The Epstein-Barr virus (also known as EBV), responsible for infectious mononucleosis, is a virus that infects the majority of the world's population. Infection occurs in several forms, most often asymptomatic, or as a fever accompanied by pharyngitis and lymphadenopathies. A rare complication of infectious mononucleosis is acute acalculous cholecystitis, an inflammation of the gallbladder characterized by ischaemia and severe cholestasis. The diagnosis of this pathology is made by imaging, but determining the cause may be tricky. We present here the case of acute acalculous cholecystitis in a 21-year-old woman. This case highlights a rare complication of EBV infection that is probably under-diagnosed, and demonstrates the usefulness of interpreting liver tests and leukocyte count in association with imaging findings.

BACKGROUND:We evaluated the contribution of a rapid antibiotic susceptibility test performed directly from a positive blood culture (PBC), the dRAST™, in the management of patients with bacteremia.METHODS:We retrospectively compared the time from sampling to availability of antibiotic susceptibility test (AST) results («time-to-result», TTR) between dRAST™ and classic AST (Vitek®2), in 150 patients with bacteremia. The antibiotic treatment of these 150 patients was classified into three categories (optimal, suboptimal, ineffective) according to the time of availability of AST results.RESULTS:Adaptation of antibiotic treatment to optimal therapy following AST results occurred in 46/100 (46 %) of Gram-negative PBC and in 4/50 (2 %) of Gram-positive HP. TTR was significantly lower with dRAST™ compared with classic AST (29:35 (± 08:48) hours versus 50:55 (± 12:45) hours, p < 0.001).CONCLUSION:For patients with bacteremia requiring adjustment of empirical antibiotic therapy based on AST, dRAST™ could allow a faster administration of optimal therapy.

Saccharomyces cerevisiae is a yeast used mainly as a probiotic for prevention or treatment of diarrhoea. However, the prevalence of S. cerevisiae fungemia has risen over the past years, notably among patients with predisposing factors. This retrospective study presents 21 cases of S. cerevisiae fungemia at the University Hospital of Liege from 2000 to 2022, their clinical relevance and therapeutic management. Each patient presented one or several risk factors prior to fungemia. The isolated strains presented high minimal inhibitory concentration for fluconazole, while MICs for amphotericin B, voriconazole and echinocandins were low. Some patients received antifungal therapy, while for others only central and peripheral lines were removed and probiotics discontinued. The MICs obtained for voriconazole and echinocandins makes them an alternative treatment to fluconazole and amphotericin B as reported in other studies. Since a S. cerevisiae fungemia can induce the same complications as candidemia, follow-up blood cultures should be collected and metastatic foci should be looked for. This study showed an important discrepancy in the clinical management of infections due to S. cerevisiae and highlights the need for guidelines.

BACKGROUND:Venous access device-related bloodstream infection (VAD-BSI) with coagulase-negative staphylococci (CoNS) is a common complication after allogeneic hematopoietic cell transplantation (alloHCT). Standard systemic antimicrobial therapy for uncomplicated VAD-BSI with methicillin-resistant CoNS consists of intravenous (IV) vancomycin (vanco). This requires hospitalization, needs new competent venous access, exposes patients to potential toxicity (mainly renal) and increases the risk of commensal flora dysbiosis with selection of vanco-resistant enterococci. Combined with VAD management (removal or antibiotic locks), oral minocycline (mino) has been evaluated as an alternative systemic therapy for the treatment of uncomplicated VAD-BSIs with CoNS at our center, primarily when the reference treatment with IV vanco was not possible (renal failure or allergy) or when hospitalization was refused by patients. Here, we retrospectively report our single center experience with this mino-based approach. PATIENTS AND METHODS:From January 2012 to December 2020, 24 uncomplicated VAD-BSIs with CoNS in 23 alloHCT patients were treated with oral mino as systemic antibiotic therapy in combination with VAD management. VAD were implantable ports (n = 17), tunneled catheter (n = 1) or PIC-lines (n = 6). Staphylococci were S. epidermidis (n = 21) or S. haemolyticus (n = 3). Mino was administered with a loading dose of 200 mg followed by 100 mg BID for 7-14 days. For 8 VAD-BSIs, patients were initially treated with IV vanco for the first 1-3 days followed by oral mino, while 16 VAD-BSIs were treated with oral mino as the sole antimicrobial agent for systemic therapy. VAD management consisted of catheter removal (for tunneled catheters and PIC-lines, n = 7) or antibiotic locks with vanco (n = 15) or gentamicin (n = 2) administered at least 3 times a week for 14 days (for ports). RESULTS:Overall, clearance of bacteremia (as assessed by negativity for the same CoNS of surveillance peripheral blood cultures drawn between day+ 3 and +30 after initiation of systemic therapy) was achieved in all but 1 patient (with port) who had persistent bacteremia at day +9. No complication such as suppurative thrombophlebitis, endocarditis, distant foci of infection or BSI-related death was observed in any patient during the 3-month period after initiation of treatment. Regarding the 17 port-BSI cases for which VAD conservative strategy was attempted, failure of 3-month VAD preservation was documented in 7/17 cases and 3-month recurrence of VAD-BSI was observed in 3/17 cases (with 1 patient with cellulitis). Treatment with mino was well tolerated except for a mild skin rash in one patient. CONCLUSION:Further prospective studies are needed to evaluate efficacy and safety of this approach.

Accurate susceptibility result of temocillin (TMO) is important for treating infections caused by multidrug-resistant Enterobacterales. This multicenter study aimed to investigate the performance of routine temocillin testing assays against Enterobacterales challenging strains. Forty-seven selected clinical isolates were blindly analyzed by 12 Belgian laboratories using VITEK® 2 (n = 5) and BD Phoenix™ (n = 3) automated systems, ETEST® gradient strip (n = 3), and disk (3 brands) diffusion method (DD; n = 6) for temocillin susceptibility using standardized methodology. Results were interpreted using EUCAST 2023 criteria and compared to the broth microdilution (BMD; Sensititre™ panel) method used as gold standard. Methods’ reproducibility was assessed by testing 3 reference strains in triplicate. A total of 702 organism-drug results were obtained against 33 TMO-susceptible and 14 TMO-resistant isolates. Excluding Proteae species (P. mirabilis and M. morganii), the essential agreement rates were excellent (91.5–100

Prevention of perinatal Group B Streptococcus (GBS) transmission is crucial in our effort to prevent Early-onset GBS disease. Here, we established the performance of the Revogene GBS DS assay for the detection of group B streptococcus on intrapartum vaginal samples in a laboratory environment using a prospective noninterventional study design. Intrapartum vaginal swabs were enriched using a selective culture method which served as study reference method. Overall, 119 patients were enrolled with an antenatal and intrapartum Group B Streptococcus colonization prevalence of 12.9% and 11.8%, respectively. Compared to intrapartum culture, the Revogene GBS DS assay had a sensitivity of 92.9% and a specificity of 99.1%, while the antenatal culture displayed a sensitivity 78.6% of and specificity of 96.2%. The Revogene GBS DS assay displayed an acceptable performance according to the European Group B Streptococcus consensus recommendations. Complementary studies in clinical practice are needed to confirm these findings.

Objectives: In order to elaborate a new national challenge panel of resistant Gram-negative bacilli and Gram-positive cocci strains for the validation of routine antimicrobial susceptibility testing (AST) methods, an interlaboratory evaluation was organised. Methods: The results of 12 well-characterised multidrug-resistant strains tested by nine laboratories using local disk diffusion (DD) and automated AST (AUST) methods were compared with the reference broth microdilution method. Results: Overall categorical agreement ranged from 70% to 100% both for DD and AUST and was >90% for all but one strain for all antibiotics. Conclusion: Our multicentre AST study showed good reproducibility and the panel can be used as national resistant reference strains for routine AST validation. (C) 2022 The Author(s). Published by Elsevier Ltd on behalf of International Society for Antimicrobial Chemotherapy.

OBJECTIVES:Based on recent pharmacokinetic/pharmacodynamic (PK/PD) evidence, continuous-infusion (CI) β-lactam administration is increasingly recommended for serious infections. Since 2016, the combination ceftazidime/avibactam (CAZ/AVI) is administered as per the manufacturer's instructions as an intermittent infusion of 2.5 g every 8 h. Thus, CI has not yet been evaluated in clinical trials. METHODS:We aimed to evaluate the use of CI of CAZ/AVI in a retrospective case series from December 2016 to October 2019. All isolates displayed in vitro susceptibility to CAZ/AVI according to EUCAST definitions. Patients were initially given CAZ/AVI as CI of 5 g every 12 h, and dosages were adjusted according to therapeutic drug monitoring of ceftazidime with a therapeutic goal of ≥4-5 × MIC in plasma and/or at the site of infection. RESULTS:CAZ/AVI was administered by CI in 10 patients with infections mainly caused by multidrug-resistant Pseudomonas aeruginosa (54.5%) and Klebsiella pneumoniae (36.4%). Bacteraemia occurred in 30% of cases. Sepsis or septic shock was present in 20% of cases. CAZ/AVI was used as monotherapy in 60% of cases. Clinical cure and microbiological eradication were achieved in 80% and 90% of cases, respectively. The 30-day mortality after CAZ/AVI treatment onset was 10%. The therapeutic goals of ≥4-5 × MIC in plasma and/or at the site of infection were achieved in 100% and 87.5% of cases, respectively, without adverse events. CONCLUSION:Despite a limited number of patients, CI of CAZ/AVI provided promising results after optimisation of PK/PD parameters both in plasma and at the site of infection.

Dysbiosis of gut microbiota (GM) has been involved in the pathophysiology of arterial hypertension (HT), via a putative role of short chain fatty acids (SCFAs). Its role in the circadian regulation of blood pressure (BP), also called “the dipping profile”, has been poorly investigated. Sixteen male volunteers and 10 female partners were subjected to 24 h ambulatory BP monitoring and were categorized in normotensive (NT) versus HT, as well as in dippers versus non-dippers. Nuclear magnetic resonance (NMR)-based metabolomics was performed on stool samples. A 5-year comparative follow-up of BP profiles and stool metabolomes was done in men. Significant correlations between stool metabolome and 24 h mean BP levels were found in both male and female cohorts and in the entire cohort (R2 = 0.72, R2 = 0.79, and R2 = 0.45, respectively). Multivariate analysis discriminated dippers versus non-dippers in both male and female cohorts and in the entire cohort (Q2 = 0.87, Q2 = 0.98, and Q2 = 0.68, respectively). Fecal amounts of acetate, propionate, and butyrate were higher in HT versus NT patients (p = 0.027; p = 0.015 and p = 0.015, respectively), as well as in non-dippers versus dippers (p = 0.027, p = 0.038, and p = 0.036, respectively) in the entire cohort. SCFA levels were significantly different in patients changing of dipping status over the 5-year follow-up. In conclusion, stool metabolome changes upon global and circadian BP profiles in both genders.

(1) Background: In the current context of the COVID-19 crisis, there is a need for fast, easy-to-use, and sensitive diagnostic tools in addition to molecular methods. We have therefore decided to evaluate the performance of newly available antigen detection kits in “real-life” laboratory conditions. (2) Methods: The sensitivity and specificity of two rapid diagnostic tests (RDT)—the COVID-19 Ag Respi-Strip from Coris Bioconcept, Belgium (CoRDT), and the coronavirus antigen rapid test cassette from Healgen Scientific, LLC, USA (HeRDT)—were evaluated on 193 nasopharyngeal samples using RT-PCR as the gold standard. (3) Results: The sensitivity obtained for HeRDT was 88% for all collected samples and 91.1% for samples with Ct ≤ 31. For the CoRDT test, the sensitivity obtained was 62% for all collected samples and 68.9% for samples with Ct ≤ 31. (4) Conclusions: Despite the excellent specificity obtained for both kits, the poor sensitivity of the CoRDT did not allow for its use in the rapid diagnosis of COVID-19. HeRDT satisfied the World Health Organization’s performance criteria for rapid antigen detection tests. Its high sensitivity, quick response, and ease of use allowed for the implementation of HeRDT at the laboratory of the University Hospital of Liège.

Objective: Dysbiosis of gut microbiota (GM) has been implicated in the pathophysiology of arterial hypertension (HT), via a putative role of food-derived short chain fatty acids (SCFAs) and other metabolites. Among the clinical manifestations of HT, the absence of a significant drop in blood pressure (BP) overnight (i.e. the non-dipping BP profile) has been associated with poor cardiovascular outcomes. The link between GM and the non-dipping BP profile is unknown. Design and method: After informed consent, 16 male patients (mean age = 52.3 ± 12.4 years; 1 patient under beta blocker) and their female partners (n = 10; mean age = 46.5 ± 13.2 years; 1 patient under thiazide diuretic and angiotensin-converting-enzyme inhibitor) were subjected to 24-hour ambulatory BP monitoring and categorized in 2 groups: HT (n = 6 men and 1 woman) and normotension (n = 19). According to the conventional night/day BP ratio >0.9, 15 individuals (n = 8 men and 7 women) were categorized as non-dippers. Metabolomics using Nuclear Magnetic Resonance was performed on stool samples, including the quantification of the 3 main SCFAs (i.e. acetate, propionate and butyrate). Results: Principal component analyses (PCA) discriminated HT versus normotensive individuals on the basis of the stool metabolomes of the entire cohort (Q 2 = 0.10). PCA also discriminated dippers versus non-dippers upon the stool metabolomes of the male and female cohorts (Q 2 = 0.76 and 0.98, respectively) or the entire cohort (Q 2 = 0.27). Significant correlations between stool metabolomes and the mean 24-hour BP levels were highlighted in male and female cohorts (R 2 = 0.63 and 0.79, respectively), as well as in the entire cohort (R 2 = 0.54). Interestingly enough, a higher variation between stool metabolomes (represented by the measure of inertia) was found in couples with a different BP status (51.4% of inertia) compared to the couples in whom both individuals presented with the same BP status (37.5% of inertia). The propionate/butyrate ratio was higher in the stools of male HT patients versus male normotensive patients (p = 0.03), but no difference was observed in the female cohort or in the entire cohort. Conclusions: In conclusion, this 26-patient cohort highlights significant correlations between the stool metabolome and (i) BP levels and (ii) the non-dipping BP profile in both genders.

We evaluated the quantitative DiaSorin Liaison severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen test in symptomatic and asymptomatic individuals consulting their general practitioners (GPs) during a period of stable intense virus circulation (213/100,000 habitants per day). Leftover reverse transcription-PCR (RT-PCR) positive (n = 204) and negative (n = 210) nasopharyngeal samples were randomly selected among fresh routine samples collected from patients consulting their GPs. ABSTRACT We evaluated the quantitative DiaSorin Liaison severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antigen test in symptomatic and asymptomatic individuals consulting their general practitioners (GPs) during a period of stable intense virus circulation (213/100,000 habitants per day). Leftover reverse transcription-PCR (RT-PCR) positive (n = 204) and negative (n = 210) nasopharyngeal samples were randomly selected among fresh routine samples collected from patients consulting their GPs. Samples were tested on Liaison XL according to the manufacturer’s instructions. Equivocal results were considered negative. The overall sensitivity and specificity of the Liaison antigen test compared to RT-PCR were 65.7% (95% confidence interval [CI], 58.9% to 71.9%) and 100% (CI, 97.8% to 100%). Sensitivity in samples with viral loads of ≥105, ≥104, and ≥103 copies/ml were 100% (CI, 96.3% to 100.0%), 96.5% (CI, 91.8% to 98.7%), and 87.4% (CI, 81.3% to 91.5%), respectively. All samples with ≤103 copies/ml were antigen negative. The ratio of antigen concentration to viral load in samples with ≥103 copies/ml was comparable in symptomatic and asymptomatic individuals (P = 0.58). The proportion of RT-PCR-positive participants with a high viral load (≥105 copies/ml) was not significantly higher in symptomatic than in asymptomatic participants (63.9% [CI, 54.9% to 72.0%] versus 51.9% [CI, 41.1% to 62.6%]; P = 0.11), but the proportion of participants with a low viral load (<103 copies/ml) was significantly higher in asymptomatic than in symptomatic RT-PCR-positive participants (35.4% [CI, 25.8% to 46.4%] versus 14.3% [CI, 9.0% to 21.8%]; P < 0.01). Sensitivity and specificity in samples with a viral load of ≥104 copies/ml were 96.5% and 100%. The correlation of antigen concentration with viral load was comparable in symptomatic and asymptomatic individuals.

To the Editor: Grupper et al. have reported on a positive humoral response post full vaccination with mRNA SARS-CoV2 BNT162b2 in only 51/136 (37.5%) kidney transplant recipients (KTRs) without prior exposure to the virus.1Grupper A, Rabinowich L, Schwartz D, et al. Reduced humoral response to mRNA SARS-CoV-2 BNT162b2 vaccine in kidney transplant recipients without prior exposure to the virus [published online ahead of print April 18, 2021]. Am J Transplant. 2021. https://doi.org/10.1111/ajt.16615Google Scholar We have conducted an IRB-approved (B707201215598–2021/80) prospective small sample-size study comparing the humoral response to BNT162b2 in 40 consecutive individuals early exposed to the Belgian vaccination program, including 20 KTRs with (n = 10, COVID-19(+)) vs. without (n = 10, COVID-19(–)) history of exposure to SARS-CoV-2 and 20 controls including 10 COVID-19(+) vs. 10 COVID-19(–). The quantification of S1/S2 IgGs by DiaSorin LIAISON® chemiluminescence immunoassay was performed at three time-points: first BNT162b2 injection (T1); second BNT162b2 injection (T2, i.e., ~21 days post T1); and ~15 days after T2 (T3). The generalized linear mixed model tested the effects of time, group, and interactions. No epidemiological difference was observed between KTRs vs. controls, nor between COVID-19(+) vs. COVID-19(–) (Table 1). The median delay between PCR-proven COVID-19 and T1 was 129 [64; 352] days. None of the 20 KTRs received IV corticosteroids or rituximab within 12 months prior to vaccination.TABLE 1Characteristics of the cohortParametersControls n = 20Kidney transplant recipients n = 20p valueCOVID–19 (–) n = 10COVID–19 (+) n = 10COVID–19 (–) n = 10COVID–19 (+) n = 10Age, years51.5 (10.5)45.1 (10.4)49.7 (13.8)52.7 (13.8)0.53Female gender, n (%)3 (30)4 (40)5 (50)6 (60)0.57BMI, kg/m224.58 (3.28)25.68 (2.95)26.45 (3.84)26.45 (4.67)0.71Time from KTx, months121.7 (106.0)77.8 (41.8)0.57Deceased donor, n (%)8 (80)9 (90)0.53CNIs, n (%)10 (100)10 (100)1.00Antimetabolite, n (%)10 (100)7 (70)0.37mTOR inhibitors, n (%)0 (0)1 (10)1.00Methylprednisolone, n (%)4 (40)5 (50)1.00Serum creatinine, mg/dl1.08 (0.29)1.55 (0.61)0.13Delay between COVID-19 and vaccination, days154.2 (107.1)158.2 (77.0)0.44Evolution of anti-S1/S2 IgG titerT1, median (min–max), AU/ml = first BNT162b2 injection0 (0)35 (0–98)0 (0)107 (0–205)<0.001aKTR COVID-19(+) vs. KTR COVID-19(–).<0.001bControl COVID-19(+) vs. control COVID-19(–).0.031cKTR COVID-19(+) vs. control COVID-10(+).1.00dKTR COVID-19(–) vs. control COVID-19(–).T2, median (min–max), AU/ml = second BNT162b2 injection35.5 (0–118)1520 (79–7290)0 (0)1131 (94–9040)<0.001aKTR COVID-19(+) vs. KTR COVID-19(–).<0.001bControl COVID-19(+) vs. control COVID-19(–).0.59cKTR COVID-19(+) vs. control COVID-10(+).<0.001dKTR COVID-19(–) vs. control COVID-19(–).T3, median (min–max), AU/ml = ~15 days after T2263 (153–2090)2300 (1470–6250)0 (0–60)2105 (212–18300)<0.001aKTR COVID-19(+) vs. KTR COVID-19(–).<0.001bControl COVID-19(+) vs. control COVID-19(–).0.88cKTR COVID-19(+) vs. control COVID-10(+).<0.001dKTR COVID-19(–) vs. control COVID-19(–).T4, median (min–max), AU/ml = ~50 days after T20 (0–46)Note: Data presented as mean (SD) unless otherwise stated.Abbreviations: AZA, azathioprine; BMI, body mass index; CNIs, calcineurin inhibitors; KTx, kidney transplantation; MMF, mycophenolate mofetil; MPA, mycophenolate sodium; mTORs, mammalian target of rapamycin inhibitors.a KTR COVID-19(+) vs. KTR COVID-19(–).b Control COVID-19(+) vs. control COVID-19(–).c KTR COVID-19(+) vs. control COVID-10(+).d KTR COVID-19(–) vs. control COVID-19(–). Open table in a new tab Note: Data presented as mean (SD) unless otherwise stated. Abbreviations: AZA, azathioprine; BMI, body mass index; CNIs, calcineurin inhibitors; KTx, kidney transplantation; MMF, mycophenolate mofetil; MPA, mycophenolate sodium; mTORs, mammalian target of rapamycin inhibitors. At T1, the median concentration of S1/S2 IgGs in the 20 COVID-19(+) was 56 [0; 205] AU/ml. No IgG was detectable in COVID-19(–) individuals (Table 1). At T2, a response was observed in 19/20 controls, with significantly higher IgG titers in COVID-19(+) compared to COVID-19(–). In KTRs, no humoral response was observed in COVID-19(–) whereas all COVID-19(+) showed detectable IgG levels. The magnitude of serological response was not different between COVID-19(+) KTRs and COVID-19(+) controls (Table 1). At T3, all controls had measurable IgGs, with significantly higher titers in COVID-19(+) vs. COVID-19(–). In KTRs, IgGs were detectable in only 1/10 COVID-19(–) (60 AU/ml), whereas IgG levels in COVID-19(+) KTRs were similar to COVID-19(+) controls (Table 1). An additional serological testing of the 10 COVID-19(–) KTRs after 50 days [39; 121] post T2 was positive in 3/10, with median IgG titers of 30 AU/ml [15; 46]. From a longitudinal point of view, serum S1/S2 IgG levels in the 20 COVID-19(+) KTR and non-KTR individuals increased significantly from T1 to T2, with no further increase from T2 to T3. The kinetics was different in the 10 COVID-19(–) controls, with significant increases from T1 to T2 and from T2 to T3. As a whole, a history of COVID-19 impacts the kinetics and the magnitude of S1/S2 IgG development post BNT162b2 vaccination in KTRs, as recently demonstrated by Cucchiari et al.2Boyarsky BJ Werbel WA Avery RK et al.Antibody response to 2-dose SARS-CoV-2 mRNA vaccine series in solid organ transplant recipients [published online ahead of print May 5, 2021].JAMA. 2021; 325 (https://doi.org/10.1001/jama.2021.7489.): 2204Crossref PubMed Scopus (589) Google Scholar We have no information about the cellular response post BNT162b2 vaccination in our cohort. Consistently with recent publications, SARS-CoV-2-naïve KTRs have a poor serological response to BNT162b2 vaccine.1Grupper A, Rabinowich L, Schwartz D, et al. Reduced humoral response to mRNA SARS-CoV-2 BNT162b2 vaccine in kidney transplant recipients without prior exposure to the virus [published online ahead of print April 18, 2021]. Am J Transplant. 2021. https://doi.org/10.1111/ajt.16615Google Scholar,3Benotmane I Gautier-Vargas G Cognard N et al.Low immunization rates among kidney transplant recipients who received 2 doses of the mRNA-1273 SARS-CoV-2 vaccine [published online ahead of print April 20, 2021].Kidney Int. 2021; 99 (S0085-2538[21]00389-6): 1498-1500Abstract Full Text Full Text PDF PubMed Scopus (125) Google Scholar,4Cucchiari D, Egri N, Bodro M, et al. Cellular and humoral response after mRNA-1273 SARS-CoV-2 vaccine in kidney transplant recipients [published online ahead of print May 26, 2021]. Am J Transplant. 2021. Am J Transplant. 2021. https://doi.org/10.1111/ajt.16701Google Scholar One may not exclude that additional vaccine injections and/or a longer follow-up may eventually elicit a full humoral response in KTRs. Still, given the current knowledge, KTRs with no history of PCR-proven COVID-19 should be advised to maintain the WHO sanitary recommendations5World Health Organization. Coronavirus disease (COVID-19) advice for the public. https://www.who.int/emergencies/diseases/novel-coronavirus-2019/advice-for-public. Updated May 12, 2021. Accessed June 9, 2021.Google Scholar against SARS-CoV-2 after BNT162b2-based vaccination. By contrast, one single BNT162b2 injection might be sufficient in KTRs with detectable S1/S2 IgGs before vaccination.

Abstract Background and Aims Dysbiosis of gut microbiota (GM) has been involved in the pathophysiology of arterial hypertension (HT), via a putative role of food-derived short chain fatty acids (SCFAs). Among the clinical manifestations of HT, the absence of a significant drop in blood pressure (BP) overnight (i.e. non-dipping BP profile) has been associated with poor cardiovascular outcomes. The link between GM and non-dipping BP profile is unknown. Method After informed consent, 16 male patients and their female partners (n=10) were subjected to 24-hours ambulatory BP monitoring and were categorized in 2 groups: HT (n=7; 6 men) and normotension (NT) (n=19). According to the conventional night–day systolic BP ratio >0.9, 15 individuals (8 men and 7 women) were categorized as non-dippers. Metabolomics using Nuclear Magnetic Resonance was performed on stool samples, including the quantification of the 3 main SCFAs (i.e. acetate, propionate and butyrate). Results Multivariate analysis (principal component analyses (PCA) and partial least squares (PLS-DA)) of stool metabolomics were not able to statistically separate HT versus NT groups. However, this approach discriminated dippers versus non-dippers groups in both male and female cohorts (Q²=0.87 and 0.98, respectively), as well as in the entire cohort (Q²=0.68). As previously described, fecal amounts of acetate, propionate and butyrate were higher in HT patients than in NT patients in the entire cohort (p=0.027; p=0.015 and p=0.015, respectively). Fecal amounts of acetate, propionate and butyrate were also significantly higher in non-dippers versus dippers in the entire cohort (p=0.027; p=0.038 and p=0.036, respectively). Significant correlations between stool metabolomes and the 24h-mean BP levels were found in male and female cohorts (R²=0.63 and 0.79 respectively) as well as in the entire cohort (R²=0.54). Conclusion In conclusion, this 26-patient cohort highlights significant correlations between stool metabolome and (i) BP levels and (ii) non-dipping BP profile in both men and women.

Purpose Broth microdilution (BMD) stays as the reference testing method for determination of antimicrobial susceptibility testing (AST) to colistin and is considered essential for patient management and for monitoring of colistin resistance. This multicenter study aimed to evaluate the performance of automated systems for colistin AST among Enterobacterales as an alternative for BMD since the majority of laboratories use automated systems as first-line method. Methods Twenty colistin resistant (COL-R) including 10 MCR producers and 10 colistin-susceptible (COL-S) Enterobacterales isolates were blindly tested for colistin susceptibility with the routine automated AST systems used by 8 laboratories (3 with BD Phoenix, 3 with Vitek2 and 2 with MicroScan). Additionally, 3 reference strains (E. coliATCC 25922,E. coliNCTC 13846, and one COL-R mcr-negativeK. pneumoniaeM/14750) were tested in triplicate by each laboratory. Results and conclusion Results were compared with BMD performed at the reference laboratory. BD Phoenix and MicroScan automated AST systems provide accurate and reproducible categorical results for the testing of colistin in Enterobacterales. However, Vitek2 system showed poor performance for the detection of COL-R isolates especially those with MICs close to the susceptibility breakpoint (categorical agreement of 88% and precision categorical agreement of 81%).