatalyzed process, a remarkable development of the mesoporosity and, as a result, a much wider pore size distribution is obtained. The effect of calcium in the steam activation is much less noticeable.

The combination aztreonam + cefotaxime (AZ + CE) was compared to amikacin + cefotaxime (AM + CE) in the treatment of nosocomial pneumonia acquired at the intensive-care unit. This study included a total of 33 patients fulfilling criteria for nosocomial pneumonia. 16 of them were randomly allocated to the AZ + CE group and 17 to the AM + CE group. The empirical treatment was effective for 78% of AZ + CE cases and 92% of AM + CE cases (p = NS). Clinical cure was observed in 77% of cases (10 out of 13 evaluable) in the AZ group and in 75% of the group treated with AM (12 cases out of 16 evaluable; p = NS). In the evaluable cases, treatment failure was associated with injections due to the following organisms: Acinetobacter calcoaceticus (1) and Pseudomonas aeruginosa (1) in the AZ group and A. calcoaceticus (1) in the AM group. Superinfections were observed only in the AM group P. aeruginosa, A. calcoaceticus, Streptococcus viridans, Candida albicans, Aspergillusfumigatus and Serratiamar-cescens. Both the peak and through serum concentrations of AZ and AM were maintained within normal ranges. Finally, an impairment of renal tubular function was observed in the group of patients treated with AM, as measured by urinary levels of N-ace-tyl-β-D-glucosaminidase and leucine aminopeptidase sequentially during the treatment. These changes in renal functions alterations mentioned were not observed in the AZ group. It is concluded that the AZ + CE combination is an effective empirical and active antibiotic treatment against severe nosocomial pneumonia. Aztreonam has no renal toxicity, which is an advantage to take into account in patients with altered renal function.

The reactivities in steam, CO 2 and air of two high-ash Spanish coal chars (from a semi-anthracite and a high volatile bituminous coal) and the effects of previous acid demineralization on these reactivities have been studied. The different acid treatments used increased the reactivities of both chars in the three atmospheres, the increase being much larger for samples treated with HCl + HF , especially in the reaction with CO 2 . This apparently anomalous increase in CO 2 reactivity (relative to steam and air) for both chars, which can also be observed in published results, seems to be mainly related to the HF treatment and the remaining mineral matter, as deduced from a study undertaken on two very low-ash carbons.