Risk assessment of central nervous system (CNS) infection patients is of key importance in predicting likely pathogens. However, data are lacking on the epidemiology globally. We performed a multicenter study to understand the burden of community-acquired CNS (CA-CNS) infections between 2012 and 2014. A total of 2583 patients with CA-CNS infections were included from 37 referral centers in 20 countries. Of these, 477 (18.5%) patients survived with sequelae and 227 (8.8%) died, and 1879 (72.7%) patients were discharged with complete cure. The most frequent infecting pathogens in this study were Streptococcus pneumoniae (n = 206, 8%) and Mycobacterium tuberculosis (n = 152, 5.9%). Varicella zoster virus and Listeria were other common pathogens in the elderly. Although staphylococci and Listeria resulted in frequent infections in immunocompromised patients, cryptococci were leading pathogens in human immunodeficiency virus (HIV)-positive individuals. Among the patients with any proven etiology, 96 (8.9%) patients presented with clinical features of a chronic CNS disease. Neurosyphilis, neurobrucellosis, neuroborreliosis, and CNS tuberculosis had a predilection to present chronic courses. Listeria monocytogenes, Staphylococcus aureus, M. tuberculosis, and S. pneumoniae were the most fatal forms, while sequelae were significantly higher for herpes simplex virus type 1 (p < 0.05 for all). Tackling the high burden of CNS infections globally can only be achieved with effective pneumococcal immunization and strategies to eliminate tuberculosis, and more must be done to improve diagnostic capacity.

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HighlightsFosfomycin is an option for ESBL infections and penetrates the prostate adequately.We describe successful use of fosfomycin in ESBL-producing E. coli prostatitis.This has also been described in 3 other case reports and 2 small case series.Adjunctive measures such as prostatectomy can be essential for management.

The interventions for riverbank stabilisation are among the most common river rehabilitation actions performed in watercourses. However, most of the interventions focus on traditional methods that, although effective at the structural level (i.e., at meeting riverbank stabilisation goals), usually produce negative effects on the ecological status of the river. Thus, due to the increased requirement for sustainable river management solutions, this paper proposes a methodology for selecting suitable technical solutions for riverbank stabilisation. This has two components: (1) characterising, diagnosing and identifying the condition and potential erosion of a riverbank by collecting information at spatial multi-scale and (2) selecting suitable technical solutions to support sustainable riverbank stabilisation through using evaluation matrices and analysis of the adequacy of each technical solution to the intervention site's conditions and stream flow characteristics. This approach allows a holistic and integrated analysis of the bank erosion problems and the selection of stabilising technical solutions that are best suited from a structural viewpoint. In order to comply with the WFD (Water Framework Directive) on river environment issues, complementary criteria are proposed that help select from the chosen technical solutions those that improve the diversity of habitats as well as mitigate the aesthetic impact with the lowest cost. The methodology was applied to a reach of the Cértima River (located in the Centro region of Portugal), where field visits were performed to help assess the riverbanks' condition as well as to select technical solutions for riverbank stabilisation. As a result, it was possible to select a set of the most suitable technical solutions to ensure physical and hydraulic required functions, to minimise morphological and landscape changes in the banks, and to promote habitat diversity. K E Y W O R D S bank erosion, bioengineering technical solutions, Centro region of Portugal, riverbank stabilisation, spatial multi-scale information ---