Abstract
Background
Carbapenem-resistant Enterobacterales (CRE) are a major public health threat, largely due to the presence of carbapenemases, which are globally disseminated in mobile genetic ...elements. The emergence of CRE carrying multiple carbapenemases has been reported in several countries, particularly after the COVID-19 pandemic. In this study, we report the emergence of dual-producing CRE (DP-CRE) in Chile and provide a phenotipic and genomic characterization using whole-genome sequencing (WGS).
Methods
We evaluated the presence of carbapenemase in a total of 1367 CRE isolates recovered from invasive infections in 11 healthcare centers since 2018. Among them, 9 DP-CRE were detected and included in this report. Antimicrobial susceptibility was tested by broth microdilution and disk diffusion methods (CLSI, 2023), while blaKPC, blaVIM, blaIMP and blaNDM genes were detected by PCR. WGS was carried out using short and long reads (Illumina and Oxford Nanopore) and hybrid assemblies were performed.
Results
All 9 DP-CRE identified were recovered between November 2021 and June 2022 from 3 healthcare centers of a single city. In terms of species, 6 were identified as E. coli, one isolate of K. pneumoniae, one K. oxytoca and one C. freundii. All DP-CRE identified carried the combination of blaKPC and blaNDM. Genomic analyses confirmed all but one isolate carried blaKPC-2 and blaNDM-7. The remaining genome belonged to a K. pneumoniae that harboured blaKPC-3 and blaNDM-7. All 9 isolates exhibited resistance to all β-lactams, including carbapenems, aztreonam (ATM), cephalosporins and β-lactam/β-lactamase inhibators. Cefiderocol (FDC) was the only compound active against all the isolates. Also, all the DP-CRE became susceptible to ATM when combined with ceftazidime/avibactam (CZA). Hybrid assemblies revealed that blaKPC and blaNDM were harboured on independent plasmids (∼58,900 bp and ∼41,100 bp, respectively) as shown in Figure 1.
Conclusion
To the best of our knowledge, this is the first report of the emergence of DP-CRE in Chile after COVID-19 pandemic. Our results highlight the relevance of active surveillance of multidrug-resistance pathogens. FDC and CZA/ATM were the only compounds that remained active in vitro against these pathogens.
Disclosures
All Authors: No reported disclosures
Abstract
Background
Vancomycin-resistant enterococci has increased globally in recent decades, with Enterococcus faecium (VREfm) being the most prevalent species. Although the prevalence of VREfm in ...Chile is high (∼70%), its molecular epidemiology is not well-described. Here, we used whole genome sequencing (WGS) to characterize the circulating lineages of VREfm in Chile.
VRE= Vancomycin resistant Enterococcus faecium, SD=Standard deviation, IQR=in˝ter-quartile range; ¥ comorbidities included diagnoses apart from the primary cause for admission such as hypertension, chronic kidney disease and coronary artery disease; *Chi-square or Fisher´s exact were used for categorial variables; T-test for continues variables; P value<0.05 was considered significant.•
Methods
A total of 96 invasive clinical VREfm isolates causing invasive infections were collected from 96 patients admitted to 3 hospitals in Chile as part of an ongoing surveillance program (2018 – 2022). Clinical data including demographics, source of infection, and hospital outcomes were collected. All isolates were subjected to WGS on an Illumina platform. After assembly, in silico MLST and resistome were determined. Further, 5 representative strains were sequenced with Oxford Nanopore Technology (ONT) to further characterize the location of the van gene cluster.
Results
The mean age of the cohort was 62 years, with 61% of males and a mean Charlson Comorbidity Score of 3. All isolates were resistant to vancomycin, ampicillin and ciprofloxacin and remained susceptible to linezolid. Resistance to teicoplanin (16%), high-level resistance to gentamicin (48%) and streptomycin (20%) was also observed. A total of 75 VREfm harbored vanB, with the most common STs being ST17 (23%) and ST656 (25%). Only 7 VREfm isolates carried vanA, 43% of which corresponded to ST17. Surprisingly, 14 VREfm simultaneously carried vanA and vanB (vanA/vanB), most of them belonging to ST233 (50%) or ST2137 (36%). For the VREfm vanA/vanB isolates, the vanB cluster was located on the chromosome, while the vanA gene cluster was harbored on a plasmid (ca. 45Mb) which also contained ermB. A summary of the clinical characteristics of the cohort is shown in Table 1.
Conclusion
vanB was the most frequently observed genotype in Chile, with ST17 and ST656 accounting for most isolates. Importantly, a substantial proportion of VREfm carried both vanA and vanB clusters in Chile, which was mainly observed in two different genomic lineages (ST233 and ST2137). Active surveillance of VREfm is essential to monitor the epidemiology of this critical pathogen in South America.
Disclosures
William R. Miller, M.D., Merck: Grant/Research Support|UpToDate: Honoraria
The Face-Name Associative Memory Exam (FNAME) has been used to detect subtle cognitive changes in clinically normal older adults at increased risk for Alzheimer's disease. FNAME assesses learning and ...delayed recall for face-name pairs. The aim of this study is to introduce a Latin American Spanish version of the FNAME (LAS-FNAME), examine its psychometric properties, and provide preliminary normative data in a sample of clinically normal, Spanish-speaking individuals from Antioquia, Colombia.
59 clinically-normal individuals (71% females) were recruited by the Grupo de Neurociencias in Antioquia (Colombia). Age ranged from 27 to 82 years (M = 50.31, SD = 15.32) and years of education ranged from 2 to 17 years (M = 9.02, SD = 4.11). All participants completed the LAS-FNAME and a brief neuropsychological evaluation. We examined associations between age, education, and sex and performance on the LAS-FNAME. Internal consistency, convergent and discriminant validity were also assessed. Test-restest reliability was computed for a subset of participants (n = 32).
LAS-FNAME exhibited moderate convergent validity with other memory measures (Free and Cued Selective Reminding Scale, r
s
=.465, p<.01; Wechsler Memory Scale III - Logical Memory Delayed Recall, r
s
=.479, p<.01). The subscales of the LAS-FNAME exhibited adequate internal consistency (α=.825). Test-retest reliability analyses demonstrated consistency of scores over time. Normative data was stratified by age (<50, 50-65, >65) and low and high educational attainment (≤8 and >8 years of education, respectively).
The LAS-FNAME is a valid and reliable measure to assess memory in clinically normal, Spanish-speaking individuals from Colombia for clinical and research purposes.
Organochlorine pesticides (OCPs) use has been restricted or forbidden in Argentina since 1998 and technical endosulfan is the last currently used OCPs on the soybean-wheat production. As they persist ...in soil for several years after application, OCPs constitute a source of environmental pollution. This work aims to assess OCPs contamination of groundwater (Gw) and streamwater (Sw) in the Quequén Grande River watershed from south Argentinean Pampas in relation to the hydrogeological characteristics. OCPs were analyzed in Sw, Gw, surface bottom sediments, soils and borehole cutting sediments (Cs) by gas chromatograph-electron capture detector. Pesticide distribution in Cs was dependent on the characteristic of the non-saturated zone. Leached pesticides over 3 m in Cs showed the pattern: HCHs = endosulfan > chlordanes > DDTs, and from 3 to 6 m heptachlor was the main group as a consequence of the past use of this compound in the area, mainly on potato crops. Endosulfan reaches Gw during application season as well as during flooding events while a retard effect was observed for Sw. Levels of α- and β-isomers were in certain cases above national (7 ng L
−1
) and international (3 ng L
−1
) limits for aquatic biota protection. As the endosulfan sulfate metabolite was present in Gw and Sw and due to its high toxicity, it should be considered in the establishment of water quality criteria for human and environmental protection.
Background
The COVID‐19 pandemic has increased psychological distress. Research shows that physical activity can reduce emotional distress and improve cognitive functioning. Yet, the pandemic has ...limited opportunities to engage in physical activity. In this study, we examined whether older adults who maintained physical activity during the pandemic perceived less subjective cognitive concerns and better emotional distress management compared to those who reduced or did not engage in activity. 8
Method
80 adults (ages 55‐94 years) from the community completed an online survey. Subjective cognitive concerns were measured using the Everyday Cognition Scale. Physical activity was measured with the question, “Have you maintained your physical activities during social isolation?” and answers were grouped into yes, no, or partially. Emotional distress was measured with the question, “How well you think you have been able to manage your emotions, worries and stress, and answers were grouped into good/very good, regular, or bad/very bad.
Result
54% of participants reported having maintained or increased their physical activity levels, 33% partially maintained their usual levels, and 13% reduced or did not engage in activity. 64% reported that they were managing their emotions, worry and stress good/very good, 30% regular, and 6% bad/very bad. Participants who maintained or increased their physical activity levels reported less cognitive concerns and greater ability to manage their emotions, worry and stress, compared to those who reduced, partially or did not engage in physical activity.
Conclusion
Encouraging individuals and providing resources for increasing physical activity may help mitigate some of the pandemic’s adverse effects on psychological well‐being.
El problema identificado en las pymes ferreteras dedicadas a la comercialización y distribución de diversos productos es la deficiente gestión de almacenes, debido a que utilizan altos tiempos para ...la realización de los procesos de recepción de productos, almacenaje y picking. Además, tienen desconocimiento de la exactitud de inventario, el cual ocasiona las roturas de stock y no permite en muchos de los casos la entrega completa de los pedidos. Todo ello ocasiona que el nivel de servicio de la empresa esté por debajo del estándar. La propuesta diseñada consiste en la aplicación de las herramientas 5S, ABC, system layout planning y estandarización del trabajo para mejorar la gestión de almacenes. Entre los principales resultados de la implementación de la propuesta, se incrementó el nivel de servicio a un 95%, se redujo el tiempo del proceso de picking en un 55%, el de almacenaje en un 57% y el de recepción de productos en un 63%.
El problema identificado en las pymes ferreteras dedicadas a la comercializacion y distribucion de diversos productos es la deficiente gestion de almacenes, debido a que utilizan altos tiempos para ...la realizacion de los procesos de recepcion de productos, almacenaje y picking. Ademas, tienen desconocimiento de la exactitud de inventario, el cual ocasiona las roturas de stock y no permite en muchos de los casos la entrega completa de los pedidos. Todo ello ocasiona que el nivel de servicio de la empresa este por debajo del estandar. La propuesta disenada consiste en la aplicacion de las herramientas 5S, ABC, system layout planning y estandarizacion del trabajo para mejorar la gestion de almacenes. Entre los principales resultados de la implementacion de la propuesta, se incremento el nivel de servicio a un 95%, se redujo el tiempo del proceso de picking en un 55%, el de almacenaje en un 57% y el de recepcion de productos en un 63%. Palabras-clave: 5S; almacen; ferreteria; SLP; ABC; estandarizacion The problem identified in hardware SMEs engaged in the marketing and distribution of various products is the poor management of their warehouses because they use long times to carry out the processes of receiving products, storage and picking. In addition, they are unaware of the inventory accuracy, which causes stock ruptures and does not allow in many cases the complete delivery of orders. All this causes the company's service level to be below standard. The proposal designed consists of the application of the 5S, ABC, System Layout Planning and Work Standardization tools to improve warehouse management. Among the main results of the research, the service level was increased to 95%, the picking process time was reduced by 55%, the storage time by 57% and the product reception time by 63%. Keywords: 5S; warehouse; hardware store; SLP; ABC; standardization
Ataxia-telangiectasia (AT) is a rare genetic disorder leading to neurological defects, telangiectasias, and immunodeficiency. We aimed to study the clinical and immunological features of Latin ...American patients with AT and analyze factors associated with mortality. Referral centers from 9 Latin American countries participated in this retrospective cohort study, and 218 patients were included. Median (IQR) ages at symptom onset and diagnosis were 1.0 (1.0-2.0) and 5.0 (3.0-8.0) years, respectively. Most patients presented recurrent airway infections, which was significantly associated with IgA deficiency. IgA deficiency was observed in 60.8% of patients and IgG deficiency in 28.6%. T- and B-lymphopenias were also present in most cases. Mean survival was 24.2 years, and Kaplan-Meier 20-year-survival rate was 52.6%, with higher mortality associated with female gender and low IgG levels. These findings suggest that immunologic status should be investigated in all patients with AT.
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