Search

[Objectives ] To investigate the role of previous antibiotic therapy in the risk of recurrence after a Clostridioides difficile infection (CDI) treated with vancomycin., [Methods] Multicentre observational study. Patients with a CDI episode achieving clinical cure with oral vancomycin and followed up 8 weeks were included. Previous antibiotic exposure up to 90 days was collected. Multivariate analysis of predictors of recurrence adjusted by the propensity score (PS) of being previously treated with each non-CDI antibiotic was performed., [Results] Two hundred and forty-one patients were included; 216 (90%) had received systemic antibiotics. Fifty-three patients (22%) had a CDI recurrence. Rates of recurrence were lower in those treated with piperacillin/tazobactam in the last month when compared with those not receiving piperacillin/tazobactam [3 (7%) versus 50 (25%); P = 0.01], whereas higher rates were seen in those treated with cephalosporins in the last month [26/87 (30%) versus 27/154 (17%); P = 0.03]. In multivariate analysis controlled by the inverse probability of treatment weighting by PS, receiving ≥5 days of piperacillin/tazobactam in the last month as the last antibiotic regimen prior to CDI was independently associated with a lower risk of recurrence [adjusted OR (AOR) 0.13; 95% CI: 0.06–0.29; P < 0.0001] whereas exposure for ≥5 days to cephalosporins (versus piperacillin/tazobactam) was associated with an increased risk (AOR 10.9; 95% CI: 4.4–27.1; P < 0.0001)., [Conclusions] Recent use of piperacillin/tazobactam might be associated with a lower risk of CDI recurrence, while recent use of cephalosporins might promote an increased risk. These findings should be considered when treating hospitalized patients.

[Background] Almost one third of the patients with candidemia develop septic shock. The understanding why some patients do and others do not develop septic shock is very limited. The objective of this study was to identify variables associated with septic shock development in a large population of patients with candidemia., [Methods] A post hoc analysis was performed on two prospective, multicenter cohort of patients with candidemia from 12 hospitals in Spain and Italy. All episodes occurring from September 2016 to February 2018 were analyzed to assess variables associated with septic shock development defined according to The Third International Consensus Definition for Sepsis and Septic Shock (Sepsis-3)., [Results] Of 317 candidemic patients, 99 (31.2%) presented septic shock attributable to candidemia. Multivariate logistic regression analysis identifies the following factors associated with septic shock development: age > 50 years (OR 2.57, 95% CI 1.03–6.41, p = 0.04), abdominal source of the infection (OR 2.18, 95% CI 1.04–4.55, p = 0.04), and admission to a general ward at the time of candidemia onset (OR 0.21, 95% CI, 0.12–0.44, p = 0.001). Septic shock development was independently associated with a greater risk of 30-day mortality (OR 2.14, 95% CI 1.08–4.24, p = 0.02)., [Conclusions] Age and abdominal source of the infection are the most important factors significantly associated with the development of septic shock in patients with candidemia. Our findings suggest that host factors and source of the infection may be more important for development of septic shock than intrinsic virulence factors of organisms.

[Background] Candidaemia is a leading cause of bloodstream infections in hospitalized patients all over the world. It remains associated with high mortality., [Objectives] To assess the impact of implementing an evidence-based package of measures (bundle) on the quality of care and outcomes of candidaemia., [Methods] A systematic review of the literature was performed to identify measures related to better outcomes in candidaemia. Eight quality-of-care indicators (QCIs) were identified and a set of written recommendations (early treatment, echinocandins in septic shock, source control, follow-up blood culture, ophthalmoscopy, echocardiography, de-escalation, length of treatment) was prospectively implemented. The study was performed in 11 tertiary hospitals in Spain. A quasi-experimental design before and during bundle implementation (September 2016 to February 2018) was used. For the pre-intervention period, data from the prospective national surveillance were used (May 2010 to April 2011)., [Results] A total of 385 and 263 episodes were included in the pre-intervention and intervention groups, respectively. Adherence to all QCIs improved in the intervention group. The intervention group had a decrease in early (OR 0.46; 95% CI 0.23–0.89; P = 0.022) and overall (OR 0.61; 95% CI 0.4–0.94; P = 0.023) mortality after controlling for potential confounders., [Conclusions] Implementing a structured, evidence-based intervention bundle significantly improved patient care and early and overall mortality in patients with candidaemia. Institutions should embrace this objective strategy and use the bundle as a means to measure high-quality medical care of patients.

[Background] Few women have been included in darunavir/cobicistat clinical development studies, and hardly any of them were antiretroviral experienced or treated with anything other than triple-based therapies., [Objectives] Our aim was to increase our knowledge about women living with HIV undergoing darunavir/cobicistat-based regimens., [Methods] A multicentre (21 hospitals), retrospective study including a centrally selected random sample of HIV-1 patients starting a darunavir/cobicistat-based regimen from June 2014 to March 2017 was planned. Baseline characteristics, 24 and 48 week viral load response (<50 copies/mL), CD4+ lymphocyte count increase, time to change darunavir/cobicistat and adverse event occurrence were all compared by sex. The study was approved by each of the 21 ethics committees, and patients signed informed consent., [Results] Out of 761 participants, 193 were women. Similar characteristics were found for both sexes, except that the women had a longer duration of HIV infection (P = 0.001), and were less frequently pre-treated with darunavir/cobicistat in their previous regimen (P = 0.02). The main reason for using a darunavir/cobicistat-based regimen was simplification, without differences by sex, while monotherapy seems to be more frequently prescribed in women than in men (P = 0.067). The main outcomes, HIV viral load response, CD4+ lymphocyte count increase at 24 or 48 weeks, occurrence of adverse events, main reasons for changing and time to the modify darunavir/cobicistat regimen, did not show differences between the sexes., [Conclusions] No sex disparities were found in the main study outcomes. These results support the use of a darunavir/cobicistat-based regimen in long-term pre-treated women. Clinical Trial.gov No. NCT03042390.

Item does not contain fulltext, Multidrug-resistant Candida auris has emerged as a cause of insidious hospital outbreaks and complicated infections. We present the analysis of an ongoing C. auris outbreak including the largest published series of C. auris bloodstream infection. All C. auris-positive patients from April-2016 to January-2017 were included. Environmental, clinical and microbiological data were recorded. Definitive isolate identification was performed by ITS-rDNA sequencing, and typing by amplified fragment length polymorphism fingerprinting. One hundred and forty patients were colonised by C. auris during the studied period (68% from surgical intensive care). Although control measures were implemented, we were not able to control the outbreak. Forty-one invasive bloodstream infections (87.8% from surgical intensive care) were included. Clinical management included prompt intravascular catheter removal and antifungal therapy with echinocandins. All isolates were fluconazole- and voriconazole-resistant, but echinocandin- and amphotericin B-susceptible. Thirty-day mortality rate was 41.4%, and severe septic metastasis as spondylodiscitis and endocarditis were observed in 5 patients (12%). C. auris was also recovered from inanimate patient surroundings and medical equipment. Despite antifungal treatment, high mortality and late complication rates were recorded. Molecular typing suggested a clonal outbreak different from those previously published.

[EN] The performance of vapor-compression systems working with subcritical refrigerants varies with the degree of subcooling. There is an optimal subcooling that maximizes efficiency. However, it depends on the operating conditions and the control of the system needs to be adapted. Most of the works available in literature are able to operate in optimal conditions only at the design point or if a system is designed to be able to adapt its subcooling, only complex control algorithms that usually are difficult to set and time-costly, are used. This work focuses on the study of the main variables influencing the optimal subcooling and analyzes two different control methodologies from the theoretical point of view. Based on the theoretical study a final control strategy is selected and tested experimentally. The reliability, stability and robustness of the selected strategy are experimentally demonstrated for a wide set of operating conditions. (c) 2018 Elsevier Ltd and IIR. All rights reserved.

[EN] Heat recovery from water sources such as sewage water or condensation loops at low temperatures (usually between 10 and 30 °C) is becoming very valuable. Heat pumps are a potential technology able to overcome the high water temperature lift of the Sanitary Hot Water (SHW) application (usually from 10 °C to 60 °C with COPs up to 6). This paper presents a model to find the optimal size of a system (heat pump and recovery heat exchanger) based on water sources to produce SHW compared to the conventional production with a gas boiler in order to maximize the benefit. The model includes a thermal and economic analysis for a base case and analyzes the influence of a wide set of parameters which could have a significant influence. Even the uncertainties involved, results point out considerable benefits from this substitution based on the capacity of the system. Thus, demonstrating the importance of the optimal size analysis before an investment is done.

[EN] This paper presents the experimental results obtained from a new heat pump prototype for sanitary hot water production, in the application of heat recovery from water sources like sewage water or condensation loops (typical temperature condition between 10 degrees C and 30 degrees C). The system configuration is able to produce a high degree of subcooling in order to take advantage from the high water temperature glide (typical value for sanitary hot water production is 10 degrees C to 60 degrees C). Subcooling is made by using a separate heat exchanger from the condenser (subcooler). The obtained results have shown a high degree of improvement by making subcooling. COP is 5.61 in nominal conditions, which is about 31% higher than the same cycle working without subcooling (Nominal point: inlet/outlet water temperature at evaporator is 20 degrees C/15 degrees C and the water inlet/outlet temperature in the heat sink is 10 degrees C and 60 degrees C). (C) 2016 Elsevier Ltd and HR. All rights reserved.

Two of the major problems of heat pump systems working in extreme conditions are the loss of efficiency of the system and the high compressor discharge temperatures. One possibility in order to overcome these issues is to perform the compression in two stages. In this frame the use of vapor injection two stage cycles represent an economic and effective solution. This study analyzes the influence of design parameters and injection conditions for two different configurations of two stage cycles, for four refrigerants (R407C, R290, R22 and R32). Design parameters, such as the displacement ratio, are optimized in terms of COP in ideal conditions for both injection systems. A deeper analysis taking into account the efficiencies of the compressor is done finding that two stage systems could reach improvements of 30% in terms of COP compared with one stage systems and that a bad design of this type of systems could represent a loss of improvement between 6% and 10%. Finally a method to control the system at any operating point in order to make it works in its optimum is done. From all the analysis, guidelines for the optimum design and control of such systems are obtained in terms of capacity, Coefficient of Performance (COP), seasonal performance factor and discharge temperature criteria.

[EN] As science and technology advance and grow in complexity the traditional idea of classifying impervious areas of knowledge is more obsolete. The idea of multidisciplinary working groups in which knowledge is joined cooperatively is taking higher consideration. With this background, taking into account that biology is undergoing a revolution in terms of the possibilities to manipulate and understand living systems similar to what physics experienced in the early twentieth century and that biological systems are the most complex of all that we know, the idea of combining engineering and biology in a same core of knowledge known as Synthetic Biology was born. This new field integrates the skills and knowledge developed in other formal sciences with the vast amount of scientific knowledge currently available in Biology. In order to make it possible efficiently, it requires additional training effort, since biology has a much more differentiated descriptive language which may have other areas such as electrical engineering, mechanical engineering, physics or mathematics. This article shows the great potential of Synthetic Biology through the cooperative work of professionals from different areas, but without neglecting the problems that it entails., [ES] Conforme la ciencia y la técnica avanzan y crecen en complejidad la idea tradicional de clasificar las áreas de conocimiento impermeables entre ellas está más en desuso y tanto en el mundo empresarial como en el universitario la idea de grupos de trabajo multidisciplinares en los que los conocimientos se sumen de forma cooperativa se está cobrando una mayor relevancia. Con esta intención presente y teniendo en cuenta que actualmente por un lado la biología está sufriendo una revolución en cuanto a las posibilidades de manipular y entender los sistemas vivos similar a la que vivió la física a principios del siglo XX y que por otro los sistemas biológicos son los más complejos de todos cuanto conocemos, nace la idea de aunar la ingeniería y la biología en un nuevo campo conocido como Biología Sintética. Este nuevo campo de conocimiento trata de integrar las técnicas y conocimientos desarrollados en otras ciencias formales con la gran cantidad de conocimiento científico descriptivo que actualmente se dispone. Para lograr esto de forma eficiente hace falta un esfuerzo formativo adicional, puesto que la biología presenta un lenguaje descriptivo mucho más diferenciado del resto de disciplinas científicas y técnicas. Este artículo pretende mostrar el gran potencial que posee la Biología Sintética gracias al trabajo coordinado de profesionales de diferentes áreas asi como la problemática que ello conlleva.

En este artículo se analizan los materiales didácticos más comunes a los que pueden recurrir los profesores y se presentan dos tipos de material alternativo coherentes con un modelo didáctico investigativo, los “Grafos” y los “Relatos de Caso”